Stimulated Saliva Research Articles

Effectiveness of low-dose doxycycline (LDD) on clinical symptoms of Sjögren's Syndrome: a randomized, double-blind, placebo controlled cross-over study

BackgroundMatrix metalloproteinases (MMPs) are proteolytic enzymes that may contribute to tissue destruction in Sjögren's syndrome (SS). Low-dose doxycycline (LDD) inhibits MMPs. We evaluated the efficacy of LDD for the subjective symptoms in primary SS patients.This was a randomized, double blind, placebo controlled cross-over study. 22 patients were randomly assigned to receive either 20 mg LDD or matching placebo twice a day for 10 weeks. The first medication period was followed by 10-week washout period, after which the patient received either LDD or placebo, depending on the first drug received, followed by the second washout period. Stimulated saliva flow rates and pH were measured before and after one and ten weeks of each medication and after washout periods. VAS scale was used to assess the effect of LDD and placebo on following six subjective symptoms: xerostomia; xerophtalmia; difficulty of swallowing; myalgia; arthralgia; and fatigue. The effect was evaluated for each medication and washout period separately.ResultsOverall, the effects of medications on subjective symptoms were minor. Wilcoxon test demonstrated increased fatigue with LDD during medication (p < 0.05). The differences may, however, reflect normal fluctuation of symptoms in SS patients.ConclusionLDD may not be useful in reducing the primary SS symptoms.

A Comparative Study of the Secretory IgA immunoglobulins(s.IgA) in Mothers and Children with SECC versus a Caries Free Group Children and their Mothers

Early childhood caries (ECC) is recognized as an infectious disease. The first step in its development is primary infection by the bacterium S. mutans which has been identified as the primary etiologic factors in dental caries. Lactobacilli were also found to play a role in the progression of disease. However the underlying mechanism of immune response to caries is unclear. The association between secretory IgA (s.IgA) and cariogenic microorganisms is still controversial. The purpose of this study was to assess the level of salivary IgA in caries free children, and children with SECC and their corresponding mothers. The study also aims at correlating the children's levels to their mothers'. Sixty children and their mothers attending the dental clinic in King Abdulaziz University participated in our study. Their age ranged from 3 - 5 years. The study groups consisted of thirty children with SECC and a control group consisting of thirty caries free children. Children together with their mothers were examined and their caries level was recorded. Stimulated saliva was collected from each participant for immunological assessment. The secretory IgA (s. IgA) level was assessed by ELISA test. Our study has shown that children with SECC and their mothers had higher levels of s. IgA than the caries free children and their mothers. A positive high correlation was found between secretory IgA of mothers and children in both groups.

Genotypic and phenotypic analysis of Streptococcus mutans from different oral cavity sites of caries‐free and caries‐active children

Streptococcus mutans exhibits extensive genotypic diversity, but the role of this variation is poorly understood. This study aimed to determine the number and distribution of genotypes of S. mutans isolated from caries-active and caries-free children and to evaluate some of their phenotypic traits. Stimulated saliva, tongue surface and biofilms over sound and carious teeth surfaces were sampled from 10 caries-free and 11 caries-active children aged 5-8 years. A total of 339 isolates of S. mutans were genotyped by arbitrarily primed polymerase chain reaction using OPA2 primer. One isolate from each genotype was tested for its acid susceptibility and its ability to form a biofilm. Fifty-one distinct genotypes were determined, one to three genotypes in each oral sample. A single genotype was detected in seven children, whereas the remaining 14 children exhibited two to seven genotypes. There were no significant differences in the number of genotypes detected in caries-free and caries-active children. No correlation was observed between the number of genotypes and the mutans streptococci salivary levels. Five of the six high biofilm-forming genotypes were obtained from caries-active children, although the differences in biofilm formation between isolates from caries-free and caries-active children were not statistically significant. Genotypes with low susceptibility to acid challenge were statistically more frequent among isolates from caries-active children than among those from caries-free children. The present data suggested that there were differences in the distribution of genotypes of S. mutans according to the oral site and that S. mutans populations differ in their acid susceptibility and ability to form biofilms, factors allowing their colonization of sucrose-rich environments.

Serum markers of chronic dehydration are associated with saliva spinability

Findings of a relationship between saliva and dehydration have been observed, but the precise nature of these relationships is unclear and no evidence of a direct link has been found. In particular, no study reports a relationship between chronic dehydration and saliva conditions in community-dwelling older adults. This study aimed to identify whether salivary conditions are sensitive to body hydration markers in an elderly population. A total of 403 subjects aged 76 years participated in the study. Stimulated saliva flow rate and spinability of saliva were measured. In addition, determinations of serum levels of uric acid, blood urea nitrogen (BUN), creatinine, sodium and potassium were made. Dehydration was defined as uric acid >/= 7 mg dL(-1) according to the standard value. The salivary spinability were significantly associated with the concentration of uric acid (OR=2.06, P=0.044) according to multiple logistic regression analysis. In addition, after adjusting for gender, the uric acid concentration and the salivary spinability was significantly associated with BUN, potassium and creatinine levels. The subjects with high uric acid levels (>/= 7 mg dL(-1)) had the most elastic saliva. Both BUN and serum creatinine are the most commonly used indicators of renal function. Therefore, our findings might demonstrate that older adults who are dehydrated showed highly elastic saliva, which was associated with renal function. In conclusion, this study suggests that there is a significant relationship between chronic dehydration status and salivary spinability level.

A Comparative Study of Streptococcus Mutans and Lactobacilli in Mothers and Children With Severe Early Childhood Caries (SECC) Versus a Caries Free Group of Children and Their Corresponding Mothers

Early childhood caries (ECC) is recognized as an infectious disease. The first step in its development is primary infection by the bacterium S. mutans which has been identified as the primary etiologic factors in dental caries. Lactobacilli were also found to play a role in the progression of the disease. However, the underlying mechanism of immune response to caries is still unclear. The purpose of this study was to assess the level of cariogenic bacteria namely S. mutans and lactobacilli in caries free children, and children with SECC and their corresponding mothers. he study also aims at correlating the children's levels to their mothers. Sixty children and their mothers attending the dental clinic in King Abdulaziz University participated in our study. Their age ranged from 3 - 5 years. The study groups consisted of 30 children with SECC and a control group comprising of 30 caries free children. Children together with their mothers were examined and their caries level was recorded. Stimulated saliva was collected from each participant for bacterial, immunological assessment, and Lactobacilli counts in each sample were determined Children with SECC had higher levels of S. mutans and Lactobacilli than caries free children. The mothers of children with SECC had a statistically higher count of Lactobacilli than caries free children's mothers. However, the difference was not statistically significant with respect to their S. mutans counts. A significant relationship exists among the mother-child pair in the SECC group with respect to S. mutans level in saliva.

Load dependency of the coefficient of friction of oral mucosa

Frictional conditions in the mouth are thought by food scientists to be critical to the perception of important food attributes such as astringency, smoothness, roughness, slipperiness, etc. This ability to detect friction probably evolved to avoid foods that could wear the teeth excessively. In modern humans, sensations related to friction and lubrication affect consumer responses to food products and are therefore commercially important. In this study, the coefficient of friction between two mucosal surfaces was measured using stimulated and unstimulated saliva at loads varying from 0.34 to 2.20 N and at speeds varying from 0.1 to 700 mm s −1. The coefficient of friction decreased with increasing load and speed for both types of saliva. Lubrication with stimulated saliva resulted in higher friction than with unstimulated saliva. Stimulated saliva has a higher protein content and lower viscosity than unstimulated saliva, which may explain the friction differences found between the two types of saliva. The reduction in friction with load is attributed to deformation of the mucosal surfaces, leading to a reduction in surface roughness.

The pH change after HCl titration into resting and stimulated saliva for a buffering capacity test

Saliva collection can provide clinical information about individual patients. However, a correlation between ranking buffering capacity using resting and stimulated saliva is still unknown. The aim of this study was to evaluate the pH change after HCl titration into resting and stimulated saliva for a salivary buffering capacity test. Resting and stimulated saliva (by chewing paraffin wax) were collected from 80 patients. After the pH of both saliva samples was measured using a hand-held pH meter, the saliva samples were titrated with 0.1N HCl to evaluate the buffering capacity. Correlations of ranking buffering capacity (high, medium, low) between stimulated saliva and resting saliva with 30 microL HCl titration and between stimulated saliva and resting saliva with 40 microL HCl titration were statistically analysed by Spearman Rank Correlation Test (p < 0.05). At 50 microL HCl titration, stimulated saliva buffering capacities were ranked into high (above pH 5.5), medium (pH from 5.5 to 4.5) and low (below pH 4.5). At 30-40 microL HCl titration, the resting saliva buffering capacities were ranked into the same categories. Spearman Rank Correlation indicated significant positive coefficients for the stimulated saliva and resting saliva buffering capacity at 30 microL titration and the stimulated saliva and resting saliva at 40 microL titration. Stimulated saliva is more resistant to variation in pH change during HCI titration than resting saliva. Stimulated saliva sampling is a good method to determine buffering capacity during a comprehensive oral health assessment.

Prospective study of the long term change of the oral flora after radiation therapy

The aim of this prospective study was to evaluate the long term change in oral pathogens following radiation therapy. Twenty-two patients with planned radiation therapy (>30 Gy) of head and neck squamous cell carcinoma were included. Before radiation therapy, after 3, 6, and 12 months samples from the deepest periodontal pocket were drawn. Five major periodontal pathogens were studied using DNA probes (Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Bacteriodes forsythus, Treponema denticola). Stimulated saliva was sampled for the microbiologic study of caries pathogens (streptococci and lactobacilli). Plaque index and decayed, missing, filled tooth surfaces (DMF-S) were recorded. A normalisation of the caries bacteria is not found correlating to a significant increase in the number of affected teeth (DMF-S) from 80.7 to 88.5 after 12 months. The plaque index remained unchanged. The incidence of periodontal pathogens did not significantly change during the follow up. In contrast to radiation caries there seems to be no microbiological evidence for "radiation periodontitis". Despite of the intensive oral hygiene no reduction of the high number of caries pathogens is found, which leads to a high risk of tooth decay even 12 months after radiation.

Low salivary IgA activity to cell‐surface antigens of mutans streptococci related to HLA‐DRB1*04

Mutans streptococci are found in almost all individuals, though there are large differences in colonization levels between individuals. These differences are not readily explained, though several factors are believed to influence the colonization. One factor is the immune response to mutans streptococci, mainly provided by salivary immunoglobulin A (IgA). In a previous study, differences in salivary IgA reactions to oral streptococci were observed between human leukocyte antigen (HLA)-DR4-positive and DR4-negative individuals. A lower salivary IgA activity to Streptococcus mutans in particular was most pronounced for two DR4 subgroups, DRB1*0401 and *0404. The main purpose of this study was to further investigate, in a larger study group, the salivary IgA activity to antigens of three oral streptococci in relation to different HLA-DRB1*04 alleles. Stimulated saliva was collected from 58 HLA-DRB1*04-positive individuals. Whole cell antigen extracts from S. mutans, Streptococcus sobrinus and Streptococcus parasanguis and the streptococcal antigen (SA) I/II were separated in SDS-PAGE, transblotted and detected with diluted saliva (Western blot), and analyzed in a computer program. All distinct immunoblot bands over 100 kDa were recorded and compared in relation to DRB1*04. The immunoblots revealed lower salivary IgA reactions to S. mutans, S. sobrinus and SA I/II, but not to S. parasanguis, for the DRB1*0401- and *0404-positive individuals compared to other DRB1*04 types. For the *0401 subgroup there was a significant association with a lower IgA response to S. mutans. The results confirm earlier observations and may also support previous demonstrated association between colonization by mutans streptococci and the serologically defined HLA-DR4.

Detection of hepatitis C virus RNA in saliva samples from patients with seric anti-HCV antibodies

We examined the frequency of HCV-RNA in saliva samples from anti-HCV positive patients. Both plasma and saliva samples from 39 HCV patients (13 with normal liver enzymes, 19 with abnormal liver enzymes and 13 with cirrhosis) were investigated. Stimulated saliva and fresh plasma were centrifuged (900 x g,10 min) and stored at -70 degrees C, after the addition of guanidine isothiocyanate RNA extraction buffer. HCV-RNA was detected by RT-nested-PCR (amplification of HCV-cDNA for two rounds, using HCV primers 939/209 and 940/211). HCV genotyping was carried out by RFLP (using Mva I and Hinf 1 or Hae III and Rsa I restriction enzymes). Thirty-two out of 39 (82%; 95% CI=70-94%) anti-HCV-positive patients had HCV-RNA in plasma samples. Eight out of 39 (20.5%; 95% CI=6.6-34.4%) had HCV-RNA in the saliva. The HCV genotype in saliva samples from these patients matched the genotype found for plasma HCV-RNA. No significant correlation between the presence of HCV and either age, gender, HCV genotype or any risk factor for HCV infection was found. The observed prevalence (20.5% of anti HCV positive patients or 25% of the patients with HCV-RNA in plasma) was lower than that previously reported from other countries. The low frequency of HCV-RNA in saliva samples observed in our study may be due to the use of cell-free saliva. Other authors reporting higher frequencies of HCV-RNA in saliva used whole saliva, without centrifugation.

Electrolyte concentrations in saliva of children aged 6-10 years with Down syndrome

Study design In this study sodium, potassium, calcium, phosphorus, zinc, and magnesium ion concentration was analyzed in stimulated whole saliva in 22 children with Down syndrome aged 6 to 10 years. These children were compared with 21 healthy children of the same age. Stimulated saliva was collected by chewing a piece of parafilm for 10 minutes. The pH was measured with a portable pH meter after collection. Electrolyte concentrations were determined by inductively coupled argon plasma with atomic emission spectrometry. Results No statistically significant differences were observed in phosphorus, zinc, magnesium, and calcium concentration between the children with Down syndrome and the control children. The sodium concentration showed about 66.8% higher value in the Down syndrome than in the control group. On the other hand the flow rate and potassium concentration were lower in the Down syndrome than in the control group. Conclusion Our results suggest that there is alteration in the metabolism of the duct and/or acinar cells of salivary glands of Down syndrome children.

Oral and nutritional status in frail elderly.

This article describes associations between oral health and nutritional status among chronically ill older adults who were living at home and receiving regular professional home care services. A structured questionnaire, oral examination, and Mini-Nutritional Assessment were completed for 51 subjects (mean age 83.7 years). Two-thirds of the sample were edentulous, and one-third had between 2 and 23 teeth (mean 10.59, SD +/- 6.92). Sixty percent of subjects complained of xerostomia, while dentists found only 48% to have clinical signs of dry mouth. More than half of the subjects had stimulated saliva rates of < 0.8 ml/min. Stimulated saliva secretion rates were lower for persons with no functional natural dentition or prostheses (p = 0.012). Subjects assessed their dentures to be more functional than did the dentist (Kappa 0.338). No one was considered malnourished. 47% were at risk of malnutrition, and 52% were well nourished. The dentist's estimation of dry mouth and eating problems were significantly associated to lower MNA scores (p = 0.049 and p = 0.015, respectively). Subjects with a natural functioning dentition had higher BMI scores (p = 0.0485).

Genetic polymorphism of Streptococcus mutans in Brazilian family members

The aim of this study was to determine whether random amplified polymorphic DNA (AP-PCR) analysis is able to differentiate genetically different clones of mutans streptococci, in 22 Brazilian family members. Stimulated saliva samples were collected from fathers, mothers and infants. For 5-18 months babies with erupting primary dentition, plaque samples were collected using sterile tooth pick tips. From these samples, mutans streptococci were isolated on SB-20 agar plates. After growth, representative colonies were identified by biochemical methods on the basis of carbohydrate fermentation. Streptococcus mutans isolates were obtained from all family members and AP-PCR typed separately with a random primer (OPA-13). Bacterial cell lysates were used as template in PCR reactions and the amplified DNA fragments obtained were compared by agarose gel electrophoresis. Results demonstrated that the father shared the baby's genotype in three families and the mother shared the baby's genotype in 12 families seven babies harbored Streptococcus mutans strains similar to those of their siblings. The technique was able to demonstrate the genetic Streptococcus mutans in Brazilian family members.

Superinfecting microorganisms in patients under treatment with cyclosporin-A and its correlation to gingival overgrowth.

The aim of this study was to identify the presence of superinfecting microorganisms (Gram-negative enteric rods and Candida sp.) in heart transplant patients and correlate this with gingival overgrowth. Thirty patients (10 females, 20 males--mean age 45 years) were examined. All were under cyclosporin-A (CsA) therapy. Patients who had taken any antibiotics 3 months prior the study or had been submitted to periodontal therapy were not enrolled. Patients were required to have at least 6 teeth. The plaque index (PI), gingival index (GI), pocket depth (PD) and clinical attachment level (CAL) were recorded. Microbiological samples were taken from sulcus/pocket (s/p) and from stimulated saliva (ss) and submitted to analysis. Patients were divided into two groups: the ones with gingival overgrowth (GO) and those without gingival overgrowth (WGO). After statistical analysis (chi-square test, Student's t-test, Fisher test, p < or = 0.05), we concluded that there was no statistical difference between groups in the parameters of gender, CsA dosage, time since transplantation, PI, GI, PD and CAL. Gram-negative rods from either the sulcus/pocket or saliva samples were not found. Candida sp. was detected (s/p-30% and ss-30%). Stimulated saliva samples analysis determined that the presence of Candida sp. was associated with patients without gingival overgrowth.

HUBUNGAN FAKTOR RESIKO KARIES DALAM SALIVA DENGAN INDEKS DMF-T PADA PENDERITA DM TIPE II DI RSCM SUB BAGIAN ENDOKRIN (Laporan Penelitian)

Dental caries is a multifactorial disease. The most important factors in the development of caries is saliva. Reduced salivary secretion in patients with type 2 diabetes melitus to the occurrence of caries have yielded controversial results. The aim of the study was to find out whether the risk factors of the saliva i.e. saliva secretion rate, buffer capacity, salivary S. mutans, salivary Lactobacilli, alone or in combination, could be used for prediction of caries activity. Thirty patients with type 2 diabetes mellitus and age range 46-73 participated. Diabetic status was determined by fasting plasma glucose is >126mg/dl, 2-hour plasma glucose is >140mg/dl. Decayed, missing, and filled teeth indices were determined by means of clinical examination. Stimulated saliva with parafin was measured for flow rate and buffer capacity, level of S. mutans & Lactobacilli were analyzed with dentobuff and dentocult. There was no decrease in salivary secretion in patients with type 2 diabetes melitus. Significant corellation were found between buffer capacity, and combination of the S. mutans & Lactobacilli counts in caries activity.

Effect of Cervitec® on Mutans Streptococci in Plaque and on Caries Formation on Occlusal Fissures of Erupting Permanent Molars

The aim of this study was to evaluate the effect of Cervitec^® on the abundance of mutans streptococci(MS) in occlusal dental plaque and on 2-year caries increment of partly erupting first permanent molars. Sixteen healthy schoolchildren aged 6–8 years, with at least 2 sound contralateral partly erupted permanent molars, received diet counselling and daily parental supervised toothbrushing with a fluoride dentifrice. Stimulated saliva samples were collected at baseline and after 1 year to evaluate MS levels. In a split-mouth design, Cervitec varnish was applied to one of the teeth at baseline and after 3 and 6 months, while the other tooth in the same jaw was a control. At the 9-month follow-up the teeth were in occlusal contact. At this time, varnish was not applied. At 3 and 6 months after the first application of varnish a significant suppression of MS was observed in plaque. Caries investigations, performed at baseline and every 3 months during the 2 years after the start of the study, showed that all the teeth treated with the varnish were free of caries after 2 years, whereas 8/16 control teeth developed incipient caries. In conclusion, our results suggest that treatment with Cervitec reduces MS in plaque on erupting permanent molars and can lead to a significant decrease in caries incidence.

Determination of mercury in blood, urine and saliva for the biological monitoring of an exposure from amalgam fillings in a group with self-reported adverse health effects

AbstractIt has been argued that the release of mercury from amalgam fillings is of toxicological relevance. The aim of the study was to determine the internal mercury exposure of two groups differing in their attitude towards possible health hazards by mercury from amalgam fillings. It was to be examined if the two groups differ with regard to the mercury concentration in different biological matrices and to compare the results with current reference values. Blood, urine and saliva samples were analyzed from 40 female subjects who claimed to suffer from serious health damage due to amalgam fillings (“amalgam sensitive subjects”). 43 female control subjects did not claim any association (“amalgam non-sensitive controls”). Mercury was determined by means of cold vapour atomic absorption spectrometry. Number and surfaces of amalgam fillings were determined by dentists for each subject. Median (range) mercury levels in blood were 2.35 (0.25 – 13.40) μg/l for “amalgam sensitive subjects” and 2.40 (0.25 – 10.50) μg/l for “amalgam non-sensitive controls”. In urine, the median mercury concentrations were 1.55 (0.06 – 14.70) μg/l and 1.88 (0.20 – 8.43) μg/g creatinine respectively. No significant differences could be found between the two groups. Mercury levels in blood and urine of the examined subjects were within the range of background levels in the general population including persons with amalgam fillings. Stimulated saliva contained 76.4 (6.7 – 406.0) μg mercury/l in “amalgam sensitive subjects” and 57.0 (2.8 – 559.0) μg mercury/l in controls (not significant). Mercury levels in saliva did not correlate with the concentrations in blood and urine, but merely with the number of amalgam fillings or of the filling surfaces. Mercury in saliva is therefore not recommended for a biological monitoring.

Saliva Flow, pH, Buffer Capacity, and Colonization by Streptococcus mutans during and after Radical Radiotherapy of Head and Neck Tumours

Background: How does oral health (saliva pH, buffer capacity, and colonization with Streptococcus mutans) change because of reduced salivary flow during and after radical radiotherapy of head and neck carcinoma dependent on ipsilateral or bilateral parotid irradiation? Patients and Methods: 20 consecutive patients who were radically irradiated because of head and neck carcinomas were studied. They were evaluated before radiotherapy, weekly during therapy, and 6 weeks after the end of treatment. Flow rate, pH and buffer capacity of saliva, and colonization with S. mutans were tested. Results: Stimulated saliva secretion rate dropped in the first radiotherapy week in both groups (p < 0.006). This effect was more pronounced in patients with bilateral parotid gland radiation (BPR) in comparison with unilateral parotid gland radiation (UPR). Depending on dose saliva production declined exponentially up to the end of treatment. No rebound was found up to 6 weeks after the end of therapy, a trend towards a further saliva production was observed. Stimulated saliva was significantly diminished when compared to production before the start of treatment (p < 0.003 for UPR and p < 0.001 for BPR). Buffer capacity was reduced parallel to the saliva deficit. The pH of saliva decreased from a mean of 7.3 before treatment to 6.3 at the end of radiotherapy and did not recover for patients with BPR. For patients with UPR, the pH decreased from a mean of 7.8 to 7.4 and remained constant. Colonization with S. mutans increased during treatment and stayed high after the end of radiotherapy. Conclusion: Saliva production is exponentially reduced during radiotherapy, starting in the first week of treatment. Recovery is not observed up to 6 weeks after therapy. Buffer capacity and pH decline during radiotherapy in relation to saliva loss. Colonization by S. mutans increases markedly during radiotherapy and remained high afterwards.

Effects of tobacco smoking on salivary immunoglobulin levels in immunodeficiency.

Salivary immunoglobulins and albumin were analysed in smoking and non-smoking immunocompetent and immunodeficient individuals. Stimulated and unstimulated saliva were compared as between individuals with selective immunoglobulin A deficiency (IgAd), common variable immunodeficiency (CVI) and immunocompetent individuals. Immunocompetent smokers showed increased levels of sIgA in unstimulated saliva, when compared with non-smoking immunocompetent individuals. In stimulated saliva, the immunocompetent smokers showed decreased levels of IgG and IgM. IgAd smokers showed decreased levels of albumin in unstimulated saliva, when compared with non-smoking IgAd individuals. The non-smoking individuals with IgAd showed increased levels of IgM in both unstimulated and stimulated saliva, when compared with immunocompetent smokers. The non-smoking CVI individuals showed decreased levels of IgG, IgA and IgM in unstimulated and stimulated saliva, as expected, when compared with the same group of immunocompetent individuals. The decreased levels of albumin in unstimulated saliva in IgAd smokers and comparable to that of the IgG non-smoking IgAd individuals support the observation of locally produced immunoglobulins that protect the oral mucosa. Instead of sIgA, non-smoking immunodeficient individuals with IgAd compensate with increased IgM levels in stimulated saliva. The increased levels of sIgA in unstimulated saliva in immunocompetent smokers may be a reflection of the protection of the oral mucosa.

Five-year follow-up study of saliva, mutans streptococci, lactobacilli and yeast counts in lymphoma patients

Twenty-two patients out of the 79 that were originally included were examined 5 years after beginning anticancer therapy for lymphomas. The patients' cumulative data on salivary flow rate, buffering capacity and acidogenic microbial counts were compared with respective data of 17 patients who died during the follow-up. Stimulated saliva samples had been taken at baseline and during the cytostatic treatment with combination chemotherapy, and 1 year and 5 years later. Chair-side kits were used at the hospital ward for the assessment of the study parameters. Mean saliva flow at baseline was 1.5 +/- 0.7 ml/min in the surviving group and 1.5 +/- 0.8 ml/min in the deceased. Salivary flow rates were not affected by the anticancer treatment and there was no statistically significant difference between the groups in this respect. A significant difference was observed between the groups in salivary buffering capacity values at baseline: only 32% of the survived had low buffering capacity in comparison to 69% of those who later died (P < 0.02). Buffering capacity values remained low in 50% of the surviving patients 5 years later. Higher mutans streptococci and lactobacilli counts were seen among the deceased than in the survived patients but mutans streptococci decreased significantly in both groups after the start of the anticancer therapy (P < 0.05). The number of positive yeast counts increased consistently during the chemotherapy in both groups, being higher in the survived when compared with the deceased patients. Yeast counts remained positive 5 years later in 73% of the survived patients, while the mean mutans streptococci and lactobacilli counts decreased below baseline values. The results showed that persistently high salivary microbial counts and low buffering capacity may be linked with poor prognosis.