Reduced Saliva Production Research Articles

Reduced salivary flow and caries status are correlated with disease activity and severity in patients with diffuse cutaneous systemic sclerosis

ObjectiveTo analyze the correlations of saliva production and pH value with disease activity, disease severity, and oral health-related quality of life in patients with diffuse cutaneous systemic sclerosis (dcSSc) without concomitant Sjögren’s syndrome (SS) or SS-related antibodies.MethodsThis cross-sectional study included 28 patients with dcSSc and matching healthy controls. Sialometric assessment and caries status were compared between the two groups. Clinical and laboratory parameters were used to evaluate disease severity, in accordance with the Medsger Severity Scale.ResultsIn patients with dsSSc, reduced saliva production and higher pH value were associated with disease activity and severity; moreover, caries status was correlated with SSc disease characteristics, including disease duration and disease severity. Oral health-related quality of life was negatively correlated with mean salivary flow rate.ConclusionsThese findings contradict the existing notion that reduced saliva production in patients with SSc is linked to SS-related antibodies or caused by underlying SS. In addition, patients with dcSSc exhibit elevated risk of cardiovascular disease and invasive dental treatment has been shown to enhance the rates of stroke and heart attack in the general population; therefore, oral health is particularly important in patients with SSc.

Flow-Identified Site of Collapse During Drug-Induced Sleep Endoscopy: Feasibility and Preliminary Results

Flow-Identified Site of Collapse During Drug-Induced Sleep Endoscopy: Feasibility and Preliminary Results

Cytokines Explored in Saliva and Tears from Radiated Cancer Patients Correlate with Clinical Manifestations, Influencing Important Immunoregulatory Cellular Pathways.

Although radiotherapy is a common form of treatment for head and neck cancer, it may lead to tissue damage in the salivary and lacrimal glands, possibly affecting cytokine expression in the gland fluid of treated individuals. Cytokine profiles in saliva and tear fluid of 29 radiated head and neck cancer patients and 20 controls were screened using a multiplex assay. Correlations between cytokine expression and clinical oral and ocular manifestations were examined, and cellular pathways influenced by these cytokines were assessed using the Functional Enrichment Analysis Tool. Significantly elevated cytokines identified in patient saliva were CCL21, IL-4, CX3CL1, CCL2, CXCL1 and CCL15. Many of these cytokines correlated positively with objective signs of oral dryness, and reduced saliva production in the patients. Although CCL21 and IL-4 levels were significantly lower in patient tear fluid, they correlated with subjective ocular symptoms. These increased salivary cytokines affected pro-inflammatory and apoptotic cellular pathways, including T cell signalling, several interleukin signalling pathways, TNF and TGF-β receptor signalling, and the apoptotic p53 pathway. In conclusion, the upregulated salivary cytokines identified suggest an interplay between innate and adaptive immunity, affecting immunoregulatory cellular pathways. Whether this is due to late effects of radiotherapy or tissue repair remains to be investigated.

Oral Lesion Associated with Hypertension: A Mini Review

Background: Hypertension is a chronic condition due to the high level of blood pressure. There are 2 types of hypertension. Hypertension patients are usually consumed anti-hypertension medication to prevent the high blood pressure which can affect the damage of blood vessel in the body. The used of anti-hypertension drugs can cause the oral lesion because antihypertension drugs have several effect on oral mucosa until the dysfunction of salivary glands. Objective: to know the oral lesions that associated with hypertension. Problem Statement: The used of anti-hypertension drug in hypertension patients have side effect. The side effect can cause the oral lesion and tissue damage in oral cavity. Discussion: Cardiovascular drugs such as anti-hypertension can cause oral ulcers such as agranulocytosis and thrompositopenia with hemorrhagic bullae, peteki, ecchymosis with bleeding. Terasozin and prasozin which are anti-hypertensive drugs can inhibit the salivary glands of alpha-adrenoreceptors, causing dry mouth due to reduced saliva production. Conclusion: Hypertension has a specific role as a cause of oral lesion. The use of antihypertension drug has shown the associated with oral mucosa damage.

Hyperglycemia and Salivary Gland Dysfunction in the Non-obese Diabetic Mouse: Caveats for Preclinical Studies in Sj\xf6gren\u2019s Syndrome

The Non-obese Diabetic (NOD) mouse model for type I diabetes also develops some features of Sjögren’s syndrome (SS). Since the source of the mice and the environment exert a strong influence on diabetes, this study investigated SS development in NOD mice obtained from two vendors. Female NOD mice from The Jackson Laboratory (JAX) and Taconic Biosciences were monitored for blood glucose and pilocarpine-induced salivation. The gut microbiome was analyzed by 16S rRNA sequencing of stool DNA. At euthanasia, serum cytokines and sialoadenitis severity were evaluated. The onset of diabetes was significantly accelerated in JAX mice compared to Taconic mice. Although the gut microbiome between the two groups was distinct, both groups developed sialoadenitis. There was no correlation between the severity of sialoadenitis and reduced saliva production. Instead, salivary gland dysfunction was associated with hyperglycemia and elevation of serum IL1β, IL16, and CXCL13. Our data suggest that inflammatory pathways linked with hyperglycemia are confounding factors for salivary gland dysfunction in female NOD mice, and might not be representative of the mechanisms operative in SS patients. Considering that NOD mice have been used to test numerous experimental therapies for SS, caution needs to be exerted before advancing these therapeutics for human trials.

PENGARUH STIMULASI PEMBERIAN TABLET HISAP VITAMIN C TERHADAP PENINGKATAN SEKRESI SALIVA PADA PASIEN GAGAL GINJAL KRONIK YANG MENJALANI TERAPI HEMODIALISA DI RS UMUM SEMBIRING

“Chronic kidney failure is a progressive and irreversible decline in kidney function, in which the body is unable to maintain fluid balance and electrolyte metabolism. In practice, patients must limit the liquid diet to prevent complications. However, this action can affect several aspects of the human body, namely dry mouth or xerostomyadue to reduce saliva production. To reduce patient complaints, the action that can be done is to stimulate the salivary glands with chemical stimulation using acidic vitamin C lozenges. The purpose of this study was to determine the stimulating effects of vitamin C lozenges to increase salivary secretion in patients with chronic renal failure undergoing hemodialysis therapy at Sembiring General Hospital. This study used a Pre-experimental design with a pretest-posttest design. The sample amounted to 48 respondents, using Purposive Sampling techniques. Data analysis techniques using Paired t Test to determine whether there are significant differences in salivary secretion at the pretest and posttest. Based on statistical test Paired t Test data analysis conducted found significant differences amount of secretion of saliva before and after the value of p = 0.000 p <0.005 found a significant increase in the secretion of saliva between pretest saliva and posttest conclusion, the stimulation of the provision of lozenges vitamin C has the effect of increasing salivary secretion in patients with chronic kidney failure undergoing hemodialysis therapy at Sembiring General Hospital”.
 
 Keywords: Stimulation, Saliva Secretion, Chronic Kidney Failure.

Respiratory morbidity in children with cerebral palsy: an overview

Respiratory problems have a significant impact on morbidity and mortality in patients with cerebral palsy (CP). In particular, recurrent aspiration, impaired airway clearance, spinal and thoracic deformity, impaired lung function, poor nutritional status, and recurrent respiratory infections negatively affect respiratory status. Bronchopulmonary dysplasia may contribute to pulmonary problems, but asthma is not more common in CP than in the general population. We discuss treatment options for each of these factors. Multiple coexisting and interacting factors that influence the respiratory status of patients with CP should be recognized and effectively addressed to reduce respiratory morbidity and mortality. WHAT THIS PAPER ADDS: Respiratory problems are a significant cause of morbidity in patients with cerebral palsy (CP). Respiratory status in patients with CP is influenced by recurrent aspiration and impaired airway clearance. Spinal and thoracic deformity, impaired lung function, poor nutrition, and respiratory infections also negatively affect respiratory status. These factors should all be addressed to reduce respiratory problems in patients with CP.

A Method for the Measurement of Salivary Gland Function in Mice

Patients with Sjögren's syndrome, an autoimmune disease affecting the exocrine glands, develop salivary gland inflammation and have reduced saliva production. Similarly, saliva production is severely compromised in patients receiving radiation treatment for head and neck cancers. Rodent models, developed to mimic these clinical conditions, facilitate an understanding of the disease pathogenesis and allow for the development of new therapeutic strategies. Therefore, the ability to accurately, reproducibly, and repeatedly measure salivary gland function in animal models is critical. Building on procedures previously described in the literature, a method was developed that meets these criteria and was used to evaluate salivary gland function in mice. An additional advantage of this new method is that it is easily mastered, and has little inter-operator variation. Salivary gland function is evaluated as the amount (weight or volume) or rate (mL/min) of saliva produced in response to pilocarpine stimulation. The collected saliva is a good source for the analyses of protein content, immunoglobulin concentrations, and other biomolecules.

A Method for the Measurement of Salivary Gland Function in Mice.

Patients with Sjögren's syndrome, an autoimmune disease affecting the exocrine glands, develop salivary gland inflammation and have reduced saliva production. Similarly, saliva production is severely compromised in patients receiving radiation treatment for head and neck cancers. Rodent models, developed to mimic these clinical conditions, facilitate an understanding of the disease pathogenesis and allow for the development of new therapeutic strategies. Therefore, the ability to accurately, reproducibly, and repeatedly measure salivary gland function in animal models is critical. Building on procedures previously described in the literature, a method was developed that meets these criteria and was used to evaluate salivary gland function in mice. An additional advantage of this new method is that it is easily mastered, and has little inter-operator variation. Salivary gland function is evaluated as the amount (weight or volume) or rate (mL/min) of saliva produced in response to pilocarpine stimulation. The collected saliva is a good source for the analyses of protein content, immunoglobulin concentrations, and other biomolecules.

The Null Effect of Chewing Gum During Hemodialysis on Dry Mouth

The study was conducted to determine the effect of chewing gum during hemodialysis on dry mouth and its symptoms. The imposition of fluid restriction and the use of medications that reduce saliva production may lead to dry mouth. This study is a randomized, controlled, single-blind, crossover experimental study. The subjects consisted of 61 hemodialysis patients recruited from 4 dialysis centers in southern Turkey. The data were collected using a Patient Identification Form, a Form for Assessing the Symptoms of Dry Mouth, and a Patient Follow-up Form. Saliva samples were obtained for analysis of flow rates. The salivary flow rates of the patients increased during the first hour on the day when gum was chewed, and this increase was statistically significant. However, no significant difference was found between the salivary flow rates at the 0- and 4-hour time points on the day when gum was chewed (P > .05). In addition, the salivary pH values were in the normal range on both days, although the pH values tended to be more acidic on the day when gum was not chewed. Overall, it was found that chewing gum for 15 minutes each hour during a hemodialysis session did not increase the saliva amount, maintain the pH value of the saliva within a normal range, or control dry mouth symptoms.

Radiation-Induced Microvascular Injury as a Mechanism of Salivary Gland Hypofunction and Potential Target for Radioprotectors

Radiation therapy is commonly used to treat patients with head and neck squamous cell carcinoma (HNSCC). One of the major side effects of radiotherapy is injury to the salivary glands (SG), which is thought to be mediated by microvascular dysfunction leading to permanent xerostomia. The goal of this study was to elucidate the mechanism of radiation-induced microvasculature damage and its impact on SG function. We measured bovine aortic endothelial cell (BAEC) apoptosis and ceramide production in response to 5 Gy irradiation, either alone or with reactive oxygen species (ROS) scavengers. We then investigated the effect of a single 15 Gy radiation dose on murine SG function. BAECs exposed to 5 Gy underwent apoptosis with increased ceramide production, both prevented by ROS scavengers. Among the 15 Gy irradiated mice, there was considerable weight loss, alopecia and SG hypofunction manifested by reduced saliva production and lower lysozyme levels. All of these effects, except for the lysozyme levels, were prevented by pretreatment with ROS scavengers. Microvessel density was significantly lower in the SG of irradiated mice compared to the control group, and this effect was significantly attenuated by pretreatment with Tempol. This study demonstrates that radiation-induced SG hypofunction is to a large extent mediated by microvascular dysfunction involving ceramide and ROS generation. These findings strongly suggest that ROS scavengers may serve as potential radioprotectors of SG function in patients undergoing radiotherapy for HNSCC.

Single-cell analysis of glandular T cell receptors in Sjögren's syndrome.

CD4+ T cells predominate in salivary gland (SG) inflammatory lesions in Sjögren's syndrome (SS). However, their antigen specificity, degree of clonal expansion, and relationship to clinical disease features remain unknown. We used multiplex reverse-transcriptase PCR to amplify paired T cell receptor α (TCRα) and β transcripts of single CD4+CD45RA- T cells from SG and peripheral blood (PB) of 10 individuals with primary SS, 9 of whom shared the HLA DR3/DQ2 risk haplotype. TCRα and β sequences were obtained from a median of 91 SG and 107 PB cells per subject. The degree of clonal expansion and frequency of cells expressing two productively rearranged α genes were increased in SG versus PB. Expanded clones from SG exhibited complementary-determining region 3 (CDR3) sequence similarity both within and among subjects, suggesting antigenic selection and shared antigen recognition. CDR3 similarities were shared among expanded clones from individuals discordant for canonical Ro and La autoantibodies, suggesting recognition of alternative SG antigen(s). The extent of SG clonal expansion correlated with reduced saliva production and increased SG fibrosis, linking expanded SG T cells with glandular dysfunction. Knowledge of paired TCRα and β sequences enables further work toward identification of target antigens and development of novel therapies.

Expansions of salivary gland CD4+ T cells from Sjögren’s syndrome patients: single-cell repertoire analysis and correlation with clinical measures of disease (HUM3P.255)

Abstract Sjögren’s syndrome is a systemic rheumatic disorder characterized by dry eyes, dry mouth and T cell infiltration of exocrine gland tissue. To determine the extent of salivary gland (SG) CD4+ memory T cell clonal expansion and whether these expansions are as frequent in peripheral blood (PB), a multiplex PCR method was used to amplify both the α and β T cell receptor (TCR) sequences from memory CD4+ T cells sorted from SG lip biopsy tissue and PB of 10 primary Sjögren’s syndrome patients. Over 3,000 TCR sequences were obtained from 50-115 (median 91) individual SG and 75-121 (median 104) individual PB T cells per patient. The percentage of cells that were part of clonal expansions was significantly higher in SG (median 11%, range 0-28%) compared to PB (median 0.9%, range 0-7%, p=0.003). Sequence analysis revealed: 1) highly homologous CDR3s among different expanded SG T cell clones within single patients, suggesting antigen-driven expansion and 2) unique cases of convergent recombination among unrelated patients, where different V segments/additions/deletions were utilized to make identical CDR3 amino acid sequences. The percentages of clonally expanded SG T cells correlated significantly with degree of SG fibrosis and reduced saliva production but not with systemic features of disease. SG clonal expansions detected in this study likely identify T cells involved in recognition of common antigen(s) and glandular dysfunction.

Antiasthmatic Inhaled Medications as Favoring Factors for Increased Concentration of Streptococcus Mutans.

Introduction:The negative impact of inhaled antiasthmatic drugs (IAD) on oral health is reflected primarily in the increased incidence of caries in asthmatic children compared to healthy children. It is believed that one of the causes of the increased incidence of caries in asthmatic children is from bronchodilator effect in reduced secretion of saliva. Decreased salivation favors bacterial colonization and studies have shown that the concentration of Streptococcus mutans, a bacterium that has the primary role in the development of caries, is higher in asthmatic than in healthy children.Material and methods:The study sample consisted of 200 patients, age from 7-14 years, divided into two groups: control group (n1 = 100) consisted of healthy children and the experimental group consisted of children suffering from asthma (n2 = 100). In both groups of respondents are identified the DMFT values, the concentration of Streptococcus mutans, the amount of stimulated saliva and plaque index value.Results:It was found that there are significant differences in the values of plaque index, salivary index and streptococcus mutans between the control and experimental groups (p> 0.05 for each of the examined variables). Those in the control group had significantly higher DMFT index than subjects in the experimental group (p = 0.004).Conclusion:IAD does not cause reduced saliva production and thus do not represent a factor favoring increased concentration of Streptococcus mutans.

A Study on Duration of Effect of Transcutaneous Electrical Nerve Stimulation Therapy on Whole Saliva Flow.

Saliva is a complex fluid, whose important role is to maintain the well being of oral cavity. Salivary gland hypofunction or hyposalivation is the condition of having reduced saliva production which leads to the subjective complaint of oral dryness termed xerostomia.(7) Management of xerostomia includes palliative therapy using topical agents or systemic therapy. Electrostimulation to produce saliva was studied in the past and showed moderate promise but never became part of mainstream therapy. Hence, this study was undertaken to evaluate the effect of transcutaneous electrical nerve stimulation (TENS) on whole salivary flow rate in healthy adults and to evaluate how long this effect of TENS lasts on salivary flow. One hundred healthy adult subjects were divided into five age groups with each group containing 20 subjects equally divided into males and females in each group. Unstimulated saliva was collected using a graduated test tube fitted with funnel and quantity was measured. Transcutaneous electrical nerve stimulation unit was activated and stimulated saliva was collected. Saliva was again collected 30 minutes and 24 hours post stimulation. The mean unstimulated whole saliva flow rate for all subjects (n = 100) was 2.60 ml/5 min. During stimulation, it increased to 3.60 ± 0.39 ml/5 min. There was 38.46% increase in salivary flow. Ninety six out of 100 responded positively to TENS therapy. Salivary flow remained increased 30 minutes and 24 hours post stimulation with the values being 3.23 ± 0.41 ml/5 min and 2.69 ± 0.39 ml/5 min respectively. Repeated measures One way analysis of variance (ANOVA) test showed that the difference between these values were statistically significant. Transcutaneous electrical nerve stimulation therapy was effective for stimulation of whole saliva in normal, healthy subjects and its effect retained till 30 minutes and a little up to 24 hours. Transcutaneous electrical nerve stimulation may work best synergistically with other sialagogues and can be used for the management of xerostomia.

Xerostomia in geriatric patients: a burgeoning global concern.

Saliva plays a key role in maintaining oral homeostasis, function, and health. The prevalence of xerostomia and its consequences are rising due to the increasing aging population, the effects of some systemic diseases, medical management, and commonly-prescribed medications that reduce saliva production. When salivary function is diminished, patients are at a greater risk of developing caries, discomfort in wearing dentures, and opportunistic diseases, such as candidiasis. The psychosocial aspects of xerostomia can range from a mild effect on self-rated oral health to frustration, embarrassment, unhappiness, or substantial disruptions in quality of life. This article reviews the clinical features, diagnosis, and prevalence of dry mouth, as well as its treatment strategies.

Is Assessment of Hyposalivation Important in Routine Dental Practice?

ABSTRACT Saliva is a key element in oral homeostasis, oral function and maintenance of oral health. Dry mouth has multiple oral health consequences and affects quality of life. The incidence of dry mouth and its public health impact are increasing due to the aging population, the effects of some systemic diseases, and medical care and commonly prescribed medications that reduce saliva production. Chronic xerostomia can contribute to oral mucosal changes, increased coronal and root caries susceptibility, candidiasis, periodontal disease, partial loss of taste acuity, and difficulty in swallowing and functional prosthetic problems. Although, oral healthcare providers routinely obtain and document a patient's medical history, evaluating salivary gland function is not a common practice unless the patient is symptomatic. This review of literature highlights the importance of saliva, and the need to measure and document hyposalivation in routine dental practice. How to cite this article Sharma V, Somasundara SY, Kumar YSP, Bhat PK. Is Assessment of Hyposalivation Important in Routine Dental Practice? J Health Sci Res 2014;5(2):10-14.

Important Variables for Halitosis Clinical Trials: Causes, Diagnostic Methods and Treatments

In 80–90% of all cases, the oralmalodor is caused by production of volatile sulfur compounds (VSC), which are hydrogen sulfide (smells like rotten egg), methyl mercaptan (rotten cabbage) and dimethyl sulfide (rotten cabbage). This last one is present in non-dental causes (from lungs, liver, kidneys and must be better investigated by a clinical physician [5,6]. The VSCs derive from gram negative, anaerobic bacteria found in periodontal pockets and in the crypts at the back of the tongue [7,8]. The oral malodor upon waking is usual and can be related to several factors including reduced saliva production during the night [9], increased microbial metabolic activity during sleep [10], as well as mouth breathing [11].

THU0415 Increased rigidity of salivary glands as indicated by sonoelastography is associated with reduced saliva production in primary sjÖgren’s syndrome

BackgroundReal-time sonoelastography (SElasto) is used to examine tissue elasticity. Chronic inflammation and fibrosis of major salivary glands leads to reduced saliva production in patients with primary Sjögren’s syndrome (pSS).ObjectivesTo investigate...

Effects of Reduced Saliva Production on Swallowing in Patients with Sjogren’s Syndrome

This study aimed to further characterize the nature of swallowing dysfunction in patients with Sjogren's syndrome (SS). Subjects filled out a perception of swallow function form. Measures of stimulated salivary flow rate were also taken, and videofluoroscopic evaluation of swallowing was completed. The amount of saliva produced by patients with SS was significantly less than that produced by normal age-matched controls, and these patients perceived their swallowing to be impaired. Few statistically significant differences were found between the SS group and normal age-matched controls on temporal measures of swallowing, and 96% of swallows in the SS group were judged to be functional. There was no correlation between perception of swallowing and amount of saliva produced. No strong correlations were found between temporal measures of swallowing and salivary flow rate. Results indicated that patients with SS tend to perceive their swallowing to be worse than physiologic swallowing measures indicate. The decreased saliva production in these patients does not appear to be the cause of their perceived swallowing difficulty but may affect their sensory judgment of swallow function. Future studies will focus on how quality of saliva affects swallowing in these patients.