Lower Salivary Flow Rate Research Articles

Oral Health of Children and Adolescents with Diabetes Mellitus

Aim: To examine the oral health of children and adolescents with and without diabetes mellitus. Background: Diabetes mellitus is the most common metabolic disease in childhood and demonstrates an increasing incidence. Many children live with gingivitis as a precursor to periodontitis. If left untreated, it can cause the development of periodontitis. The links between periodontitis and diabetes mellitus are known but have been little studied in the age group of children and adolescents. Materials and Methods: Clinical examination and collection of sulcus fluid from participants aged 5 to 21 years was performed. The following data were collected: demographic variables, caries prevalence, DMF-T, VPI, PUFA, salivary flow rate, HbA1c, PSI, and the concentration of IL-1β, IL-6, MMP-8, and TNF-α. Results: Patients with diabetes mellitus showed a significantly lower salivary flow rate with higher concentrations of MMP-8 and IL-1β. The data indicate that at this age, regular visits to the dentist are of great importance for the promotion of oral health in children and adolescents regardless of diabetes and that patients with diabetes mellitus in particular benefit from prevention, as they belong to the periodontitis risk group. Conclusions: Patients with low salivary flow rates and increased inflammatory mediators are high-risk patients for whom dental preventive measures play a major role.

Hypophysitis and central nervous system involvement in association with Sjögren’s syndrome along with hypoparathyroidism: a case report

BackgroundPatients with autoimmune diseases can develop multiple autoimmune diseases over a long period of time, and the presence of more than one autoimmune disease in a single patient is defined as polyautoimmunity. Polyautoimmunity may be clinical evidence that autoimmune diseases share similar immunological mechanisms.Case presentationWe report a 30-year-old woman with a unique combination of autoimmune diseases predominantly affecting the central nervous system, with hypoparathyroidism, hypophysitis, medulla involvement, and pons and temporal lobe involvement associated with primary Sjögren's syndrome (pSS), occurring independently over a long period. The patient who had a history of muscle cramps and one seizure incident, presented with vomiting and blurred vision. She was diagnosed with hypophysitis and hypoparathyroidism with calcifications in the basal ganglia and cerebellum. She recovered after four months of corticosteroid treatment for hypophysitis and was started on treatment for hypoparathyroidism. Eight months later, she developed vomiting, hiccups, vertigo, and ataxia with a focal lesion in the medulla. She recovered with immunosuppressive treatment for 2 years. Fifty-eight months after the onset of hypophysitis, she developed diplopia and dry mouth and eyes. MRI showed infiltrative lesions in the left pons and left temporal lobe. Based on positive anti-Sjögren's syndrome-related antigen A antibodies and low unstimulated whole salivary flow rate, pSS was diagnosed. She received corticosteroids and continued mycophenolate mofetil treatment with recovery of neurological symptoms.ConclusionThis case highlights the need for long-term follow-up to detect autoimmune disease processes involving various organs.

Enhancing Intraoral Fluoride Retention in Older Adults: A Randomized Crossover Study.

Previous studies have shown that a calcium prerinse can increase intraoral fluoride retention from a fluoride rinse. To explore the potential of this approach to control root caries, we assessed intraoral fluoride bioavailability after a calcium prerinse in older adults with normal to low salivary flow rates. In a 2-period crossover trial (NCT04239872), 20 participants (65-80 y old), with low or normal salivary flow rate, rinsed for 1 min with a 0.05% NaF mouth rinse (226 ppm F, F only) or with this rinse immediately after a 1-min rinse with 150 mM calcium lactate (Ca→F). Dental biofilm and saliva samples were collected before and up to 2 h after the rinse(s). Fluoride concentrations in saliva (whole and clarified) and dental biofilm (fluid and solid phases) were blindly determined. Data were statistically analyzed by a mixed-effects model for the effect of treatment, time, and their interaction (α = 5%). The Ca→F group resulted in significantly higher fluoride concentrations in all variables analyzed, for almost all of the collection time points. The effect was greater in the biofilm solids and whole saliva (compatible with the formation of calcium fluoride deposits) and still significant (P < 0.001) after 2 h in the biofilm fluid and clarified saliva, suggesting that fluoride stored in insoluble particles was released, increasing free fluoride. The use of a calcium prerinse before a fluoride rinse was able to prolong intraoral fluoride bioavailability in older adults. A calcium prerinse increased intraoral fluoride bioavailability in older individuals. This approach could be used to improve root caries control without the need to increase the fluoride concentration in dental products.

Associations between Zinc Deficiency, Taste Changes, and Salivary Flow Rates following Gastric Bypass and Sleeve Gastrectomy Surgeries.

The prevalence of taste change (hypogeusia) and its association with zinc deficiency is unclear due to differences in methods of assessment. We investigate the prevalence of hypogeusia using mixed methods and link it with changes in zinc levels following mini gastric bypass (MGB) and sleeve gastrectomy (SG). This was a prospective observational study of MGB (N = 18) and SG (N = 25). Hypogeusia was evaluated by using a validated questionnaire and by taste strips procedure along with serum zinc levels and salivary flow rate measurements. The mean age was 40.0 ± 9.7 years; 60.5% were female. By using a questionnaire, MGB patients experienced greater hypogeusia than SG at 3 months (72.0% vs 36.0%; (p=0.03)), but not at 6 months (56.0% vs 45.0%; (p=0.74)), respectively. Using taste strips, at 6 months, more MGB patients experienced hypogeusia compared with SG (44.0% vs 11.0%; p=0.03). Zinc level was reduced following MGB at 6 months (85.6 ± 16.9 μgm/dl vs 67.5 ± 9.2 μgm/dl; (P=0.004)) but was increased at 6 months following SG (76.9 ± 11.4 vs 84.9 ± 21.7 μgm/dl). Reduction in the rate of salivary flow was observed in 66.0% and 72.0% of MGB and SG patients, respectively, at 3 months and in 53.0% and 70.0% at 6 months. Taste change is more prevalent following MGB compared with SG, especially at 6 months postoperation which parallel with changes in zinc levels. More than half of all patients who had undergone bariatric surgery (BS) had low to very low salivary flow rates during the follow-up. This study suggests an association between low zinc levels and reduced salivary flow with hypogeusia following BS.

Evaluation of major salivary glands with ultrasonography in multiple sclerosis patients

BackgroundThis study aimed to investigate the homogeneity of the major salivary glands in multiple sclerosis (MS) patients using ultrasonography (USG), assess DMFT indices, measure resting salivary flow rates, and compare these values with healthy individuals.MethodsIn this study, 20 individuals diagnosed with Relapsing-Remitting Multiple Sclerosis (RRMS) (mean age 36.15 ± 8.51) and 20 systemically healthy individuals (mean age 35.7 ± 9.22) were included. Oral and radiologic examinations were performed in all individuals. The parotid and submandibular salivary glands were examined using USG, and their homogeneity was assessed based on the scoring system recommended by the Outcome Measures in Rheumatology Clinical Trials (OMERACT) study group. Resting salivary flow rates and DMFT indices were measured, and the obtained data were subjected to statistical analysis.ResultsThe parotid glands exhibited more heterogeneity on USG within the MS patient group than the control group, with a statistically significant difference between the two groups (p = 0.015). A statistically significant correlation was observed in total homogeneity values between the patient and control groups (p = 0.021). Furthermore, the MS patient group exhibited higher DMFT indices and lower salivary flow rates than the control group. The difference between the DMFT indices and salivary flow rate between the patient groups was statistically significant (p = 0.004 and p = 0.002 respectively).ConclusionsThe parenchyma of the major salivary glands in MS patients exhibited decreased homogeneity than the healthy controls. Additionally, the MS group showed a decrease in salivary flow rate and an increase in the DMFT index. Autonomic dysfunction and medications used for MS are thought to cause salivary gland hypofunction and dry mouth. It can be interpreted that hyposalivation and motor skill losses in MS patients lead to an increase in DMFT index.

Descriptive temporal sensory properties and volatile composition of Pinot noir wines produced with contrasting alcoholic fermentation temperatures and cap management regimes

Pinot noir is rapidly becoming a winemaking staple in the Central Coast of California. Therefore, it is important to understand how factors such as fermentation temperature and cap management affect the chemical and sensory impact of such wines. Herein, Pinot noir wines were made with three contrasting alcoholic fermentation temperature regimes (Cold, Cold/Hot, Hot) and combined factorially with two cap management regimes (with or without punch downs). The impact of these factors on colour, aroma, and the temporal retronasal aroma and mouthfeel profile was assessed by a trained sensory panel (n = 13) using descriptive analysis (DA) and time-intensity (TI), respectively. Combining a hot fermentation temperature and no punch downs led to wines with higher colour saturation and purple hue. In contrast, wines fermented at cold fermentation temperatures with no punch downs showed reduction aromas. In terms of individual main effects, wines fermented at cold temperatures had more orthonasal aroma, while wines fermented at hot temperatures had higher astringency. To understand the relationship between selected volatile aromas and perceived sensory results, a partial least square regression (PLSR) was conducted. PLSR indicated that cold fermentation temperature wines with punch downs were associated with esters, including ethyl hexanoate and ethyl heptanoate, as well as β-damascenone, which aligned with sensory results. The effect of salivary flow rate on the temporal sensory profile post-expectoration was also analysed. Low salivary flow rate panellists perceived both astringency and length significantly later and more intensely than high salivary flow rate panellists. However, the time of maximum intensity was perceived significantly later for high salivary flow rate panellists. Overall, fermentation temperature had a more significant impact on the sensory and volatile composition of Pinot noir wines than the cap management regime. However, cap management still appeared to affect sensory and volatile chemistry results through significant interactions. Therefore, the relationship between fermentation temperature and cap management was not straightforward from avolatile chemistry or sensory perspective. The importance of accounting for salivary flow rate in panellists when using time-based sensory analysis was also highlighted.

The Relationship Between Salivary Flow Rate and Malnutrition in Elderly

Purpose: This study aimed to evaluate the relationship between salivary flow rate (SFR) and nutritional status of elderly.Materials and methods: The study included 63 elderly people (20 males, 43 females, age: 70.83±6.42 years) who applied to the dentist's office. The data were collected by face-to-face interview method and sociodemographic characteristics, information on employment status and lifestyle habits of the participants were recorded in the questionnaire. To determine nutritional status, 3-day food consumption records were taken, Mini Nutritional Assessment Test (MNA) was applied and anthropometric parameters were measured. The carious teeth (DMFT) index and oral health impact scale (OHIP-14) were used to assess oral health, and unstimulated SFR was measured.&#x0D; Results: According to MNA, 23.8% of the elderly were malnourished or at risk of malnutrition. The mean SFR of the elderly was 0.40±0.31 ml/min and 15.9% of them had low SFR. The mean SFR of the elderly with normal body weight was higher than that of the obese (p

Assessing Adherence to Provider's Recommendations in Caries Risk Assessment and Management: A Retrospective Data Review.

To evaluate the distribution of caries risk category of patients at a dental institution and determine adherence to providers' recommendations. A cross-sectional retrospective review of 1,235 patients records that included data collection on demographics, the sum of the number of decayed, missing due to caries, and filled teeth in the permanent teeth (DMFT), presence of frequent snacking, stimulated salivary flow rate, stimulated saliva pH, saliva buffering capacity, biofilm activity, caries risk category, anti-caries prescription accept/decline, and change in the caries risk category. Statistical analysis was carried out through Pearson's Chi-squared test and linear model ANOVA with a significance level of 0.05. Pearson's Chi-squared test showed a statistically significant difference in frequency by risk category (p < 0.001) indicating that patients were skewed toward high and extreme caries risk. Linear model ANOVA showed that higher risk categories were associated with lower salivary flow rates (p = 0.010) and higher biofilm activity (p < 0.001). About, 1 out of 3 patients were reported to have frequent snacking (N = 391, 32%). Frequent snacking patients were more likely to present with higher caries risk assessment (p < 0.001), younger age (p < 0.001), and female (p < 0.001). Despite recommendations from the dental student provider, only 27% accepted the anti-cavity prescriptions while 61% declined the recommendation. Distribution of caries risk category is not evenly distributed, but rather skewed toward high and extreme caries risk levels. Despite the identified risks, there is low adherence to the recommendations provided by healthcare providers. The results underscore the necessity for targeted interventions and initiatives aimed at fostering behavioral changes to enhance oral health outcomes. There is a high need for targeted interventions and initiatives that promote behavioral changes to enhance oral health outcomes.

The potential impact of delivery mode and breastfeeding on oral Candida species carriage in a population of young adults.

In early life, children are exposed to microorganisms from maternal and environmental sources, which influence the development of their microbiome throughout life. Several studies have demonstrated the influence of the delivery mode and breastfeeding on the oral microbiome of children, mostly regarding bacterial colonization. However, their influence on the oral fungal carriage is still underexplored. This study aimed to assess the association of the delivery and feeding mode with the oral carriage of yeasts in adulthood. Fungal oral carriage was evaluated by collecting unstimulated saliva in 185 healthy dental students (mean age of 21.51±1.55 years old; 81.6% females). Yeast identification was performed by culture in ChromAgar Candida medium and sequencing of the 18S genes and ITS regions for determination of the species. Demographic and clinical data of each participant was recorded through questionnaires and oral examinations were performed in a subgroup of participants (n=49). Candida species were isolated in 37.5% of all participants. The prevalence of yeasts in the oral cavity was significantly higher in those who were born by vaginal delivery compared to those born by caesarean-section (p=0.035), whereas no statistically significant differences were observed regarding breastfeeding (p=0.398). Low salivary flow rate and frequency of dental visits also were associated with oral yeast carriage (p<0.05). Our study suggests a possible impact of the type of delivery on fungal colonization, which is sustained throughout life due to oral health-related factors.

Using the modified Schirmer test for dry mouth assessment: A cross-sectional study.

This study aimed to establish whether the modified Schirmer test could serve as a diagnostic tool for dry mouth, that is, whether it could reliably measure salivary film at selected locations within the oral cavity, and to identify levels of sensitivity/specificity and determine reference values. Therefore, a cross-sectional study (N = 120, mean age 63.5 [SD 13.9] years) was performed. The test was used at five locations (hard palate; buccal mucosa in molar region at 4 mm above occlusal plane; anterior tongue; lower lip; mouth floor), and results were recorded after 1, 2 and 3min. A statistically significant discriminatory ability of the Schirmer test for the unstimulated salivary flow rates could be shown for the palate (at 3min), buccal mucosa (at 1min), mouth floor (at 1 min), and tongue (at 2 and 3min) (areas under the curve 0.64-0.68), with individual sensitivity/specificity values depending on test location/time points. Thus, the modified Schirmer test has potential to become a simple and reproducible instrument for the detection of dry mouth based on low unstimulated salivary flow rates in dentistry and especially outreach care. Care must be taken concerning intraoral test location and measurement time.

Salivation in Parkinson's disease: A scoping review.

We aimed to provide an overview of the available literature that includes both objective assessments (namely hypersalivation and hyposalivation) and the subjective experience (namely xerostomia and drooling) of salivary problems in patients with Parkinson's disease. In patients with Parkinson's disease, there may be complaints of salivary problems such as xerostomia or drooling. This can have consequences for their oral health and quality of life. To date, systematic reviews have focused on drooling only. A literature search in 4 databases was performed up to 12 February 2021. Two researchers independently assessed studies for eligibility. In total, 63 studies were included. The prevalence of self-reported xerostomia ranged from 49% to 77%, and that of self-reported drooling ranged from 5% to 80%. Ten articles reported a significantly lower mean salivary flow in patients with Parkinson's disease than in controls. None of the articles with both a control group and a patient group reported a significantly higher salivary flow in patients with Parkinson's disease. When questioned about subjective salivary problems, a significantly higher prevalence of both xerostomia (7 studies) and drooling (14 studies) was found in patients with Parkinson's disease than in controls. Patients with Parkinson's disease have a lower salivary flow rate and higher prevalence of both xerostomia and drooling than controls. The complexity of salivary problems present in patients with Parkinson's disease necessitates a multidisciplinary approach in order to avoid mutually counteracting treatments from different healthcare professionals.

Salivary changes in chronic kidney disease and in patients undergoing hemodialysis: a systematic review and meta-analysis.

This study isaimed at describing changes in salivary flow rate and ionic composition present in the saliva of chronic kidney disease (CKD) patients by assessing the pH, calcium, phosphate, and phosphorus concentrations and comparing them to healthy individuals, along with exploring the influence of hemodialysis on these parameters. The bibliographical search was performed in nine databases to find all types of studies, includingobservational clinical studies, without restrictions regarding publication year or language. Two reviewers selected the studies, extracted the data, and assessed the risk of bias using JBI tools. Random-effect meta-analysis was performed with the standardized mean difference (SMD) as effect estimate, at a 95% confidence interval. Thirty-three studies were included in the qualitative synthesis and 31 studies were included in the meta-analysis. Chronic kidney disease patients presented lower salivary flow rate (SMD: -1.73; 95% CI = -2.14; -1.31), higher pH (SMD: 1.57; 95% CI = 1.11; 2.03), and higher phosphorus concentration (SMD: 0.86; 95% CI = 0.63; 1.09) in saliva. Concurrently, salivary flow rate and pH presented significant changes after hemodialysis, with higher salivary flow rate (SMD: 0.53; 95% CI = 0.25; 0.81) and lower pH (SMD: -0.53; 95% CI = -0.88; -0.19) in patients on hemodialysis treatment. Chronic kidney disease patients present reduced salivary flow rate and increased pH and phosphorus concentration in saliva. Hemodialysis can increase the salivary flow rate of these patients.

Investigation of the effect of gastroesophageal reflux disease on dental erosion and oral tissue alterations

Aim: This study aimed to investigate the relationship between gastroesophageal reflux disease (GERD) and dental erosion and the alterations in oral tissues. Materials and Methods: In this study, the GERD group consisted of 50 individuals with gastroesophageal reflux symptoms, and the control group consisted of 50 healthy individuals. The prevalence of teeth wears and caries was evaluated using the Smith and Knight tooth wear index (TWI) and the decayed, missing, and filled teeth index (DMFT), respectively. Oral complaints were also evaluated. Stimulated saliva samples were collected, and the salivary buffering capacity, pH and flow rate values were measured. Results: In the GERD group, wear was observed in the palatal surface of the maxillary teeth, whereas no wear was observed in the control group (p&amp;lt;0.05). Although the incisal surfaces of the maxillary anterior teeth and the occlusal surfaces of the maxillary/mandibular posterior teeth were observed as eroded in both groups, the values in the patient group were significantly higher compared with those of controls (p&amp;lt;0.05). In the GERD group, complaints of inflammatory mouth sensitivity, tongue sensitivity, nonspecific itching and burning, halitosis, dry mouth, tooth sensitivity, erythema in the soft/hard palatinal mucosa/uvula were significantly more frequent than the control group (p&amp;lt;0.05, for each). The groups were similar with respect to DMFT (p=0.480). The salivary flow rate, pH and buffering capacity values were found to be significantly lower in the GERD group (p&amp;lt;0.05, for each). Conclusion: The results showed that patients with GERD had wear in palatal surfaces of maxillary teeth. Moreover, these patients also complained more commonly from oral tissue alterations and had lower salivary flow rate, pH, and buffering capacity. Hence dentists should consider GERD as a potential risk factor for oral health.

Protease inhibitor concentrations in the saliva of individuals experiencing oral dryness

BackgroundOral dryness is a common symptom that may interfere with swallowing, chewing, and taste. The most common reason for oral dryness is hyposalivation. Some individuals experiencing oral dryness do not have hyposalivation, however, and the reverse is also true. Here, we focused on healthy individuals with a lower salivary flow rate and evaluated the relationship between the perception of oral dryness and salivary parameters to clarify the cause underlying the perception of oral dryness.MethodsA total of 59 participants were divided into 2 groups with a lower or higher salivary flow rate according to the median salivary flow rate. In participants with a lower salivary flow rate, we assessed salivary bacterial counts, protease activities, protein concentrations, oral parameters, and the subjective perception of oral dryness.ResultsProtease activities and concentrations of protease inhibitors such as cystatin-D and cystatin-SA in the saliva of participants experiencing oral dryness were significantly higher and lower, respectively, than in those not experiencing oral dryness, even though no difference in the salivary flow rate was detected. Salivary cystatin-D and cystatin-SA concentrations correlated negatively with salivary protease activities.ConclusionsThe composition of salivary protease inhibitors and increased protease activities affect the subjective perception of oral dryness.

Predicting dental caries increment using salivary biomarkers in a remote Indigenous Australian child population

BackgroundThe burden of childhood dental caries amongst Indigenous Australians is higher than in other Australians. Because of differences in lifestyle and the evolutionary history of the oral microbiota, associated risk indicators may differ. Here, we evaluate associations between caries increment, salivary biomarkers and baseline caries among children aged 5–17 years residing in a remote rural Indigenous community.MethodsThis study was part of a trial assessing cost-effectiveness of an intervention to prevent dental caries among children. Baseline epidemiology and application of topical caries-preventive measures was conducted in 2015, followed-up in 2016 and 2017. Children who did not consent or failed to attend the prevention visits but did attend for follow-up epidemiology constituted a natural comparison group for evaluating the intervention. Saliva flow, pH, buffering and bacterial loads were measured at all visits. Caries was scored by the International Caries Detection and Assessment system. Outcome was caries increment. Explanatory variables were sex, being in experimental or comparison group, baseline caries, saliva flowrate and buffering, pH, and salivary loads of mutans streptococci (MS), Lactobacilli (LB), and yeast. Chi Square tests compared caries incidence in relation to explanatory variables and Generalised Linear Models explored associations between explanatory and outcome variables.ResultsOf 408 participants at baseline, only 208 presented at 2-year follow-up. Of caries-free children at baseline, significantly fewer had incipient (p = 0.01) and advanced (p = 0.04) caries after two years. Children in the experimental group experienced fewer tooth surfaces with advanced caries (p = 0.02) than comparison children. Having caries at baseline (p = 0.02) and low salivary flow-rates (p < 0.001) saw a significant increase in advanced caries after two years. Children with high salivary loads of MS (p = 0.03) and LB (p = 0.004) experienced more advanced carious surfaces. Multivariable analysis revealed 58% reduction (p = 0.001) in advanced caries among children with high salivary flow rates. Caries increment was 61% (p = 0.03) more for incipient and 121% (p = 0.007) more for advanced caries among children who harboured higher loads of MS.ConclusionAs with other ethnicities, children with low salivary flow and those with high MS had higher incipient and advanced caries increments after two years. Such risk assessments facilitate targeted preventive interventions for such communities.Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), No: ACTRN12615000693527: 3 July 2015.

MICROEVOLUTION OF CANDIDA ALBICANS STRAINS IN OLDER PEOPLE WITH LOW SALIVARY FLOW

Background Populations are aging worldwide, and older people are more likely to take medications and undergo treatment leading to side effects such as salivary gland hypofunction. It is not known how reduced salivary flow in older people affects the Candida albicans strains colonizing the oral cavity. The presence of resistant Candida strains could be debilitating for immunocompromised older people. Objective The aim of this study was to compare C. albicans strains colonizing the mouths of older people with low and normal salivary flow. Methods Participants aged 65 and above (n = 50) were examined, and their salivary flow rates (SFRs) were determined. Swabs and smears of the palate and tongue and saliva samples were collected. Smear products were stained with periodic acid-Schiff (PAS). Yeasts were cultured, quantified, and presumptively identified using CHROMagar Candida agar. Multilocus sequence typing was used to compare C. albicans strains. Results Twenty-four participants had a low SFR ( 400 CFU/mL saliva) (68% vs 38%), presented with more PAS-positive smears (47% vs 19%), and had more C. albicans strains with evidence of microevolution (8 of 12 participants vs 1 of 5 participants) than those with normal salivary flow. Conclusions Increased yeast presence in older people with low salivary flow was confirmed. There was a link between SFR and microevolution of C. albicans. The genetic changes may be because C. albicans is under pressure to adapt to a low-saliva environment.

THE DIAGNOSTIC CHALLENGE OF CHILDHOOD PRIMARY SJÖGREN SYNDROME: A SINGLE-CENTER CASE SERIES

<h3>Background</h3> Primary Sjögren syndrome (pSS) is a chronic autoimmune disease affecting the exocrine glands, most commonly observed in middle-aged women. Childhood pSS is both rare and underdiagnosed, since pediatric patients often do not fulfill the diagnostic criteria applicable to adults. <h3>Objective</h3> To present 7 pediatric cases evaluated for pSS and emphasize the need for childhood-adapted diagnostic criteria. <h3>Methods</h3> All pediatric cases under investigation for pSS referred to our department between January 2018 and December 2019 for oral evaluation and labial minor salivary gland biopsy were reviewed, and the relevant data were analyzed. <h3>Results</h3> Seven of 144 patients with suspected pSS were children (4.86%), and they were aged between 5 and 15 years old. Sicca symptoms and low unstimulated salivary flow rate were present in 1 patient each. Although focal lymphocytic sialadenitis (FLS) was observed in all patients, a focus score of 1/4 mm² was present in 5 of 7 cases, in 1 of which light chain B-cell monoclonality was also noted. Four of these 5 patients were subsequently diagnosed with pSS according to the American College of Rheumatology/European League Against Rheumatism 2016 classification criteria, whereas 1 seropositive patient, 1 with a high focus score, and 1 with recurrent parotid swelling and a positive family history did not meet the above criteria. <h3>Conclusions</h3> Pediatric patients may not fulfill the strict adult criteria for pSS, since destruction of the exocrine glands may not be measurable from the onset. Instead, recurrent parotid gland swelling and presence of any FLS, regardless of the focus score, may serve as alternative criteria in order to avoid underdiagnosis.

POS1486-HPR DAILY ACTIVITY IMPAIRMENT IS MEDIATED BY BOTH ORAL DRYNESS AND ORAL HEALTH RELATED QUALITY OF LIFE IN PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME

Background:Both oral functions and oral health-related quality of life (OHRQoL) are poorly affected by low salivary flow rate in patients with primary Sjögren’s syndrome (pSS).Objectives:The aim of the study was to evaluate the effects of oral dryness and OHRQoL on daily life in patients with primary Sjögren’s syndrome (pSS).Methods:In this cross-sectional study, 86 patients with pSS (M/F: 5/81; mean age: 52.4 ± 11.6 years) were included. The data were collected by clinical examination and a questionnaire regarding patient-reported outcome measures (PROMs). Patient filled PROMs regarding Oral Health Impact Profile-14 (OHIP-14) for OHRQoL, Work Productivity and Activity Impairment scale (WPAI) for Daily life and the EULAR Sjogren’s Syndrome Patient Reported Index (ESSPRI) for their symptoms. Unstimulated whole saliva flow rates (U-WSFR) of patients were calculated as ml/min. Increases in PROMs and decreases in U-WSFR reflected poor conditions. After preliminary analysis, a mediation analysis was used to evaluate the relations among variables.Results:WPAI-Daily activity impairment score was higher in patients with low U-WSFR (≤0,1 ml/min) than the others (67±29,8 vs 52,5±28,6) (p=0.042). Both U-WSFR (0,43±0,57 ml/min) and ESSPRI-Dryness score (6.31 ± 2.71) were correlated with scores of OHIP-14 (25,96±17,13)(r:- 0,38 p=0.000; r: 0,37 p=0.000) and WPAI-Daily activity impairment (57,96±29,71)(r: -0,36 p=0.004; r: 0,53 p=0.000). Moreover, scores of ESSPRI-Pain (5,16±3,12) and ESSPRI-Fatigue (5,41±2,97) were also related to WPAI-Daily activity impairment score (r: 0,41 p=0.001; r:0,49 p=0.000, respectively).In the mediation analysis, WPAI-Daily activity impairment score (57.9 ± 29.7) was directly mediated by ESSPRI-Dryness score (p=0.0010) and indirectly mediated by OHIP-14 score (25.9 ± 17.1) (p=0.0357). After mediation analysis, a bootstrap analysis with 5000 replications was applied to estimate the mediation effect to generate 95% CI. Percentile bootstrap of OHIP-14 score was found to be an effective mediator for Daily activity impairment based on 5000 bootstrap samples.Conclusion:Both oral dryness and poor OHRQoL in patients with pSS affected daily activity impairment. Therefore, the patients’ needs for improving oral health were critical components of treatment plans to improve the daily activity of SjS patients.Disclosure of Interests:None declared

Saliva pH and Flow Rate in Patients with Periodontal Disease and Associated Cardiovascular Disease.

BackgroundPeriodontal disease, a frequent oral health problem, is connected with cardiovascular morbidity and mortality. This study aimed to assess the unstimulated saliva flow rate and saliva pH as markers of the severity of periodontal disease in patients with cardiovascular disease.Material/MethodsA cohort of 155 patients (78 men and 77 women, aged 30–92 years) was included, and a structured questionnaire obtained information about their health status, oral healthcare behaviors, and eating habits. An oral examination was performed to assess periodontal status and presence of dental calculus. The unstimulated whole salivary flow rate and salivary pH were measured. An oral hygienization was performed, and 3 months later, salivary flow rate and pH were reevaluated.ResultsA severe form of periodontal disease was found in 22.4% of patients. Disease severity was strongly correlated with low pH values (6.25 in stage IV periodontal disease), lower salivary flow rate (0.28 mL/min), smoking, poor oral hygiene habits and obesity, with no significant differences by sex. We observed a significant increase of pH (up to 6.30±0.17) in patients with severe periodontal disease (P=0.001) and salivary flow rate values (0.29±0.07 mL/min; P=0.014) 3 months after oral hygienization. There was a strong association between the severity of periodontal disease and presence of cardiovascular disease (P=0.001).ConclusionsOur study suggests that the decrease of salivary flow rate and pH level might be associated with the severity of periodontal disease.

Salivary Biomarker Levels and Oral Health Status of Children with Cerebral Palsy and Their Healthy Siblings: A Comparative Study.

BackgroundThe dental needs of cerebral palsy children are an area of study much in need of attention. The neglect of this aspect should be rectified, and simpler diagnostic methodologies should be established and used to serve this purpose.AimThis study aimed to determine oral health status and salivary biomarkers (salivary flow rate, pH, buffering capacity) among children with cerebral palsy (CP), to compare their data with that of their healthy siblings, and to evaluate the relationship between salivary biomarkers and dental caries.MethodsA total of 30 CP children (study group) and 30 normal healthy siblings (controls) were selected between the ages of 5 and 12 years. Salivary biomarkers were assessed, and oral health status was examined.Statistical AnalysisChi-square test was used for comparison of oral health status. Unpaired t test was used to compare caries indexes (decay/filled teeth–primary dentition [dft] and decay/missing/filled teeth–permanent dentition [DMFT]) and salivary biomarkers between the groups. Pearson correlation was used to find the correlation between salivary biomarkers and caries.ResultsThe dft scores were significantly higher in the study group (P<0.05). The pH values and salivary flow rates were significantly lower in the study group (P<0.05 and P<0.001, respectively). There was a significant correlation between DMFT scores and salivary flow rate in the study group (P<0.05).ConclusionLow pH and low salivary flow rate might be risk factors for dental caries in CP populations; moreover, the significant correlation between DMFT score and salivary flow rate suggests that salivary flow rate could be used as a screening tool for assessing at-risk subjects in such populations.