Altered Salivary Flow Research Articles

Complete Mouth Rehabilitation in a Patient with Fanconi Anaemia: A Rare Genetic Disorder

Fanconi anaemia is a rare, progressive congenital bone marrow failure syndrome characterised by autosomal recessive inheritance and clinical manifestations, including growth retardation, bone marrow failure leading to pancytopenia, an elevated risk of malignancy, skin pigmentation, and skeletal malformations. Patients who have undergone bone marrow transplantation can be treated comprehensively in the dental clinic like other routine patients, provided their blood indices are within normal limits. Its complications include aplastic anaemia, malignancies like acute myeloid leukaemia, liver tumours, and squamous cell carcinoma, often developing post-bone marrow transplantation. Dental anomalies, altered salivary flow, and increased susceptibility to cancer necessitate early diagnosis and specialised dental care. Hereby, the authors present a case of 15-year-old male with Fanconi Anaemia who had undergone bone marrow transplantation and was treated comprehensively in a hospital setting. The present case report aimed to equip healthcare practitioners, especially dentists, with the knowledge needed for accurate diagnosis and effective management.

Unilateral gingival enlargement in a patient with neurofibromatosis type 1 - Case report

Neurofibromatosis type 1 (NF1), also known as von Recklinghausen disease, is an autosomal disease caused by mutations in the NF1 tumor suppressor gene. NF1 affects bones, nerves, soft tissues and skin. Oral manifestations of NF1 consist of soft tissue tumors, bone defects, periodontal and dental changes, and altered salivary flow. We report one such case, a 26-year-old man with Gingival enlargement, Café au lait spots, axillary freckling, and multiple nodules on his body.

The effects of oral birth control pills (contraceptive pills) intake on lyophilized saliva and its oral manifestations

A woman is susceptible to oral diseases at various stages in her life span. Besides, multiple biological, behavioral, and social factors affect the general health condition. Many drugs or chemicals can influence the oral cavity & associated structures. An example of these drugs group is oral contraceptive pills (OCS) which women widely use to prevent pregnancy and determine the number of children, and hormonal therapy. This study aims to evaluate the effect of oral contraceptive pills use on salivary secretion and composition in addition to the occurrence of any oral manifestations with the uses of these drugs among women aged 16-45 years. The total number of sample subjects is 51 women. The samples were separated into two groups: The first group included 21 unmarried women with no previous experience with oral contraceptive pills (control group). In contrast, the second group consisted of 30 women who were married and using this drug (study group). This study is considered to be a comparative study between these two groups concerning the analysis of the salivary composition, unstimulated salivary flow rates and PH level: The results obtained from this study showed a marked significant difference in salivary analysis between the drug user & nonuser drug groups concerning the salivary flow rate while the PH had no statistical differences between them. However, the two groups had a significant difference in alkaline phosphatase enzyme. The salivary analysis showed highly substantial variations in immunoglobulin A (IgA) & total protein levels in saliva between control & study groups; also, in this study, there was a positive association between gingival inflammation with gingival index score (2) (80%), gingival index score (3) (100%) and duration for taking the drug. By this drug administration, the altered salivary flow rate & levels of salivary contents that include (secretary proteins, IgA and enzymes) may influence and play an essential role in oral & dental health. Keywords: saliva; oral health; oral contraceptive pills.

Acute Unilateral Parotid Gland Swelling following General Anaesthesia for Arthroscopic Shoulder Surgery: A Case Report

Acute enlargement of the parotid gland following general anaesthetic administration is an uncommon, harmless, and self-limiting complication. The most likely cause was thought to be anaesthesia mumps, which involves a complex interaction of multiple factors, including factors such as direct trauma, patient position leading to altered salivary flow along with an increase in viscosity due to dehydration, its occurrence following arthroscopic shoulder surgery under general anaesthesia is relatively rare. It is usually a self-limiting disease and requires only follow-up observation, and in a few case reports, evaluation with imaging studies has been performed. However, severe complications may sometimes occur. If upper airway obstruction develops as in the present case, then emergency airway management must also be considered. Several surgical subspecialties, including orthopaedics, obstetrics and gynaecology, neurology, and spinal surgery, have recognised this uncommon postoperative syndrome. The present case report describes the medical condition of a 50-year-old female patient who experienced postoperative parotitis and underwent arthroscopic shoulder surgery for rotator cuff repair involving general anaesthesia.

Sialendoscopy for Improvement of Salivary Flow in Patients with Sjögren Syndrome - Comparative Analysis of Intraglandular Washing Solutions.

Introduction Among the potential diseases that present altered salivary flow and activity is Sjögren syndrome. Sialendoscopy seems to be an important therapeutic option. Objective To compare the results obtained with sialendoscopy for improving salivary flow measured by scintigraphy in patients with primary Sjögren syndrome to those obtained with other intraglandular washing solutions. Methods Patients from our institution's rheumatology clinic diagnosed with primary Sjögren syndrome underwent parotid scintigraphy prior to the sialendoscopy procedure. During the sialendoscopy procedure, one of the parotid glands was randomized to receive a wash with saline while the other was washed with a corticosteroid solution. After 1 month, a new scintigraphy examination of the parotid glands was performed to observe the salivary flow for comparison. Results A total of 13 female patients with mean age of 53.38 years (range, 27–76 years) were included in this study. After sialendoscopy, 10 patients (76.92%) were observed to have improvement in salivary excretion with radiopharmaceutical during scintigraphy. When analyzing each gland that was treated separately (26 glands), after sialendoscopy, improvement was observed in 18 glands (69.23%), 8 treated with dexamethasone and 10 with saline solution in the wash. There was no improvement in 8 glands (30.77%). Conclusion This study demonstrates that sialendoscopy is as an important tool to improve salivary flow measured by scintigraphy in patients with primary Sjogren syndrome, increasing salivary excretion through dilation and consequent unblocking of the ducts. These data suggest that there is no statistically significant difference between intraductal washing solutions using saline or dexamethasone solution.

Salivary Changes in Helicobacter Pylori-Positive (HP+) Chronic Gastritis

Abstract Introduction: Diagnosis and monitoring of chronic gastritis are most commonly by invasive endoscopic-biopsy technique. Finding non-invasive laboratory markers would save money and inconvenience for the patient. Saliva, with its essential protective role for the digestive system, is increasingly recognised as a good non-invasive diagnostic material. Aim: To study several biochemical parameters in the saliva of patients with chronic gastritis (HP+ and HP-), to compare their levels with those of healthy subjects and to establish correlation relationships between their serum and salivary concentrations with a view to their possible use as a diagnostic tool. Material and method: 140 subjects were studied, of which 60 patients (mean 58.73±12.08y) with chronic gastritis (44HP+ and 16HP-) with disease activity assessed by subjective complaints, serological and endoscopic findings. The control group consisted of 80 healthy- non-smoking volunteers (mean 56.86±8.67y). Unstimulated saliva and serum were used for analysis. The parameters we study are Uric Acid (UA), Total Protein (TPro), Albumin (Alb) and Secretory IgA (sIg A). They are analysed with B.Coulter ready-made kits with an adaptation of the oral fluid methods of an Olympus AU 640 biochemical analyser and ELISA Reader DiaMetra Italy. Results: Significantly higher values of sIgA(p<0.0001), Alb(p<0.0001) and TP(p=0.0434) were observed in HP+ patients compared to the control group, but not for UA. We found a correlation between saliva/serum values for UA only (r=0.3389, p=0.011). A moderate negative correlation existed between UA and endoscopic inflammatory changes (r=-0.4203, p=0.016). These changes are thought to be compensatory for the gastric inflammation, increased oxidative stress and altered salivary flow rate. Conclusion: The data indicate significant changes in salivary parameters in HP+ chronic gastritis. Saliva has its weaknesses as a biological material, but it reflects well the pathological processes in the digestive system, especially with HP+ infection. Keywords Albumin; HP+ Chronic Gastritis; Saliva; Sig A; Total Protein; Uric Acid

Evaluation of Sialometric Analysis of Patients Suffering from Depressive Disorders.

Depressive disorders, worldwide, may rank second by the year 2020. In India; about 10 million people suffer from depressive disorders, the prevalence rate being recorded as 31.2 for every 1000 individuals. A significant impairment of all personal hygiene may occur due a depressive episode which in turn may result in altered salivary flow. The present study was a hospital- based clinical cross-sectional study which was conducted in Bhopal, the heart of Madhya Pradesh, India. It was done to assess the relationship of bring about a comparison of sialometric alterations between normal and subjects with depressive disorders. The survey period extended over a period of one year and two months, from May 2009 to July 2010. It was conducted in Bhopal, Madhya Pradesh, Central India. A sample size of 150 individuals, 50 of each group, was taken in the study. Whole salivary flow rates were determined by gravimetric method (i.e., in millilitres per minute). The Tenovuo criterion was used, to which numerical scores (SFI) were attributed. Results showed that the unstimulated salivary flow rates between patients of Group I and Group III (p< 0.0001) and between Group II and Group III (p < 0.0001) were statistically significant. The study also showed statistically significant relation between subjective and objective oral dryness (chi 2= 55.789, df= 6 and p< 0.0001). It was observed that subjective sensation of dry mouth may exist even in the presence of normal salivary flow rates. This might be acknowledged as a psychophysiological expression of depression and may not necessarily reflect actual salivary gland function. The lack of secreted mucins rather than the quantity of saliva may play a role in the genesis of xerostomia.

Evaluation of Histological Changes in the Salivary Glands of Sprague-Dawley rats Following Injections of Various Forms of Areca Nut Preparations

Introduction: The habit of areca nut chewing impinges on the daily lives of about one-tenth of the world’s population. Areca nut is used in many forms ranging from raw to commercial varieties. The consumption of areca nut is found to have important effects on salivary glands leading to an altered salivary flow rate and pH of saliva. Areca nut consumption is significantly associated with the development of oral submucous fibrosis (OSF). OSF in the early stages is characterized by an increased salivation and advanced stages by an increased dryness of the oral mucosa. Aims and Objectives: The present study aimed to evaluate the histopathological tissue changes in the rat submandibular salivary glands subjected to various forms of areca nut (raw, roasted, and boiled), pan masala extracts, and pure arecoline solution over a period of 36-week. Materials and Methods: 3-4 months old Sprague-Dawley rats were randomly selected and divided into six groups - Control, raw areca nut, boiled areca nut, roasted areca nut, pan masala, and pure arecoline groups; treated with the respective solutions. The control group was treated with distilled water. Rats were sacrificed randomly at an interval of every 6 weeks and submandibular glands dissected out and assessed for any histological changes. Results: Significant histological changes were observed in the rat submandibular tissues including fusion and dilatation of acini and ducts with pooling of the salivary secretions in the initial weeks of treatment and degenerative changes in the later weeks. Among all the groups, the pure arecoline treated group showed significant and early degenerative changes in comparison to the other groups. Conclusion:Chronic consumption of areca nut in various forms leads to deleterious effects on the salivary gland histology leading to degeneration of acini and ductal structures. This degenerative effect leads to an overall decreased salivary output reflecting as dryness of mucosa in the advanced stages of OSF and probably to a decreased local immunity and hence an increased propensity for malignant transformation in the later stages of OSF.

Dental Management of Patients with Dementia in Primary Dental Care

Dementia is an umbrella term for a set of symptoms that include memory loss, changes in mood and problems with reasoning, attention and communication. It is a progressive condition and there is ample evidence that oral health declines as the severity of dementia increases. Most of this decline is attributable to the effects of cognitive impairment on oral hygiene capability and/or acceptance of help from others in supporting oral hygiene. Factors such as altered salivary flow, taste change, use of high-energy food supplements and syrup-based medications also contribute to the risk of oral and dental diseases. In its role as part of the wider health and social care network, the primary dental care team can make an important contribution to securing the oral health of people living with dementia.

Evaluation of Oral Hygiene Status, Salivary Characteristics and Dental Caries Experience in Acute Lymphoblastic Leukemic (ALL) Children

Leukemia constitutes approximately 30% of all childhood cancers and Acute Lymphoblastic Leukemia (ALL) is the most common type of malignancy. Oral dryness, ulceration, increased dental decay seen is due to altered salivary flow rate and buffering capacity in these children. Oxidative stress may play an important role in the malignancies resulting in onset of inflammatory oral pathologies. Saliva constitutes first line of defense against free radical-mediated oxidative stress. The present study attempted to relate the oral health status, salivary flow rate, salivary pH, gingival health status, dental caries experience and total salivary antioxidant levels in ALL children. A total of 120 children aged 4-10 years (90 leukemic children, study group and 30 normal healthy siblings, control group) were divided into 4 groups of 30 each. Oral health status, gingival status and dental caries experience was recorded followed by un-stimulated saliva collection. Total antioxidant capacity of un-stimulated saliva was evaluated. The results depicted deterioration in oral health status, gingival status and increased dental caries experience in leukemic children. Salivary flow rate, salivary pH and total salivary antioxidant levels were lowered in leukemic children when compared with control group.

Sialoendoscopy and Sialography: Strategies for Assessment and Treatment of Salivary Gland Obstructions

Obstruction of salivary glands is a rather common problem in which patients usually suffer from swelling and tenderness of the involved salivary gland and altered salivary flow from the duct orifice. Surgical procedures have been carried out in the past to treat such problems; however, they were indicated only for obstructions in the anterior portion of the salivary gland duct (anterior to the first molar in the Wharton’s duct and anterior to the Masseter muscle in the Stensen’s duct).

Salivary secretion and connective tissue disease in man.

Parotid and submandibular gland secretions collected from patients with rheumatoid arthritis or systemic sclerosis have been analysed and the results compared with those obtained from a matched group of healthy individuals. Flow rates were measured and the saliva samples assayed for amylase, kallikrein, protein, and salivary IgA concentration. The results showed that only patients with rheumatoid arthritis had a reduced salivary flow, especially parotid flow, with a significantly increased concentration of salivary IgA in both parotid and submandibular saliva. Patients with systemic sclerosis did not show significantly altered salivary flow rates, but there was a marked depletion of salivary IgA content in both parotid and submandibular saliva. Neither disease states appeared to alter the kallikrein or amylase content of saliva. The possible clinical value of these findings is discussed.