Severe/frequent recurrent aphthous ulcers and salivary flow rates

Abstract

Study design The unstimulated salivary flow rate was measured in 79 consecutive patients referred for oral and maxillofacial pathology consultation because of severe or frequent recurrent aphthous ulcers (RAU). The unstimulated salivary flow rate (USFR) was measured using volumetric collection of whole saliva for 5 minutes and using the modified Schirmer test (MST) with a Schirmer tear test strip (Eagle Vision, Memphis, Tenn) for 3 minutes. Results Sixty-seven patients (60%) had RAU with USFR > 0.1 mL/min, average age 34 years, range 6-78 years. Theirty-two patients (40%) had RAU with USFR ≤ 0.1 mL/min, average age 48 years, range 17-80 years. Of the 67 patients with USFR > 0.1 mL/min, 3/67 (4%) had abnormal saliva with 2 patients having sialorrhea (USFR > 2 mL/min) and 1 patient with thick gelatinous saliva. Secretagogues, pilocarpine or cevimeline, were prescribed for patients with USFR ≤ 0.1 mL/min. The presence of adequate saliva protects the mucosa from minor irritation and reduces antigenic exposure, 2 triggers of RAU in susceptible patients. Conclusion Diminished USFR due to salivary gland hypofunction may be a precipitating factor for RAU. Identification and management of diminished salivary flow should be helpful to identifying an important precipitating factor and to recognizing that the xerostomic patient is at risk for the complication of candidiasis in RAU patients treated with corticosteroids, a mainstay of RAU treatment. Often normal salivary flow rates can be reestablished with secretagogue medication pilocarpine or cevimeline. The unstimulated salivary flow rate was measured in 79 consecutive patients referred for oral and maxillofacial pathology consultation because of severe or frequent recurrent aphthous ulcers (RAU). The unstimulated salivary flow rate (USFR) was measured using volumetric collection of whole saliva for 5 minutes and using the modified Schirmer test (MST) with a Schirmer tear test strip (Eagle Vision, Memphis, Tenn) for 3 minutes. Sixty-seven patients (60%) had RAU with USFR > 0.1 mL/min, average age 34 years, range 6-78 years. Theirty-two patients (40%) had RAU with USFR ≤ 0.1 mL/min, average age 48 years, range 17-80 years. Of the 67 patients with USFR > 0.1 mL/min, 3/67 (4%) had abnormal saliva with 2 patients having sialorrhea (USFR > 2 mL/min) and 1 patient with thick gelatinous saliva. Secretagogues, pilocarpine or cevimeline, were prescribed for patients with USFR ≤ 0.1 mL/min. The presence of adequate saliva protects the mucosa from minor irritation and reduces antigenic exposure, 2 triggers of RAU in susceptible patients. Diminished USFR due to salivary gland hypofunction may be a precipitating factor for RAU. Identification and management of diminished salivary flow should be helpful to identifying an important precipitating factor and to recognizing that the xerostomic patient is at risk for the complication of candidiasis in RAU patients treated with corticosteroids, a mainstay of RAU treatment. Often normal salivary flow rates can be reestablished with secretagogue medication pilocarpine or cevimeline.