Salivary Flow In Patients Research Articles

Profile of salivary gland flow dysfunctions in patients with differentiated thyroid carcinoma submitted to radioiodine therapy

AIM: To evaluate the effects of radioiodine therapy on salivary flow in patients with differentiated thyroid cancer. METHODS: A sample comprising 88 patients submitted to ablation with iodine 131 was included in the study. The patients were submitted to sialometry and evaluation of the presence of xerostomia before, 10 days and 3 months after radioiodine therapy. RESULTS: Xerostomia was observed in 36.4% of the patients before radioiodine therapy, 59.15% at 10 days after therapy, and 25% at 3 months after therapy. Significant differences were observed in non-stimulated salivary flow rates between the second and third evaluations (p<0.020) and in stimulated salivary flow between the first and second evaluations (p<0.010). CONCLUSIONS: The results suggest that changes in salivary flow resulting from radioiodine therapy are more pronounced during the first weeks after treatment and seem to regress after 3 months.

Sialometric analysis in young patients with chronic renal insufficiency

The present study aimed to evaluate whether or not quantitative changes occur in the salivary flow of patients with chronic renal insufficiency (CRI) who have been submitted to Hemodialysis. Twenty-nine chronic renal patients, between 4 and 25 years of age, submitted to Hemodialysis at Hospital Pequeno Príncipe in Curitiba, Paraná, Brazil participated in this study. The results form this study were compared with those of a group consisting of 29 healthy patients, paired by sex and age, whose parents sought out dental treatment at local health clinic in Campo Magro, Paraná. For Sialometric evaluations, samples were collected at the beginning, during and at the end of Hemodialysis, as well as after the analyses had been performed. Salivary flow was calculated by the Banderas-Tarabay formula (1997). The results revealed that the mean salivary flow values presented no difference between the groups. It could therefore be concluded that CRI did not determine quantitative alterations in salivary fluid.

Impact of highly active antiretroviral therapy on salivary flow in patients with human-immuno deficiency virus disease in Southern India

Aims:To ascertain and compare between highly active antiretroviral therapy (HAART) and non-HAART patients, the stimulated salivary flow rates and unstimulated salivary flow rates (USFR and SSFR) and to correlate the salivary flow rates with immune suppression.Materials and Methods:One hundred human-immuno deficiency virus seropositive patients attending RAGAS-YRG CARE were examined and divided into two groups, a HAART group (patients on combination antiretroviral therapy) comprising 50 patients and a non-HAART group comprising 50 patients. The HAART group was followed every 3 months after the baseline visit (0) for a period of 9 months, during which a clinical oral examination and collection of unstimulated and stimulated saliva was done. Their salivary gland function was assessed using a xerostomia inventory during each visit. The study on non-HAART group was cross-sectional.Statistical Analysis:Statistical analysis were performed with the aid of the Statistical Package for the Social Sciences (SPSS version 10.05) software.Results:There was no significant difference in mean SSFR and USFR between the two groups at baseline. In the HAART group, the mean stimulated salivary flow rate increased from baseline to 3 months (P = 0.02), with the increase being maintained at 6 months and 9 months. When salivary flow rates were correlated with Cluster of Differentiation, CD4 counts, patients in the HAART group with a CD4 ≤ 200 at 6 months visit had a higher mean stimulated salivary flow rate when compared with patients with CD4 ≥ 200 (P = 0.02). The xerostomia inventory did not reveal any significant difference between the two groups and HAART was not significantly associated with xerostomia.Conclusion:In our study HAART was neither associated with xerostomia nor a reduction in salivary flow rate and immune suppression was not a significant factor for decreasing the salivary flow rate.

Changes in Tongue Pressure, Pulmonary Function, and Salivary Flow in Patients with Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving nerve cells that control voluntary muscle movement (Rowland LP, Shneider NA, N Engl J Med 344(22):1688-1700, 2001). The aim of this study were to determine the pattern of neurodegenerative change in (1) isometric tongue strength (ITS) and spontaneous saliva swallow (SSS) pressure, (2) saliva weight, and (3) forced vital capacity (FVC) in patients with ALS who present with primary spinal versus primary bulbar symptoms. Twenty-three consecutive patients (age=48-80years, mean=59.5years) were enrolled. Data were collected over three visits (12-week interval) for each group: 9 patients with bulbar symptoms and 14 with spinal symptoms. A significant difference was noted in SSS and ITS in the group with bulbar symptoms from Trial 1 to II and from Trial II to III. SSS and ITS showed a significant difference when comparing Trial I to III but not when comparing Trial I to II for the spinal symptom group, indicating that this group experienced a slower decline in SSS. Saliva production did not show a significant change in the bulbar symptom group but did in the spinal group. FVC was significantly different when comparing Trial I to III and Trial II to III for both groups. FVC, SSS, and ITS may be complimentary measures used as a gauge of an ALS patient's ability to efficiently take oral nutrition and to support required alterations in diet consistency.

Assessing for Dry Mouth in Patients With Orofacial Pain may be Beneficial, but Study Does Not Provide Evidence

Article Title and Bibliographic Information Xerostomia and salivary flow in patients with orofacial pain compared with controls. da Silva LA, Teixeira MJ, de Siqueira JT, de Siqueira SR. Arch Oral Biol 2011;56:1142-7. Reviewer Wenche S. Borgnakke, DDS, MPH, PhD Purpose/Question To investigate whether salivary flow (saliva secretion per minute) and xerostomia (feeling of oral dryness) were related to orofacial pain Source of Funding The Foundation of Research of the State of Sao Paulo (FAPESP), Brazil; Grant # 2009/00350-6 Type of Study/Design Case-control study Level of Evidence Level 2: Limited-quality, patient-oriented evidence Strength of Recommendation Grade Not applicable

Stimulating neuronal processes that benefit patients and our profession

Stimulating neuronal processes that benefit patients and our profession

Correlation of Parotid Gland Function in Head and Neck Cancer Patients treated with Intensity-modulated Radiotherapy

ABSTRACTXerostomia is one of the most common side effects after radiation therapy for treating head and neck cancers. Our objective was to evaluate the salivary flow in patients treated with Intensity-modulated radiotherapy with two samples: (a) Resting saliva and (b) stimulated saliva. We performed three salivary sample collections: At the beginning, during and immediately after radiotherapy. The results showed that there was a significant decrease in the whole resting (11.46%) and stimulated (15.06%) salivary flow values during the first 3 weeks of the radiotherapy (p = 0.0025, p = 0.0034 respectively).How to cite this articleKhosa SK, Vahanwala S, Pagare SS. Correlation of Parotid Gland Function in Head and Neck Cancer Patients treated with Intensity-modulated Radiotherapy. Int J Head and Neck Surg 2012;3(1):1-4.

Xerostomia and salivary flow in patients with orofacial pain compared with controls

ObjectivesPain in the orofacial region is frequently reported by patients in dental and medical offices. Facial pain, headache, masticatory abnormalities and other complaints often become chronic and may be associated with local disturbances, such as xerostomia and teeth abnormalities. The objective of this study was to investigate salivary flow and xerostomia in patients with orofacial pain. DesignThis was a case-control study; we evaluated 82 patients with chronic orofacial pain compared with 56 healthy subjects using a Clinical Pain Questionnaire (pain characteristics, duration, intensity and descriptors), complete dental examination (including static and dynamic evaluation of the jaw) and a Xerostomia Inventory. The salivary flow was quantitatively evaluated. Data was compared through Pearson's chi-square, Fisher's exact, analysis of variance (ANOVA) 1 factor and Mann–Whitney tests. ResultsPatients often had temporomandibular disorder (TMD) (P=0.001) and pain during facial (P<0.001) and neck palpation (P=0.002). There were no differences in dental examination or other structural aspects of the jaw between the groups. There were more complaints associated with xerostomia in the study group, including burning sensation in the oral mucosa (P=0.003), in the throat (P=0.035) and in the stomach (P=0.050). Patients had lower salivary flow (P=0.008). ConclusionsOrofacial pain patients need to be evaluated with regard to their salivary function, which was often found abnormal in this sample and may have contributed to the complaints of these patients. Assessing salivary flow and xerostomia may help in the treatment of chronic orofacial pain.

A comparison of salivary substitutes versus a natural sialogogue (citric acid) in patients complaining of dry mouth as an adverse drug reaction: a clinical, randomized controlled study

We aimed to compare the efficacy of saliva substitutes and citric acid long-term therapy for oral dryness relief and unstimulated salivary flow in patients reporting drug-induced xerostomia. Fifty-four patients reporting drug-induced xerostomia were randomly subdivided into 3 groups and respectively administered artificial saliva, 3% citric acid, or distilled water in mouthwash 4 times a day for 30 days. Patients underwent measurement of unstimulated whole saliva before and after they finished therapy and were asked to note in a daily diary any symptomatologic changes 15 minutes and 1 hour after each daily intake of test solution. Fifteen minutes after solution intake, 12 patients (67%) belonging to the artificial saliva group, 9 (50%) from the citric acid group, and 2 (11%) from the water group reported significant symptomatologic improvement. One hour after solution intake, 7 patients (39%) from the artificial saliva group, 10 (56%) from the citric acid group, and 0 from the water group noted significant symptomatologic improvement. None of the drugs tested affected unstimulated whole saliva flow. Both artificial saliva and citric acid provided immediate relief from oral dryness. Citric acid also provided a longer-lasting feeling of oral moistness at 1 hour after use owing to its protracted activity on salivary gland function.

Sicca symptoms, and lacrimal and salivary flow in Albanian patients with rheumatoid arthritis

Rheumatoid arthritis affects primarily the synovial joints, but is often accompanied by extra-articular manifestations, including lacrimal and salivary gland involvement. The aim of the present study was to estimate the prevalence of ocular and oral sicca symptoms and reduced lacrimal and salivary flow in rheumatoid arthritis and the relation between sicca symptoms and objective measures of lacrimal and salivary flow. We examined 88 consecutive hospitalized patients with rheumatoid arthritis and 88 age- and gender-matched healthy controls. The examination included the standardized questionnaire for keratoconjunctivitis sicca and xerostomia which forms part of the European criteria for Sjögren's syndrome, the Schirmer's I test and measurement of unstimulated whole salivary flow rate. A significantly higher proportion of patients (40.9%) reported ocular sicca symptoms than healthy matched controls (8.0%). Further, a significantly higher proportion of patients (44.3%) reported oral sicca symptoms compared to controls (13.6%). 48.9% of the patients had low Schirmer I score, compared to 20.5% of controls. Reduced salivary flow was found in 27.3% of patients, compared to 9.1% of controls. The differences in lacrimal and salivary flow between patient and control group were statistically significant. The minimum prevalence of secondary Sjögren's syndrome was 14.8%. Weak association was observed between sicca symptoms and the objective measures of lacrimal and salivary flow in patients, and no association was detected in control subjects. Sicca symptoms and reduced lacrimal and salivary flow were common manifestations in rheumatoid arthritis and should be given adequate consideration during management of patients with rheumatoid arthritis.

Somesthetic, gustatory, olfactory function and salivary flow in patients with neuropathic trigeminal pain

To determine somesthetic, olfactory, gustative and salivary abnormalities in patients with burning mouth syndrome (BMS), idiopathic trigeminal neuralgia (ITN) and trigeminal postherpetic neuralgia (PHN). Twenty patients from each group (BMS, ITN, PHN) and 60 healthy controls were evaluated with a systematized quantitative approach of thermal (cold and warm), mechanical, pain, gustation, olfaction and salivary flow; data were analyzed with ANOVA, Tukey, Kruskal-Wallis and Dunn tests with a level of significance of 5%. There were no salivary differences among the groups with matched ages; the cold perception was abnormal only at the mandibular branch of PHN (P = 0.001) and warm was abnormal in all trigeminal branches of PHN and BMS; mechanical sensitivity was altered at the mandibular branch of PHN and in all trigeminal branches of BMS. The salty, sweet and olfactory thresholds were higher in all studied groups; the sour threshold was lower and there were no differences of bitter. All groups showed abnormal thresholds of gustation and olfaction; somesthetic findings were discrete in ITN and more common in PHN and BMS; central mechanisms of balance of sensorial inputs might be underlying these observations.

Effect of oral iron supplementation on unstimulated salivary flow rate: a randomized, double‐blind, placebo‐controlled trial

No treatment is known to permanently increase salivary flow in patients with hyposalivation. The objective of this study was to investigate the effect of iron supplementation on salivary flow rate. A double-blind, randomized, placebo-controlled trial was carried out on 50 individuals with a low unstimulated whole salivary flow rate and low serum ferritin. Half the individuals received 60 mg iron orally twice a day for 3 months, while the other half received placebo. No statistically significant difference was found between the groups after treatment for the unstimulated flow rate and in the subjective assessments of oral dryness. The serum ferritin values increased significantly in the iron group but not in the placebo group. Oral supplementation with iron for 3 months has no effect on salivary flow rate among individuals with hyposalivation and low serum ferritin values.

Pilocarpine for the treatment of salivary glands’ impairment caused by radioiodine therapy for thyroid cancer

To study the effect of single-dose pilocarpine hydrochloride 5 mg on the whole unstimulated and stimulated salivary flow in patients suffering from thyroid cancer treated with radioiodine therapy, and to investigate the changes in vital signs during the treatment. Five such patients were referred with complaints of dry mouth, rampant caries, and pain in the parotid gland region or history of chronic recurrent suppurative sialodenitis. A single dose of 5 mg pilocarpine hydrochloride was administered to each patient and blood pressure, heart rate, body temperature and salivary secretion rate were monitored at 1, 2 and 3 h. A significant elevation of unstimulated and stimulated saliva flow rate was observed in four patients without significant alteration of the monitored vital signs. Treatment with pilocarpine hydrochloride may be beneficial in the case of impaired salivary function in patients treated with radioiodine.

The long-term effect of anti TNF-α treatment on temporomandibular joints, oral mucosa, and salivary flow in patients with active rheumatoid arthritis: A pilot study

The objective of this study was to evaluate the long-term effects of anti-TNF-alpha treatment on temporomandibular joints (TMJs), oral mucosa, and salivary flow in RA. Seventeen patients received infusions of TNF-alpha blocking agents after 0, 2, and 6 weeks, and then every 8 weeks until week 54 (follow-up). Clinical dysfunction index (Di) for the TMJ system, salivary flow, disease activity score (DAS28), and other medical assessments were calculated at weeks 0 and 54. Median Di was 5.0 (range 0-21) at baseline and 1.0 (range 0-6) (P = .001) at follow-up. Mean salivary flow was 3.2 mL/15 minutes at baseline and 4.6 at follow-up (P = .055). Two (11.7%) of the patients developed oral candidiasis during the period of treatment. The median DAS28 was 6.2 (range, 4.7-7.7) at baseline and 4.1 (range, 1.6-6.8) at follow-up (P = .001). We conclude that anti-TNF-alpha blocking treatments have beneficial effects on oral as well as general manifestations of RA.

Quantitative changes at the salivary flow in patients undergone conventional and hyperfractionated radiotherapy

Quantitative changes at the salivary flow in patients undergone conventional and hyperfractionated radiotherapy

Reduction of salivary flow with botulinum toxin: extended report on 33 patients with drooling, salivary fistulas, and sialadenitis.

The aim of the study was the evaluation of the clinical data of 33 patients who had had drooling attributable to various diseases, salivary fistulas, and sialadenitis and had been treated with injection of botulinum toxin type A (Botox). A controlled follow-up study documenting efficiency, possible side effects, and duration of the effect of treatment was also performed. Retrospective clinical evaluation. Thirty-three patients with drooling attributable to head and neck carcinoma, neurodegenerative diseases, stroke, or idiopathic hypersalivation or with salivary fistula or chronic sialadenitis received injections of 20 to 65 U botulinum toxin type A into salivary glands under sonographic control. The entire salivary flow rate and the output per minute of the salivary analytes thiocyanate, total protein, alpha-amylase, acid phosphatase, kallikrein, and immunoglobulin A were measured at various times before and after injection. The patients were examined with regard to severity of their symptoms, including sonographic control investigation of their cephalic salivary glands. Twenty-six patients (79% of all patients) reported a distinct improvement of their symptoms after toxin injection. Seven patients noted a return of high salivation rates and requested a second injection after 4 to 7 months. Duration of toxin effect varied widely among individuals. In general, salivary flow rates and thiocyanate output dropped sharply within 1 week after injection and had increased again after a period of 12 to 16 weeks. Conversely, amylase outputs increased during this period, whereas the outputs of the other analytes remained roughly constant. Sonography did not reveal any major changes in salivary gland parenchyma, and side effects were not noted. Reduction of salivary flow in patients with drooling, salivary fistulas, or chronic sialadenitis by local injection of botulinum toxin type A into the salivary glands proved to be a dependable therapy for these disorders, as shown in the present extended report on 33 patients. Side effects were not observed. The effect of toxin application lasted for approximately 3 months. Based on their results, the authors recommend botulinum toxin injection as the therapy of choice in patients with the problem of drooling.

Evaluation of salivary flow in patients during head and neck radiotherapy

Radiotherapy is frequently employed for the treatment of head and neck squamous cell carcinoma. Among the side effects, xerostomia is one of the most important. With the objective of evaluating the role of radiotherapy in salivary flow, we performed three salivary sample collections: at the beginning of, during, and immediately after radiotherapy. The results showed that the salivary flow values of the first collection were very similar to those of the control group. However, during treatment, there was a significant decrease of the salivary flow (p = 0.0008), which continued low immediately after radiotherapy (p = 0.0009). Our study showed that radiotherapy leads to an important reduction of salivary flow during and after radiotherapy.

Whole stimulated salivary flow in patients with chronic hepatitis C virus infection.

Salivary gland disorders have been included among the extra-hepatic manifestations related to HCV infection. The whole stimulated salivary flow rate (spitting technique) was studied in 74 HCV infected patients to evaluate salivary gland dysfunction. The salivary flow of the patients with chronic HCV infection was similar to that of the healthy controls. The association between subjective xerostomia salivary flow was seen to be very weak. No significant associations were found between salivary flow and age, sex, risk factor of acquired infection, ALT, AST, GGT, ALP values, time lapsed since the diagnosis or HCV-RNA detection in saliva. Although the functional repercussion of hepatitis C related lymphocytic sialoadenitis remains unclear, we did not find a significant reduction in the whole stimulated salivary flow in HCV infected patients.

Xerostomia: Etiology and Clinical Management

AbstractXerostomia, or dry mouth, is a serious oral health problem that, when left untreated, leads to deterioration and disease in the oral cavity. Patients with dry mouth include those on xerogenic medications (including many elderly patients), those undergoing chemotherapy and radiation, and individuals with Sjögren syndrome, an autoimmune disease. Common complaints with dry mouth include difficulty in speaking, chewing, and tasting and swallowing foods. Patients with dry mouth will also complain of food sticking to the teeth, taste alterations, foods burning the oral tissues, and a burning tongue. The lack of saliva may lead to such complications as fungal infections (eg, candidiasis), atrophy of the filiform papillae of the tongue, mucosal ulcerations, salivary gland enlargement, an increase in the number of cariogenic, aerobic organisms Streptococcus and Lactobacillus, and rapidly progressing caries. Recommended therapy for patients with xerostomia includes regular dental visits, fluoride therapy, nutritional counseling, and patient education regarding oral home care to manage the high risk for dental decay. Some patients may also benefit from the use of artificial salivas or Pilocarpine, which is effective in increasing salivary flow in patients with functional salivary glands. Salivary stimulants and increased water intake are also recommended.

Salivary abnormalities in Prader-Willi syndrome.

Prader-Willi syndrome (PWS) is characterized by psychomotor and growth retardation, infantile hypotonia, characteristic facies, small hands and feet, dental abnormalities, and early onset of childhood hyperphagia with consequent obesity. PWS is associated with abnormalities of chromosome 15. Approximately 75% of patients have a deletion of 15q11q13 on the paternal homologue, whereas 20-25% have inherited both chromosome 15s from the mother and none from the father, a condition known as maternal uniparental disomy (UPD). Thus, it is a lack of paternal alleles in the 15q11q13 region that results in PWS. Thick, sticky saliva is a consistent finding in patients with PWS. We have characterized salivary flow and composition in individuals with PWS. Salivary flow in patients with PWS is approximately 20% of that in controls. In addition, the salivary ions and proteins are present in increased amounts, possibly reflecting a concentration effect relative to decreased water in the saliva. Both deletion and uniparental disomy patients exhibit these findings, suggesting that the gene(s) involved are subject to imprinting.