Dry Mouth Group Research Articles

Oral health status, related behaviours and perceived stress in xerostomia, Sicca and Sjögren's syndromes patients - a cross-sectional study.

Mouth dryness increases the risk of some oral health-related conditions. Furthermore, it is unclear if patients with dry mouth engage in appropriate oral health-related behaviours. The study examined oral health, related behaviours, and perceived stress in dry-mouth patients and compared them to matched controls without mouth dryness. Information about 182 dry-mouth patients and 302 age- and sex-matched subjects was retrieved. Three dry mouth groups: xerostomia, Sicca syndrome and Sjögren's syndrome, were formed based on patient self-reported and objectively assessed symptoms. The World Health Organization's Oral Health for Adults and Perceived Stress Scale (PSS-10) questionnaires inquired about sociodemographic characteristics, oral health-related behaviours, and self-perceived stress. Clinical oral health assessments included: caries experience measured as total numbers of decayed (DS), missing (MS), filled surfaces (FS), number of remaining teeth, erosive tooth wear and extent of periodontal pocketing. Data were analyzed using bivariate and multivariable tests. The dry-mouth participants had higher mean (SD) DMFS scores than their matched controls: xerostomia patients vs. controls: 74.6 (34.4) and 66.3 (35.4), Sicca syndrome patients vs. controls: 88.3 (34.0) and 70.1 (33.9), and Sjögren's syndrome patients vs. controls: 95.7 (31.5) and 74 (33.2). In comparison to controls, individuals with Sicca and patients with Sjögren's syndromes had lower mean (SD) number of remaining teeth, 15.9 (10.1) vs. 21.7 (8.4) and 13.8 (10.0) vs. 20.1 (9.2), and a lower mean (SD) extent of periodontal pocketing, 20.7 (28.6) vs. 41.1 (31.0), and 21.2 (24.1) vs. 34.8 (34.2), respectively. Xerostomia, Sicca syndrome and Sjögren's syndrome patients had higher odds of using fluoridated toothpaste; OR 1.8 (95%CI 1.1-2.9), OR 5.6 (95%CI 1.7-18.3) and OR 6.9 (95%CI 2.2-21.3), respectively. Participants with Sjögren's syndrome had lower odds of the last dental visit being within the last year; OR 0.2 (95%CI 0.1-0.8). Dry-mouth patients had higher caries experience and fewer teeth than comparison groups but a lower extent of periodontal pocketing. Even though more participants with dry mouth used fluoridated toothpastes, their oral health-related behaviours were not optimal.

Role of Transient Receptor Potential Vanilloid 1 in Sonic Hedgehog-Dependent Taste Bud Differentiation.

Taste bud cell differentiation is extremely important for taste sensation. Immature taste bud cells cannot function during taste perception transmission to the nerve. In this study, we investigated whether hedgehog signaling affected taste bud cell differentiation and whether transient receptor potential vanilloid 1 (TRPV1) played a key role in dry mouth. The induction of dry mouth due to salivary gland resection (SGR) was confirmed on the basis of reduced salivation and disrupted fungiform papillae. The expression of keratin 8 (K8) of taste bud cells, neurofilament (NF), sonic hedgehog (Shh), and glioma-associated oncogene homolog 1 (Gli1) around taste bud cells was downregulated; however, the expression of TRPV1, P2X purinoceptor 3 (P2X3), and hematopoietic stem cell factor (c-Kit) was upregulated at the NF ends in the dry mouth group. To investigate the effect of TRPV1 defect on dry mouth, we induced dry mouth in the TRPV-/- group. The K8, NF, and P2X3 expression patterns were the same in the TRPV1 wild-type and TRPV1-/- dry mouth groups. However, Shh and c-Kit expression decreased regardless of dry mouth in the case of TRPV1 deficiency. These results indicated that TRPV1 positively regulated proliferation during taste bud cell injury by blocking the Shh/Gli1 pathway. In addition, not only cell proliferation but also differentiation of taste bud cells could not be regulated under TRPV1-deficiency conditions. Thus, TRPV1 positively regulates taste bud cell innervation and differentiation; this finding could be valuable in the clinical treatment of dry mouth-related taste dysfunction.

Therapeutic effect of intraductal saline irrigation in chronic obstructive sialadenitis

BackgroundThe aim of the present study was to evaluate the effectiveness of intraductal irrigation using normal saline in chronic obstructive sialadenitis.MethodsPatients who had one of the following symptoms were recruited: pain, swelling, stiffness, and dry mouth. A total of 58 salivary glands in 33 patients were diagnosed as having sialadenitis using sialography and ultrasonography. The patients were divided into two groups (swelling group and dry mouth group), according to the major complaint. Repeated intraductal irrigation was performed on each gland. Difference of symptom severity evaluated using numerical rating scale (NRS), and ductal width measured using ultrasonography were compared between the two groups.ResultsThe average NRS score was significantly decreased from 6.0 to 3.3 after 3–5 visits of intraductal irrigation (P < 0.05). The reduction in NRS was greater in the swelling group than in the dry mouth group, although the difference between the groups was not statistically significant. There was no change of ductal width before and after the irrigation.ConclusionsIntraductal irrigation according to this study method using normal saline is a simple treatment for the patients with chronic obstructive sialadenitis. It provides a conservative treatment option reducing the subjective symptoms.

Salivary gland ultrasonography as a diagnostic aid in Sjögren syndrome: a prospective investigational study

Objectives Salivary glands ultrasonography (SGUS) is an emerging diagnostic aid for Sjogren syndrome (SS) with positive potentials because of its availability, noninvasiveness, and safety. The aim of this investigation was to assess and compare the ultrasonographic features of the parotid and submandibular salivary glands in patients with SS or dry mouth (DM) and in healthy controls and to evaluate the sensitivity and specificity of SGUS in the diagnosis of SS. Study Design This was a prospective observational 3-group comparison study. Patients diagnosed with SS (according to the 2016 American College of Rheumatology [ACR] and European League Against Rheumatism [EULAR] criteria, patients with DM (diagnosed on the basis of the subjective reporting of oral dryness and unstimulated salivary flow of Results Thirty-four female patients were enrolled in this investigation, of whom 76.5% were white. Twelve patients (35.3%) had definitive diagnosis of SS; 12 (35.3%) had DM; and 10 (29.4%) were healthy controls. The median age (interquartile range [IQR]) of patients in all 3 groups was 56.6 (± 14.2) years. Ninety-two percent of patients in both the SS and DM groups were on sialogogues, with the majority using cevimeline (83.3% and 41.6%, respectively). Overall, patients with SS showed significant SGUS features and had higher scores compared with patients with DM and controls. The median inhomogeneity score was significantly higher in the SS group compared with the DM and control groups in the right parotid gland (RPG), left submandibular gland (LSMG), and left parotid gland (LPG) (P = .000, .000, and .012, respectively), with no statistically significant differences detected between the SS and DM groups in the right submandibular gland (RSMG) only (P = .604). The median size of the hypoechogenic bands was statistically higher in all salivary glands (i.e., RSMG, RPG, LSMG, and LPG) in the SS group compared with the DM and healthy control groups (P =.000). When comparing the sizes of the glands, there were no statistically significant differences among the 3 groups in the median transvers dimension and height of the RPG (P = .846 and .137, respectively) and LPG (P = .382 and .538, respectively). Moreover, no statistically significant differences were observed in the median anteroposterior dimension and depth of the RSMG (P = .470 and .147, respectively) and LSMG (P = .495 and .695, respectively) among the 3 groups. Lack of visibility of the posterior borders of all glands was detected in the majority of patients in the SS group (RSMG = 66.6%; RPG = 83.3%; LSMG = 75%; LPG = 83.3%), whereas all patients in the DM and control groups had visible posterior borders (P = .000). The size of the sialolith, if present, did not show any statistically significant differences among the 3 groups in RSMG, RPG, LSMG, and LPG (P = .160, .136, .065, and .377, respectively). The SGUS, with a cutoff value of ≥ 2, showed sensitivity of 100% and specificity of 81.6% for detecting SS ultrasonographic features. Conclusions SGUS is a useful, noninvasive diagnostic modality with high sensitivity and specificity. Parenchymal inhomogeneity scores, sizes of the hypoechogenic bands, and visibility of the glands’ posterior borders may all have a good potential for detection of SS. We propose that the ACR and the EULAR take SGUS into consideration when reviewing/updating the diagnostic criteria for SS in the future.

Nutrient intakes and medication use in elderly individuals with and without dry mouths.

BACKGROUND/OBJECTIVESThe nutrition of the elderly depends on various factors. Oral health, especially oral dryness, can be an important risk factor. In this study, we attempted to determine whether dry mouth is associated with compromised nutrient intakes.SUBJECTS/METHODSA total of 120 participants aged 65–86 yrs (mean age: 69 ± 1 y) were included in this study. Demographic and health-related characteristics, living status, meals, number of medications, medical conditions, chewing ability, and quality of life, the Oral Health Impact Profile (the OHIP-14) were assessed. We performed one day 24-hr recall assessment for nutrient analyses. The differences of the means between the dry-mouth and non-dry-mouth groups were analyzed. Elderly subjects with xerostomia-induced dry mouth were classified as those who reported at least one dryness symptom on a questionnaire.RESULTSA significant difference in population distribution was observed among the elderly who took medications for hypertension, diabetes and osteoporosis and was significantly higher in the dry-mouth group (70.2%) than in the non-dry-mouth group (44.4%) (P = 0.005). Compared with the non-dry-mouth group (50.8%), a significantly higher proportion (73.7%) of participants in the dry-mouth group took multiple medicines (≥ 4 medications) (P = 0.019). The intakes of vegetable fat, vitamin E, folate and water in the dry-mouth group were lower than in the non-dry-mouth group. The intakes of fluoride and ω-3 fatty acids were significantly lower in the dry-mouth group than in the non-dry-mouth group.CONCLUSIONThe participants in the dry-mouth group exhibited low nutrient and water intakes. It is recommended that the elderly with dry mouth should drink sufficient water and receive targeted and specific nutritional guidance to prevent malnutrition.

Effect of denture adhesives on oral moisture: A multicenter randomized controlled trial

PurposeThe purpose of this study was to investigate the effect of denture adhesives on oral moisture in a 10-center parallel randomized clinical trial. MethodsTwo hundred edentulous subjects wearing complete dentures were allocated into three groups: cream-type adhesive, powder-type adhesive and control groups. The adhesives (and saline solution in the control group) were applied to the mucosal surface of the dentures for 4 days, and baseline data and data after the intervention for eight meals over 4 days were obtained. For the main outcome, oral moisture was measured with a moisture checking device. Secondary outcomes were denture satisfaction, masticatory performance, denture retention, and occlusal force. In addition to between-group and within-group comparisons of oral moisture, investigations for secondary outcomes were undertaken in subgroups classified according to the degree of oral moisture at baseline (normal subgroup and dry mouth subgroup). Intention-to-treat analysis was also performed. ResultsBetween-group and within-group comparisons of oral moisture showed no significant differences. The cream-type and powder-type denture adhesives were significantly effective in the dry mouth group for denture satisfaction ratings of ability to masticate, stability, retention, and comfort of mandibular dentures (p<0.05). The masticatory performance and retentive force of the dry mouth denture adhesive using groups were significantly improved after intervention (p<0.05). ConclusionsThe oral moisture of complete denture wearers was not influenced by the use of denture adhesives. Our findings showed that denture adhesives improved subjective denture satisfaction, masticatory performance, and retention for complete denture patients with oral dryness.

Evaluation of oral wetness using an improved moisture-checking device for the diagnosis of dry mouth

PurposeIn 2013, we reported the results of a third-generation oral moisture-checking device in a multicentre clinical study involving patients with dry mouth and healthy volunteers. Subsequently, several improvements have been made to the third-generation device, and a fourth-generation device is now commercially available. This study aimed to confirm the usefulness of this improved fourth-generation device in the diagnosis of dry mouth and to assess the physiological wetness of lingual mucosa by using this device. Materials and MethodThis multicentre study comprised subjects with dry mouth (dry mouth group) and those without dry mouth (healthy group). ResultsIn this study, the degree of moisture was considerably different between the two groups. Receiver operating characteristic analysis revealed an area under the curve value of 0.831. Sensitivity and specificity values were close to 80% in cases where the degree of moisture ≥29.6 was defined as normal, ≤27.9 was defined as dry mouth, and 28.0–29.5 was defined as borderline dry mouth. ConclusionsThese results suggest that the improved fourth-generation moisture-checking device can be used for the diagnosis of oral dryness.

Enhanced salivary secretion by interferential current stimulation in patients with dry mouth: a pilot study

This pilot study tested the effects of submandibular and sublingual gland stimulation by interferential current stimulation (IFCS), a noninvasive mode of electrical stimulation. Three groups were enrolled in this study: 20 young adults, 19 older adults, and 21 patients with dry mouth. Four electrodes were attached to the submandibular area, and the secreted saliva was collected by using Salivette cotton rolls (Sarstedt K. K., Tokyo, Japan) for 15minutes, either with or without IFCS. Patients were randomly chosen to receive IFCS. Each subject rated pain and discomfort on the Visual Analogue Scale (VAS) after each experiment. Saliva chromogranin A levels were measured as a stress marker. To compare data between conditions with and without IFCS, a two-sample Student t test analysis was performed. Saliva flow was slightly increased in those in the dry mouth group receiving IFCS compared with those who did not receive IFCS (approximately 130%). However, no such difference was found in the young and older adult groups. There was no significant difference in the VAS values of pain and discomfort or in the stress marker levels between patients who received or did not receive IFCS in the three groups. IFCS delivered to submandibular and sublingual glands may promote saliva secretion in persons who suffer from dry mouth in a manner that does not induce pain or physical stress.

A prospective, observational study to assess the association between dry mouth and solifenacin treatment in patients with overactive bladder syndrome.

Dry mouth is among the most common side effects of antimuscarinic therapy. This study evaluated the drug-related change in dry mouth after the solifenacin treatment and the impact of dry mouth on the drug efficacy against overactive bladder syndrome (OAB). OAB patients (n = 331) were enrolled in a prospective, multicenter, 8-week observational study of solifenacin treatment. Participants were >20 years of age and presented with OAB symptoms for ≥3 months, a total overactive bladder symptom score (OABSS) of ≥3, and an urgency score of ≥2. Primary endpoints were changes in dry mouth according to baseline dry mouth status using Xerostomia Inventory (XI) and the effect of dry mouth to the drug efficacy according to improvements in the OABSS. Three hundred and thirty-three patients were initially screened for the study, with 331 actually enrolled. One hundred and ninety-four patients completed the study. Mean total XI scores increased by 2.8 points in the entire patient population, with larger increases for patients stratified into the non-dry mouth group (NDG) versus the dry mouth group (DG) (4.0 vs. 1.9, p = 0.015) at study baseline. Mean total OABSSs decreased by 3.2 points, with no significant differences between the NDG and the DG (-3.4 vs. -3.0 points, p = 0.578). The dry mouth aggravated in 71 patients (29.2 %) (NDG 30.1 % and DG 27.1 %), but only 10/331 individuals (3.0 %) stopped medication due to xerostomia. Dry mouth progressed in approximately 30 % of the OAB patients, regardless of its presence before solifenacin treatment. However, OAB symptoms were well relieved by solifenacin, and the adverse influence of dry mouth on drug persistence was low.

FRI0437 How do we Treat Patients with Focus Score ≥1, but not Consistent with the New American College of Rheumatology Classification Criteria for SjÖGren's Syndrome? Evaluation from Study in Japanese Patients

BackgroundOne of the criteria for Sjögren's syndrome (SS) is focal lymphocytic infiltration in minor salivary gland biopsy (MSGB). Few studies have revealed that the proportion of patients with focus score...

A simple test for salivary gland function measuring resting and stimulated submandibular and sublingual secretions

This study examined the application of a simple screening test for salivary gland function by measuring resting and stimulated submandibular and sublingual secretions. An assay system was designed to use filter paper incorporating the chromophore of melanoidin or stimuli such as capsaicin and citric acid. We investigated the relationship between resting and stimulated secretions and melanoidin migration at 2 minutes for healthy and dry mouth groups. The healthy group showed a significant increase in the migration of melanoidin in the paper after citric acid or capsaicin stimulation. In contrast, patients with Sjögren syndrome showed no significant migration in spite of the stimulation. However, some participants with Sjögren syndrome or dry mouth showed a significant increase in the migration of melanoidin after stimulation. These results show that the newly developed method should be useful for evaluation of residual salivary gland function and screening for hyposalivation with dry mouth.

Evaluation of an oral moisture-checking device for screening dry mouth

Objective: This multicenter clinical study was to assess the clinical usability of an oral moisture-checking device in detecting the dry mouth patients and evaluating the optimal measurement site. Materials and Methods: The study group comprised 250 patients with dry mouth and 241 healthy volunteer subjects at 13 medical centers. This device was used to measure the moisture degrees of the lingual mucosa and the buccal mucosa. Subjective oral dryness, objective oral dryness, and saliva flow rates were also compared between the two groups. For statistical analysis, receiver-operating characteristic analysis was performed to calculate the area under the curve (AUC). Results: The moisture degree of the lingual mucosa was significantly lower in the dry mouth group (27.2 ± 4.9) than that in the healthy group (29.5 ± 3.1, AUC = 0.653). When a lingual mucosa moisture degree of 31.0 or higher was defined as normal, less than 27.0 as dry mouth, and 27.0 to less than 31.0 as borderline zone of dry mouth, both the sensitivity and the specificity for the diagnosis of dry mouth were close to 80%. Conclusion: These results suggest that the oral moisture-checking device is a usable screening device for dry mouth.

Salivary and serum soluble interleukin-2 receptor in primary Sjögren’s syndrome

Salivary and serum concentrations of soluble interleukin-2 receptor (sIL-2R) were studied in a group of patients with Sjögren’s syndrome and a group suffering from dry mouth. Salivary sIL-2R levels was significantly higher (57.9±15.1 vs 16.7±4.7 pg/ml) ( p<0.05) in the group of 26 patients with Sjögren’s syndrome than in the dry-mouth group. Both the salivary and the serum sIL-2R of normal controls were below the level of detection. No significantly statistical differences were noted between the concentrations of serum sIL-2R in either abnormal groups. No correlations were found between salivary or serum sIL-2R and the erythrocyte sedimentation rate, C-reactive protein, the presence of various autoantibodies or the focus score from lip biopsies in the group of patients with Sjögren’s syndrome. The results show that, although the salivary sIL-2R does not actually reflect the extent of inflammation, it might have an important role in the diagnosis of Sjögren’s syndrome.

Oral mucosal wetness in hypo- and normosalivators

After a person swallows, a film of residual saliva covers the oral hard- and soft-tissue surfaces. Here, the thickness of this film was measured at 11 selected mucosal surfaces on each side of the mouth (22 sites total) in two groups of dry-mouth and one group of normal individuals. Each group contained 25 individuals; one of the dry-mouth groups had resting flow rates ≤0.1 ml/min while the other and the normal had flow rates above that. Residual saliva thickness was determined by placing frying-pan-shaped filter-paper strips (Sialopaper™) against the mucosa at each site for 5 s and measuring the saliva volume collected with a modified Periotron 6000® micro-moisture meter; the thickness was then calculated by dividing the collected saliva volume by the strip area. The two groups with dry-mouth symptoms had mean resting (unstimulated) saliva flow rates of 0.04 and 0.19 ml/min and mean mucosal saliva thicknesses of 22.4 and 27.8 μm, respectively. The control group had a higher mean saliva flow rate of 0.39 ml/min and mucosal saliva thickness of 41.8 μm. As was observed in a previous study on normo salivators, the various sites had a characteristic pattern of wetness, with the hard palate and lips the least moist regions. In this study, these observations were also true in the two dry-mouth groups. Lower resting saliva flow rates were associated with lower mucosal thickness of saliva and with dryness symptoms becoming evident when hyposalivation was below about 0.1–0.2 ml/min. The characteristic pattern of mucosal wetness was not affected by saliva flow rate. As saliva readily collects in the floor of the mouth and is then spread over other mucosal surfaces upon swallowing, it was suggested that hyposalivation could also lead to the dryness symptoms because there was not enough saliva to cover the various oral surfaces, especially the palate and the lips. In this regard, a critical level of moisture was proposed as necessary to protect vulnerable mucosal surfaces from becoming dry. Lower resting saliva flow rates and correspondingly lower mucosal wetness were also associated with a more acidic salivary pH, which was shown earlier to be associated with lower dental plaque pH.

Salivary eicosanoid concentration in patients with Sjögren's syndrome.

To investigate eicosanoid concentrations in the saliva of patients with primary Sjögren's syndrome (SS). Whole mixed saliva of 36 subjects was assayed for eicosanoid concentrations using a radioimmunoassay. Patients with primary SS having positive lip biopsy served as the study group; their results were compared with data from patients with dry mouth and negative lip biopsy (dry mouth group), and with a group of normal healthy controls. Concentrations of thromboxane B2 were significantly (p < 0.01) increased in 18 patients with primary SS compared with 10 patients with dry mouth and eight healthy normal controls (1.95 (SD 0.51) ng/ml saliva compared with 0.52 (0.1) ng/ml and 0.3 (0.1) ng/ml, respectively). Similarly, prostaglandin E2 concentrations were also significantly increased (p < 0.01) in 11 patients with primary SS compared with five patients with dry mouth and eight normal controls (3.75 (0.82) ng/ml saliva compared with 0.32 (0.1) ng/ml and 0.41 (0.1) ng/ml, respectively). Salivary concentrations of eicosanoids are significantly increased in patients with primary SS, and this may prove helpful in the diagnosis of this disease.