Saliva Flow Rate Research Articles

Apigenin, a Single Active Component of Herbal Extract, Alleviates Xerostomia via ERα-Mediated Upregulation of AQP5 Activation.

Xerostomia is a common symptom in menopausal women, suggesting the role of sex steroids in disease development. Shreds of literature had reported the potential use of herbal extracts to relieve xerostomia. However, a cocktail of multiple components in herbal extract makes it difficult to understand the exact mechanism of action. Aquaporin5 (AQP5), the specific aquaporin expressed in salivary glands, plays an important role in salivary secretion as a downstream of estrogen signaling. In this study, we aimed to unravel a single active herbal component as a therapeutic for xerostomia and investigate its mechanism of action. The effects of apigenin (flavonoid), dauricine (alkaloids), protopine (alkaloids), and lentinan (polysaccharides) on AQP5 transcription were screened in vitro. Only apigenin robustly induced AQP5 transcription and expression, and this effect was even robust compared to the effect of estradiol (E2, a positive control). Overexpression of estrogen receptor α (ERα) in the human salivary gland cell line (HSG) upregulated the AQP5 transcription and expression and the knockdown ERα reversed this effect, suggesting the role of ERα signaling on AQP5 activation in HSG cells. Docking results showed apigenin-specific binding sites in ERα. We further analyzed the therapeutic effect of apigenin on ovariectomized mice as a xerostomia model. The saliva secretion in the xerostomia group was reduced to one-third of the sham group, whereas the apigenin or E2 treatment for 12 weeks reversed this effect. Meanwhile, the water consumption in the xerostomia group was augmented obviously compared to the sham group, whereas the water consumption in the apigenin and E2 group was declined to the level of the sham group. Immunohistochemistry of submandibular glands revealed the downregulation of AQP5 expression in xerostomia mice compared to control. Apigenin, or E2 treatment, upregulated AQP5 expression in xerostomia mice. In conclusion, apigenin, a single active component of herbal extract, upregulated AQP5 expression in HSG cells via activation of ERα signaling and restored saliva flow rates in OVX mice. These results revealed apigenin as a single active component of herbal extract with the potential to treat xerostomia.

The effect and mechanism of gene Fam20a on the development and function of salivary glands in mice

ObjectiveThe influence of the knockout of gene Fam20a on mice salivary glands was studied in this research, to provide a potential gene therapeutic target for salivary gland dysfunction. DesignThe control group with genotype Fam20af/f and conditional knockout (cKO) group with Fam20af/f;K14-Cre were constructed with Cre-Loxp. The influence of Fam20a on the salivary glands was studied in terms of morphology, functionality and molecular mechanism. ResultsIn terms of morphology, the cross-sectional area ratio of ductal to the total was reduced in the cKO mice, while that of extracellular matrix to the total was increased. At the sub-microscopic level, the knockout of Fam20a led to abnormal sub-microscopic structure of the duct cells. Functionally, saliva flow rate was significantly reduced in cKO mice. The result was consistent with the change of acinar cell marker Aquaporin 5 which was abnormally diffusely expressed in the cytoplasm of acinar cells. Meanwhile, the expression of ductal cell markers Cytokeratin 7 and nerve growth factor β were significantly decreased, suggesting the abnormal development and function of the duct cells. The research on the mechanism reveals that the loss of Fam20a led to the decreased expression and varied localization of bone morphogenetic protein 4 (BMP4), and a significant decrease of the proportion of phosphorylated extracellular signal-regulated protein1/2 (ERK1/2) to total ERK1/2. These changes suggested that the loss of Fam20a attenuated the activity of the BMP/ERK signaling pathway. ConclusionsFam20a affects the morphology and function of salivary glands, probably by attenuating the activity of the BMP/ERK signaling pathway.

Efficacy of a 1% malic acid spray for xerostomia treatment: A systematic review and meta-analysis.

To assess the efficacy of topical sialogogue spray containing malic acid 1% for treating xerostomia. We searched PubMed, Cochrane Library, Embase, ClinicalTrials.gov and Web of Science databases. Literature search, screening, study selection, data collection, data extraction and assessment of bias risk were independently conducted by two reviewers. The study appraisal was performed by Cochrane Collaboration's tool for assessing bias risk. The systematic review registration number was PROSPERO-CRD42021241322. All statistical analyses were performed using Review Manager version 5.4. Five original articles involving 244 patients with xerostomia who received topical sialogogue spray (malic acid 1%) or placebo for two weeks were included in this review. Based on the questionnaire survey, the topical sialogogue spray (malic acid 1%) improved the symptoms of dry mouth significantly better than the placebo, which was reflected in the Dry Mouth Questionnaire (DMQ), Xerostomia Inventory (XI) and Visual Analogue Scale (VAS) scores. Regarding the increase in unstimulated and stimulated saliva flow rates, the intervention group was also better than the placebo group after a two-week course of treatment. Although the included studies are limited, our results show that topical sialogogue spray (malic acid 1%) is an effective method for the treatment of xerostomia. Additional randomised controlled trials in the future are needed to provide high-quality evidence of this therapy and to improve clinical practice guidelines.

Evaluation of the consequences of menopause on women with respect to salivary flow rate, gustatory function, and pH

Context: Saliva is considered a predictive gateway to the body. Alterations in salivary secretion can be assessed quantitatively and/or qualitatively. Thus, estimation of salivary components may give insight to the general health of an individual and be considered the mirror of the body's health. The health needs of women vary mainly due to hormonal fluctuations occurring throughout the woman's life. Hence, the “menstruation cycle and menopause” may affect the metabolism of periodontal tissue including swollen salivary glands, bright red swollen gums, or bleeding gums or might cause alterations in the flow rate of saliva, its pH, as well as taste function. Due to menopause, there are unique hormonal changes in women and they are more receptive to salivary alterations, such as sensitivity to hot and cold food, altered taste, burning sensation, and reduced flow rate of saliva that lead to xerostomia and atrophic gingivitis also. Aim: This research project is designed for the evaluation of “salivary flow rate,” gustatory perception, and “pH” of resting saliva in premenopausal, menopausal, and postmenopausal women. Subjects and Methods: The evaluation of salivary flow rate, gustatory perception, and salivary pH was carried out in a total of 105 women, each 35 from, the premenopausal, menopausal, and postmenopausal categories. Results: The present study observed significant alterations of reduced salivary flow rate, reduced sweet intensity, and pH in postmenopausal women than the menstruating women. Conclusion: Menopause is followed by a variety of alterations, few of which occur in the mouth. The use of salivary flow rate, gustatory perception, and pH is helpful to identify the risks linked with menopause.

Effect of salivary antimicrobial factors on microbial composition of tongue coating in patients with coronary heart disease with phlegm-stasis syndrome

Objective: Phlegm-stasis syndrome is one of the most common traditional Chinese medicine (TCM) syndromes and found in 59% of patients with coronary heart disease (CHD) in routine TCM clinical practice in China. One of the diagnostic criteria of phlegm-stasis syndrome is its characteristic white-greasy and thin tongue coating. We have previously reported that different types of tongue coating have different microbiome characteristics that can be used as diagnostic markers. However, the microbial characteristics of tongue coating of CHD patients with phlegm-stasis syndrome, including coating feature and underlying reason of formation, have rarely been reported. Herein, we examined the characteristic microbiome of tongue coating, and discussed the cause of tongue coating formation via salivary proteins in patients with phlegm-stasis syndrome. Methods: We examined white-greasy and thin tongue coatings obtained from 10 patients with CHD having phlegm-stasis syndrome (n = 10), and compared with those of patients with almost no coating – patients with Qi-Yin deficiency syndrome (n = 10) – and healthy controls (n = 10). 16S rRNA sequencing of tongue coating microbiome and isobaric tags for relative and absolute quantitation (iTRAQ)-based quantitative analysis of salivary proteins were used to detect tongue coating and salivary protein separately. Salivary levels of sIgA, lysozyme, and amylase were detected by ELISA. Results: We identified Candidatus_Saccharimonas and Candidate_division_TM7_norank as the prominent members of tongue coating in patients with CHD having phlegm-stasis syndrome. Salivary proteins involved in biological processes, pentose phosphate pathway, and complement and coagulation cascades were among the differentially expressed proteins identified in patients with CHD having phlegm-stasis syndrome on iTRAQ analysis. Moreover, the formation of microbiota in tongue coating was associated with salivary sIgA, lysozyme, and saliva flow rate. Conclusions: We explored the characteristics of microbial composition of tongue coating patients with CHD having phlegm-stasis syndrome and identified correlations between salivary proteins and microbiome formation, providing a theoretical and mechanistic basis for tongue coating formation.

Effect of salivary antimicrobial factors on microbial composition of tongue coating in patients with coronary heart disease with phlegm-stasis syndrome

Objective: Phlegm-stasis syndrome is one of the most common traditional Chinese medicine (TCM) syndromes and found in 59% of patients with coronary heart disease (CHD) in routine TCM clinical practice in China. One of the diagnostic criteria of phlegm-stasis syndrome is its characteristic white-greasy and thin tongue coating. We have previously reported that different types of tongue coating have different microbiome characteristics that can be used as diagnostic markers. However, the microbial characteristics of tongue coating of CHD patients with phlegm-stasis syndrome, including coating feature and underlying reason of formation, have rarely been reported. Herein, we examined the characteristic microbiome of tongue coating, and discussed the cause of tongue coating formation via salivary proteins in patients with phlegm-stasis syndrome. Methods: We examined white-greasy and thin tongue coatings obtained from 10 patients with CHD having phlegm-stasis syndrome (n = 10), and compared with those of patients with almost no coating – patients with Qi-Yin deficiency syndrome (n = 10) – and healthy controls (n = 10). 16S rRNA sequencing of tongue coating microbiome and isobaric tags for relative and absolute quantitation (iTRAQ)-based quantitative analysis of salivary proteins were used to detect tongue coating and salivary protein separately. Salivary levels of sIgA, lysozyme, and amylase were detected by ELISA. Results: We identified Candidatus_Saccharimonas and Candidate_division_TM7_norank as the prominent members of tongue coating in patients with CHD having phlegm-stasis syndrome. Salivary proteins involved in biological processes, pentose phosphate pathway, and complement and coagulation cascades were among the differentially expressed proteins identified in patients with CHD having phlegm-stasis syndrome on iTRAQ analysis. Moreover, the formation of microbiota in tongue coating was associated with salivary sIgA, lysozyme, and saliva flow rate. Conclusions: We explored the characteristics of microbial composition of tongue coating patients with CHD having phlegm-stasis syndrome and identified correlations between salivary proteins and microbiome formation, providing a theoretical and mechanistic basis for tongue coating formation.

Evaluation of Salivary Helicobacter pylori, Calcium, Urea, pH and Flow Rate in Hemodialysis Patients.

Helicobacter pylori infection is identified as a major cause of stomach ulcers, chronic inflammation and gastric cancer in hemodialysis patients. Dialysis also leads to changes in the composition and flow of saliva. The aim of this study was to investigate the salivary Helicobacter pylori infection, Calcium, Urea, pH and flow rate in hemodialysis patients in comparison to the healthy control group. In this study 48 hemodialysis patients and 48 healthy subjects were compared. The prevalence of Helicobacter pylori infection was determined by PCR method. Calcium, Urea, pH, salivary flow and gastrointestinal complications in both groups were measured and compared. Prevalence of Helicobacter pylori was 12.48 (25.0%) in the study group and 2.48 (4.2%) in the controls (P=0.000). Urea, calcium and pH were significantly higher in the patient group. The mean salivary flow rate decreased significantly in the patient group. 58.3% of patients group had gastrointestinal complications. Oral cavity as an important external source of Helicobacter pylori may play an important role in gastrointestinal problems of hemodialysis patients. Helicobacter pylori, Urea, calcium and pH were significantly higher in the patient group. Chronic renal failure can increase pH, urea and calcium in saliva and decrease salivary flow rate.

Evaluation of Realistic Sensation Using Biological Reaction Measurements for Food Videos Presented by KMMD.

We have prototyped a KANSEI multimedia display (KMMD) that is able to release scent through the screen in order to realize collaboration between images and scents. Two types of “sukiyaki” food videos were presented to subjects using this device, and a method for objectively evaluating the realistic sensation of the food videos was examined using biological reaction measurements. The sukiyaki scent was added to one type of video to improve appetite. Viewers’ saliva flow rate, line of sight, pupil diameter, autonomic nerve activity, and cerebral blood flow were measured at the same time, and changes in these measured values were analyzed. As a result, the scent was effective in improving the sensation, as if the food was present in front of the eyes and increasing the saliva flow rate. Additionally, in a realistic scene, it was found that the line of sight follows the performer’s eating behavior as if the viewers themselves are eating. The sympathetic nervous system temporarily increases, mydriasis occurs, and the frontal lobe is activated. Furthermore, the possibility of objective evaluation of realistic sensations was demonstrated by the correlation between appetite, accompanied by salivary sensation, and the biological reaction measurement results.

Specialized pro-resolving receptors are expressed in salivary glands with Sjögren's syndrome

Our previous studies demonstrated that resolvin D1 (RvD1) and its aspirin-trigged (AT) form AT-RvD1, are effective in decreasing inflammation while restoring saliva flow rates in a Sjögren's syndrome (SS)-like mouse model before and after disease onset. Resolvins are specialized pro-resolving mediators (SPM) that actively regulate inflammation. However, we only have extensive data within the salivary glands for RvD1 and AT-RvD1, both of which bind to the receptor ALX/FPR2. As such, the presence of other SPM receptors is unknown within salivary glands. Therefore, the goal of this study was to determine the expression of SPM receptors in non-SS and SS patients. For this purpose, six human minor salivary glands from female subjects were analyzed by H&E using the Chisholm and Mason classification to determine the degree of lymphocytic infiltration. Next, confocal immunofluorescence analysis was performed to determine the presence and distribution of different SPM receptors in mucous acini and striated ducts. We observed diffuse presence of lymphocytic infiltration and clinical data were consistent with SS diagnosis in three patients. Moreover, confocal immunofluorescence analysis indicated the presence of the receptors ALX/FPR2, BLT1 and CMKLR1 in the mucous acini and striated ducts of both non-SS and SS patients. GPR32 was absent in SS and non-SS minor salivary glands. In summary, our results showed that various SPM receptors are expressed in non-SS and SS minor salivary glands, all of which may pose as potential targets for promoting pro-epithelial and anti-inflammatory/pro-resolution signaling on SS patients.

Functional outcomes after submandibular gland-sparing neck dissection in patients with oral squamous cell carcinoma

The feasibility of submandibular gland (SMG) preservation during neck dissection has been described. The aim of this study was to analyse the functional outcomes in patients undergoing SMG preservation during neck dissection for cT1–2N0 oral squamous cell carcinoma. Consecutive patients were divided into two groups based on the management of the SMG, and underwent a saliva flow test before surgery, 7 days after surgery, and at 3, 6, 9, and 12 months after surgery. All enrolled patients completed the fourth version of the University of Washington Quality of Life (UWQOL) questionnaire at 12 months after surgery. In patients who underwent SMG preservation during neck dissection, the flow rate at 7 days after surgery was significantly lower than that preoperative; however, it gradually returned to baseline at 9 months after surgery. The saliva flow rate at 9 months after surgery was similar to that at 12 months after surgery. Further, patients with SMG preservation had higher scores for the activity, swallowing, chewing, and saliva domains than patients without SMG preservation. The results of the study suggest that saliva secretion ability can be preserved following SMG-sparing neck dissection, and that SMG preservation improves postoperative quality of life.

In vivo kinetic release of five metal ions (iron, titanium, nickel, copper, and chromium) from fixed orthodontic alloys in Erbil city-Kurdistan region/Iraq.

The orthodontic kinetic release of metal ions was studied in order to have a conclusive in vivo data for variation of metal ion concentrations with time (month) at normal oral temperature 37°C, which affects the saliva quality and quantity, pH, and chemical and physical characteristics of food and liquid. The superficial breakdown and release of metals from the alloy brackets were investigated by scanning electron microscopy (SEM) and energy dispersive X-Ray spectroscopy (EDS) images. The kinetic release experiment of the metal ion concentrations (nickel, chromium, titanium, iron, and copper) in the saliva uptakes follows a pseudo-second-order kinetic model; the release rate of metal ions was in series Fe2+ > Ti2+ > Ni2+ > Cu2+ > Cr3+, and the highest saliva pH and flow rate were detected after 1 month for fixed orthodontics appliance was (7.16 ± 0.55) and (0.88 ± 0.55) respectively.

Oral physiology, sensory acuity, product experience and personality traits impact consumers’ ability to detect particles in yoghurt

Food texture is a major driver of consumer food acceptance and is influenced by the presence of particles. The objective of this study was to determine if individual differences in human factors (demographic, oral physiology, product experience and psychology) are associated to consumers’ ability to detect particles in semisolid foods (namely yoghurt). A systematic design was employed involving nine yoghurt samples with spherical agar microgels added at levels in the range of human sensory threshold for particle detection in yoghurt. Consumers (n = 117) rated product acceptability, identified specific product sensory properties by Check All That Apply (CATA), and completed a questionnaire including demographics, personality typing, and product related questions. In addition, consumer saliva flow rate, mouth volume, tactile sensitivity, fungiform papillae density, and 6-n-propylthiouracil (PROP) and salt (NaCl) sensitivity were measured. Consumers who identified particles and/or drying in samples (by CATA) had significantly higher fungiform papillae density, were more oral tactile sensitive and were more sensitive to salt taste. The same consumers were more likely to have an open personality type, reported a preference for more cohesive yoghurt textures (fatty, spoonable, not-separated) and were more likely to have a history of consuming yoghurt products in combination with cereal and for preparation of smoothies. These results demonstrate that acceptance and rejection of particles in soft-foods is driven by a combination of intrinsic product factors and human factors. Understanding these drivers will assist the food industry to more accurately target products to specific markets.

Hyposalivation Response to Low-Level Laser in Diabetic Type 2 Patients

Abstract Background: Diabetes mellitus is a chronic metabolic disorder, which usually leads to various complications. Among these complications is salivary hypofunction characterized by an abnormal reduction in saliva flow rate. Aim of Study: The aim of this study was to find out the efficacy of LLLT on hyposalivation in diabetic type 2 patients. Patients and Methods: Twenty-five diabetic type 2 patients from both sexes (16 females and 9 males) were included in the study. Their ages ranged from 40 to 55 years old. Patients were recruited from the outpatient clinic of internal medicine, Suez Canal hospital. All patients included in the study were with whole resting saliva !90.16ml/min. The study was con-ducted from August 2020 to March 2021. The salivary flow rate was measured using the 'low forced spitting' method. The collection period was 5min. The salivary flow rate (ml/min) was calculated by dividing the collected salivary amount (volume in ml) by the time of collection period (5 minutes). The salivary flow rate was measured before starting of sessions (pretreatment), after the 6th session (post I), and after the 12th session (post II) in the same procedure. Patients were assigned into one experimental group received 12 sessions (2 sessions per week for 6 weeks) of low-level laser. LLLT was performed on the major salivary glands punctually. Three points were applied extraorally to each parotid gland, two to each sub-mandibular gland, and two to each sublingual gland. A total of 14 points were applied per session. Application duration was 30 sec per point (total duration of 14 points was 420sec). Results: There was a significant increase in salivary flow rate at the post I and post II compared with pretreatment (p < 0.001). The percent of change at the post I was 118.18% and at post II was 218.18%. There was a significant increase in salivary flow rate at post II compared with post I (p < 0.001) and the percentage of increase was 45.83%. Conclusion: These results suggested that LLLT had a hopeful effective role in improving hyposalivation related to diabetic complications.

Inorganic nitrate alleviates irradiation-induced salivary gland damage by inhibiting pyroptosis

Over 80% of patients undergoing radiotherapy (RT) for head and neck cancer (HNC) suffer reduced saliva secretion and dry mouth symptoms due to salivary gland damage. Although therapeutic interventions to alleviate such RT-induced damage are available, long-term hypofunction remains a significant issue. Therefore, novel therapeutic solutions to prevent irradiation (IR)-induced salivary gland damage are required. This study explored the protective effect of inorganic nitrate in preventing IR-induced salivary gland injury via pyroptosis suppression, both in vivo and in vitro. In the treatment group, C57BL/6 mice were pretreated with 2 mmol/L NaNO3 supplied in drinking water one week before a single-dose of 15 Gy IR in the submandibular gland (SMG) region. Human vein endothelial cells (HUVECs) and mice SMG cells were treated with 10 μmol/L or 100 μmol/L NaNO3 2 h before a single-dose of 8 Gy IR. In vivo, IR-induced decreased saliva flow rate and body weight loss could be alleviated by nitrate supplementation. Nitrate prevented acinar and microvascular endothelial cell loss. Moreover, nitrate improved mitochondrial function and significantly decreased pyroptosis-related indexes. In vitro, nitrate supplementation reduced reactive oxygen species (ROS) generation by preserving mitochondrial homeostasis to inhibit NLPR3 inflammasome-mediated pyroptosis both in HUVECs and SMG cells. Nitrate showed potential as an oral protective agent to prevent IR-induced salivary gland damage; prospective insight into the underlying molecular mechanisms is presented.

Labial gland-derived mesenchymal stem cells and their exosomes ameliorate murine Sj\xf6gren's syndrome by modulating the balance of Treg and Th17 cells

BackgroundSjögren's syndrome (SS) is a chronic, systemic autoimmune disorder characterized by sicca syndrome and/or systemic manifestations. The disease severely affects the health and life of patients, and the treatment of SS has always been a clinical challenge and essentially palliative. Mesenchymal stem cells (MSCs) have been reported to exert immunomodulatory effects and as a potential novel therapeutic strategy for SS. Labial gland-derived MSCs (LGMSCs) are a population of resident stem cells in the labial gland, first isolated by our group. Exosomes released by MSCs contain a large variety of bioactive molecules and considered to function as an extension of MSCs.MethodsLGMSCs were isolated from patients who were needed surgery to remove the lip mucocele and LGMSCs derived exosomes (LGMSC-Exos) were isolated by ultracentrifugation. The non-obese diabetic (NOD) mice were treated with LGMSCs or LGMSC-Exos by tail vein injection. The saliva flow rate of mice was determined and salivary glands were dissected and stained with hematoxylin and eosin. In vitro, peripheral blood mononuclear cells (PBMCs) from SS patients were cocultured with LGMSCs or LGMSC-Exos. Percentage of T helper 17 (Th17) cells and regulatory T (Treg) cells were determined by flow cytometry. The serum levels of cytokines in NOD mice and in the supernatant of the co-culture system by ELISA.ResultsTreatment with LGMSCs or LGMSC-Exos reduced inflammatory infiltration in the salivary glands, and restored salivary gland secretory function in NOD mice. Importantly, LGMSCs or LGMSC-Exos were demonstrated to inhibit the differentiation of Th17 cells but promote the induction of Treg cells in NOD mice and PBMCs from SS patients in vitro, accompanied by reduced interleukin 17 (IL-17), interferon gamma, and IL-6 levels and enhanced transforming growth factor beta and IL-10 secretion by T cells.ConclusionsLGMSCs are potential candidates for MSCs-based therapy and LGMSC-Exos might be utilized for establishing a new cell-free therapy against SS.

Sclerosing Sialadenitis Is Associated With Salivary Gland Hypofunction and a Unique Gene Expression Profile in Sjögren's Syndrome.

PurposeTo develop a novel method to quantify the amount of fibrosis in the salivary gland and to investigate the relationship between fibrosis and specific symptoms associated with Sjögren’s syndrome (SS) using this method.Materials and MethodsParaffin-embedded labial salivary gland (LSG) slides from 20 female SS patients and their clinical and LSG pathology data were obtained from the Sjögren’s International Collaborative Clinical Alliance. Relative interstitial fibrosis area (RIFA) in Masson’s trichrome-stained LSG sections was quantified from digitally scanned slides and used for correlation analysis. Gene expression levels were assessed by microarray analysis. Core promoter accessibility for RIFA-correlated genes was determined using DNase I hypersensitive sites sequencing analysis.ResultsRIFA was significantly correlated with unstimulated whole saliva flow rate in SS patients. Sixteen genes were significantly and positively correlated with RIFA. In a separate analysis, a group of differentially expressed genes was identified by comparing severe and moderate fibrosis groups. This combined set of genes was distinct from differentially expressed genes identified in lung epithelium from idiopathic pulmonary fibrosis patients compared with controls. Single-cell RNA sequencing analysis of salivary glands suggested most of the RIFA-correlated genes are expressed by fibroblasts in the gland and are in a permissive chromatin state.ConclusionRIFA quantification is a novel method for assessing interstitial fibrosis and the impact of fibrosis on SS symptoms. Loss of gland function may be associated with salivary gland fibrosis, which is likely to be driven by a unique set of genes that are mainly expressed by fibroblasts.

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.

Natural developing process of immunoglobulin G4-related sialadenitis after submandibular gland excision: a retrospective cohort study.

This study aimed to evaluate the long-term outcome and quality of life of IgG4-related sialadenitis (IgG4-RS) patients after submandibular gland (SMG) excision without immunomediate therapy. This retrospective review included patients with IgG4-RS who did not undergo further treatment following SMG excision. All patients diagnosed with IgG4-RS between January 1955 and December 2012 at the Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, were enrolled. The main outcome measures included postoperative IgG4-RS progression rate and differences between patients with and without recurrent disease. The degree of subjective oral dryness was evaluated using the summated xerostomia inventory (SXI); the objective secretory function was assessed by whole saliva flow rate measurements. Serological findings were analyzed during the follow-up. SMG excision was adopted in all of the 83 patients. The median follow-up period was 108 (range 7-396) months. Clinical progression was observed in 54.2% of cases. Patients with other organ involvement (OOI) indicated higher progression rate to a significant extent (P = 0.015, HR = 2.108). The annual progression rate was 20.7% in the group with OOI and was 14.1% in the group without OOI. All cases showed higher levels of serum IgG4; the level was in positive correlation with follow-up time when no therapy was added. 82.4% of cases experienced xerostomia after the surgery, and the degree of dry mouth in patients underwent bilateral resection was significantly more severe than those in unilateral resection. Surgical excision of involved SMG cannot control the disease progression, which is not recommended for treatment of IgG4-RS. Differential diagnosis is crucial in order to prevent irreversible organ loss and relevant salivary gland dysfunction. Key Points • Surgical excision of involved SMG cannot control progression of IgG4-RS.

The effect of space maintainers on salivary pH, flow rate, and the oral microflora

Abstract Background Space maintainers are used to preserve created space caused by the premature loss of primary teeth but they may also upset the oral environment and play a role in caries formation. The current research aimed to assess the impact of removable and fixed space maintainers on salivary pH, flow rate, and the oral microflora. Methods Thirty-eight patients aged between 4 and 10 years, each of whom required a fixed (n = 19) or removable space maintainer (n = 19), were enrolled in this research. The salivary pH, saliva flow rate, salivary Streptococcus mutans, and Lactobacillus counts were measured immediately prior to the placement of the space maintainers (baseline-T0) and during the follow-up period, at the 1st (T1), 3rd (T3), and 6th (T6) month. The Wilcoxon, Mann–Whitney U test and Friedman tests were applied for statistical analyses. Results Streptococcus mutans and Lactobacillus counts were significantly higher at the 6th month time period in comparison with the baseline scores for both groups (P &lt; 0.001). The salivary pH and flow rates did not change significantly at any measurement period (P &gt; 0.05). Conclusions Space maintainers can favour caries formation by changing the oral microflora. It is advisable to warn patients and their parents of the risks and provide motivation to perform meticulous oral hygiene.

Efficacy and safety of Tripterygium glycosides in Sjögren's syndrome treatment: evidence from 12 randomized controlled trials.

Tripterygium glycosides (TGs) has been widely used in the treatment of Sjögren's syndrome (SS). Seven databases, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Medical Database, China Science and Technology Journal Database, and the Chinese Biomedicine database, were selected to collect randomized controlled trials (RCTs) related to the treatment of SS with TGs alone or in combination. The participants, intervention, comparison, outcome, and study design principle were adopted for the inclusion of related studies. The risk of bias was assessed using the Cochrane Collaboration's tool. Meta-analysis was conducted using RevMan 5.3, with risk ratios (RRs) or standard mean differences (SMDs) and 95% confidence intervals (CIs). Overall, 12 trials involving 668 patients were analyzed. The results of the meta-analysis showed that TGs in combination with total glucosides of paeony (TGP) had significantly lower symptom scores than TGs alone on dry eyes (SMD =-0.61, 95% CI: -1.12 to -0.10, P=0.02) or dry mouth (SMD =-1.29, 95% CI: -1.84 to -0.74, P<0.00001). The efficacy rates of TG + TGP vs. TGs (P<0.00001) and TG + HM vs. TGs (P=0.01) were significantly different. In addition, compared to hydroxychloroquine (HCQ), TGs could induce expression of C-reactive protein (P=0.007), globulin (P<0.00001), and immunoglobulin A (IgA) (P=0.006), whereas the TG + TGP group had lower levels of immunoglobulin G (IgG) (P<0.00001), immunoglobulin M (IgM) (P=0.02), and IgA (P<0.00001), as well as saliva flow rate (P<0.00001) and lacrimal gland function (P<0.00001). The adverse events between TGs and HCQ were not evident, and there was no increase in the risk of adverse reactions when combined with other drugs. TGs are potentially effective for treating SS without increasing the risk of adverse events. High-quality, multi-center, and large-scale RCTs are required.