Salivary Gland Function In Patients Research Articles

Mesenchymal Stem/Stromal Cell Therapy for Radiation-Induced Xerostomia in Previous Head and Neck Cancer Patients: A Phase II Randomized, Placebo-Controlled Trial.

No effective treatment exists for radiation-induced xerostomia. The objective of this study was to compare the effect of adipose-derived mesenchymal stem/stromal cell (ASC) injection, relative to placebo, on salivary gland function in patients with radiation-induced xerostomia. In this single-centre, double-blind, placebo-controlled trial, patients with hyposalivation were randomised to receive ultrasound-guided injections of allogeneic ASCs or placebo into the submandibular glands. Patients were followed for 4 months. We evaluated unstimulated whole salivary flow rate (UWS), stimulated salivary flow rate, and patient-reported outcomes. Adverse events were recorded and immune response determined in blood samples. We enrolled 120 patients. ASC treatment resulted in a statistically significant UWS increase of 0.04 [95% confidence interval (CI), 0.02-0.06] mL/min (38%) compared with pretreatment baseline whereas placebo treatment did not cause a significant increase [0.01 (95% CI, -0.01 to 0.04) mL/min (21%)]. Both the ASC and placebo treatment yielded notable symptom reductions, with dry mouth decreasing by 13.6 and 7.7 units, sticky saliva decreased by 14.8 and 9.3 units, swallowing difficulties decreased by 7.9 and 8.0 units, and the summary score of the Xerostomia Questionnaire decreased 5.9 and 5.1 units for the ASC and placebo arms, respectively. We found no statistically significant group difference between the ASC and placebo arms for any of the outcomes. We could not confirm superiority of the ASC relative to placebo. ASC therapy significantly improved UWS in previous patients with head and neck cancer, whereas placebo resulted in an insignificant increase.

The association between autoantibody types and salivary gland hypofunction in patients with primary Sjögren's syndrome.

This study analyzed the association between autoantibody types and salivary gland hypofunction in patients with primary Sjögren's syndrome (pSS). A retrospective analysis was performed on patients who visited the Department of Orofacial Pain and Oral Medicine at Yonsei University Dental Hospital from January 1, 2010 to May 31, 2021, and who were diagnosed with pSS. Out of 191 patients who fulfilled the 2016 American College of Rheumatology/European League Against Rheumatism classification criteria, 50 were positive for both anti-Ro/SSA and anti-La/SSB, whereas 97 had anti-Ro/SSA but not anti-La/SSB antibodies. Forty-four patients for whom neither anti-Ro/SSA nor anti-La/SSB antibodies were found were diagnosed with Sjögren's syndrome by minor salivary gland biopsy. The anti-Ro/SSA antibody-positive group showed higher rheumatoid factor (RF) levels than the anti-Ro/SSA antibody-negative group. The anti-La/SSB antibody-positive group showed lower unstimulated whole saliva (UWS), stimulated whole saliva (SWS), higher erythrocyte sedimentation rate and RF level than the anti-La/SSB antibody-negative group. In addition, the group with both anti-Ro/SSA and anti-La/SSB antibodies showed lower UWS than the group with only anti-Ro/SSA antibodies. However, there were no significant differences in UWS or SWS after taking pilocarpine, and C-reactive protein. UWS and SWS were lower when a patient was positive for anti-La/SSB, showing that anti-La/SSB is more likely to be involved in salivary gland hypofunction than anti-Ro/SSA in patients with pSS. Therefore, performing laboratory tests, including anti-La/SSB, helps predict the prognosis of salivary gland function in patients with suspected pSS.

Effect of vitamin E and supragingival scaling on salivary gland function in patients with differentiated thyroid cancer treated with 131I.

The aim of this study was to evaluate the effect of vitamin E and supragingival scaling with vitamin C on the salivary glands of patients with differentiated thyroid carcinoma after 131I treatment. A total of 89 prospective patients with differentiated thyroid carcinoma were enrolled and randomly divided into the following groups: vitamin E group (n = 30, group A), vitamin C group (n = 30, group B) and supragingival scaling with vitamin C group (n = 29, group C). Using functional indices (e.g. maximum uptake fraction, uptake index, excretion fraction, secretion time and excretion rate), changes in the salivary gland functions before and a month after 131I treatment were assessed by dynamic imaging of salivary gland. We compared the before and after 131I therapy results of the three groups. In group A (P < 0.05), the excretion fraction and excretion rate of the left parotid gland were significantly higher, and the uptake index of the bilateral submandibular glands was significantly lower. No significant changes in salivary gland functional parameters were observed in group B (P > 0.05). The uptake index of the bilateral parotid glands and the excretion rate of the left parotid gland were significantly higher in group C (P < 0.05). The degree of serum amylase level reduction decreased significantly in group C (P < 0.05). Vitamin E showed a protective effect on parotid excretion function in patients with differentiated thyroid carcinoma who underwent 131I treatment. Supragingival scaling may be a promising radiation protector because it is associated with a protective effect on the salivary gland functions.

Effects of Radioiodine Treatment on Salivary Gland Function in Patients with Differentiated Thyroid Carcinoma: Experience at INMAS, Mitford

Background: Radioiodine therapy is very effective and popular method of choice for the treatment of carcinoma thyroid. Dry mouth is acommon side effects after radioiodine therapy and sequel of the salivary gland dysfunction. Many of the patients are suffering from this side effect. This study was designed to evaluatethe functionof the salivary gland of the patients treated with radioiodine therapy. Materials and methods: This cross sectional study was done in the Institute of Nuclear Medicine and Allied Sciences Mitford Dhaka for about 06 months from August 2019 to March 2020. About 51 patients were enrolled for this study having single dose of radioiodine therapy. Dynamic sialo scintigraphy with citrus stimulation was done after intravenous injection of 02 mci of Tc-99m. After 10 minutes of dynamic study lemon juice was given orally for the augmentation of the gland function. Result was interpreted as salivary gland dysfunction when a curve was uprising after lemon juice augmentation and normal functioning when fall off curve. Then data were compiled and analyzed by SPSS version 22. Results: The mean age of the study subjects were 35.1 ± 9.8, age ranged from 14~56 years, sixwere male and 45 were female participants. The mean dose was 4.3±1.1GBq, ranges from 1.8~7.4GBq. The proportion of salivary gland dysfunction was 60.8% while 39.2% had normal salivary gland function.Right salivary gland dysfunction was found in52.9% patients while 54.9% patient showed left salivary gland dysfunction. A little above a decile (13.7%) showed right submandibular gland dysfunction while a little less than that(7.8%) showed left submandibular gland dysfunction. Salivary gland dysfunction was related to the dose of the radioiodine therapy (p&lt;0.5). Higher dose of RAIT produced the odds of dysfunction in right parotid gland as 1.01, that of left parotid as 0.04, that of right submandibular as 0.09and that of left submandibular 0.60. Conclusion: Higher dose of radioiodine therapy was related with salivary gland dysfunction Bangladesh J. Nuclear Med. 24(1&amp;2): 36-41, 2021

Salivary gland condition before and after kidney transplantation: evaluation of salivary gland function in patients with end-stage chronic renal failure before and after kidney transplantation

The authors conducted a study of the state of the salivary glands in 50 patients with end-stage chronic renal failure. There was a pronounced violation of the function of the salivary glands (SG) in these patients by the type of xerostomy, which led to a change in the qualitative and quantitative indicators of mixed saliva. After the kidney transplant, the function of the SG improved, but did not fully recover. At the same time, there was an improvement in the hygienic condition of the oral cavity. Saliva cleanses the mucous membrane of the mouth from bacteria and food. It also immunoglobulins and lysozyme are involved in the formation of oral immunity. Saliva forms a food lump and makes it easier to swallow food. A decrease in salivation leads to digestive disorders and tooth decay. All patients with end-stage chronic renal failure showed a dysfunction in the work of the SG. A decrease in kidney function led to a change in the composition and nature of salivation. With saliva, toxic products were excreted, which normally were excreted only by the kidneys. Normalisation of salivation occurred after hemodialysis. Patients after kidney transplantation require long-term follow-up and preventive therapy for the salivary glands in order to improve and restore their function. Currently, there is no information in the literature about the state of SG in patients after kidney transplantation. This was the basis for this work.

Effects of low-level light therapy on xerostomia related to hyposalivation: a systematic review and meta-analysis of clinical trials

Hyposalivation is a condition represented by a reduced salivary flow and may include symptoms such as mouth dryness (xerostomia), loss of taste, pain, dysphagia, and dysphonia, all of which greatly affect an individual's quality of life.The aim of the present study was to systematically review the effects of low-level light therapy irradiation (photobiomodulation) on salivary gland function in patients with hyposalivation.The main question of the systematic review was: "Does low-level light irradiation therapy of the salivary glands affect salivary flow rate or indicators of salivary function (ion and protein concentrations) in patients with xerostomia or hyposalivation?" The question was based on the PICO (participant, intervention, control, outcome) principle and followed the PRISMA guidelines. Databases were explored and papers published between the years 1997 and 2020 were reviewed for the following Mesh-term keywords and their corresponding entry terms in different combinations: "Low-level light therapy," "Xerostomia," "Saliva," "Salivary glands," "Salivation."The initial sample consisted of 220 articles. Of those, 47 articles were used for full-text analysis and 18 were used for a systematic review, 14 were used in meta-analysis. According to their individual quality, most articles were classified as high quality of evidence according to the GRADE score. Meta-analysis of the evidence observed increase of unstimulated salivary flow 0.51 SMD compared to placebo (95% CI: 0.16-0.86), I2 = 50%, p = 0.005.The findings of our review revealed evidence of a beneficial effect of photobiomodulation therapy on salivary gland function. The therapy alleviates xerostomia and hyposalivation. However, these effects are reported short term only and did not induce lasting effects of photobiomodulation therapy on patients' quality of life.

Enhanced Salivary and General Oxidative Stress in Hashimoto's Thyroiditis Women in Euthyreosis.

Hashimoto’s thyroiditis (HT) is one of the most common autoimmune diseases. Although HT is inextricably linked to oxidative stress, there have been no studies assessing salivary redox homeostasis or salivary gland function in patients with HT. This study is the first to compare antioxidant defense and oxidative stress biomarkers in non-stimulated (NWS) and stimulated (SWS) whole saliva and plasma/erythrocytes of HT patients compared to controls. The study included 45 women with HT in the euthyreosis period as well as an age- and gender-matched control group. We showed that NWS secretion was significantly lower in HT patients compared to healthy controls, similar to salivary amylase activity in NWS and SWS. Catalase and peroxidase activities were considerably higher in NWS and SWS of HT patients, while the concentrations of reduced glutathione and uric acid were significantly lower in comparison with healthy subjects. Total antioxidant potential was significantly lower, while total oxidant status and the level of oxidation products of proteins (advanced glycation end products, advanced oxidation protein products) and lipids (malondialdehyde, lipid hydroperoxides) were significantly higher in NWS, SWS and plasma of HT patients. In conclusion, in both salivary glands of women with HT in euthyreosis, the ability to maintain redox homeostasis was hindered. In HT patients we observed oxidative damage to salivary proteins and lipids; thus, some biomarkers of oxidative stress may present a potential diagnostic value.

Analysis of novel Sjogren\u2019s syndrome autoantibodies in patients with dry eyes

BackgroundDry eye is a common problem in Ophthalmology and may occur for many reasons including Sjogren’s syndrome (SS). Recent studies have identified autoantibodies, anti-salivary gland protein 1 (SP1), anti-carbonic anhydrase 6 (CA6) and anti-parotid secretory protein (PSP), which occur early in the course of SS.The current studies were designed to evaluate how many patients with idiopathic dry eye and no evidence of systemic diseases from a dry eye practice have these autoantibodies.MethodsPatients from a dry eye clinic and normal controls were assessed by Schirmer’s test for tear flow. Sera were assessed for autoantibodies using ELISA assays. Statistics was performed with Prism 7 software and student’s unpaired t test.ResultsIn this study 60% of the dry eye patients expressed one of these autoantibodies. Only 30% expressed one of the autoantibodies associated with long-standing SS, which are included in the diagnostic criteria for SS, anti-Ro and anti-La. Patients with disease for less than 2 years and mild dry eyes did not express anti-Ro or anti-La, while 25% expressed anti-SP1. Similar observations, with smaller numbers, were made when patients had not only dry eye but also dry mouth.ConclusionsAntibodies to SP1, CA6 and PSP occur in some patients with idiopathic dry eyes. Further studies will be needed to determine how many of these patients go on to develop systemic manifestations of SS. Testing for these autoantibodies may allow early recognition of patients with SS. This will lead to improved management of the patients and the development of new strategies to maintain normal lacrimal and salivary gland function in patients with SS.

Effect of Transcutaneous Electrical Nerve Stimulation on Parotid Saliva Flow in Patients with Hyposalivation.

Context:In recent days, we have come across an increase incidence of dry mouth as a side effects of drugs and in order to bring an awareness about a simple non- invasive method to increase the salivary flow, we have used TENS which in many way is beneficial to patients with metabolic disorders.Aims and Objectives:The aim is to assess the effectiveness of transcutaneous electrical nerve stimulation on salivary gland function in patients with hyposalivation.Subjects and Methods:The present study included total of 25 subjects with complaint of hyposalivation. Written informed consent was obtained from all the participants. Subjects with pacemakers, autoimmune diseases, pregnancy, and history of salivary gland pathology were excluded from the study. Subjects were asked to refrain from eating, drinking, chewing gum, smoking, and oral hygiene procedures for at least 1 h before the appointment. Unstimulated saliva was collected using modified Carlson Crittenden cup placed over the Stenson's duct bilaterally for 5 min and measured. TENS pads were placed over the parotid region and were activated. The intensity control switch was adjusted for patient's comfort. The intensity was turned up 1 increment at a time at 5 s intervals until the optimal intensity level was reached and stimulated saliva was then collected for 5 min using the modified Carlson Crittenden cup and measured. Any increase in parotid salivary flow (SF) with electrostimulation was considered a positive finding.Statistical Analysis Used:A paired t-test, evaluating mean changes in stimulated versus unstimulated SF rates, was applied to look for statistically significant differences using PASW 18.0 for Windows. An independent sample t-test was performed to note difference between genders.Results:There was significant increase in parotid SF in 19 of 25 patients after transcutaneous electrical nerve stimulation. Males showed more salivary secretion when compared to females.Conclusions:From the results of the study and within limitations of the study, it can be concluded that TENS was effective in increasing the SF rate in hyposalivatory patients with residual saliva. TENS was less effective in patients who are under xerogenic drugs. Thus, TENS may be an ever-growing armamentarium in the management of salivary gland hypofunction when other therapies have failed or are contraindicated.

Salivary Amylase as a Marker of Salivary Gland Function in Patients Undergoing Radiotherapy for Oral Cancer.

The aim of this study was to evaluate salivary amylase in patients with primary oral cancer undergoing radiotherapy as the main modality of treatment. The study was conducted on ten histologically proven cases of oral cancer undergoing radiotherapy. Stimulated whole saliva was collected at three stages of radiotherapy-0, 3, and 6 weeks. Salivary amylase was estimated using Henry-Chiamori method and comparison was made with appropriate age- and gender-matched controls. Salivary amylase levels showed significant decrease in healthy subjects when compared to oral cancer patients (P < 0.001). The latter group also showed changing trend with initial decrease from 0 to 3 weeks followed by increase from 3 to 6 weeks following radiotherapy (P < 0.0528). The trend in changes in the levels of salivary amylase could be used as a surrogate marker of salivary gland function in patients with oral cancer undergoing radiotherapy as primary treatment.

Diffusion-weighted magnetic resonance imaging for evaluation of salivary gland function in head and neck cancer patients treated with intensity-modulated radiotherapy

Background and purposesPermanent xerostomia as a result of radiation-induced salivary gland damage remains a common side effect of radiotherapy (RT) of the head and neck. The purpose of this study was to evaluate the usefulness of diffusion-weighted magnetic resonance imaging (DW-MRI) in assessing the post-RT salivary gland function in patients with head and neck cancer (HNC). Materials and methodsIn this prospective study, 20 HNC patients scheduled for bilateral neck chemoradiotherapy (CRT) with weekly cisplatin went through diffusion-weighted magnetic resonance imaging (DW-MRI) and salivary gland scintigraphy (SGS) prior to and at a mean of six months after completing the treatment. The changes in apparent diffusion coefficient (ADC) before and after treatment were compared with ejection fraction (EF) measured with SGS and the radiation dose absorbed by the salivary glands. ResultsAs a result of gustatory stimulation with ascorbic acid, the ADC showed a biphasic response with an initial increase and subsequent decrease. This pattern was seen both before and after RT. Post-RT ADC increased as a function of RT dose absorbed by the salivary glands. A moderate statistical correlation between pre- and post-RT ADCs at rest and EF measured with SGS was found. ConclusionsDW-MRI seems a promising tool for detection of physiological and functional changes in major salivary glands after RT.

Value of magnetic resonance sialography in evaluation of salivary gland function in patients with nasopharyngeal carcinoma treated with radiotherapy

Objective To investigate the feasibility of magnetic resonance sialography (MRS) in the evaluation of salivary gland function in patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy. Methods The MRS images of parotid and submandibular glands were collected in resting and stimulated states among 32 patients with nasopharyngeal carcinoma before and after radiotherapy. The visibility of the salivary ducts and radiation-induced xerostomia were evaluated, and the relationship between radiation-induced acute xerostomia grade and MRS score was analyzed. Comparison of the visibility and score between two groups was made by paired t test, and the correlation between acute xerostomia grade and MRS score was determined using the Spearman rank correlation method. Results Both the visibility of salivary duct and MRS score were significantly reduced after radiotherapy (P=0.000, P=0.000). There were significant differences in the variation of MRS scores of the parotid (DPS) and submandibular glands (DSS) from the resting state to the stimulated state between patients with severe and non-severe acute xerostomia (P=0.009; P=0.005). There were no significant differences in MRS scores of the parotid and submandibular glands in resting and stimulated states between patients with severe and non-severe acute xerostomia (P=0.881, P=0.305, P=0.327, P=0.229). The Spearman correlation analysis showed that the acute xerostomia grade was negatively correlated with DPS and DSS (R=-0.472, P=0.006; R=-0.482, P=0.005). Conclusions MRS score is correlated with xerostomia grade. MRS can be used to evaluate the salivary gland function in patients with nasopharyngeal carcinoma treated with radiotherapy. Key words: Xerostomia; Magnetic resonance sialography; Salivary gland; Nasopharyngeal neoplasms/radiotherapy

Effects of radiotherapy on salivary gland function in patients with head and neck cancers

Background/purposeWe explored changes in salivary gland function of head-and-neck cancer patients after radiotherapy, including pH of saliva, stimulated salivary flow rate, and saliva buffering capacity. The pH of saliva included that of parotid gland, submaxillary gland, and total resting saliva. We also investigated whether the acidity of dental plaque lowered pH of saliva. Materials and methodsFrom a total of 62 patients, 11 had repeated measurements taken before and every month after radiotherapy. The remaining 51 patients had a single measurement taken after radiotherapy. Seven normal patients served as the control group. ResultsIn the repeated measurement group, all examinations decreased dramatically in the 1st month after radiotherapy (P < 0.0001), and recovered from the 3rd month to the 6th month, but the flow rate could not return to pretreatment level. In the single measurement group, unilabiate linear regression analysis showed that the time-period after radiotherapy was a significant predictor influencing the pH of the submaxillary gland and total resting saliva. Pearson correlation coefficient analysis showed that the pH of dental plaque had a positive linear correlation with that of saliva. Concerning the influence of time-period, within 1 year after radiotherapy, all examinations were dropped. After 1 year the pH of resting saliva and plaque began to increase over time. The stimulated flow rate, pH of stimulated saliva, and buffering capacity, dropped < 1 year after radiotherapy group, increased 1–5 years after radiotherapy group, but dropped again > 5 years after radiotherapy group. ConclusionOur results indicated that oral hygiene care is important especially during the early period after radiotherapy.

Evaluation of the effect of isotretinoin on salivary gland function by Tc-99m pertechnetate imaging in acne vulgaris patients.

Isotretinoin is an effective drug utilized in the management of acne vulgaris and is known to cause dry mouth. In this study, we aimed to evaluate this effect of isotretinoin on the salivary gland function in patients with acne vulgaris using technetium-99m (Tc-99m) pertechnetate imaging of the salivary glands. The study population consisted of 28 patients with acne vulgaris (6 males and 22 females, mean age 20.2 ± 2.3 years), who were treated with isotretinoin for 6 months. We performed radionuclide imaging of the salivary glands pretreatment and at months 3 and 6 of treatment. After 185 MBq (5 mCi) of Tc-99m pertechnetate was intravenously administered, imaging of the salivary glands was performed over a 25-min period. We measured the following glandular function parameters for the parotid and submandibular salivary glands via time-activity curves: uptake ratio, maximum accumulation, and ejection fraction. Statistically significant differences were observed in the values obtained at months 3 and 6 of treatment, compared with the pretreatment values. This study demonstrated that radionuclide imaging of the salivary glands can clearly show the glandular functions that are affected by drugs such as isotretinoin.

Establishment of Functional Acinar-like Cultures from Human Salivary Glands

Disorders of human salivary glands resulting from therapeutic radiation treatment for head and neck cancers or from the autoimmune disease Sjögren syndrome (SS) frequently result in the reduction or complete loss of saliva secretion. Such irreversible dysfunction of the salivary glands is due to the impairment of acinar cells, the major glandular cells of protein, salt secretion, and fluid movement. Availability of primary epithelial cells from human salivary gland tissue is critical for studying the underlying mechanisms of these irreversible disorders. We applied 2 culture system techniques on human minor salivary gland epithelial cells (phmSG) and optimized the growth conditions to achieve the maintenance of phmSG in an acinar-like phenotype. These phmSG cells exhibited progenitor cell markers (keratin 5 and nanog) as well as acinar-specific markers—namely, α-amylase, cystatin C, TMEM16A, and NKCC1. Importantly, with an increase of the calcium concentration in the growth medium, these phmSG cells were further promoted to acinar-like cells in vitro, as indicated by an increase in AQP5 expression. In addition, these phmSG cells also demonstrated functional calcium mobilization, formation of epithelial monolayer with high transepithelial electrical resistance (TER), and polarized secretion of α-amylase secretion after β-adrenergic receptor stimulation. Taken together, suitable growth conditions have been established to isolate and support culture of acinar-like cells from the human salivary gland. These primary epithelial cells can be useful for study of molecular mechanisms involved in regulating the function of acinar cells and in the loss of salivary gland function in patients.

Assessment of the effect of interferon-beta1a therapy on thyroid and salivary gland functions in patients with multiple sclerosis using quantitative salivary gland scintigraphy.

Objective: Interferon-beta (IFN-β) is widely used in patients with multiple sclerosis (MS), a demyelinating disease of the central nervous system. High incidence of thyroid dysfunction has been reported after administration of IFN-β in MS patients. The aim of this study was to assess the effect of IFN-β1a therapy on simultaneous thyroid and salivary gland function in patients with MS using quantitative salivary gland scintigraphy (QSGS). Methods: Fifteen relapsing-remitting (RR) MS patients treated with IFN-β1a and two control groups consisting of 15 untreated RRMS patients and 20 healthy age and sex-matched individuals were included in the study. The functional status of the salivary and thyroid glands was analysed with the QSGS and laboratory tests, including thyroid function and thyroid antibody. After intravenous administration of 150 MBq Tc-99m pertechnetate, dynamic study was performed for 25 minutes. Salivary gland secretion was stimulated with oral lemon juice at 15 minutes. At the end of dynamic study, a static image in the same projection was taken. Uptake ratios at 12-14 min (UR%) and stimulated excretion fraction (EF%) of each parotid and submandibular gland were calculated automatically from SGS. Thyroid uptake ratio (TUR) of thyroid gland was calculated from the static image. Results: All MS patients treated and untreated with IFN-β1a, and healthy individuals were euthyroid. Anti-thyroid peroxidase antibody (anti-TPO) was detected in 4 out of 15 MS patients (26.6%) treated with IFN-β1a. There was no significant differences in the UR, EF and TUR values among MS patients treated and untreated with IFN-β1a, and healthy controls (p>0.05). Although the TUR values in MS patients treated with IFN-β1a were less than those of the both control group, the difference was not statistically significant (p>0.05). Conclusion: IFN-β1a therapy was demonstrated to have no effect on thyroid and salivary gland functions using QSGS in patients with MS. Thyroid and salivary gland functions were also found to remain unchanged in untreated MS patients.

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

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

PP138: Effects of pilocarpine on salivary gland function after postoperative radioiodine therapy for differntiated thyroid cancer

Purpose The aim of this study was to investigate the effect of pilocarpine on salivary gland function in patients with postoperative 131I therapy-induced salivary dysfunction using a visual analog symptom scale and quantitative analysis of salivary flow rate, as well as salivary gland scintigraphy. Materials and methods Fifty patients who had RI-induced salivary dysfunction (sialadenitis, xerostomia, or hypogeusia) after treatment of 131I for postoperative ablation of differentiated thyroid cancer were enrolled. 25 patients were assigned randomly to the pilocarpine treatment group, which received 5 mg pilocarpine tid in addition to traditional conservative treatment such as hydration, sucking on sour candies or lemons, and massaging the affected gland, and 25 patients were assigned to the control group with only conservative treatment. Salivary dysfunction was graded according to a visual analog symptom scale before and 3 month after treatment. Salivary flow rate was measured and quantitative salivary gland scintigraphy was performed for analysis of salivary parenchymal function. Results There were no statistical differences in the mean age and the mean dose of 131I administered between two groups. The salivary symptom scale on sialadenitis was significantly improved in the treatment group compared to the control group. But pilocarpine treated group showed no significant improvement of the function parameter by salivary flow rate as well as quantitative salivary scintigraphy compared to the control group. Conclusions Pilocarpine treatment reduced the occurrence of symptoms on salivary dysfunction. Salivary flow rate and scintigraphic parameters were not statistically different between the pilocarpine treated and control group, which suggest that adding pilocarpine to traditional sialogogues may not improve the parenchymal damage to salivary gland.

Does hyperbaric oxygen therapy have the potential to improve salivary gland function in irradiated head and neck cancer patients?

Following radiotherapy, many patients with osteoradionecrosis suffer from xerostomia, thereby decreasing their quality of life. Patients can develop problems with speech, eating, increased dental caries, dysphagia, fractured dentition, chronic refractory osteomyelitis and osteoradionecrosis. Symptoms associated with salivary gland dysfunction can be severe enough that patients terminate the course of their radiotherapy prematurely due to the decrease in their quality of life. Currently, the only treatments available to patients are palliative. A definitive treatment has yet to be discovered. Head and neck cancers, which comprise 5% of overall cancer treatments, rank 8th most expensive to treat in the United States today. Hyperbaric oxygen is being considered for the therapy of radiated salivary glands because it has been shown to stimulate capillary angiogenesis and fibroplasia in radiation treated tissues. It has been hypothesized that salivary acinar cells undergo apoptosis following radiation therapy. The purpose of this paper is to discuss the mechanisms of salivary gland injury and evaluate whether hyperbaric oxygen therapy improves salivary gland function in patients who develop xerostomia and osteoradionecrosis following head and neck radiation.

Effect of Ribavirin Therapy on Salivary Gland Function: An Oral Medicine Prespective

Dear Editor, We read with keen interest the recently published paper entitled Ribavirin impairs salivary gland function during combination treatment with pegylated interferon alfa-2a in hepatitis C by Aghemo et al[1] in your esteemed journal. The study described the effect of ribavirin plus interferon therapy (combination therapy) on salivary gland function. However, we think we must put pen to paper with respect to draw the attention of your respectful readers to possible misinterpretation of the data that has been presented. Even at the beginning of the third millennium, hepatitis C virus (HCV) infection remains a major global public health problem, and to date, combination therapy seems to be the most effective treatment option. Nonetheless, this treatment might result in some side effects such as lichen planus, skin rash, psychological disturbances, poor appetite, anemia, and leucopenia [2]. Derived results of the study by Aghemo et al might be affected by some confounding factors. First, although the authors had mentioned that a limitation of their study was using patients who had hepatitis B virus (HBV) infection as the control subjects, it cannot iron out all the attributed results of choosing an unsuitable control group. Previous studies have shown that HCV infection in the epithelial cells of the salivary glands is a factor associated with the development of sialadenitis and Sjogren's syndrome [3]. However, to our knowledge, no previous study has shown such a conclusive correlation with HBV infection. Because of the observed inconsistencies in the findings of these studies, it does not seem appropriate to conclude that the use of drugs is the sole cause of salivary gland malfunction. In addition, it is unclear that why the authors used such a small control group; the use of a small sample size raises questions regarding the reliability of the rate of side effects expressed by the patients in this group. An advantage of their study was that they used stimulated saliva for evaluating sialadenitis. Previous studies have confirmed that stimulated whole saliva is especially useful in measuring salivary gland function in patients with common autoimmune disorders. The main advantage of gustatory stimulation is reduction in the variability of salivary flow rates among study subjects [4]. Several studies have been conducted on the role of oral fluids (namely saliva and gingival crevicular fluid) in viral hepatitis. However, no conclusive results have been obtained on the role of oral fluids in the transmission or diagnosis of viral hepatitis, its progress, or treatment monitoring. Further studies are required to assess the variations in the levels of oral fluid secretion in patients with viral hepatitis. If such changes can be proven, it might help identify why the rate of dental caries is significantly higher in patients with HCV infection than in the general population [5]. We suggest that randomized controlled trials and experimental observations, including salivary gland function monitoring before and after treatment, to be conducted in HCV-infected patients. Evaluating the presence of HCV in salivary gland tissues could also yield accurate results.