Reduction In Salivary Flow Research Articles

Immediate effects of photobiomodulation on saliva production.

To verify the immediate effects of photobiomodulation on the production of salivary flow and the correlation of demographic, anthropometric and medication use data. The study included 100 healthy individuals, aged between 18 and 76 years (mean 27.2 years), randomly split into an experimental group and a placebo group. Assessments of anthropometric measurements, self-perception of saliva production and sialometry were performed. Next, LASER irradiation was carried out at an infrared wavelength (808 nanometers) with 100 milliwatts (mw) of power at five intraoral points: on the sublingual glands and bilaterally on the submandibular and parotid glands, at doses of 9, 18 and 24 joules (J). Sialometry was repeated after each application. The control group received the same procedures with placebo equipment. There was a statistical association in the self-perception of reduced saliva in the experimental group for the 24J dose and in sialometry and in the reduction in salivary flow for the 18J and 24J doses and an increase to 9J, in both groups. There was no association when comparing the experimental and placebo groups. Multiple multinomial regression analysis revealed that the reduction or increase in salivary flow is independent of demographic, anthropometric and medication use variables. The bioinhibitory action of photobiomodulation on healthy salivary glands occurred at a dose of 18J and 24J, while the biostimulant action happened at a dose of 9J, regardless of demographic, anthropometric variables and medication use. The self-perception of reduced salivary flow occurred at 24J.

SAT563 Follicular Thyroid Cancer Masquerading as Chest Wall Mass With an Aggressive Course

Abstract Disclosure: I. Goyal: None. E. Punni: None. L. Adhikari: None. Introduction:Follicular thyroid cancers (FTC) are more aggressive than papillary thyroid cancer and usually have more advanced tumor stage at the time of presentation. Musculoskeletal metastases are rare though, but when present can cause various complications like pathological fractures and nerve compression. Clinical case:A 75-year-old female was seen in orthopedics clinic for a left infraclavicular chest wall mass. MRI chest showed a large destructive mass invading the manubrium. Biopsy showed follicular cells consistent with ectopic thyroid tissue. CT neck/chest showed 2x1.8 cm right thyroid lobe nodule and left sternoclavicular joint metastasis. She underwent total thyroidectomy and resection of portions of manubrium, left clavicle and left 1st and 2nd rib. Pathology showed FTC in right thyroid lobe, measuring 2.6 cm in greatest dimension with angioinvasion, and FTC of manubrium, adjacent connective tissue and sternoclavicular joint and ribs, measuring 6.3 cm in greatest dimension. Pathological TNM staging was pT2N0M1. Her 6-week post-op thyroglobulin (Tg) level was 28.7 ng/mL (Beckman Coulter Immunometric Assay, reference value <0.1 athyrotic). She was started on levothyroxine supplementation to achieve a TSH <0.01 uIu/mL. She was subsequently treated with 200 mCi of radio-active iodine (RAI) as adjuvant therapy. Post-therapy whole body scan showed increased activity in the right strap muscle and iodine-avid osseous metastasis in right hemisacrum. She further received radiation therapy to neck and sternal regions, and the right sacroiliac joint. Following this, patient was monitored with serial Tg panel and neck ultrasound (US). Her initial post-op US neck showed a soft tissue fullness in right thyroidectomy bed, concerning for residual disease but this was no longer seen after 3 months. Her Tg level downtrended from 28.7 ng/mL to 12.6 ng/mL and further to 1.8 ng/mL at 1-year follow-up. However, her course was complicated by development of several oral ulcers resulting from high-dose RAI therapy which were treated symptomatically with hydration, topical analgesics and Listerine mouth washes. The patient reported ongoing bowel incontinence since her initial cancer diagnosis. MRI pelvis showed rim-enhancing 4.5cm lesion centered at right sacral ala and extending into adjacent S1/S2 neural foramina. She was re-referred for palliative radiation therapy.Conclusion:This case of FTC is unique due to its uncommon initial presentation. Skeletal metastases to sacrum resulted in bowel incontinence in our patient. When present, skeletal metastases need treatment with high-dose (200 mCi) RAI. RAI therapy can cause xerostomia, hypogeusia and sialadenitis due to reductions in salivary flow. Clinicians should be aware of the early and late-onset complications of RAI therapy, discuss these with the patient before therapy and manage the complications adequately if these occur. Presentation Date: Saturday, June 17, 2023

Estimation of Salivary Flow Rate in Myocardial Infarct Patients and its Association with Type II Diabetes Mellitus

Objective: The aim of our study was to investigate the association between salivary flow rate in diabetes mellitus and the development of coronary artery disease. Methodology: A cross-sectional study was executed in the Cardiology Department of Civil Hospital Karachi. Unstimulated saliva was collected between 9 and 11 a.m. Participants were asked to refrain from eating and drinking for 1 hour before saliva collection. They were then instructed to collect 5 ml of unstimulated saliva in a 15 ml falcon tube for 10 minutes. Finally, the patient’s oral hygiene status was recorded by a dentist. Data was entered in SPSS version 21. Descriptive analysis and significance of relationship was analyzed using chi-square test. Results: Out of 100 myocardial infarct patients between the age range of 30-70 years, 71(71%) were male and 29 (29%) were female. Overall frequency of diabetes mellitus was 55%. Significant relationships were found between occurrence of myocardial infarction in diabetes mellitus, among salivary flow rate reduction and age of the patient, and salivary flow rate reduction and gender of patient Salivary flow reduction below 3mL/10 minute was found in 48 diabetic patients whereas 11 nondiabetic patients had this clinical finding. No significant relationship was found between occurrence of caries and periodontitis with presence of diabetes. Conclusion: Careful monitoring of the oral symptoms related to severity of DM particularly the salivary flow rate can be helpful in early diagnosis of patients at possibility of developing cardiovascular complications. Keywords: Myocardial infarction, unstimulated saliva, Type II DM, Salivary flow rate.

Heart Rate Variability and Salivary Biomarkers Differences between Fibromyalgia and Healthy Participants after an Exercise Fatigue Protocol: An Experimental Study.

Previous studies showed that people with Fibromyalgia (FM) suffer from dysautonomia. Dysautonomia consists of persistent autonomic nervous system hyperactivity at rest and hyporeactivity during stressful situations. There is evidence that parameters reflecting the complex interplay between the autonomic nervous system and the cardiovascular system during exercise can provide significant prognostic information. Therefore, this study aimed to investigate the differences between people with FM and healthy controls on heart rate variability (HRV) and salivary parameters (such as flow, protein concentration, enzymatic activities of amylase, catalase and glutathione peroxidase) in two moments: (1) at baseline, and (2) after an exercise fatigue protocol. A total of 37 participants, twenty-one were people with fibromyalgia and sixteen were healthy controls, participated in this cross-sectional study. HRV and salivary samples were collected before and after an exercise fatigue protocol. The fatigue protocol consisted of 20 repetitions of knee extensions and flexions of the dominant leg at 180 °·s−1 (degrees per second). Significant differences were found in the HRV (stress index, LF and HF variables) and salivary biomarkers (with a higher concentration of salivary amylase in people with FM compared to healthy controls). Exercise acute effects on HRV showed that people with FM did not significantly react to exercise. However, significant differences between baseline and post-exercise on HRV significantly induce alteration on the HRV of healthy controls. Catalase significantly increased after exercise in healthy controls whereas salivary flow significantly increased in women with FM after an exercise fatigue protocol. Our study suggests that a higher α-amylase activity and an impaired HRV can be used as possible biomarkers of fibromyalgia, associated with a reduction in salivary flow without changes in HRV and catalase activity after a fatigue exercise protocol. More studies should be carried out in the future to evaluate this hypothesis, in order to find diagnostic biomarkers in fibromyalgia.

SIALOMETRIC CHANGES IN PATIENTS UNDER CHEMOTHERAPY TREATMENT: A NARRATIVE REVIEW

<h3>Objectives</h3> The objective of this study was to summarize the theoretical contributions concerning the sialometric changes occurring in patients during chemotherapy treatment. <h3>Study Design</h3> This study is a narrative review of the literature through secondary data analysis. The literature survey was carried out from March to April 2021 using the Virtual Health Library, Scielo, and PubMed as the databases and with the descriptors "Salivary Glands," "Hyposalivation," "Cancer," and "Chemotherapy." The included studies were published in the previous 10 years in any language. <h3>Results</h3> Chemotherapy was responsible for altering salivary flow in patients due to the high sensitivity of oral structures to the toxic effects of chemotherapy drugs. The studies used the tests of unstimulated sialometry and stimulated sialometry for the sialometric evaluation of patients. The results showed a reduction in the average salivary flow rate and high salivary viscosity. Changes in pH were also observed and decreased during and after treatment. The behavior in children undergoing antineoplastic treatment was opposite to that found in adults. The salivary flow and salivary pH remained the same during chemotherapy. <h3>Conclusions</h3> Adult patients developing antineoplastic therapy using chemotherapy drugs have a marked reduction in salivary flow and salivary pH.

EFFECTIVENESS OF EXTRAORAL PBM IN THE PREVENTION OF SALIVARY HYPOFLOW IN IRRADIATED PATIENTS: DOUBLE-BLIND RCT

<h3>Objectives</h3> Evaluate the efficacy of extraoral photobiomodulation in preventing salivary hypoflow in patients undergoing radiotherapy. <h3>Study Design</h3> Fifty-two patients divided into an intervention group with 23 patients undergoing extraoral photobiomodulation and a control group with 29 patients undergoing placebo extraoral photobiomodulation, 3 times a week, during the radiotherapy period. The parameters used were 30 mW, 7.5 J/cm², 10 s/point, 0.3 J/point, 830 nm wavelength, and 0.028 cm² area. The salivary flow at rest and the Xerostomia Inventory were evaluated at 3 moments during radiotherapy and 1 month after the end. <h3>Results</h3> When comparing salivary volumes before and after radiotherapy, most of the sample had salivary flow >0.2 mL/min (control 69% vs 65% intervention, <i>P</i> > .05). The prevalence of xerostomia was higher in the control group (21% vs 17%, <i>P</i> > .05), as well as the complaint of severe xerostomia at the end of radiotherapy (35% vs 30%, <i>P</i> > .05). Oral pain was the most frequent complication (control 26% vs intervention 20%, <i>P</i> > .05). <h3>Conclusions</h3> Extraoral photobiomodulation was not effective in preventing the reduction of salivary flow during radiotherapy, but it maintained higher flow values when compared to the control group, as well as lower prevalence and severity of xerostomia.

Comparative Assessment of Salivary Flow Rates Among Reverse Smokers and Smokers Using Modified Schirmer Test

Background: Saliva, a complex fluid secreted by the salivary glands within the oral cavity, is the first to interact with smoke while smoking. Nicotine in smoke causes structural and functional changes in the saliva, leading to a significant reduction in salivary flow. Aim: The present study was done to compare the salivary flow between reverse smokers, regular smokers, and non-smokers with the help of the Modified Schirmer Test (MST) to assess unstimulated saliva. Materials and Methodology: Ninety subjects were randomly divided into three groups; Group A (30) subjects who had the habit of reverse smoking daily for &gt;6 months, Group B (30) subjects who had the habit of smoking daily for &gt;6 months, and Group C (30) healthy, non-tobacco users. MST was done in the morning hours; they were not asked to eat/drink for 2 h before the procedure. Later, they were asked to raise their tongue, and the rounded end of Schirmer's strip was placed on the floor of the mouth. Wetting of the strip was recorded every 1, 2, and 3-minute intervals. Results: Data was recorded, and statistical analysis was done by the paired t-test. The mean value of salivary flow rate in reverse smokers per 3 minutes (19.73 ± 4.16) was less when compared to conventional smokers (22.53 ± 2.75) and healthy individuals (31.53 ± 2.90), with a significant P value of P &lt; 0.0001. Conclusion: There was a significantly reduced unstimulated salivary flow rate in reverse smokers compared to conventional smokers and healthy individuals.

Salivary Flow Reduction in Elderly Patients

Salivary Flow Reduction in Elderly Patients

Radiotherapy changes the salivary proteome in head and neck cancer patients: evaluation before, during, and after treatment.

Salivary glands are affected during radiotherapy in the head and neck region, leading to a reduction in salivary flow and changes its composition. Besides negatively affecting the oral soft tissues, this can also lead to dental impairment. Thus, we evaluated the effect of radiotherapy in the proteomic profile of the saliva in patients with head and neck cancer (HNC). HNC patients had their saliva collected before (BRT), during (2-5 weeks; DRT), and after (3-4 months; ART) radiotherapy. Saliva was also collected from healthy volunteers (control; C). Samples were processed for proteomic analysis. In total, 1055 proteins were identified, among which 46 were common to all groups, while 86, 86, 286, and 395 were exclusively found in C, BRT, DRT, and ART, respectively. Remarkably, alpha-enolase was increased 35-fold DRT compared with BRT, while proline-rich proteins were decreased. ART there was a 16-fold increase in scaffold attachment factor-B1 and a 3-fold decrease in alpha-enolase and several cystatins. When compared with C, salivary proteins of BRT patients showed increases cystatin-C, lysozyme C, histatin-1, and proline-rich proteins CONCLUSION/CLINICAL REVELANCE: Both HNC and radiotherapy remarkably change the salivary protein composition. Altogether, our results, for the first time, suggest investigating alpha-enolase levels in saliva DRT in future studies as a possible biomarker and strategy to predict the efficiency of the treatment. Moreover, our data provide important insights for designing dental products that are more effective for these patients and contribute to a better understanding of the progressive changes in salivary proteins induced by radiotherapy. Graphical abstract.

Choline Acetyltransferase Induces the Functional Regeneration of the Salivary Gland in Aging SAMP1/Kl -/- Mice.

Salivary gland dysfunction induces salivary flow reduction and a dry mouth, and commonly involves oral dysfunction, tooth structure deterioration, and infection through reduced salivation. This study aimed to investigate the impact of aging on the salivary gland by a metabolomics approach in an extensive aging mouse model, SAMP1/Klotho -/- mice. We found that the salivary secretion of SAMP1/Klotho -/- mice was dramatically decreased compared with that of SAMP1/Klotho WT (+/+) mice. Metabolomics profiling analysis showed that the level of acetylcholine was significantly decreased in SAMP1/Klotho -/- mice, although the corresponding levels of acetylcholine precursors, acetyl-CoA and choline, increased. Interestingly, the mRNA and protein expression of choline acetyltransferase (ChAT), which is responsible for catalyzing acetylcholine synthesis, was significantly decreased in SAMP1/Klotho -/- mice. The overexpression of ChAT induced the expression of salivary gland functional markers (α–amylase, ZO-1, and Aqua5) in primary cultured salivary gland cells from SAMP1/Klotho +/+ and -/- mice. In an in vivo study, adeno-associated virus (AAV)-ChAT transduction significantly increased saliva secretion compared with the control in SAMP1/Klotho -/- mice. These results suggest that the dysfunction in acetylcholine biosynthesis induced by ChAT reduction may cause impaired salivary gland function

Temporomandibular Disorders and Oral Features in Idiopathic Inflammatory Myopathies (IIMs) Patients: An Observational Study.

Aim: Inflammatory idiopathic myopathies (IIMs) are inflammatory processes affecting skeletal musculature and extramuscular organs. Temporomandibular disorders (TMD) involve jaw muscles and temporomandibular joint. The aim of this observational study was to investigate the prevalence of the main TMD symptoms and signs as well as oral implications in IIM patients.Methods: The study group included 54 patients (42 women and 12 men), 22 of whom affected by dermatomyositis (DM), 29 by polymyositis (PM) and 3 by inclusion body myositis (IBM). A group of 54 patients not affected by this disease, served as CG. Oral and TMD signs and symptoms were evaluated by means of a questionnaire and through clinical examination.Results: About oral symptoms, the study group complained more frequently dysgeusia, with loss of taste or unpleasant taste (p<0.0001) and feeling of burning mouth (9.4% versus 0 controls). Xerostomia was more prevalent in the study group respect to the CG (p<0.0001). Dysphagia was reported by 48.1% of IIM patients while was absent in CG (p<0.0001). About oral signs, cheilitis (p<0.05) and oral ulcers (p<0.05) were significantly more frequent in CG. As regard to TMD symptoms, arthralgia and tinnitus didn't showed significant differences between the two groups, while neck/shoulders and masticatory muscle pain was significantly more referred in IIM patients than in the CG (p<0.05). About TMJ signs, sounds were overlapping in the two groups: click=11.1% in both IIM patients and CG (p>0.05), crepitation in 11.1% of IIM and 9.3% of controls (p>0.05). No significant difference was detected about deflection (9.3%, p>0.05), while deviation was wider in CG (p<0.05). Active opening and lateralities showed no significant differences, while endfeel was significantly increased in IIM group for a higher presence of muscular contracture. Bruxism was present only in CG.Conclusion: The data collected from this observational study seem to support the existence of a relationship between the prevalence of TMD symptoms and signs as well as oral features in patients with myositis. A remarkable reduction of salivary flow and dysphagia were more frequent and severe in IIM patients, as well as muscle contracture and myofacial pain evoked by palpation, this result being highly significant.

A retrospective study on the oral health of patients in the intesive care unit

&lt;p&gt;&lt;strong&gt;Introduction&lt;/strong&gt;: the oral condition of patients in the Intensive Care Unit (ICU) is extremely important for clinical status monitoring,&lt;br /&gt;as lesions in the oral mucosa may imply complications and worsening of the health status of these patients. A higher probability&lt;br /&gt;of adherence, colonization, and bacterial infection in the oral cavity of patients in the ICU has also been reported. The poor oral&lt;br /&gt;hygiene conditions of these patients may be related to the reduction of salivary flow and difficulties in maintaining oral hygiene in a&lt;br /&gt;hospital environment, which rarely employs dentists on staff. &lt;strong&gt;Objective&lt;/strong&gt;: to analyze the dental condition of patients admitted to the&lt;br /&gt;ICU of Roberto Santos General Hospital, Salvador, Bahia, Brazil. &lt;strong&gt;Methodology&lt;/strong&gt;: a total of 73 patients were evaluated through an oral&lt;br /&gt;examination performed with a wooden spatula and sterile gauze under natural light, and data were collected and analyzed. &lt;strong&gt;Results&lt;/strong&gt;:&lt;br /&gt;The most commom oral lesions were tongue-coating (41%) and ulcerations in the oral mucosa caused by trauma or dehydration&lt;br /&gt;(19.1%). The occurrence of pseudomembranous candidiasis (8.2%), dehydration of the lips and mucosa (26%), and angular cheilitis&lt;br /&gt;(9.5%) was additionally recorded. It was observed that 31.5% patients had more than 10 days of hospitalization and of these, 26%&lt;br /&gt;presented pseudomembranous candidiasis. This clinical condition was not seen in patients with a shorter hospital stay. &lt;strong&gt;Conclusions&lt;/strong&gt;:&lt;br /&gt;this study suggest a possible association between the length of stay of these patients and the clinical conditions presented. Thus, the&lt;br /&gt;results of this study may guide preventive and curative measures implemented by dental surgeons who may, in the future, be part&lt;br /&gt;of the multidisciplinary team of professionals working in the hospital environment, especially in ICUs.&lt;/p&gt;

SALIVARY CHANGES ARISING FROM ANTI ACNE THERAPY WITH ISOTRETINOIN ORAL USE: A SYSTEMATIC REVIEW WITH META-ANALYSES

Isotretinoin is a retinoid considered a gold standard in the treatment of acne and studies show that hyposalivation and xerostomia may be adverse effects. Therefore, we evaluate the effect of this treatment on salivary flow (SF) through a systematic review of the literature with meta-analysis. We also evaluated changes in the secondary salivary buffer capacity (BC) with regards to a possible salivary hypoflow. We searched the main databases, including gray literature. From the search strategy, we found 577 articles. By following the PRISMA flow diagram, we submitted 3 studies to meta-analysis to evaluate changes in SF. In the 3 studies included, the use of isotretinoin led to SF reduction (P

Evaluation of the masticatory biomechanical function in Down syndrome and its Influence on sleep disorders, body adiposity and salivary parameters

To evaluate the phenotypic features of the masticatory biomechanics in atypical subjects with Down syndrome (DS). Its influence was analysed on sleep disorders, body adiposity and its risks, and some physicochemical properties of saliva. Seventy subjects were enrolled to assess masticatory biomechanical function and divided into two groups: DS and control groups. Electrical activities of the masseter and temporal muscles (at rest and in maximum voluntary clench-MVC), maximum bite force-MBF and maximum mouth opening-MMO were investigated. Among the atypical subjects, just 24 participants underwent the anthropometry, the polysomnography II and the saliva testing (salivary flow rate-SFR, buffer capacity-BC and salivary cortisol levels, morning/SC-AM and night/SC-PM). MVC and MBF values showed high statistical significance in the control group (P<.001) than in the DS group of 35. MMO values were slightly increased in the DS group in relation to the control group. Overweight and obesity were found in both genders. Atypical women showed higher risk to develop cardiovascular-metabolic diseases than in atypical men. OSA severe was 20% for atypical women and 42.8% for atypical men, whereas snoring index was present in all genders. SFR was reduced in 100% of atypical subjects (hyposalivation in 10% women and 28.5% men). Furthermore, 100% BC, 66.6% SC-AM and 91.6% SC-PM showed normal patterns. Masseter and temporal muscle hypotonia was found in all atypical subjects with DS. This muscle dysfunction strongly was related to overweight/obesity, risks for development of cardiovascular/metabolic diseases, OSA severity, successive snoring episodes and salivary flow reduction in DS.

Impact of benign parotid gland tumors on whole salivary flow rate

The impact of benign tumors of the parotid gland on whole salivary flow or sialochemistry is unclear. A total of 22 patients with benign parotid tumors and 18 healthy controls underwent measurements of unstimulated and stimulated whole saliva flow and sialochemistry (Na+, K+, Ca++, Amylase, and pH). Assessment of xerostomia was performed by means of a visual analogue scale (VAS) and a questionnaire (QoL). Stimulated whole salivary flow was significantly lower in patients with benign parotid tumors in comparison to the control group (2.76 ± 0.96 ml/min vs. 3.85 ± 0.72 ml/min; p = 0.009). However, assessment of unstimulated whole salivary flow, sialochemistry, and subjective parameters (VAS, QoL) showed no significant differences between the patient and control groups (0.73 ± 0.41 ml/min vs. 0.68 ± 0.39 ml/min; p = 1). Benign salivary gland tumors appear to reduce whole stimulated salivary flow and leave unstimulated whole salivary flow and sialochemistry unchanged. The patients' subjective feelings of dry mouth do not seem to be influenced by the reduction in salivary flow.

A Review of the Role of Probiotic Supplementation in Dental Caries.

Dental diseases are among the common health issues experienced around the world. Dental caries is one of the most predominant oral diseases worldwide. Major factors associated with caries development include poor oral hygiene, the content of specific carbohydrates in the diet, dental biofilm formation, the cariogenic microbial load, reduction in salivary flow, insufficient fluoride exposure, gingival recession, genetic factors, and lack of personal attention to one's dental health. Several preventive measures have been implemented to reduce the risk of the development of caries. Probiotics are live microbes that when administered in suitable amounts confer health benefits on the host; they are recognized as potential adjunct therapeutic agents for several diseases. The present manuscript summarizes recent findings on the role of probiotics in dental caries prevention and the possible mechanisms of probiotic effects. Review of the literature indicates the regular consumption of probiotic products significantly reduced the risk of caries by inhibiting cariogenic bacteria and enriching commensal microbes in the oral cavity. Buffering the salivary pH, production of bacteriocin and enzymes (dextranase, mutanase, and urease), the capacity of competing for the adhesion and colonization on tooth surfaces are the possible mechanisms behind the beneficial effect of probiotics. Further studies are necessary to address the efficacy of long-term probiotic supplementation on the control of dental diseases and the influence of childhood probiotic supplementation on the risk of caries development.

Comparison of a daily and alternate-day photobiomodulation protocol in the prevention of oral mucositis in patients undergoing radiochemotherapy for oral cancer: a triple-blind, controlled clinical trial.

Preventive Photobiomodulation Therapy (PBMT) significantly reduces oral mucositis (OM) severity in patients undergoing Radiochemotherapy (RCT) for the treatment of oral cancer, but daily applications generate cost, overload the dental team, and reduce the number of patients assisted.To evaluate the effectiveness of two PBMT protocols in preventing OM in patients undergoing RCT for oral cancer. 16 patients diagnosed with oral cancer undergoing RCT were included, equally divided into two groups: a group treated daily with PBMT, and another group also submitted to daily treatment, however, performing the application of PBMT every three days, interspersed with a simulation of PBMT (placebo). A red laser was used (~660 nm), 0.1W power, 1J of energy applied per point, 9 points per area (labial mucosa, buccal mucosa, lateral borders of the tongue, body of the tongue, and floor of the mouth) from the beginning of RCT until the end of the oncological treatment. Daily assessments were performed regarding OM scores, the World Health Organization (WHO) pain scale, and the visual analog scale (VAS). Weight, salivary flow (SGAPP), OHIP-14, and DMFT were evaluated on the initial and final days of RT. OM incidence and clinical data were compared by Pearson's chi-square test or Fisher's exact test. Pain and other scale scores were compared using the Mann-Whitney and Friedman/Dunn tests (SPSS v20.0 p<0.05). In the group with PBMT on alternate days, there was an increase in the frequency of grade 2 and grade 3 oral mucositis and an increased risk of grade 2 oral mucositis, in addition to higher mean pain scores and greater reduction in salivary flow. The daily PBMT protocol proved more effective in controlling the frequency and severity of OM, pain, and salivary flow.

Temporomandibular Disorders and Oral Features in Systemic Lupus Erythematosus Patients: An Observational Study of Symptoms and Signs.

Aims: Systemic Lupus Erythematosus (SLE) is a connective tissue disease characterized by a wide range of pleomorphic pictures, including mucocutaneous, renal, musculoskeletal and neurological symptoms. It involves oral tissues, with hyposalivation, tooth decay, gingivitis, angular cheilitis, ulcers and glossitis. Temporomandibular disorders represent a heterogeneous group of inflammatory or degenerative diseases of the stomatognatic system, with algic and/or dysfunctional clinical features involving temporomandibular joint (TMJ) and related masticatory muscles. The aim of this study was to investigate the prevalence of oral manifestations and temporomandibular disorders (TMD) in SLE patients (Lp) compared with a control group.Methods: Fifty-five patients (9 men and 46 women) with diagnosed Lupus were recruited in the study group. A randomly selected group of 55 patients, matched by sex and age, served as control group. The examination for TMD symptoms and signs was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) through a questionnaire and clinical examination.Results: Lupus patients complained more frequently (95.8%) of oral and TMJ symptoms (dysgeusia, stomatodynia, masticatory muscle pain during function, neck and shoulder muscles pain and presence of tinnitus) but only xerostomia (χ2=4,1548 p=0,0415), temple headache (χ2=4,4542 p=0,035) and the sensation of a stuck jaw (Mid-p-test p=0,043) were significant. About signs, cheilitis (p=0,0284) oral ulcers (χ2=4,0104 p=0,045) and fissured tongue are significantly more frequent in study group. The salivary flow was significantly decreased in the study group respect to the control one (p<0.0001). As regard to the oral kinematics, restricted movements (RM) in protrusion and left lateral movement were significantly different between study group and controls. In particular, 85,2% of Lp showed limited protrusion versus 56,4% of controls (χ2= 10,91 p<0,001); 59,3% of Lp had also a limitation during left lateral movement versus 47,3% of controls (T=2,225 p=0,0282). About bruxism, only the indentations on the lateral edges of the tongue were found in Lp group (72,7%), with a significant difference respect to controls (χ2=7,37 p=0,007).Conclusions: While masticatory muscles have an overlapping behavior in both groups, the findings collected show a more severe TMJ kinematic impairment in Lp than in controls, with protrusion and left lateral movements significantly different. In addition, a remarkable reduction of salivary flow has been detected in Lp compared to controls. In conclusion, this autoimmune disease seems to play a role in oral manifestations and TMJ disorders, causing an increase in orofacial pain and an altered chewing function.

Effects of treatments for drooling on caries risk in children and adolescents with cerebral palsy.

BackgroundNeuromuscular impairment makes individuals with cerebral palsy (CP) more prone to drooling. Among the treatment options, there are procedures that interfere with saliva production. It is imperative to evaluate the effect of the different modalities since the reduction in salivary flow rate/production may exacerbate the risk of dental caries.Material and MethodsThe aim of this study was to compare the effects of different treatments for drooling on caries risk and salivary parameters in children and adolescents with CP.Study designA total of 142 children and adolescents with CP, aged 6 to 18 years, were assigned to groups based on the different treatments they had received for drooling: G1—anticholinergic drugs (n = 18), G2—botulinum toxin injection (n = 16), G3—salivary glands surgery (n = 16), G4—no treatment (n = 42), and G5—non-drooling subjects (n = 50). All participants were evaluated on the Simplified Oral Hygiene Index, and for the prevalence of dental caries (decayed, missing, and filled teeth index and white spot lesions). Unstimulated whole saliva was collected, and salivary flow rate and osmolality were measured. Chi-square, ANOVA and Poisson regression were calculated. Prevalence ratios and their respective 95 % confidence intervals were obtained. The significance level was fixed at 5%.ResultsNo differences were found in the decayed, missing, and filled teeth index (p = 0.128) and Simplified Oral Hygiene Index (p = 0.674) among the different groups. G3 presented significantly higher percentages of WSL (p<0.001), lower values of salivary flow rate (p<0.001), and higher values of osmolality (p<0.001). The white spot lesion prevalence ratio was higher only for G3 (Prevalence ratio = 14.36; IC 95% = 4.64-44.40; p<0.001).ConclusionsChildren and adolescents with CP who had received surgical treatment for drooling exhibited higher number of white spot lesions because of the reduced salivary flow rate and higher salivary osmolality. Key words:Cerebral palsy, saliva, sialorrhea, dental caries, osmolar concentration.

Caries-associated oral microbiome in head and neck cancer radiation patients: a longitudinal study

ABSTRACTHead and neck cancer (HNC) therapy often leads to caries development. Our goal was to characterize the oral microbiome of HNC patients who underwent radiation therapy (RT) at baseline (T0), and 6 (T6) and 18 (T18) months post-RT, and to determine if there was a relationship with increased caries. HOMINGS was used to determine the relative abundance (RA) of >600 bacterial species in oral samples of 31 HNC patients. The DMFS score was used to define patient groups with tooth decay increase (DMFS[+]) or no increase (DMFS[-]).A change in microbiome beta-diversity was observed at T6 and T18. The Streptococcus mutans RA increased at T6 in both DMFS[+] and DMFS[-] groups. The RA of Prevotella melaninogenica, the species often associated with caries in young children, decreased at T6 in the DMFS[-] group. The RA of the health-associated species, Abiotrophia defective, decreased in the DMFS[+] group. The oral microbiome underwent significant changes in radiation-treated HNC patients, whether they developed caries or not. Caries rates were not associated with a difference in salivary flow reduction between DMFS[+] andDMFS[-] groups. Patients who develop caries might be more susceptible to certain species associated with oral disease or have fewer potentially protective oral species.