Complaints Of Dry Mouth Research Articles

Taste genetics and gastrointestinal symptoms experienced in chronic kidney disease.

It is unknown what causes uraemic symptoms in renal disease. Chronic kidney disease (CKD) patients are known to have increased levels of urea, sodium, potassium and phosphate in their saliva compared with those without renal disease. The present cross-sectional study investigated associations between known genetic traits of taste and self-reported upper gastrointestinal (GI) symptoms experienced in CKD patients with the changes in saliva composition found in renal failure. Fifty-six CKD patients (35 males, 21 females, age 67±14 years), with stages 4 and 5 renal failure, selected from a tertiary hospital renal outpatient clinic participated in this study. Subjects answered a questionnaire to assess upper GI symptoms and tested for the genetic taste recognition thresholds of thiourea, phenylthiocarbamide and sodium benzoate. Saliva samples were collected to determine biochemical composition. Possible associations between genetic taste variations, saliva composition and upper GI symptoms were investigated. Of the 56 patients enroled, 29 (52%) reported major upper GI uraemic symptoms, whereas 27 (48%) had no symptoms or only minor complaints of dry mouth. There was a strong association between the symptomatic burden a patient experienced and the genetic ability to taste thiourea (P<0.0003). Uraemic symptoms of taste changes (P<0.004) and nausea (P<0.002) were found to be related to a patient's genetic ability to taste thiourea. This study provides evidence that the genetic ability to taste thiourea as bitter, in combination with the increase in active compounds found in CKD patient's saliva, impacts on the uraemic upper GI symptoms experienced.

Diagnosis and management of xerostomia and hyposalivation.

Xerostomia, the subjective complaint of dry mouth, and hyposalivation remain a significant burden for many individuals. Diagnosis of xerostomia and salivary gland hypofunction is dependent upon a careful and detailed history and thorough oral examination. There exist many options for treatment and symptom management: salivary stimulants, topical agents, saliva substitutes, and systemic sialogogues. The aim of this review is to investigate the current state of knowledge on management and treatment of patients affected by xerostomia and/or hyposalivation.

Impact of Buccotherm® on xerostomia: a single blind study.

The purpose of this single blind study was to investigate effects of Buccotherm® spray on subjective symptoms of xerostomia patients. Twenty patients with dry mouth complaint were instructed to use placebo six times a day for 2 weeks. After a wash period, mineral water spray was provided. Patients were asked to reply questions regarding dry mouth using visual analog scale (VAS). Baseline and subsequent subjective findings on 1 hour after the application of the materials at the end of 1st, 7th, and 14th days were recorded. At the end of 14-day treatment, no statistically significant differences were observed between the efficacy of placebo and commercial mineral water dental spray (p > 0.05). The VAS scores revealed that difficulty in mastication (p = 0.006), difficulty in swallowing (p = 0.00), need to sip liquids while eating (p = 0.000), difficulty in speech (p = 0.003), and waking up at night to sip water (p = 0.005) were statistically lower for placebo than commercial mineral water spray. The commercial mineral water dental spray was not more efficient than placebo in the management of dry mouth-related symptoms. This study emphasizes the fundamental role of saliva in oral health and evaluates the clinical utility of a commercial dental spray.

A case-control study to evaluate salivary cortisol levels in patients with dry mouth

Objective: The purpose of this study is to evaluate the salivary cortisol levels in patients with dry mouth. Materials and Methods: The study population consisted of 20 patients with a complaint of dry mouth and 20 asymptomatic age- and sex-matched controls. In patients who complained of dry mouth, the salivary flow rate (ml/minute) was estimated by measuring the quantity of the saliva collected in the collector. The concentration of cortisol in the saliva (΅g/dl) was determined by using a salivary enzyme-linked immunoassay (ELISA) kit. Statistical Analysis: The results were evaluated using the Student's t-test. Results: There was only a mild increase in salivary cortisol in both stimulated and unstimulated saliva in patients with dry mouth compared to the controls (p-value 0.981 and 0.481, respectively), which was not statistically significant. Conclusion: There may not be a clear association between the salivary cortisol level and dry mouth. In older individuals, age-associated salivary gland hypofunction and life changes may be the main risk factors for dry mouth compared to stress and anxiety.

Sjögren's Syndrome

Sjögren's syndrome (SS) is a chronic autoimmune disorder that typically affects exocrine glands--mainly labial and lacrimal--leading to complaints of dry mouth and eyes. Given that periepithelial mononuclear cell infiltrates, both in exocrine glands and in other parenchymal organs (kidney, lung, and liver), are the histopathological disease hallmark, the term autoimmune epithelitis has been proposed. B cell hyperactivity is another cardinal SS feature manifested by the presence of autoantibodies and hypergammaglobulinemia, as well as clinical/serological phenotypes mediated by immune complexes, such as peripheral neuropathy, vasculitic lesions, and hypocomplementemia. These have been designated adverse predictors for lymphoma development in approximately 5% to 10% of patients. Activation of the type I interferon/B cell-activating factor axis in SS has recently attracted particular attention. Inappropriate overexpression of endogenous nucleic acids in a genetically susceptible individual might provide a plausible scenario for the immune activation observed in SS.

Relationship between xerostomia and salivary flow rates in HIV‐infected individuals

The aim of the present study was to determine the relationship between self-reported xerostomia and salivary flow rates among HIV-infected individuals. A cross-sectional study was performed on 173 individuals (81 HIV-infected individuals, mean age: 32 years, and 92 non-HIV controls, mean age: 30 years). Subjective complaints of dry mouth, based on a self-report of xerostomia questions, and dry mouth, based on a visual analogue scale (VAS), were recorded along with measurements of salivary flow rate of both unstimulated and wax-stimulated whole saliva. The relationship between subjective responses to the xerostomia questions, the VAS of dry mouth, and objective measurements of salivary flow rates were analyzed. Responses to the questions--Do you carry water or a saliva substitute? and Have you had taste disturbance?--were significantly different between HIV-infected and non-HIV individuals (P < 0.05). Individuals' responses to questions concerning dry mouth were significantly correlated with a low unstimulated salivary flow rate. A significant correlation between the VAS of dry mouth and salivary flow rates was observed (P = 0.023). Responses to self-reported xerostomia questions reflects low unstimulated salivary flow rates. Thus, questions concerning dry mouth might be useful tools to identify HIV-infected individuals with hyposalivation, especially at a resting stage.

Autopercepção de Saúde Bucal de Idosos Institucionalizados e não Institucionalizados do Município de Araraquara-SP

O estudo avaliou a autopercepção de saúde bucal de idosos institucionalizados e não institucionalizados do município de Araraquara/SP. Foram selecionados 40 moradores da Instituição de Longa Permanência (ILP) e 40 frequentadores de um Grupo da terceira idade (SESI), com faixa etária entre 60 e 95 anos, de ambos os sexos. Os participantes foram questionados sobre suas condições sociodemográficas, submetidos à avaliação cognitiva por meio do Mini Exame do Estado Mental (MEEM) e posteriormente, avaliados quanto à autopercepção de saúde bucal com o Geriatric Oral Health Assessment Index (GOHAI). Os dados foram analisados descritivamente. Os resultados mostraram que prevaleceu o gênero feminino, com idade entre 70 e 79 anos, a maioria analfabeta ou com ensino fundamental incompleto, 50% moravam com companheiro e 25% sozinhos ou com a família. Encontrou-se condição de normalidade tanto para o grupo não institucionalizado como institucionalizado (65,0% e 87,5%, respectivamente) na avaliação cognitiva. Para o GOHAI, 85% no SESI e 92,5% na ILP não sentiam desconforto ao engolir alimentos. Quanto à satisfação com dentes e próteses, 72,5% do grupo da ILP consideram-se parcialmente felizes ou descontente. Na avaliação clínica, houve queixa frequente de sensação de boca seca; 85% do SESI utilizavam prótese, das quais 62,5% eram satisfatórias; na ILP, 72,5% usavam próteses, das quais 22,5% apresentaram desgaste excessivo. Dessa forma, conclui-se que a autopercepção de saúde bucal dos idosos institucionalizados e não institucionalizados é baixa, o que sugere o planejamento de ações de educação e prevenção em saúde bucal das principais doenças que acometem esses indivíduos.

English

Xerostomia commonly called as dry mouth, is the subjective feeling of oral dryness. It is not a diagnosis, but a symptom with multiple possible causes. Although dry mouth is most frequently associated with altered salivary gland function, there are other etiologies for this condition. The most frequent cause of dry mouth complaints is the use of certain drugs, depression or psychological conditions, systemic diseases, radiotherapy etc. It is important to perform a complete evaluation of the patient with dry mouth, to determine the possible cause of the xerostomia so that appropriate management can be instituted in a timely manner. The patient with xerostomia who has salivary gland hypo- function is at risk for many oral complications and it is critical to institute appropriate preventive measures. The dentist and dental hygienist has an important role in recognition and management of the patient with xerostomia. Xerostomia may also be a consequence of systemic disease and early recognition may aid in their prompt treatment. Management may be viewed as a series of goals: to provide symptomatic relief of dryness complaints; to institute appropriate preventive measures; to treat any ongoing oral problems; if salivary function is decreased, to stimulate remaining function; and to address the underlying disease process.

Oral findings in postmenopausal women attending dental hospital in western part of India.

Objectives: To know the nature, incidence and severity of oral manifestations occurring in postmenopausal women. Study design: Oral changes were observed in 365 postmenopausal women and 365 age matched male individuals attending the department of Oral Medicine and Radiology. The patients were asked about complaints of dry mouth, taste and breath changes, mucosal and facial pain and were examined for oral changes such as ulceration, white and red lesions. The results obtained from the study were then correlated with various other similar studies. Results: The important oral findings in postmenopausal women were mucosal burning/pain (25.8%), dry mouth (27.1%), altered taste (3.6%), altered breath (6.3%) and facial pain (3.6%). Oral submucous fibrosis (OSMF) was significantly more common in males (5.5%) as compared to postmenopausal females (1.9%). Conclusion: Results from the present study reveal that oral symptoms are common problems in postmenopausal women. Postmenopausal patients showed significantly more oral changes than the control. These changes could be related to the hormone alterations. Therefore, dentists need to refer postmenopausal women with oral symptoms to a gynaecologist for more careful examinations and medical interventions if necessary. Key words:Menopause; postmenopause; xerostomia; pallor; oral changes.

Oral medicine 1. Oorzaken en klinisch beeld van monddroogheid

Healthcare providers do not always recognize dry mouth and the problems associated with it. The symptoms of dry mouth and the patterns of complaints associated with it are the feeling that the mouth is dry; foamy or very watery saliva; a red appearance of the mucosa under a denture and the excessive presence of remaining food particles on the mucosa or the denture. The most serious detrimental aspect of dry mouth complaints is a reduced secretion of saliva, but afeeling ofa dry mouth can also exist without an objectively assessed hyposalivation. The most important causes of dry mouth are the side effects ofmedications, systemic diseases, radiotherapy in the head and neck region and occasionally a psychiatric disorder. Early recognition of the symptoms and the establishment ofa precise diagnosis are essential for proper treatment and for optimizing the quality of life of the patient. Basic investigation consists of an extensive patient history, inspection of the head and neck region and the oral cavity, evaluation ofthefunctioning of the salivary glands, and, if necessary, additional investigations.

Xerostomia: A day and night difference

PurposeTo compare patient-reported xerostomia during daytime and during nighttime with objectively measured parotid and submandibular gland function in a cohort of head-and-neck cancer (HNC) patients treated with RT. Materials and methodsA cohort of 138 HNC patients underwent objective measurements of parotid (PF) and submandibular (SMF) gland function and completed a xerostomia questionnaire (XQ) before RT, at 6weeks, 6months and 1year after RT. No attempt was made to spare the submandibular gland(s). The XQ contained specific questions concerning the sensation of dry mouth during day- (XD) and nighttime (XN), scored on a 5-point Likert scale. Patients with no or mild (grade 1–3) xerostomia and patients with more severe (grade 4–5) complaints were grouped together. ResultsBefore RT, no association existed between dry mouth complaints and PF or SMF. At 6weeks, 6months and 1year after RT; 37%, 51% and 36% had grade 4–5 XD and 65%, 64% and 56% had grade 4–5 XN, respectively. Patients with grade 4–5 XD and XN had significantly worse SMF at all time points after RT compared to patients with grade 1–3 XD and XN, while PF was significantly worse only at 6weeks after RT. In multivariate analyses, SMF was consistently the most important factor related to XN after treatment. PF significantly influenced XD at 6weeks and 1year after RT. ConclusionsDifferentiating between complaints during day- and nighttime in xerostomia research is necessary. Dry mouth at night is a frequent problem after (parotid-sparing) RT for HNC and is explained by submandibular gland dysfunction. Sparing of the contralateral submandibular gland, in addition to parotid gland sparing, may result in improved patient-reported xerostomia.

MUC5B levels in submandibular gland saliva of patients treated with radiotherapy for head-and-neck cancer: A pilot study

BackgroundThe salivary mucin MUC5B, present in (sero)mucous secretions including submandibular gland (SMG) saliva, plays an important role in the lubrication of the oral mucosa and is thought to be related to the feeling of dry mouth. We investigated if MUC5B levels in SMG saliva could distinguish between the presence or absence of severe dry mouth complaints 12 months after radiotherapy (RT) for head-and-neck cancer (HNC).FindingsTwenty-nine HNC patients with a residual stimulated SMG secretion rate of ≥0.2 ml/10 min at 12 months after RT were analyzed. MUC5B (in U; normalized to 1) and total protein levels (mg/ml) were measured in SMG saliva at baseline and 12 months after RT using ELISA and BCA protein assay, respectively. Overall, median MUC5B levels decreased after RT from 0.12 to 0.03 U (p = 0.47). Patients were dichotomized into none/mild xerostomia (n = 12) and severe xerostomia (n = 17) based on a questionnaire completed at 12 months. SMG and whole saliva flow rates decreased after RT but were comparable in both groups. The median MUC5B level was higher in patients with no or mild xerostomia compared to patients with severe xerostomia (0.14 vs 0.01 U, p = 0.22). Half of the patients with severe xerostomia had no detectable MUC5B at 12 months after RT. No differences in total protein levels were observed.ConclusionsQualitative saliva parameters like MUC5B need further investigation in RT-induced xerostomia. This pilot study showed a trend towards lower MUC5B levels in the SMG saliva of patients with severe xerostomia 12 months after RT for HNC.

Oral manifestations in patients with hypogammaglobulinemia

The overall objective of this study was to assess the oral manifestations and their association with immunologic status and health history, of individuals with hypogammaglobulinemia. A case-controlled study of 100 subjects with hypogammaglobulinemia and 93 control individuals was performed. All participants were examined for dental caries, periodontal disease, mucosal lesions/infections, and general oral health problems. Decayed, missing, filled teeth and community periodontal index were recorded. Complete blood count, serum immunoglobulins, and lymphocyte immunophenotyping were measured on the same day of the oral health assessment. Individuals with hypogammaglobulinemia showed higher prevalence of enamel hypoplasia and complaints of dry mouth, and lower prevalence of dental caries and periodontal disease. The systemic conditions associated with hypogammaglobulinemia were not associated with enhanced susceptibility to caries, gingivitis, or periodontitis; however, individuals with hypogammaglobulinemia were more likely to report more episodes of recurrent aphthous ulcers compared with control individuals.

Evaluation of the clinical efficacy of Biotène Oral Balance in patients with secondary Sjögren’s syndrome: a pilot study

The objective of the present study was to evaluate the efficacy of Oral Balance saliva substitute in alleviating dry mouth symptoms in a sample of patients with secondary Sjögren's syndrome. Twenty-one consecutive secondary Sjögren's syndrome patients with dry mouth complaints and hyposalivation were included in this study. Patients used a lactoperoxidase-system-containing gel (Biotène Oral Balance) for 4 weeks. The effects on subjective oral symptoms were recorded by means of a 7-items questionnaire which contained questions regarding dry mouth sensation and its effect on chewing, swallowing, taste, speech, burning sensation and denture retention. The severity of symptoms was assessed using a visual analogical scale. Oral symptom scores and unstimulated whole salivary flow were recorded at baseline and after 4 weeks' use of the product. Two patients withdrew from the study, because of nausea and unpleasant taste caused by the product. Nineteen patients (all women, mean age 52.7 years) participated throughout the entire study. Wilcoxon signed-ranked tests indicated significant improvements in visual analogical scale scores posttreatment for 5 of the 7 items on the oral dryness questionnaire, although no increase in salivary flow was found. However, the improvement in certain variables did not take a positive course in all cases. Patients with lower salivary flow at baseline tended to have greater improvement in oral symptoms. The study suggests that the use of Oral Balance gel is effective in alleviating the dry mouth symptoms in secondary Sjögren's syndrome patients, but a randomized controlled trial is needed to assess the placebo effect.

A screening test for capsaicin-stimulated salivary flow using filter paper: a study for diagnosis of hyposalivation with a complaint of dry mouth

The purpose of this study was to develop a simple screening technique for diagnosis of hyposalivation with dry mouth by estimation of capsaicin-stimulated salivary flow using filter paper. An assay system comprising 5 spots containing starch and potassium iodide on filter paper incorporating or without capsaicin and a coloring reagent was designed. We investigated whether the number of colored spots using the filter paper incorporating capsaicin could distinguish between healthy subjects and subjects with hyposalivation and dry mouth. In the healthy group (>200 μL/min; n = 33), the capsaicin-stimulated salivary flow significantly increased as compared with the resting salivary flow, from 1.2 ± 1.4 to 2.9 ± 1.3 colored spots (P < .05). In contrast, the hyposalivation group with dry mouth (<100 μL/min; n = 32) hardly changed (4.4 ± 1.0 vs 4.9 ± 0.2), except for 3 subjects who had considerable elevated secretion on capsaicin stimulation. By measuring resting and stimulated salivary flows, this method should be useful for evaluating retained functional ability of salivary glands and screening of hyposalivation with dry mouth.

Xerostomia appearance in type 1 diabetes mellitus children in RSUPN dr. Cipto Mangunkusumo Jakarta

Diabetes mellitus is a chronic metabolic disease characterized by hyperglycemia due to insulin deficiency. As a result, there will be metabolic disturbances on carbohydrate, fat, and protein. Diabetes mellitus type 1 may occur because of pancreatic B cells damage resulting in decreased secretion of insulin in absolute terms. Xerostomia is the medical term for the subjective complaint of dry mouth due to the lack of saliva and can occur in patients with type 1 diabetes mellitus. The purpose of this study was to obtain data on the salivary flow rate and oral dryness complaints in children with type 1 diabetes mellitus The method of this study was descriptive by survey technique. The sample was obtained by purposive sampling and consisted of 30 children with type 1 diabetes mellitus in RSUPN Dr. Cipto Mangunkusumo Jakarta in April to May 2010. The study was conducted with an objective examination by measuring the salivary flow rate and subjective examination using a questionnaire. The results showed that the salivary flow rate from an average of 30 respondents was below normal values. The most common complaints about the dryness of the mouth cavity were thirst, 24 patients (80.00%), and oral dryness 19 patients (63.33%). The conclusion from this study showed that children with type 1 diabetes mellitus were having oral dryness complaints and the decrease of salivary flow rate.

The influence of causes of hyposalivation on clinical outcome of nizatidine in patients with dry mouth

It was reported that nizatidine, a histamine H 2-receptor antagonist, promoted salivation by inhibiting acetylcholinesterase and increasing acetylcholine in cholinergic nerves. However, little is known concerning the appropriate usage of the drug for dry mouth. Therefore, the relationship between the causes of dry mouth and the effects of nizatidine was investigated in order to examine the indication of the drug in dry mouth. In the study, 45 patients who came to the Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hachioji Medical Center, with a chief complaint of dry mouth during the 1-year period from August 2006 to August 2007, were given nizatidine at 300 mg/day continually for 4 weeks. At 2 weeks and 4 weeks of administration, gum tests were conducted on the patients, and the effect of nizatidine was evaluated on a visual analog scale. The cases were divided into groups according to the causes of hyposalivation, and the effect of nizatidine was examined for each group. As a result, the group with aging as the cause, and the group with drug side effects as the cause, was observed to have increased salivary secretion and improvement in subjective symptoms.

Systemic and Local Interleukin-17 and Linked Cytokines Associated with Sjögren’s Syndrome Immunopathogenesis

Recently recognized as a distinct CD4(+) T helper (Th) lineage, Th17 cells have been implicated in host responses to infections and in pathogenesis associated with autoimmune diseases. This cytokine is implicated in primary Sjögren's syndrome (pSS) immunopathology because of the increased levels of circulating interleukin (IL)-17 in pSS. Plasma and minor salivary glands (MSGs) from patients with pSS were therefore evaluated for CD4(+) T cells, T regulatory cells, IL-17, and supporting cytokines by immunohistochemistry, RT-PCR, and microbead assays. MSGs from pSS patients contain IL-17-expressing cells as a dominant population within inflammatory lesions. IL-17 protein expression progressively increased with higher biopsy focus scores (P < 0.0001), in parallel with detection by RT-PCR. Transforming growth factor-beta, IL-6 and IL-23, which are requisite promoters of Th17 differentiation, were found in abundance compared with the amounts in control tissues. Although transforming growth factor-beta is also a pivotal differentiation factor for immunosuppressive Foxp3(+) T regulatory cells (Tregs), an increase in Foxp3(+) Tregs was evident in biopsy specimens with mild and moderate inflammation but this increase was disproportionate to escalating pro-inflammatory Th17 populations in advanced disease. Furthermore, the Th17-centric cytokines IL-17, IL-6, IL-23, and IL-12 were significantly elevated in pSS plasma. These data identify a profusion of IL-17-generating cells and supporting cytokines within diseased pSS MSGs without a compensatory increase in immunomodulatory Tregs; this imbalance seems to foster a pathogenic milieu that may be causative and predictive of infiltrative injury and amenable to therapeutic intervention.

The effects of high frequency, low intensity ultrasound therapy on parotid flow rates

Saliva plays a critical role in maintaining oral health and comfort. Development of a single device capable of simulating salivary flow with no taste or adverse side effects is desirable. This clinical investigation on 23 healthy volunteers with no dry mouth complaints evaluated the effectiveness of ultrasonic therapy in mechanical stimulation of the parotid gland to increase saliva flow. Stimulated and unstimulated parotid saliva was collected. Differences in mean salivary flow rates and affects of age and ethnicity were measured. The mean difference between stimulated and unstimulated saliva flow rates was 0.009 mL/min +/- SD = 0.042, t (df = 22) = 1.27 with P = .31. There were no significant differences of age (P = .26), gender (P = .38), or race/ethnicity (P = .58) for the difference of stimulated and unstimulated conditions. Results indicate that high-frequency low-intensity ultrasound therapy is not effective in stimulating salivary flow rates.

Effects of carboxymethylcellulose (CMC)-based artificial saliva in patients with xerostomia

The purpose of this study was to investigate the effects of carboxymethylcellulose (CMC)-based artificial saliva according to residual secretory potency, assessed by the salivary flow rate in patients with dry mouth. Fifty patients (6 men and 44 women, 57.8 ± 13.2 year of age) with a chief complaint of dry mouth were asked a standardized series of questions regarding dry mouth-related symptoms and behaviors. Whole salivary flow rates were measured under unstimulated and stimulated conditions. After using CMC-based artificial saliva for 2 weeks, each patient completed the same questionnaire. Use of the artificial saliva decreased the severity of ‘oral dryness at night or on awakening’, ‘oral dryness at other times of the day’, and ‘the effect of oral dryness on daily life’ ( P < 0.05). Patients with an undetectable flow rate of stimulated whole saliva responded better on ‘oral dryness during eating’ compared with the other patients ( P < 0.05). The use of CMC-based artificial saliva also improved dry mouth-related behaviors, especially ‘awakening from sleep at night because of oral dryness’. In conclusion, CMC-based artificial saliva demonstrated moderate effects in reducing dry mouth-related symptoms and behaviors with more significant effects appearing in patients whose residual secretory potency was severely compromised.