Unstimulated Flow Rate Research Articles

Oral microbiome of the inner surface of face masks and whole saliva during the COVID-19 pandemic.

Wearing a face mask was strongly recommended during the COVID-19 pandemic. The purpose of this study was to investigate the diversity of the oral microbiome, the abundance of each bacterium on the inner surface of the mask, and the effects of xerostomia on the microbiota. The study was conducted on 55 generally healthy adults (45 women and 10 men, mean age 38.18 ± 12.49 years). Unstimulated flow rate (UFR) and stimulated flow rate (SFR) were measured in whole saliva samples collected for each condition. The 14 major oral bacterial species, including Porphyromonas gingivalis (P. gingivalis), Lactobacillus casei (L. casei), Tannerella forsythia (T. forsythia), and Treponema denticola (T. denticola) on the inner surface of the mask and in the UFR and SFR samples, were analyzed by real-time PCR. We found that the total DNA copy number of oral bacteria was significantly higher in UFR and SFR than in the mask (p < 0.001). On the inner surface of the mask, P. gingivalis and L. casei were the most abundant Gram-negative and Gram-positive species, respectively. The oral microbiome profile of the mask differed from that of the UFR and SFR samples. Shannon's diversity index was also significantly higher in the UFR and SFR than in the mask (2.64 ± 0.78, 2.66 ± 0.76, and 1.26 ± 1.51, respectively, p < 0.001). Shannon's diversity index of UFR and SFR had a significant positive correlation with each other (r = 0.828, p < 0.001), but there was no significant relationship with Shannon's diversity index of mask. Red complex abundance, including P. gingivalis, T. forsythia, and T. denticola, was significantly higher in UFR than in the mask. Interestingly, the DNA copy number of each of the 14 bacteria, the total bacterial amount, and Shannon's diversity index did not differ in the absence or presence of xerostomia (p > 0.05). In summary, oral bacteria migrated to and existed on the inside of the mask, and the presence of xerostomia did not affect the bacterial profiles. The inner surface of the mask had an independent oral microbiome profile, although this showed lower quantity and diversity than the UFR and SFR samples.

Oral physiological characteristics among Chinese subjects in the eastern region of China

ObjectivesWith an increasing number of elderly in China, it becomes imperative to establish a comprehensive understanding of their physiological capabilities and investigate fundamental mechanisms underpinning the discrepancies between Chinese individuals and other ethnical groups, which will facilitate government policymaking, design and development of special food products. DesignIn this study, 100 healthy Chinese subjects in the eastern region of China (22–89 years old) were recruited with full consent, then divided into young adult, middle-aged and elderly groups. Subjects’ maximum biting force (MBF), maximum tongue pressure (MTP), maximum oral volume (MOV), and saliva flow rate were recorded. Unstimulated (US) and stimulated (SS) saliva were collected. Subjects were then objectively clustered into 3 different levels of oral processing capability. A total of 10 young subjects from two different clusters were selected for chewing efficiency (CE) determination. ConclusionsWith increased age, there is a decline in subject’s dental status, MBF and MTP. Gender affects greatly on MOV; males have larger MOV. No significant effects on SS and US flow rate were found with age and gender. The finding of a similar CE and differences in overall capability in relevant physiological variables (MBF and MOV in young adults) suggest that the degree of CE is not determined by a total capability of various oral physiological variables. In contrast, the findings suggest that CE will be non-impaired as long as each of the relevant physiological variables (i.e. dental status, MBF) operates at a supra-threshold level.

SALIVARY PROFILE AND XEROSTOMIA ON THE ELDERLY IN DEPOK, WEST JAVA, INDONESIA: ANALYSIS OF DEMOGRAPHIC FACTORS AND SYSTEMIC DISEASE

Objective: The objective of this study is to determine the profiles of saliva between sexes, age groups, types of systemic disease, medications, and xerostomia on an elderly population in Depok.Methods: The study was observational analytical with a cross-sectional study design. Sampling was through a consecutive sampling technique in subjects aged ≥60 years living in Depok. Subjects were examined for their saliva’s volume, stimulated and unstimulated salivary analysis, pH, and buffer capacity. Subjects answered fox questionnaires about xerostomia and questionnaires about systemic diseases and medications.Results: Gender had a significant difference in salivary flow rate but was not significant to pH or buffer capacity. There were no significant differences between types of salivary profile among age, systemic diseases, and medications. The correlation coefficient between xerostomia and stimulated flow rate was higher (0.426) than the unstimulated flow rate (0.303).Conclusion: The unstimulated and stimulated flow rates exhibited a significant difference between men and women but did not differ significantly between age groups, systemic diseases, or medications. The pH and buffer capacity was not significantly different between sexes, age groups, type of systemic diseases, or medications. Xerostomia was associated with salivary flow rate.

Objective and subjective assessment of xerostomia in patients of locally advanced head-and-neck cancers treated by intensity-modulated radiotherapy.

Parotid-sparing intensity-modulated radiotherapy (IMRT) effectively reduces xerostomia in head-and-neck cancer (HNC). Changes in the salivary output at 1 year were studied and correlation with quality of life (QOL) changes in patients of locally advanced HNC (LAHNC) was drawn. Between October 2009 and October 2011, 20 patients of LAHNC were treated with IMRT using simultaneous integrated boost technique. High-risk clinical target volume (CTV) was given a dose of 66 Gy/30 fr, intermediate-risk CTV 60 Gy/30 fr, and low-risk CTV 54 Gy/30 fr. The saliva flow rate was estimated for 5 min at rest (unstimulated) and after using lemon drops (stimulated) for the next 5 min, at baseline (pretreatment), and 3, 6, and 12 months following treatment. Evaluation of patients' perception of dry mouth was done using EORTC-QLQ-C30 and HN35 questionnaires at the same time points. Baseline unstimulated and stimulated salivary flow rates were 0.659 ml/min and 1.69 ml/min, respectively. At 3 months, a significant reduction in unstimulated (0.346 ml/min) and stimulated (0.80 ml/min) flow rate was observed. Unstimulated flow rate continued to decrease further till 6 months (0.295 ml/min), but slight improvement was seen in stimulated flow rate (0.91 ml/min). At 12 months, minimal recovery was observed in both unstimulated (0.362 ml/min) and stimulated flow rates (1.09 ml/min). EORTC-QOL questionnaire mean scores for dryness and stickiness of saliva were 10 and 15 at baseline and increased to 36 and 25, respectively, at 3 months. At 6 months, symptom score for dryness further increased to 45 and then decreased to 33 at 12 months. Stickiness score remained static from 3 to 12 months. Salivary flow rate correlated well with dry mouth (P < 0.05) but not with the perception of sticky saliva (P = 0.82) at 6 months and beyond. Both salivary flow rate and xerostomia-related questions worsened at 3 months even with IMRT and showed a similar pattern of recovery.

Evaluation of masticatory and salivary parameters in preschool children with different morphological occlusion

Objective: To better understand the relationship between malocclusion and masticatory and salivary functions in the primary dentition, the aim was to evaluate the differences in masticatory performance (MP), facial morphology (FM), maximal bite force (BF) and salivary parameters in 65 preschool children with normal occlusion (n = 22), functional posterior crossbite (n = 20) and anterior open bite (n = 23), and to explore the relationship between these variables. Material and Methods: MP, FM and BF were assessed by sieving method, anthropometry and gnatodynamometer, respectively. Stimulated (SS) and unstimulated (US) saliva flow and composition were measured by automated colorimetric technique. Data were analyzed using ANOVA/Kruskal-Wallis, t-test/Wilcoxon and Pearson/Spearman correlation test. The relationship between SS flow rate and the independent variables were assessed using multiple linear regression. Results: The lower face dimension was smaller in crossbite-group, and a decreased BF in the crossbite-side of the dental arch was observed. BF correlated positively with intergonial width in open bite group. In malocclusion groups, better MP correlated with byzigomatic and intergonial widths. US flow rate was lower in crossbite-group and total protein concentration differed between SS and US saliva only in the crossbite-group, being lower in US. Amylase activity was higher in SS than US in all groups. SS flow rate related positively with age and negatively with the presence of malocclusion. Conclusion: In young subjects, significant correlations were found between masticatory parameters and facial dimensions; in addition, some important masticatory and salivary parameters differed between children with different morphological occlusions, hence the importance of the early assessment of these parameters.KEYWORDS Bite Force; Dental Occlusion; Masticatory System; Primary Dentition.

Influence of Hypertension on pH of Saliva and Flow Rate in Elder Adults Correlating with Oral Health Status.

One of the most prevalent systemic conditions seen in the elderly individuals is hypertension, but very sparse knowledge regarding the influence of hypertension on oral health in known. Therefore, this study was carried out to evaluate the relationship between hypertension and salivary pH, flow rate and its effect on oral health status. The study included 40 elderly individuals above 60 years of age, of which 20 individuals (control group) were normotensive without using any medication and 20 individuals (study group) were hypertensive using anti-hypertensive medication. Stimulated and unstimulated saliva samples were collected from all individuals and pH was measured using saliva pH strips, flow rate was measured using calibrated test tubes and was correlated with oral health status. Then the values were sent for statistical analysis where unpaired t-test, chi-square test were used. The results showed that there was no significant association of hypertension with stimulated and unstimulated flow rate, rather there was a significant association of hyper-tension with stimulated salivary pH i.e., there was a significant decrease in the pH of stimulated saliva. The study also revealed a significant association with presence of bleeding on probing and periodontal pockets in individuals who were hypertensive and using anti-hypertensive medication. Hence, it is a necessity to monitor blood pressure for reconstruction and maintenance of oral health in older adults. More longitudinal studies are to be carried out to explore further relationship between oral health and hypertension in older adults.

Salivary and serum insulin-like growth factor (IGF-1) assays in anorexic patients

Objectives. The purpose of this study was to measure the salivary and serum free IGF-1 concentration of patients with anorexia nervosa (AN) in comparison to an average population. Methods. A controlled clinical trial was designed for an age- and gender-matched group of 121 AN patients and 77 healthy individuals. A clinical examination was made and blood and salivary samples were taken during the acute stage of AN (BMI < 15 kg/m2) in the first week of hospitalization. An enzyme immunoassay (ELISA) suitable for measuring free IGF-1 was used. Results. Anorexic patients had significant reductions in salivary unstimulated flow rate (UFR), pH and free IGF-1 levels in their saliva and serum. Significant correlations between serum IGF-1 and BMI; salivary IGF-1 and UFR and pH were detected. Conclusions. Salivary and serum IGF-1 analyses appear to be a reliable biochemical indicator of malnutrition in AN patients. Measurement of salivary IGF-1 levels would allow new perspectives in monitoring AN in its early stages.

Influence of sport mouthguards on the ecological factors of the children oral cavity.

BackgroundThe use of fixed and/or removable dental devices is an attributable factor that may affect the oral cavity homeostasis. The aim of this study was to monitor the oral environmental changes caused by dental devices, as sports mouthguards with the aid of a chair-side test.MethodsSixty children with sports-mouthguards were analyzed at baseline (T0), after 6 months of dental devices use (T1), after a year (T2) and after almost 6 months without using it (T3). At T0, a clinical monitoring was performed and the DMFT index was recorded. At each time of observation, the following parameters were recorded: FMPS, FMBS, unstimulated-flow rate, saliva consistency, resting pH, stimulated saliva, buffer capacity, the CFU/ml of Streptococcus mutans.ResultsIn 60 subjects, mean age 9.9 ± 1.2, mean value of DMFT 1.55 ± 1.29,dmf-t 3.43 ± 1.21, FMPS and FMBS values increased significantly at T2. The values of unstimulated flow rate vary significantly within the observation times. The pH value and the buffering capacity reduced significantly at T2. The tests for the detection of S. mutans were negative in all the subjects in several observation times. All patients regularly used fluoridated toothpaste and comply with normal standards of oral hygiene; but over time the patients lost their initial motivation.ConclusionsSport treatment with dental devices dues to changes in oral ecological factors: increases FMPS, FMBS and reduces the buffering capacity and the salivary pH. The use of removable devices increases the retentive plaque surfaces and inhibits the protective effect of saliva.The so-called “chair-side” tests were able to easily monitor patients and to determine the risk of oral disease during sport treatment.

Saliva Parameters and Erosive Wear in Adolescents

The aim of this study was to investigate the relationship between several parameters of saliva and erosive wear in adolescents. (Un-)stimulated saliva was collected from 88 adolescents with erosion and 49 controls (age 16 ± 1 years). Flow rate, pH and buffer capacity were determined immediately. Total protein content, carbonic anhydrase VI, amylase, albumin, calcium, phosphate, urea, sodium, chloride and potassium were measured at a later time. Unstimulated flow rate was found to be significantly lower in subjects with erosive wear (p = 0.016). The chloride concentration in unstimulated saliva was found to be significantly higher in the erosion group (p = 0.019).

OP0065 Tolerance and efficacy of rituximab in primary sjogren syndrome (TEARS): Results of a randomized controlled trial

BackgroundCurrent pharmacological treatments can improve the sicca symptoms but they are unable to modify the course of of primary Sjogren’s syndrome (pSS). There is evidence for a critical role of...

Emphasising the importance of determining appropriate criteria for evaluation of xerostomia

To the Editor: We read the article by Visvanathan et al. (1) about “xerostomia” enthusiastically. It explained that the mean salivary flow rate is highly variable (usually 0.25 ml/min) and the values less than 0.12–0.16 ml/min are considered abnormal (2). According to the literature, stimulated whole saliva flow rates of < 0.7 ml/min and unstimulated whole saliva flow rates of < 0.1 ml/min are considered as salivary gland hypofunction (3-5). So, it would be better to clarify whether the stimulated or unstimulated flow rate is the subject matter and the criteria for measuring each one be detailed. None.

Unstimulated flow rates from minor salivary glands in the buccal mucosa

Unstimulated flow rates from minor salivary glands in the buccal mucosa

Effectiveness of a recent topical sialogogue in the management of drug-induced xerostomia

Objectives: Use of certain drugs is the most common aetiology of xerostomia. Systemic sialogogues provide a longer effect than topic ones, but also induce relevant side effects. Topical sialogogues, as malic acid, allow a safe use as they induce no systemic side-effects or pharmacological interactions, being especially interesting in cases of mild hyposalivation and oral dryness, mainly the chronic use of xerostomizing drugs. The aim of this study was to evaluate the clinical effect of 1% malic acid in patients affected by xerostomia due to antihypertensives or antidepressants. Study Design: 10 patients with drug-induced xerostomia were prospectively evaluated before and after using malic acid spray during three weeks. Xerostomia Inventory (XI) was used to evaluate subjective improvement. Unstimulated and stimulated salivary flow rates were determinated. Results: Severity significantly decreased, from 38.22 to 31.00 points (p = 0.011) after using the product. 77.8% of subjects did not complain about xerostomia at the end and 66.6% achieved an improvement > 6 points. Unstimulated flow rate singnificantly increased, from 0.163 to 0.226 mL/min (p = 0.021) at the third week. Conclusions: 1% malic acid spray induces some improvement in the management of mild and reversible xerostomia. Carrying out of randomized controlled trials is justified according to this study .

Hyposalivation, xerostomia and oral health status of HIV-infected subjects in Thailand before HAART era

The aims of this study were to determine hyposalivation, xerostomia, and oral health status of HIV-subjects in Thailand before highly active antiretroviral therapy era. Oral examination and measurement of saliva flow rate of both unstimulated and wax-stimulated whole saliva were performed in 135 subjects (56 HIV-subjects, mean age: 34.5 years, and 79 non-HIV controls, mean age: 29.5 years). Presence of oral candidiasis, cervical root caries, and number of existing teeth were recorded. Microbiological investigation of oral Candida was conducted using oral rinse technique. Risk factors associated with hyposalivation and xerostomia were analysed. The unstimulated flow rates in HIV-subjects and non-HIV controls were 0.19 and 0.33 ml/min (P = 0.0024). For stimulated flow rates, the corresponding figures were 1.45 and 1.62 ml/min (P = 0.31). The unstimulated flow rate was significantly higher in the asymptomatic HIV-subjects: 0.17 ml/min, when compared with the symptomatic/AIDS group 0.11 ml/min (P = 0.003). No significant difference between the groups could be found with respect to stimulated flow rate. Hyposalivation was significantly associated with the colony forming unit of Candida. Smoking and alcohol consumption were significantly associated with hyposalivation, but not xerostomia. The following factors were significantly associated with both hyposalivation and xerostomia; sex, stage of HIV infection, risk group of HIV infection, systemic disease, and medication use. Salivary flow rate of HIV-subjects in Thailand was affected by HIV infection. The rate was significantly decreased with advanced stage of the disease. Various factors including medication use were associated with hyposalivation and xerostomia among the subjects.

Relationship between salivary flow rate and clinical symptoms and behaviours in patients with dry mouth

The purpose of this study was to investigate the relationship between whole salivary flow rate and dry mouth-related subjective symptoms and behaviours in patients with dry mouth. Seventy-eight patients (13 men and 65 women, 58.2 +/- 13.5 years) with dry mouth were asked a standardized series of questions concerning dry mouth-related symptoms and behaviours. Whole salivary flow rates were measured under unstimulated and stimulated conditions. The effect of oral dryness on daily life was significantly associated with the flow rate of stimulated whole saliva (r(s) = -0.30, P < 0.01) and frequency of oral dryness (r(s) = 0.46, P < 0.01). Dry mouth-related symptoms and behaviours were significantly associated with the whole salivary flow rate and the correlation was more remarkable with respect to stimulated whole saliva. The most common dry mouth-associated complaint was sensation of burning mouth. The effect of oral dryness on daily life was significantly affected by the presence of taste disturbances. Collectively, dry mouth-related symptoms and behaviours were significantly associated with whole salivary flow rate. Moreover, the severity of dry mouth-related symptoms was more closely correlated with the flow rate of stimulated saliva, compared with the unstimulated flow rate.

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.

Evaluation of unstimulated flow rates of whole and palatal saliva in healthy patients wearing complete dentures and in patients with Sjogren's syndrome

Evaluation of unstimulated flow rates of whole and palatal saliva in healthy patients wearing complete dentures and in patients with Sjogren's syndrome

The unstimulated salivary flow rate after prolonged gum chewing

To determine whether, after a prolonged period of gum chewing, the unstimulated salivary flow rate falls below the unstimulated flow rate before gum chewing. Six males and six females each collected whole saliva at intervals for up to 105 min on two separate days. On one control day they collected unstimulated saliva over the -10 to 0 and 90 to 105 min periods. On the other day, they made the same collections of unstimulated saliva but, in addition, chewed two tablets of Wrigley's peppermint-flavoured gum over the 0-90 min period. The data on flow rates were subjected to repeated-measures ANOVA and Duncan tests. The unstimulated flow rates in the -10 to 0 and 90 to 105 min periods were not significantly different on the same day or between days and the values were all significantly less (P<0.05) than the stimulated flow rates, while gum was being chewed. This study provided no evidence that the unstimulated salivary flow rate is reduced after prolonged gum chewing. Patients who complain of mouth dryness after prolonged gum chewing may have become accustomed to the larger volume of saliva present in the mouth during the gum chewing.

Evaluation of unstimulated flow rates of whole and palatal saliva in healthy patients wearing complete dentures and in patients with Sjogren's syndrome

Statement of problem The palate and upper lip are the regions of oral mucosa covered with the least amount of saliva. These areas are important for maxillary denture retention and stability. Thus, patients with xerostomia or hyposalivation may have problems with the stability of maxillary complete dentures. Purpose The purpose of this study was to compare the unstimulated whole saliva (UWS) and palatal saliva (PS) flow rates of healthy patients wearing complete dentures and patients with Sjogren's syndrome (SS) and to determine whether xerostomia or hyposalivation has a negative influence on maxillary complete denture stability. A further aim was to determine the influence of new complete dentures on UWS and PS flow rates in healthy individuals. Material and methods Thirty-five complete denture wearers, 24 healthy individuals (controls) and 11 patients who fulfilled the diagnostic criteria for primary Sjogren's syndrome (as proposed by the European Community Study Group) were investigated. All participants were questioned about possible subjective oral complaints (xerostomia or instability of the dentures) through use of a standardized questionnaire. In the first part of the study, UWS and PS flow rates of the healthy subjects (controls) and of the SS patients were measured at the initial visit. The flow rate of UWS (mL/min) was collected by the “spitting” method; saliva was collected into preweighed vessels for 5 minutes while subjects were seated in an upright position. Patients were asked to refrain from smoking, eating, and drinking for 2 hours prior to the test session, to avoid swallowing, and to make as few movements as possible during the procedure. The PS flow rate (μL/min/cm 2) was measured using previously weighed filter paper discs placed bilaterally in the region of the maxillary second molars, 15 mm palatally from the edentulous ridge, for 30 seconds. The measuring vessels and paper discs were weighed before and after each collection. In the second part of the study, new complete dentures were fabricated for healthy patients. Flow rates of UWS and PS were measured 7 days after the insertion to compare data with prefabrication values. Mann-Whitney and Wilcoxon rank sum tests and chi-square test were used to analyze the data (α=.05). Results The UWS flow rates were significantly lower in SS patients compared to healthy controls (0.36 ± 0.33 vs 0.09 ± 0.11 mL/min, P<.05), yet the PS flow rate for both groups was not significantly different. Although every SS patient had xerostomia, and 8 out of 11 had hyposalivation, no patient complained about denture instability. Neither UWS flow rate (0.36 ± 0.33 mL/min and 0.39 ± 0.35 mL/min) nor PS flow rate (1.66 ± 0.99 μL/cm 2/min and 1.86 ± 0.45 μL/cm 2/min) was different from the preinsertion values after 1 week of new denture insertion in healthy patients. Conclusion Palatal mucous saliva may help stabilize the maxillary complete denture in patients with hyposalivation. The results suggest that neither UWS or PS flow rate are influenced by the placement of new dentures in complete denture wearers.

The effects of prolonged gum chewing on salivary flow rate and composition

Objective: To determine the effect of gum chewing for 2 h on salivary flow rate and composition. Design: Five male and five females each collected whole saliva at intervals over a 2 h period on three separate days, prior to which they collected unstimulated saliva for 5 min. For one 2 h session they continued to collect only unstimulated saliva while for the others one tablet of Wrigley’s Extra peppermint- or fruit-flavoured (peach) gum was chewed continuously. Flow rates were calculated and the saliva was assayed for pH and for Na, K, Ca, Cl, inorganic P and protein concentrations. The data were subjected to repeated-measures ANOVA and Duncan tests. Results: When only unstimulated saliva was collected, there was no significant change in salivary flow rate over the 2 h. With the chewing gums the flow rate increased initially and then, after 35–40 min, fell to similar plateau values which remained significantly higher than the initial unstimulated flow rate and significantly higher than the flow rate at the corresponding time intervals when only unstimulated saliva was collected. With both gums the salivary pH from 2 min to 2 h was significantly higher than that of unstimulated saliva. The changes in the salivary electrolyte and protein concentrations due to the flow rate increase elicited by the chewing gum were largely as expected from previous studies on parotid and submandibular saliva. Conclusion: During prolonged chewing gum use, both salivary flow rates and pH remained significantly above the values for unstimulated saliva.