Normal Salivary Gland Function Research Articles

Approaches to preventive periodontal care for geriatric patients with somatic disorders

During the last two decades the acute interest in longevity has been kept by the world’s scientific community in relation to quality of health of older adults and prevention of emerging diseases including oral disorders in the old age. This article presents the study of oral conditions in 100 patients between the ages of 60 and 69 who were divided into three groups. This study aims to define approaches to preventive periodontal care for elderly patients with comorbidities. The primary group included patients with periodontal disease (PD) and salivary gland dysfunction: Sjogren’s disease and syndrome, non-insulin dependent diabetes mellitus, chronic pancreatitis. Two experimental groups included patients with normal salivary gland function and PD as well practically healthy persons without PD and normal salivary gland function. A comparative analysis of the results showed spread of dental caries (100%) and periodontal diseases (80%). The clear correlation between periodontium complex inflammation and poor oral hygiene is defined, mostly with men (p<0.05). Structural and optical properties of mixed saliva significantly change subject to periodontium inflammation and xerostomia: severity of xerostomia corresponding to profound hemodynamic and microcirculatory changes causes more intensive structural developmental abnormalities of mixed saliva. The important component of the Periodontal Treatment Protocol is to help older people develop skills and controls of effective thorough tooth brushing.

Conservative and functional surgery in the treatment of salivary gland tumours

The principle of modern oncological surgery is to conserve the functional organs or tissues as much as possible based on eradication of the tumour. For salivary gland tumours, conservative and functional salivary surgery, including partial sialoadenectomy as well as anatomical and functional preservation of the facial nerve, great auricular nerve, superficial musculo-aponeurotic system (SMAS), and Stensen’s duct, has become increasingly popular. In the present review, we discuss the following aspects of conservative and functional surgery in the treatment of salivary gland tumours: (i) partial superficial parotidectomy (PP) to treat benign parotid gland tumours, (ii) modification of surgical incisions to improve cosmetic results, (iii) modification of the surgical approach to decrease complications, (iv) extracardial dissection to treat benign superficial parotid tumours, (v) partial sialoadenectomy to treat benign submandibular gland tumours, and (vi) 125I brachytherapy to preserve facial nerves. The majority of the operated parotid or submandibular glands are preserved, and surgical complications are also decreased. Conservative and functional surgery plays a significant role in maintaining normal salivary gland function and in improving patients’ quality of life during the treatment of salivary gland tumours and thus should be further promoted.

Investigation of autoantibodies to SP-1 in Chinese patients with primary Sjögren's syndrome

In order to evaluate autoantibody to SP-1 as an early biomarker in pSS, we investigated autoantibody to SP-1 in Chinese patients with primary Sjögren's syndrome (pSS). Autoantibodies to SP-1 are significantly increased in pSS patients compared to RA patients, SLE patients, and healthy people without secondary SS. The presence of anti SP-1 antibodies was negatively correlated with the focus score (FS), RF, and salivary gland function. It was positively correlated with FS=0, RF≤20, and normal salivary gland function. In further studies, the autoantigen SP-1 was identified in ductal epithelia of salivary glands in il14α TG mice by IIF. SP-1 mRNAs expression increased with growing age in il14α TG mice. SP-1 mRNA was also identified in labial biopsies of patients with pSS. In conclusion, autoantibody to SP-1 is an early marker in pSS. It is useful to diagnose pSS patients who lack RF or antibodies to Ro/La.

Prediction of risk for symptomatic sialadenitis by post-therapeutic dual 131I scintigraphy in patients with differentiated thyroid cancer

The aim of this study is to predict the risk of symptomatic sialadenitis after (131)I therapy using the early (third day post-therapy) and delayed (fifth or sixth day post-therapy) post-therapeutic (131)I scintigraphy images in patients with differentiated thyroid cancer (DTC). Included in the study were 112 patients with DTC who underwent early and delayed (131)I scans after (131)I treatment. All patients had normal salivary gland function on salivary scintigraphy performed in the week before the (131)I treatment. Scintigraphy images were visually analyzed and the salivary gland-to-background uptake ratio (SUR) and percent change of the SUR between early and delayed scans were calculated. Calculation of effective half-life and absorbed dose in the salivary glands was performed based on the MIRD schema. Of 112 patients, symptomatic sialadenitis was diagnosed in 46 patients (41 %). Of these 46 patients, 83 % (38 patients) had persistent (131)I uptake in the salivary glands on both early and delayed scans. Among 55 patients with persistent (131)I uptake in the salivary glands, 69 % experienced symptomatic sialadenitis, while only 14 % of the other 57 patients experienced symptomatic sialadenitis (p < 0.0001). On the early (131)I scintigraphy, SURs of bilateral parotid glands on early scan in patients with symptomatic sialadenitis were significantly higher than in other patients (p = 0.001 for right and p = 0.004 for left). Further, patients with symptomatic sialadenitis had a higher decreasing rate of the SUR and shorter effective half-life of (131)I in bilateral parotid glands than other patients. Using visual analysis and SURs of right and left parotid glands on early (131)I scan as parameters, the sensitivities for predicting symptomatic sialadenitis were 83, 80, and 93 %, respectively. The mean values of effective half-life and absorbed dose in the parotid and submandibular glands were 20.8 ± 6.3 h and 2.7 ± 0.8 Gy, and 22.1 ± 7.9 h and 2.8 ± 1.1 Gy, respectively. Symptomatic sialadenitis can be predicted by post-therapeutic (131)I scintigraphy with high sensitivity. Post-therapeutic (131)I scintigraphy could provide effective information on the risk of symptomatic sialadenitis in DTC patients who underwent (131)I treatment.

A kinetic compartment model for evaluating salivary gland scintigraphies

The semi-quantitative analysis of salivary gland scintigraphy with (99m) Tc-pertechnetate has been used to evaluate salivary gland function. However, no objective parameters distinguishing abnormal from normal functions have been established thus far. We propose using a simple kinetic model applied to the four major salivary glands. This kinetic model is based on a two-compartment model and the assumption of first-order kinetics to characterize normal salivary gland function and other selected parameters to evaluate the normal function of salivary glands. Thirty patients referred for (99m) Tc-pertechnetate thyroid scintigraphy were studied. Dynamic imaging of the head in a fixed anterior projection was performed after an intravenous bolus injection of 150 MBq (99m) Tc-pertechnetate using a gamma scintillation camera. After 30 min, lemon juice was orally administered through a syringe. Time activity curves were generated for each of the four major salivary glands (i.e. the right and left submandibular and right and left parotid glands). Excretion fractions (the fraction of mobilizable radioactivity after administering lemon juice) and the gland activity-to-thyroid activity ratio were calculated. The data were fitted to both a one- and two-phase uptake model. The median uptake slope and maximal activity were significantly higher in the parotid glands than the submandibular glands (P<0·0001). The gland-to-thyroid ratio was higher in the parotid glands than the submandibular glands (P<0·0001), and the ejection fractions were higher in the parotid glands (P<0·0001). No difference was found in functional contributions of the parotid and submandibular glands. Tracer accumulation can be represented by a one-phase simple uptake model. The background regions that have been previously recommended in the literature are acceptable.

SAT0395 Sonoelastography detects salivary gland dysfunction in patients with primary sjögren’s syndrome

BackgroundSialoscintigraphy (Szinti) is used to investigate salivary gland function in patients with primary Sjögren’s syndrome (pSS). Real-time sonoelastography (SElasto) indicates tissue rigidity of salivary glands and correlates with an impaired...

Investigating Early Events in Sjogren’s Disease (135.8)

Abstract Little is known about the early events in Sjogren’s disease. Previous studies have demonstrated that interleukin 14 alpha transgenic mice (IL14aTG) replicate the clinical and immunological features of Sjogren’s disease (Clin. Immunol. 130:304, 2009). Salivary gland function is lost before lymphocytic infiltration of the salivary glands. The current studies were designed to investigate the early events involved with salivary gland injury. Western blot studies demonstrated lymphotoxin (LTA) in the salivary gland secretions of IL14aTG mice, while salivary gland function was being lost. IL14aTG mice lacking LTA maintained normal salivary gland structure and function, although autoantibodies were deposited in the salivary glands. Because IL-14aTG mice produce high levels of interferon-a (INF-a) and INF-a can induce production of LTA, we investigated IL14aTG mice lacking the α/β interferon receptor. These mice retained normal salivary gland function, although mild lymphocytic infiltration was noted in the lachrymal glands. Because IL14aTG mice have increased numbers of B1 cells, we produced IL14aTG mice lacking btk. Interestingly, these mice maintained normal salivary gland function despite lymphocytic infiltration of the salivary glands. Thus cytokine injury involving LTA and IFN-a are necessary for the development of salivary gland injury in Sjogren’s disease. The roles of particular autoantibodies and lymphocytic infiltration of the salivary glands need to be elucidated.

MUC‐1 mucin in normal human salivary glands detected by HMFG‐1 and HMFG‐2 monoclonal antibodies

The aim of this study was to determine the immunoexpression of normal salivary gland cells using two human milk fat globule membrane protein antibodies (HMFG-1 and HMFG-2). Paraffin-embedded, 5 microm-thick slides from parotid and submandibular gland tissues were cut and immunostained with monoclonal antibodies HMFG-1 and HMFG-2 against MUC1 protein. HMFG antigens were found in secretory epithelial cells and ductal cells lining the striated and intercalated ducts in the intraductal secretion material, and sometimes in the myoepithelial cells. Our results suggest that HMFG-1 and HMFG-2 proteins may play a role in normal salivary gland function, mainly in the manufacturing and secretion of saliva.

Review of the Pharmacological Properties and Clinical Usefulness of Muscarinic Agonists for Xerostomia in Patients with Sj??gren??s Syndrome

The anti-xerostomia effects of muscarinic agonists (cholinomimetics) are reviewed. Cevimeline (cevimeline monohydrochloride hemihydrate) is a novel muscarinic agonist that stimulates salivary secretion in animals and humans both with normal salivary gland function and with impaired salivary secretion (xerostomia or oral dryness) as effectively as pilocarpine. Other classic and nonselective muscarinic agonists, such as arecoline, carbachol, muscarine and oxotremorine, as well as acetylcholine, failed to exhibit a sufficient salivation effect even at sublethal doses in animals.Oral administration of cevimeline 30mg to humans induces a moderate and lasting increase in salivary flow, and the effect is maintained for at least 4 to 6 hours, longer than with pilocarpine. Mean increases in salivary flow rates after cevimeline treatment were 2-fold higher than after placebo, and no evidence of tolerance of the pharmacological effect has been observed during prolonged administration for up to 12 months.The clinical efficacy of cevimeline in relieving symptoms of xerostomia, including oral dryness and difficulties in chewing, swallowing and speaking, has been demonstrated by placebo-controlled, double-blind, randomised clinical trials in the USA and Japan. In these studies, cevimeline 30mg three times daily increased salivary flow and improved the symptoms of xerostomia in a significantly higher percentage of patients compared with placebo. Some patients receiving cevimeline therapy for xerostomia experienced adverse events such as sweating, gastrointestinal symptoms (nausea, diarrhoea, abdominal pain and vomiting), dizziness and rigors; these effects were related to muscarinic activity and were generally mild and tolerable in comparison with those of pilocarpine.These findings suggest that muscarinic M3 agonists are suitable for the treatment of xerostomia. Cevimeline in particular has a long-lasting salivation effect with fewer adverse events than pilocarpine, and so is expected to be more useful for the treatment of xerostomia in patients with Sjögren's syndrome, reducing symptom severity and improving their quality of life.

Cytokine expression in human labial minor salivary gland epithelial cells in health and disease

Microdissection of biopsy material from labial minor salivary glands followed by RT-PCR demonstrates extensive production of cytokines IL-2, IL-6, IL-10, TNF-α, TGF-β, and IFN-γ in both normal glands and in glands affected by Sjogren's syndrome. Continuation of these studies should expand our knowledge of normal salivary gland function and the pathogenis of Sjogren'syndrome.

Oral pilocarpine: a review of its pharmacological properties and clinical potential in xerostomia.

Pilocarpine is a cholinergic agonist which stimulates salivary secretion both in individuals with normal salivary gland function and in those with impaired salivary flow (xerostomia or oral dryness). A rapid increase in salivary flow rate is observed following oral pilocarpine administration and peak levels are maintained for at least 1 to 2 hours. Mean salivary flow rates after administration of pilocarpine are 2- to 10-fold higher than after placebo, and no evidence of tolerance to the pharmacological effects of the drug has been observed during prolonged administration for up to 5 months. The clinical efficacy of oral pilocarpine in relieving symptoms of xerostomia (resulting from radiation therapy to the head and neck region or salivary gland dysfunction), including oral dryness and difficulty in chewing, swallowing and speaking, has been demonstrated in double-blind placebo-controlled clinical trials. In these studies, pilocarpine 5 to 10mg 3 times daily increased salivary flow and improved symptoms of xerostomia in a significantly higher percentage of patients than did placebo (54 versus 25% in one study). Preliminary findings indicate that administration of pilocarpine during radiation therapy may reduce the severity of xerostomia; however, this requires further investigation. The majority of patients receiving oral pilocarpine therapy for xerostomia experience adverse events (most commonly sweating); however, these are generally mild and tolerable in nature. Thus, pilocarpine is an effective agent for the treatment of xerostomia, increasing salivary flow and reducing symptom severity to a significantly greater extent than placebo. Further clinical trials should evaluate the potential beneficial effects of pilocarpine on the incidence of dental caries and oral candidiasis during prolonged therapy, its prophylactic efficacy during radiation therapy and its efficacy relative to that of other salivary stimulants.

Immunoreactive Histatin 5 in Salivary Gland Tumors.

Histatin is a group of histidine-rich polypeptides specific to parotid and submandibular gland secretions with several different biological functions such as stabilization of mineral-solute interaction in oral fluid, and antibacterial and antifungal actions. The authors generated polyclonal antibody to histatin by using purified histatin 5 as an immunogen and assayed the immunoreactivity by enzyme linked immunosorbent assay (ELISA) and immunoblotting. The antibody was further used to localize histatin in normal and tumors of salivary glans, pleomorphic adenoma, Warthin's tumor, adenoid cystic, acinic cell, mucoepidermoid, papillary cystadenocarcinoma and undifferentiated carcinoma by immunohistochemical methods. The normal major and minor human salivary glands showed an intense immunoreactivity in ductal cells, trace immunoreactivity in serous acini and no immunoreactivity in mucous acinar cells, suggesting histatin in mainly produced by ductal cells and to a lesser extent by serous cells. A consistent immunoreactivity of histatin in ductal segments of normal glands and a variable expression in the tumor cells of all the neoplastic lesions examined may implicate a role of this polypeptide in normal salivary gland function and salivary tumors. In addition, the findings may implicate common precursor cells, however, differing in the state of differentiation in normal and neoplastic conditions.

Cholinergic involvement in nervous control of salivary fluid secretion in ixodid ticks

1. Approximately one-third of all adult Amblyomma maculatum ticks become bloated with a huge increase in hemolymph volume while feeding on sheep infused with fenthion at the rate of 2.5 mg/kg/day. 2. Almost all other ticks die early and appear severely desiccated while attempting to feed on the same animals. 3. All ticks are loosely attached and the usual inflammation seen at the site of tick attachment is absent. 4. These facts, along with increased haemolymph concentrations of Na +, K + and Cl − in the hemolymph and an inability of pilocarpine to induce salivation in bloated ticks suggest that normal salivary gland function is disrupted. The results support the hypothesis of cholinergic neurotransmitter involvement in the overall nervous control of ixodid tick salivary gland function.