Clear Saliva Research Articles

SALIVARY CHARACTERISTICS AMONG 12-YEAR-OLD CHILDREN WITH SIGNIFICANT CARIES INDEX FROM URBAN AND SUBURBAN SCHOOLS IN CAN THO CITY

Background: Dental caries is the most prevalent chronic childhood disease with numerous predisposing factors. Salivary properties have been linked to progressive dental caries in previous studies. However, the role of these contributing factors in the management of dental caries in children remains insufficient. Thus, the investigation of salivary characteristics from different types of communities within a specific pediatric population is an obvious demand. Objectives: To assess the salivary characteristics among school-going children aged 12 years from two urban and suburban schools in Can Tho city. Materials and methods: A cross-sectional descriptive study was conducted on 62 twelve-year-old students with significant caries index in two locations with different socioeconomic status in Can Tho city. Those participants underwent saliva testing by using a saliva testing kit (Saiva-Check BUFFER) to evaluate stimulated and unstimulated saliva parameters including consistency, flow rate, pH and buffering capacity. Results: Out of the total population, males and females made up 40.3% and 59.7%, respectively. Both boys and girls had similarities in all salivary parameters (p > 0.05). Nearly half of suburban students (48.4%) had resting frothy bubbly saliva while more than half of urban students (58.1%) had watery clear saliva at rest. All students had moderate and normal acidic saliva before and after stimulation regardless of living areas. The discrepancy in resting salivary viscosity, resting salivary pH was statistically significant based on region (p < 0.05). 64.5% of the students in both suburban and urban enclaves had a normal stimulated saliva flow rate. In contrast, a normal or high buffering capacity of stimulated saliva was only seen in a few students. Regarding the flow rate, pH, and buffering capacity of stimulated saliva, there were no differences between urban and suburban areas (p > 0.05). Conclusions: The findings of this study provide additional proof of the significance of salivary properties in assessing dental caries, especially in socioeconomic deprivation areas. Furthermore, it also implies that salivary parameters should be taken into account as a potential indicator for managing high caries-risk children.

Do Saliva-Saturated Spit Hoods Interfere With Ventilation?

Spit hoods are used by law enforcement, officers in correctional facilities, and medical personnel during the restraint of agitated subjects that are actively spitting to prevent the transmission of droplet-transmitted pathogens. We could find no studies reporting on the time course of normal breathing to clear saliva from such a saturated spit hood. We purchased samples of 3 popular spit hood models and applied a section over the output of a pneumatic test system. We used a digital anemometer, digital manometer, and an inline controllable fan for back pressure and flow. The pressure was 3 mm Hg to match quiet breathing. The tested area was saturated with artificial saliva, and air pressure was applied while we recorded the pressure and airflow. Within 5 seconds, the spit hoods all cleared sufficient artificial saliva to allow 1 m/s of airflow, which exceeds that of an N95 mask with similar pressure. Commonly used spit hoods offer very low resistance to breathing even after being initially saturated with artificial saliva. Our results do not support the hypothesis that a saliva-filled spit hood might contribute to death.

Современный метод хирургического лечения стриктуры протока околоушной слюнной железы

INTRODUCTION: A modern principle of treatment for obstructive pathologies of salivary glands is saving the gland itself and its functions using minimally invasive methods. This article describes a clinical case of elimination of the stricture of the parotid salivary gland duct and compensation for its expanded section behind the gland with intraoperative visualization using ultrasound. Under US control, the expanded portion was punctured from external access; a conductor was inserted, which passed into the oral cavity through the natural orifice. Through the formed opening, a catheter was installed, which expanded the narrowed area and prevented the reappearance of the stricture. Control examinations in 1, 6 and 12 months showed the functioning of the orifice with release of clear saliva in the satisfactory amount. The patient noted absence of enlargement of the parotid salivary gland and absence of pain at rest and in chewing. Control US in 6 and 12 months showed absence of any signs of stricture and reduction of the orifice diameter to 2 mm. CONCLUSION: The developed method of elimination of stricture of the parotid salivary gland duct can lead to reduction of duration and the scope of surgical intervention, of the risk of re-stricture, postoperative and rehabilitation periods, frequency of using costly equipment, which makes the procedure available.

SIALODOCHITIS FIBRINOSA OF KUSSMAUL: A CASE PRESENTATION

<h3>Objective</h3> Sialodochitis fibrinosa of Kussmaul is a rare phenomenon that was first reported in 1879. It is characterized by recurrent major salivary gland swelling in patients with atopic background. Treatment includes antihistamines, systemic glucocorticoids, massage, mucolytic agents, sialendoscopy, and surgery. To date, less than 70 cases have been reported in the literature. <h3>Case Summary</h3> A 42-year-old woman was referred from the emergency room to the Oral Medicine unit at Sheba Medical Center with the chief complaint of severe xerostomia and asphyxia due to submandibular swelling. Her medical history was significant only for asthma. The patient reported facial and submandibular swelling accompanied by severe pain, 3 weeks before her presentation. Two months earlier, she had developed urticaria, which was treated with antihistamines. The patient denied any symptoms associated with xerophthalmia. Complete blood count as well as lipase, IgG4, and angiotensin converting enzyme (ACE) levels were within normal limits. Blood levels of amylase and C-reactive protein were elevated. Virology (hepatitis B virus, cytomegalovirus, hepatitis C virus, human immunodeficiency virus [HIV], measles, mumps) and autoimmune panel were negative. Salivary glands ultrasound failed to demonstrate any pathologic findings. Clinical examination revealed enlarged cervical lymph nodes, bilateral mild swelling posterior to angle of mandible, perioral rash, dry tongue covered with white coating, erythema around the orifices of parotid ducts, and labial minor salivary glands enlargement. There was no secretion upon milking of major salivary glands. After stimulation with citric acid, foamy saliva secretion was noted, and on milking a mucous plug was released followed by clear saliva secretion. Sialography demonstrated dilated parotid gland ducts. No focal lymphocytic infiltration was noticed on minor salivary gland biopsy. Cytology of the mucous plugs demonstrated the presence of eosinophils. In the light of salivary glands swelling, dilated parotid ducts, the presence of eosinophils within the mucous plugs, and atopic background, the diagnosis of sialodochitis fibrinosa of Kussmaul was made. <h3>Conclusions</h3> Sialodochitis fibrinosa should be included in the differential diagnosis of patients presenting with sialadenitis, recurrent swelling of major salivary glands, and atopic background.

Saliva as a gold-standard sample for SARS-CoV-2 detection

Saliva as a gold-standard sample for SARS-CoV-2 detection

Challenges in managing drooling in children

Drooling is the unintentional loss of saliva from the mouth, either anteriorly (visible) or posteriorly (with a risk of coughing, vomiting, aspiration and chronic respiratory disorders).1,2 Anterior drooling is normal...

Stensen Duct Relocation After Cheek Mucosa Tumor Resection

Cheek mucosa cancer might surround Stensen meatus requiring preservation and relocation of the duct. Sialodochoplasty is necessary to avoid subsequent stricture, cheek swelling, and obstructive sequelae that could make following oncologic follow-up difficult. We report a simple successful technique of parotid duct cannulation and relocation in a 77-year-old woman who underwent cheek mucosa tumor resection for squamous cell carcinoma and free fasciocutaneous forearm reconstruction. Ability of milk clear saliva from the duct orifice after 6 weeks from surgery was assessed clinically, and no fistula or swelling was experienced. Stensen duct cannulation and relocation are a useful adjunctive procedure in the treatment of oral mucosa cancer, preserving salivary gland function while not compromising cancer resection.

Burning Tongue and Lips

A 64-year-old woman visited one of us (M.T.B.) in the Oral Medicine Practice, Carolinas Medical Center, Charlotte, N.C., with a chief complaint of burning tongue and lips. She reported that she began to experience the sensation of a burning and coated tongue in June 2007. The burning sensation soon included her lips, and her tongue felt like sandpaper. The patient also reported having an abnormal taste but not a decreased taste sensation. Four weeks before she developed the burning sensation, the patient was treated with cephalexin and minocycline for a toe infection and staphylococcal blepharitis. In October 2007, she was treated with clindamycin for a recurrent staphylococcal blepharitis infection. The patient’s physician had treated her for an intraoral fungal infection with clotrimazole troches, fluconazole tablets and itraconazole tablets. She reported that her best response to treatment resulted from using clotrimazole troches, but that a coated tongue always returned when she discontinued use of her medications. She also reported having been treated with dexamethasone elixir, which worsened her condition. The patient’s medical history was significant for anxiety, osteoarthritis and peripheral neuropathy. She was being treated with several medications, including testosterone, progesterone, gabapentin, diclofenac sodium, nortriptyline, alprazolam, glucosamine and chondroitin. She had no known allergies, denied using tobacco or illicit drugs and drank wine occasionally in a social setting. A comprehensive review of systems revealed a woman who was moderately distressed as a result of her oral condition. She denied experiencing fatigue but complained of dry mouth of eight months’ duration and dry eyes of 12 to 15 months’ duration. The patient denied having any other systemic abnormalities. The clinician (M.T.B.) performed an extraoral examination, which revealed bilateral angular cheilitis. The intraoral examination revealed a well-restored dentition and no obvious signs of acute infection. The clinician expressed clear saliva from all four major salivary gland orifices except for the Stensen duct of the left parotid gland. The dorsal surface of the tongue had a generalized white coating with areas of erythema, and the tissues appeared dry (Figure 1). The clinician found no other soft-tissue abnormalities. Burning tongue and lips

Parotid abscess caused by Salmonella enteriditis in a patient with parotid masses

Parotid abscess is a condition resulting from the progression of acute bacterial parotitis. It may be distinguished from acute parotitis by fluctuance, pitting, and loculated suppuration. Predisposing factors include dehydration, certain medications, some medical conditions, and an immunocompromised state. The typical bacterial organisms of a parotid abscess are similar to those seen with acute parotitis. The most common organism isolated is Staphylococcus aureus. Additional bacterial pathogens include Streptococcus pneumoniae, Streptococcus pyogenes, Escherichia coli, Haemophilus influenzae, and oral anaerobes (Bacteroides and Peptostreptococcus). Infection of the parotid gland by Salmonella species has been reported in immunocompromised individuals, as well as patients with histories of recent gastrointestinal illness. We describe a case of parotid abscess caused by Salmonella enteriditis in an otherwise healthy patient with known parotid masses. A 75-year-old white man with a 5-year history of bilateral parotid masses presented to the otolaryngology clinic with complaints of a new onset of right-sided facial pain. During his initial evaluation 5 years previous, an (MRI) Magnetic resonance Imaging scan showed bilateral intraparotid masses consistent with Warthin’s tumor. The MRI estimated the right parotid neoplasm to be 4 3 4 cm, and the left to be 3 2 3 cm. The patient was asymptomatic and declined surgical intervention at that time. Two days before the most recent presentation, he experienced a sudden onset of right-sided facial pain, for which he took acetaminophen with adequate relief. The pain became progressively worse over the following 2 days and was refractory to acetaminophen and ibuprofen. The day before presentation he reported having a fever, which was not measured. On the day of presentation he noted a significant increase in pain and the size of the right parotid/facial mass. He denied any nausea, vomiting, diarrhea, or abdominal cramps. The patient denied regular use of alcohol or tobacco. Past surgical history, past medical history, family history and social history were noncontributory. The patient is not an intravenous drug user and has never received a blood transfusion. He denied recent ingestion of eggs or poultry. He had no recent exposure to reptiles. On physical examination, the patient was in mild distress. Visual inspection showed significant facial assymetry. There was a protuberance of tissue in the parotid regions bilaterally, especially on the right. Gross examination showed a 6 by 8 cm right parotid mass with decreased mobility and no skin fixation. There was a small amount of skin erythema near the mass center. On palpation, the area was found to be firm and tender without discrete nodules or fluctuance. No purulence was expressed from Stensen’s duct, and there was flow of clear saliva. The left parotid mass was 3 by 4 cm; it was soft and nontender without erythema. Facial nerve function was intact bilaterally. The remainder of the examination, including flexible fiberoptic laryngoscopy, was unremarkable. The patient underwent fine needle aspiration and a second MRI of the lesion. The fine From the Naval Medical Center Portsmouth, Portsmouth, VA. Address reprint requests to Shawn D. Kosnik, DO, LT MC USN, Naval Medical Center Portsmouth, Charette Health Care Center, 27 Effingham Street, Portsmouth, VA 23708-5000. This is aUSgovernmentwork. There are no restrictions on its use. 0196-0709/02/2302-0001$0.00/0 doi:10.1053/ajot.2002.31217

Trismus and preauricular swelling in a 20-year-old black woman

A 22-year-old Haitian woman was referred to our institution with a 6-week history of trismus and preauricular swelling. The patient had initially presented to a dentist after experiencing pain and “stiffness” of her jaw on the left side. A diagnosis of myofascial pain syndrome was made, and the patient was treated with a soft diet and a nonsteroidal antiinflammatory agent. However, over the course of the next 3 weeks the pain and trismus progressively worsened and was now associated with a left preauricular swelling. The patient was referred to an otolaryngologist, who made the presumptive diagnosis of acute parotitis and placed the patient on a first generation cephalosporin. During the following 2 weeks, the left facial swelling and pain worsened significantly despite her compliance wilh the antibiotic regimen. At that time, she presented to our institution for further evaluation. The patient dcnicd any history of fever, chills, odynophagia, or recent trauma. Her medical history was unremarkable. She was born in Haiti and emigrated to the United States at the age of 6. Since then she has not traveled outside the United States. She denied owning any pets and did not abuse drugs. She was employed as a ward clerk in a New York City hospital The patient presented with normal vital signs and an oral temperature of 99.8”F. The clinical examination was significant for a large, tender, erythematous swelling of the left preauricular region extending from the zygomatic arch to the angle of the left mandible. Mandibular opening was limited to 10 mm and was associated with crepitus in the left temporomandibular joint. Thcrc was no cervical adcnopathy detected on palpation. Clear saliva flowed easily from the left Stenson’s duct. Results of an otoscopic examination of the left ear were normal. The oral mucosa, tongue, floor of

Monitoring Phenytoin Therapy Using Citric Acid-Stimulated Saliva in Infants and Children

Two factors have limited the use of saliva in monitoring phenytoin therapy: availability of adequate volume of clear saliva and lack of a sensitive phenytoin assay. The applicability of citric acid-stimulated saliva and of a sensitive analytical assay (fluorescence polarization immunoassay, "TDx" Abbott) was evaluated in this study. Phenytoin was measured in paired plasma-saliva specimens from epileptic children during the long-term or the initial phase of phenytoin therapy. Analysis was carried out in plasma and in the clear supernatant of saliva (following centrifugation). Pooled-estimate SD of the analytical assay variability was 0.175 micrograms/ml for plasma total phenytoin, 0.063 for plasma free phenytoin, and 0.009 for saliva phenytoin. Recovery measurements of phenytoin spiked into saliva samples gave a coefficient of variation of less than 5%. Correlations between saliva and total plasma phenytoin levels and between saliva and free plasma phenytoin levels were strong and highly significant (r = 0.99, p less than 0.01). The percentage of temporal fluctuation (as determined by saliva phenytoin profiles) during 10-24 h ranged between 25.5-177 (mean, 58.3; SD, 47.3). Ratios of plasma total phenytoin/saliva phenytoin and of plasma free phenytoin/saliva phenytoin levels were 9.54 +/- 1.05 and 0.71 +/- 0.09, respectively. Dialysis experiments showed no binding of phenytoin to saliva supernatant. The greater saliva phenytoin concentrations as compared to plasma free phenytoin concentrations could be due to active transport of phenytoin from plasma to saliva. Measurement of phenytoin in citric acid-stimulated saliva by fluorescent polarization immunoassay is a reliable, noninvasive, and convenient method for monitoring phenytoin therapy in children.

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<h3>PATHOLOGIC QUIZ CASE 1</h3> Jed A. Kwartler, MD, Anjali Limaye, MD, Newark, NJ A 36-year-old man presented with a nontender, indurated, nondraining mass in the left submandibular area of three weeks' duration. His history was significant for cigarette smoking and intravenous drug abuse. He denied any history of blunt trauma to the area, but did admit to attempted drug injections in the region of the mass. He denied any recent dental work. Physical examination revealed a 6 × 4-cm firm, nontender, left submandibular mass. Oral examination did not demonstrate any mucosal lesions, and the dentition appeared intact. Clear saliva could be milked from Wharton's duct. An aspiration biopsy was performed and revealed the mass to be cystic. A large amount of foul-smelling purulent material was evacuated and was sent for culture and cytologic examination. What is your diagnosis? <h3>PATHOLOGIC QUIZ CASE 2</h3> Howard K. Nam, MD; Miriam L. Christ, MD;

顎下腺体移行部唾石症の唾液腺シンチグラフィーによる術後腺機能の検討

Controversy continued as to surgical treatment of a sialolith located close to the submandibular gland, the opinions being excision of the submandibular gland and transoral removal of the stone.To determine the extent of grandular recovery, we examined the submandibular gland function with 99mTc-pertechnetate sialo-scintigraphy following sailolithectomy or spontaneous excretion in four cases of sialolithiasis in which the stone was located on the posterior submandibular duct. An intraindividual comparison of the function of the treated gland with that of the contralateral normal gland was made by time-activity curve from regions of interest over both submadibular glands.In two cases the function of surgically treated submandibuar gland was restored to the same condition as that of the contralateral normal gland at more than two months later after the removal of the stone. In the other two cases submandibular gland was firm on palpation and extensive inflammation was noted showing pus secretion from the orifice of Wharton's duct at first visit. Salivary excrete function on the sialo-scintigraphy was not seen soon after removal of the stone. More than three months later, however, it recovered to about 60% of contralateral normal gland associated with a production of clear saliva from treated submandibular gland.These results suggested that functional recovery may be expectd to some extent in a submandibular gland strikingly damaged by sialolithiasis, and that transoral removal is a valid treatment for a stone located close to the submandibular gland.

The effects of exercise on protein and electrolyte secretion in parotid saliva.

1. Ten subjects collected ten 1 min samples of parotid saliva at a constant flow rate 1-2 hr before exercise, immediately after running 3-8 miles and 3 hr after exercise. 2. Exercise had no significant effects on the concentration of sodium, potassium, calcium, magnesium, chloride, bicarbonate or inorganic phosphate. 3. Exercise caused a marked elevation in total protein concentration and in seven of the subjects the initial samples after exercise were cloudy due to protein precipitation. The precipitated protein could be dissolved in sodium EDTA. 4. The saliva samples collected immediately after exercise from the seven subjects in which precipitation occurred contained higher concentrations of protein, calcium and phosphate than in those of the other three subjects. 5. Electrophoretic analysis revealed that all proteins appeared to show a proportional increase in the cloudy saliva, as compared with the clear saliva but differential precipitation of certain proteins occurred in the former which was largely restricted to proteins having a high affinity for calcium phosphate. 6. Electronmicroscopic examination of centrifuged cloudy saliva produced after exercise revealed the presence of rounded droplets of homogeneous structure in contrast to the fine granular deposits produced in clear parotid saliva by in vitro procedures causing precipitation of calcium phosphate crystals on which protein adsorbed.

Studies on vitamin B12 binding proteins in human saliva.

While many workers in recent years have demonstrated the presence of at least three vitamin B12 binding proteins in normal serum, human saliva has been described to consist of only one binding protein, namely, transcobalamin I, or the higher molecular weight protein. TC-II and TC-III have not been reported in saliva.In our attempts to standardize a technique of isolating these vitamin B12 binders on a small DEAE-cellulose column (1), we also used saliva from patients to determine the effect of different buffers on the pattern of elution of salivary binding proteins. Data, so accumulated, indicate that saliva not only contains both TC-II and TC-III in small amounts, but that the TC-II of saliva is also capable of mediating B12 uptake by human lymphocytes transformed with phytohemagglutinin (PHA) in vitro.Materials and methods. Saliva from normal human volunteers, both male and female, were obtained, centrifuged to remove any particulate matter and the clear saliva stored at −20°. Once thawed, samples were ...

The Resident's Page

<h3>PATHOLOGIC QUIZ CASE 1</h3> James W. Linehan, MD, Palo Alto, Calif A 13-month-old white boy was referred with a history of progressive left parotid swelling since birth. There was no history of local infection, cutaneous drainage, trauma, facial paresis, or systemic disease. The parotid mass did not fluctuate in size with mastication. During a five-month follow-up there was no evidence of infection or obstruction of Stensen's duct; clear saliva flowed readily with compression of the parotid. The infant was otherwise in good health. Palpation revealed a diffuse, nontender, immobile, soft but nonfluctant 4×3 cm tumor situated in the posterior-inferior portion of the parotid gland. There was no evidence of facial weakness or of overlying dermal changes. Intraoral examination, including that of Stensen's duct, was normal; there was no cervical adenopathy. An ethiodal sialogram was suggestive of a vascular tumor. The mass was removed surgically (Fig 1 and 2). <h3>PATHOLOGIC QUIZ</h3>