Unstimulated Salivary Flow Rate Research Articles

The value of separate detection of anti-Ro52, anti-Ro60 and anti-SSB/La reactivities in relation to diagnosis and phenotypes in primary Sjögren's syndrome.

Autoantibody detection is an essential step in pSS diagnosis. However, the value of separate anti-Ro52, anti-Ro60 and anti-SSB/La detection in pSS diagnosis and phenotyping has not been extensively studied. This study aimed to explore disease characteristics of anti-SSA/Ro positive, suspected and definite pSS patients, in relation to serological profiles based on anti-Ro52, anti-Ro60 and anti-SSB/La reactivity. Of 187 anti-SSA/Ro positive patients included in the Belgian Sjögren's Syndrome Transition Trial (BeSSTT), 155 were considered definite pSS patients, due to fulfilment of the 2016 ACR-EULAR classification criteria, and 32 suspected, due to reactivity against SSA/Ro without presence of other criteria. None of the patients met any of the ACR-EULAR exclusion criteria for pSS. Patients were grouped based on the presence of anti-Ro52, anti-Ro60 and anti-SSB/La antibodies. Mono-reactivity against Ro60 or Ro52, double reactivity against Ro52/Ro60 and triple reactivity against Ro52/Ro60 and SSB was detected in respectively 30, 23, 70 and 60 patients. Mono-anti-Ro60 positive patients showed the least pSS features. Mono-anti-Ro52 positive patients reported a significantly higher dryness burden (p=0.016) and tended toward more salivary gland ultrasound (SGUS) abnormalities (p=0.054) than mono-anti-Ro60 positives. Double positive patients showed similar characteristics as mono-anti-Ro52 positive patients, whereas triple positive patients showed lowest unstimulated salivary flow rates (p=0.002) and Schirmer tests (p=0.002), highest ocular staining scores (p<0.001), most positive labial salivary gland biopsies (p=0.039), most laboratory abnormalities compatible with B-cell hyperactivity and highest SGUS scores (p<0.001) compared to other patient groups. These data indicate that separate detection of anti-Ro52, anti-Ro60 and anti-SSB/La reactivity is not only relevant towards pSS diagnosis, but markedly aids in patient stratification and evaluation of disease burden. Our results suggest a stepwise model in which mono-reactivity against Ro60 displayed the least objective and subjective glandular pSS features, whereas glandular abnormalities and signs of B-cell hyperactivity were most present in patients showing triple reactivity against Ro60, Ro52 and SSB/La.

Using the modified Schirmer test for dry mouth assessment: A cross-sectional study.

This study aimed to establish whether the modified Schirmer test could serve as a diagnostic tool for dry mouth, that is, whether it could reliably measure salivary film at selected locations within the oral cavity, and to identify levels of sensitivity/specificity and determine reference values. Therefore, a cross-sectional study (N = 120, mean age 63.5 [SD 13.9] years) was performed. The test was used at five locations (hard palate; buccal mucosa in molar region at 4 mm above occlusal plane; anterior tongue; lower lip; mouth floor), and results were recorded after 1, 2 and 3min. A statistically significant discriminatory ability of the Schirmer test for the unstimulated salivary flow rates could be shown for the palate (at 3min), buccal mucosa (at 1min), mouth floor (at 1 min), and tongue (at 2 and 3min) (areas under the curve 0.64-0.68), with individual sensitivity/specificity values depending on test location/time points. Thus, the modified Schirmer test has potential to become a simple and reproducible instrument for the detection of dry mouth based on low unstimulated salivary flow rates in dentistry and especially outreach care. Care must be taken concerning intraoral test location and measurement time.

Impact on xerostomia for patients with nasopharyngeal carcinoma treated with superficial parotid lobe-sparing intensity-modulated radiation therapy (SPLS-IMRT): A prospective phase II randomized controlled study.

6059 Background: In the intensity-modulated radiation therapy (IMRT) era, xerostomia remains one of the most common radiation-induced toxicities in nasopharyngeal carcinoma (NPC) patients. We first proposed the superficial parotid lobe–sparing IMRT (SPLS-IMRT) technique in NPC, which has been proved to significantly reduce the mean doses of bilateral entire parotid glands and superficial parotid lobes. To further validate its clinical benefits, we conducted a prospective phase II randomized controlled study to compare the incidence of xerostomia in NPC patients treated with SPLS-IMRT and conventional IMRT (C-IMRT). Methods: Patients with histologically confirmed NPC who met the eligibility criteria were randomly assigned in a 1:1 ratio to receive either SPLS-IMRT or C-IMRT. The V36 (the percentage volume receiving a dose of 36 Gy) of the entire parotid gland was constrained to be less than 40% in both groups. Additionally, V26 (the percentage volume receiving a dose of 26 Gy) of the superficial parotid lobe was constrained to be less than 30% in the SPLS-IMRT group. The primary endpoint was the incidence of xerostomia at 12 months post-IMRT. The secondary endpoints included the xerostomia questionnaire (XQ) score, unstimulated salivary flow rate (USFR), stimulated salivary flow rate (SSFR), and survival outcomes. Results: From January 2018 to September 2018, 90 patients were enrolled (45 per group). Eighty-two patients were included for xerostomia analysis (42 in the SPLS-IMRT group and 40 in the C-IMRT group). At 12 months post-IMRT, the incidence of xerostomia in the SPLS-IMRT group was significantly lower than that in the C-IMRT group (83.4% vs. 95.0%; P = 0.007), especially the grade 3 xerostomia (0% vs. 12.5%; P &lt; 0.001). However, the median change in XQ score (XQchange) was similar between the two groups (11.9 points vs. 14.1 points; P = 0.194). Moreover, there was a significantly higher median fractional USFR (0.67 vs. 0.35; P = 0.024) and SSFR (0.66 vs. 0.32; P = 0.021) in the SPLS-IMRT group than the C-IMRT group. All 90 patients were included for survival analysis. With a median follow-up time of 37.8 months (IQR, 33.9–38.5 months), the 3-year locoregional relapse-free survival, distant metastasis-free survival, and overall survival in the SPLS-IMRT and C-IMRT groups were 92.5% vs. 90.9% (hazard ratio [HR], 1.84; P = 0.477), 83.8% vs. 81.7% (HR, 1.13; P = 0.816), and 88.9% vs. 88.2% (HR, 0.96; P = 0.949), respectively. Conclusions: SPLS-IMRT significantly reduced the incidence of xerostomia at 12 months post-IMRT in NPC by recovering parotid gland function earlier than C-IMRT, without compromising survivals. Phase III clinical trials are needed to confirm this result. Clinical trial information: NCT05020067.

POS0790 18F-FLUORODEOXYGLUCOSE (FDG) PET-CT IMAGING OF SALIVARY GLANDS IN PRIMARY SJÖGREN’S SYNDROME AND ITS CORRELATION WITH ULTRASONOGRAPHIC SCORES AND SALIVARY FLOW RATE COMPARED TO HEALTHY CONTROLS

BackgroundThe use of salivary gland imaging modalities in patients with primary Sjögren’s syndrome (pSS) has been increasing recently. The contribution of each imaging method in terms of diagnosis or disease activity differs from each other. Although ultrasound and MRI are the most commonly used imaging modalities, the role of PET-CT for diagnosing pSS and determining glandular and extraglandular involvement has largely been neglected.ObjectivesThis study aimed to compare the sizes and metabolic activities of the major salivary glands in patients with pSS and healthy controls (HC). Correlation of the 18F-FDG PET-CT uptake characteristics with ultrasound scores and salivary flow rates of the patients and HC was also determined.Methods22 patients with pSS and 10 age/sex-matched HC were included in the study. The sizes and FDG uptakes of the parotid and submandibular glands of pSS patients and HC were assessed by PET-CT. The maximum standardized uptake value (SUVmax) was evaluated for FDG uptakes, and each patient’s liver uptake and salivary gland uptake ratio were calculated. In addition, correlations of gland sizes and FDG uptakes in PET-CT with OMERACT and Hocevar ultrasound scores, stimulated and unstimulated SFR, ESSPRI dryness scores and disease durations of pSS patients were calculated by Spearman test.ResultsThe mean age (SD) of the patients was 58.6 years (10.5) versus 58.6 years (19.1) of HC; the mean (SD) disease duration was 8.96 (8.77) years. ANA was positive in all patients, anti-SSA positivity was present in 82.6%, and 30.4% of patients experienced ≥1 parotid swelling episode.Compared to HCs, the mean size of both submandibular glands (p=0.006 for left and p=0.032 for right) and SUVmax of the left submandibular gland (p=0.044) were significantly smaller in patients with pSS. In pSS patients, both right and left parotid sizes were smaller and SUVmax uptake was greater than in HC; these differences however did not reach statistical significance.When the PET-CT involvement characteristics of the patients were compared with the salivary gland ultrasonography scores, there was a statistically significant negative correlation between the left parotid gland size in PET-CT and the ultrasonographic inhomogeneity of Hocevar score and OMERACT score. There was a statistically significant negative correlation between right parotid gland size measured on PET-CT with ultrasonographic inhomogeneity, hyperechoic foci, parenchymal echogenicity, Hocevar total score, and OMERACT score. No statistically significant correlation was found between SUVmax scores detected by PET-CT and ultrasound scores in both parotid glands and submandibular glands.A statistically significant positive correlation was found between the total gland size measured in PET-CT and the unstimulated salivary flow rate (p=0.038, r=0.604). There was a negative correlation between total gland size and ESSPRI dryness scores and symptom duration, which did not reach statistical significance.ConclusionPET-CT SUVmax measurements do not provide sufficient information for pSS-related involvement of the major salivary glands. Secondly, size measurement of the parotid glands by PET-CT is associated with OMERACT ultrasound scores, and also the sizes of both submandibular and parotid glands are smaller than HC.Table 1.Correlations of gland sizes and ultrasonographic scoresGlandOMERACT ScoreParenchymalHomogeneityHypoechoic AreasHiperechoicVisibility of Gland BorderParenchymal InhomogenicityTotalSize (PET/CT)EchogenityFociR-Parotisr-.699*-.717*-.704*-0,598-.656*-0,368-.758**-.645*p0,0170,0130,0160,0520,0280,2660,0070,032L-Parotisr-.699*-.717*-.704*-0,598-.656*-0,368-.758**-0,482p0,0170,0130,0160,0520,0280,2660,0070,134R-Submr-0,0110.118-0,011-0,2700,203-0,0060,2470.024p0,9720.7140,9720,3970,5260,9860,4390.942L-Submr0,2450,3060,2450,0710,3270,1180,3060,435p0,4430,3330,4430,8260,3000,7140,3330,158Disclosure of InterestsNone declared

AB0574 PREDICTOR FACTORS IN EMPOWERMENT OF PATIENTS WITH PRIMARY SJOGREN SYNDROME IN THE FRAME OF VALUE BASED HEALTH CARE

BackgroundPatient empowerment is a key component in developing awareness of the disease in patient-centred care in the setting of chronic disease management.ObjectivesThis study aimed to evaluate predictive factors in the empowerment of patients with Sjögren’s Syndrome (pSS), while examining patients reported outcome measures (PROMs) in the setting of value-based health care.MethodsIn this cross-sectional study, 169 patients with pSS (F/M: 162/7; mean age: 52.94±12.20 years) were included. Data was collected from the clinical examination, major salivary gland ultrasonography (SGUS) and a structured questionnaire regarding utilisation of health services and PROMs regarding Oral Health Impact Profile-14 (OHIP-14), Hospital Anxiety and Depression Scale (HADS; HADS-Anxiety and HADS-Depression) and Self-reported General Health Status (100-m VAS; 0: very poor vs 10: very good). Both stimulated (S-SFRs) and unstimulated salivary flow rates (U-SFRs) of patients were measured as ml/min. Patients with hyposalivation were grouped as according to U-SFR (≤0.1 ml/min). Furthermore, Outcome Measures from Rheumatology ultrasonography (OMERACT US) scores (from 0: normal to 3 points: severe inhomogeneity) were collected to evaluate glandular involvement of patients. After initial statistical analyses was carried out, mediation analysis was performed to evaluate the associations.ResultsThe rate of patients with hyposalivation was found as 45% and most (85.7%) had elevated SGUS scores (≥2 points). In addition, self-reported oral health problems were common in the study group (from 23.8% to 53.4%). Among this cohort, the patients suffered from Burning oral sensation (27 %) had poor scores in OHIP-14 (29.81±14.48 vs 20.22±12.43), HADS-Depression (10.07±4.49 vs 6.65±4.20) and Self-reported general health status (45.43±17.95 vs 55.56±22.43) compared to those without Burning oral sensation (p=0.006, p=0.019, p=0.018, respectively). Furthermore, significant correlations were observed between OHIP-14 score and HADS-A score (r: 0.4 p: 0.004) and HADS-D scores (r: 0.58 p=0.000). Utilising mediation analysis, the HADS-Depression score was directly mediated by the presence of Burning oral sensation (p=0.0005) and indirectly mediated by OHIP-14 score (p=0.0360). In this group, the interval from the last dental visit was mean: 19 months. Interestingly, 60% preferred to relate their oral discomfort during visits (3 times a year), to rheumatologists.ConclusionBetter health outcomes could be achieved by reducing oral discomfort, increasing dental visits, improvement of oral health related quality of life and managing depression by a multidisciplinary team with dentists and psychiatrists in patient-centred care. Since these factors have a significant effect on patients’ daily life, treatment plans are needed to provide patient empowerment by using suitable strategies in the frame of value-based health care.Disclosure of InterestsNone declared

Comparative Assessment of Salivary Flow Rates Among Reverse Smokers and Smokers Using Modified Schirmer Test

Background: Saliva, a complex fluid secreted by the salivary glands within the oral cavity, is the first to interact with smoke while smoking. Nicotine in smoke causes structural and functional changes in the saliva, leading to a significant reduction in salivary flow. Aim: The present study was done to compare the salivary flow between reverse smokers, regular smokers, and non-smokers with the help of the Modified Schirmer Test (MST) to assess unstimulated saliva. Materials and Methodology: Ninety subjects were randomly divided into three groups; Group A (30) subjects who had the habit of reverse smoking daily for &gt;6 months, Group B (30) subjects who had the habit of smoking daily for &gt;6 months, and Group C (30) healthy, non-tobacco users. MST was done in the morning hours; they were not asked to eat/drink for 2 h before the procedure. Later, they were asked to raise their tongue, and the rounded end of Schirmer's strip was placed on the floor of the mouth. Wetting of the strip was recorded every 1, 2, and 3-minute intervals. Results: Data was recorded, and statistical analysis was done by the paired t-test. The mean value of salivary flow rate in reverse smokers per 3 minutes (19.73 ± 4.16) was less when compared to conventional smokers (22.53 ± 2.75) and healthy individuals (31.53 ± 2.90), with a significant P value of P &lt; 0.0001. Conclusion: There was a significantly reduced unstimulated salivary flow rate in reverse smokers compared to conventional smokers and healthy individuals.

Evaluation of Salivary Components and Dental Plaque in Relation to Dental Caries Status in Type 1 Diabetes Mellitus.

PurposeTo evaluate the dental caries prevalence in Type 1 Diabetes Mellitus (T1DM) as compared to healthy children and, to assess the salivary components (flow rate, glucose, α-Amylase, Streptococcus mutans) and dental plaque in relation to their dental caries status.MethodsDental caries were estimated by using the DMFS index and dental plaque by Sillness and Loe plaque index. The following methods were used to assess the salivary components; draining method to determine the flow rate; glucose oxidase peroxidase method for glucose; substrate method for α-Amylase, Mitis Salivarius Bacitracin agar was used to culture Streptococcus mutans.ResultsCaries prevalence was significantly lower in T1DM. In the diabetic group, a significant positive correlation was found between DMFS value and plaque, DMFS value and salivary glucose, and also with DMFS value and salivary α-Amylase. A significant negative correlation was found between the DMFS value and the unstimulated salivary flow rate. The multivariate regression analysis demonstrated that decrease in the unstimulated salivary flow rate to be significantly associated with increasing DMFS values.ConclusionThe caries prevalence was found to be low in T1DM when compared to the healthy children, the cause for it being related to the low plaque scores. Low caries prevalence could also be due to the restriction of sucrose in their diet.Clinical significanceAs clinicians, along with restoring the smiles of a child patient, we have to retrospectively analyze the factors involved in the causation of dental caries. Educating the parents and the child in regard to this will help prevent the occurrence of any new carious lesion.How to cite this articleManjushree R, Anandakrishna L, Prasad KS K, et al. Evaluation of Salivary Components and Dental Plaque in Relation to Dental Caries Status in Type 1 Diabetes Mellitus. Int J Clin Pediatr Dent 2022;15(S-2):S121-S125.

An assessment of unstimulated salivary flow rate, IgA and clinical oral dryness among active and passive smokers.

The aim of this study was to assess the impact of smoking on the whole salivary flow rate (SFR), IgA levels and clinical oral dryness (COD) among active and passive smokers. The participants were categorized as active smokers (N = 54) or passive smokers (N = 163). Saliva was collected in tubes and placed in ice storage at -70°C. Salivary IgA levels were assessed in duplication using the enzyme linked immunosorbent assay (ELISA) method. Following the saliva sample collection, the subjects were assessed for COD using the COD score, SFR and caries. Chi-square test, the t-test and ANOVA were employed to compare the clinical impact of the smoking status associated with specific variables (smoking status, number of cigarettes, active caries, gender, age, COD score, IgA level and SFR). A p-value of <0.05 was considered significant. Two hundred and seventeen subjects with the mean age of 32.86±6.30 years, with 145 males (66.8%) and 72 females (33.2%), were included in the study. Among the active smokers, 88.8% were males compared to 11.2% females. The active smokers had the mean age of 32.52 years, a COD score of 1.43, an IgA level of 1.39 g/l, and a SFR of 0.37 ml/min. Among the passive smokers, 59.5% were males and 40.5% were females, with the mean age of 32.97 years, a COD score of 0.87 g/l, an IgA level of 1.47, and a SFR of 0.42 ml/min. Active caries showed a positive correlation with the number of cigarettes, with significance in the >35 years age group (p < 0.05). The study demonstrated significant differences in SFR, IgA and COD scores among the active and passive smokers. The number of cigarettes had a negative impact on saliva production, IgA levels, the oral health status, and the progression of caries with respect to age and gender. Smoking potentially leads to xerostomia associated with active caries. Int J Occup Med Environ Health. 2022;35(1):39-51.

Evaluation of the efficacy of transcutaneous electrical nerve stimulation (TENS) on salivary flow rate in patients with xerostomia - A case control study.

Introduction:In oral cavity, saliva is a physiological fluid present in the oral cavity. Oral fluid is an absolute media exploring for health and disease surveillance. Saliva is a complex fluid. Xerostomia is the subjective complain of dryness in the oral cavity due to decreased salivary flow. Transcutaneous electrical nerve stimulation (TENS) is an established physical therapy, which is useful for the pain relief.Materials and Methods:A total of 25 subjects of xerostomia and 25 age and sex matched normal subjects visiting the Department of Oral Medicine and Radiology, Pacific Dental College and Hospital were included in the study. For patients with positive mirror stick test unstimulated saliva were collected with ‘low forced spitting’ method in a graduated test tube for 5 minutes. Individuals with unstimulated salivary flow equal to or less than 0.5 mL per 5 min were included in the study group (xerostomia) and individuals with salivary flow more than 0.5 mL per 5 min were included in the control group (age and sex matched). The TENS unit were then activated and intensity control switch were gradually increased to tolerable level of patient for 15 min. At this optimal intensity, stimulated saliva were collected for 5 min with same method in a separate graduated test tube and flow rate were compared with unstimulated salivary flow rate. Same were done with 25 control patients.Results:The data thus obtained was subjected to statistical analysis. The following findings were observed in the study. There was increase salivary flow rate in xerostomic individuals after TENS application. More improvement was found in inter appointment salivary flow than two follow-ups. Healthy group showed more improvement than xerostomia after TENS therapy Known cases of diabetes mellitus patients with xerostomia revealed more improvement than other etiologies of xerostomia included in this study.Conclusion:This present study has an important therapeutic value in the treatment of patients with xerostomia. TENS therapy was highly effective in stimulating whole salivary flow. The encouraging results of this present study indicate that TENS has the potential to increase salivary flow rate and can be an important alternative in the xerostomia treatment.

Comparative Evaluation of Salivary Flow Rate in Smokers and Non Smokers: A Cross-sectional Study

Introduction: Saliva is a complex and significant body fluid which is exceptionally fundamental for oral health and is the most effectively available fluid in the human body. Structural and function changes in saliva occur when it is exposed to cigarette smoke that contains several toxic components and is known to be one of the main risk factors for developing numerous oral conditions. There are conflicting reports about the correlation between cigarette smoking and mouth dryness. Additionally, there is paucity of studies to investigate the Salivary Flow Rate (SFR) in smokers in India. Aim: To assess the salivary flow rate in smokers and non smokers and also to study the effect of duration and frequency of smoking habit on SFR. Materials and Methods: This analytical cross-sectional study was conducted in which unstimulated whole saliva of 50 smokers and 50 non smokers visiting Outpatient Department (OPD) at Mahatma Gandhi Vidyamandir’s, Karmaveer Bhausaheb Hiray Dental College and Hospital Nashik, Maharashtra, India, was from January 2019 to January 2020. Unstimulated SFR was measured and expressed in mL/minute using a graduated glass tube. Comparison of SFR was done among the smokers and non smokers using Unpaired t-test. One-way Analysis of Variance (ANOVA) test was used to compare the frequency and duration of smoking habit and SFR among smokers. Results: There was a statistically significant reduction (p-value &lt;0.0001) in the salivary flow rate of smokers in comparison to non smokers. It was also observed that there was reduction in salivary flow rate with increase in the duration (p-value &lt;0.001) and frequency (p-value=0.012) of tobacco smoking habit. Conclusion: Salivary flow rate is significantly reduced in smokers when compared to non smokers. The duration and frequency of smoking habit had a significant impact on the reduction in SFR. Reduced SFR has a high impact on oral health and may further lead to several oral complications. Therefore, measures should be taken by counseling the smokers to quit the habit and educating them about the ill-effects of xerostomia.

Effect of Mobile Phone Radiation on Parotid and Submandibular Salivary GlandsAn Ultrasonographic Study

Introduction: In this era of digitalism, mobile phones have become a cultural accessory. Frequent smartphone usage results in possible adverse effects from low radiofrequency radiation and thermal effect emitted by these devices. One of the major concerns is salivary glands as the mobile phones are held against the side of face in close proximity to these glands. Aim: To assess the effect of cell phone radiation on the volume, systolic velocity, salivary flow rate of parotid and submandibular gland between the dominant and non dominant side of mobile phone users. Materials and Methods: A cross-sectional study was conducted in the Department of Oral Medicine and Radiology with the sample size of 100 (50 males and 50 females). Inclusion criteria were based on the frequency of mobile phone usage of more than two hours per day. Mobile phone usage was determined based on patient’s answer to the questionnaire. Ultrasonography (USG) of both parotid and submandibular gland was done bilaterally to measure the volume of the glands and Colour Doppler of external carotid artery to measure systolic velocity. Modified Schirmer tear strips were used bilaterally to measure unstimulated salivary flow rate. The data was entered into MS excel and significance was calculated using independent sample t-test. Results: In parotid gland, mean volume, mean systolic velocity and mean salivary flow rate were of higher value in the dominant side (14.22±2.17 mL; 15.14±3.74 cm/s; 0.37±0.26 mm/5 mins) compared to the non dominant side (13.76±2.14 mL; 14.53±3.39 cm/s; 0.24±0.2 mm/5 mins). In submandibular gland, mean volume, mean systolic velocity and mean salivary flow rate were of higher value in the dominant side (9.60±1.96 mL; 15.70±6.44 cm/s; 0.30±0.22 mm/5 mins) compared to the non dominant side (8.88±2.17 mL; 13.87±4.83 cm/s; 0.26±0.21 mm/5 mins). Conclusion: The volume, systolic velocity of blood flow, the salivary flow rate, of the parotid gland and submandibular gland were significantly more on the dominant side than the non dominant side of mobile phone usage. The study emphasised that prolonged mobile phone usage causes biological changes in salivary glands and its flow rate.

Salivary parameters and their correlation with neutrophil counts in children with acute lymphoblastic leukemia.

Chemotherapy for Acute Lymphoblastic Leukemia (ALL) is known to render children immuno-deficient. A concomitant suppression of local defence mechanisms, such as saliva may further aggravate the adverse consequences of chemotherapy. The present study was conducted to evaluate alterations in salivary flow rate, pH and buffering capacity and to correlate these parameters with Absolute Neutrophil Counts (ANC). A cohort of 43 patients, aged 3-12years were evaluated for the aforementioned parameters at baseline, post-induction and post-consolidation phases. Salivary collection was done and ANC was measured from routine haematological reports. A decrease in the salivary parameters was observed at the end of Induction phase as compared to baseline, with a statistically significant decrease in unstimulated salivary flow rates (p < 0.01). Statistically significant positive correlations were found between ANC and salivary flow rate (p = 0.005), pH (p < 0.00) and buffering capacity (p < 0.00). On testing the significance of these correlations, all the values for these parameters were found to be statistically significant. Salivary parameters showed derangements over the phases of chemotherapy, with maximum decrease at the end of induction phase. The positive correlations of salivary parameters with ANC of the subjects may be considered indicative of a concomitant immunological compromise in these children.

Hyperbaric oxygen treatment of mandibular osteoradionecrosis: Combined data from the two randomized clinical trials DAHANCA-21 and NWHHT2009-1

PurposeOsteoradionecrosis (ORN) of the mandible is a serious complication of head and neck radiotherapy. This study aims to investigate the effect of hyperbaric oxygen (HBO) treatment on ORN in two randomized, controlled multicentre trials. Methods and materialsPatients with ORN with indication for surgical treatment were randomised to either group 1: surgical removal of necrotic mandibular bone supplemented by 30 pre- and 10 postoperative HBO exposures at 243 kPa for 90 min each, or group 2: surgical removal of necrotic bone only. Primary outcome was healing of ORN one year after surgery evaluated by a clinically adjusted version of the Common Toxicity Criteria of Adverse Events (CTCAE) v 3.0. Secondary outcomes included xerostomia, unstimulated and stimulated whole salivation rates, trismus, dysphagia, pain, Activities of Daily Living (ADL) and quality of life according to EORTC. Data were combined from two separate trials. Ninety-seven were enrolled and 65 were eligible for the intent-to-treat analysis. The 33% drop-out was equally distributed between groups. ResultsIn group 1, 70% (21/30) healed compared to 51% (18/35) in group 2. HBO was associated with an increased chance of healing independent of baseline ORN grade or smoking status as well as improved xerostomia, unstimulated whole salivary flow rate, and dysphagia. Due to insufficient recruitment, none of the endpoints reached a statistically significant difference between groups. ADL data could only be obtained from 50 patients. ConclusionHyperbaric oxygen did not significantly improve the healing outcome of osteoradionecrosis after surgical removal of necrotic bone as compared to standard care (70% vs. 51%). This effect is not statistically significant due to the fact that the study was underpowered and is therefore prone to type II error.

Salivary Flow Rate Before, During and After Insertion of Complete Denture in Different Age Group: a Comparative study

Background: Increase in salivary flow accompanying complete denture insertion is a well-known phenomenon. Complete dentures act as a mechanical stimulant, increasing salivary flow after insertion. This study compares unstimulated and stimulated salivary flow rates before, during, and after insertion of a complete denture in different age groups.Method: Forty subjects meeting inclusion criteria were selected. Unstimulated saliva was collected first. Stimulation was produced by chewing paraffin wax and collected of saliva in a graduated container. This procedure was carried out before insertion, during insertion, 24 hours after, and 7 days after insertion of complete dentures. The study data were entered, edited, and coded in Microsoft Excel. The unstimulated and stimulated salivary flow rate was compared at different time intervals.Result: Unstimulated salivary rate was lowest before denture insertion with mean values of 0.27ml/minute. The highest flow rate was recorded during denture insertion (mean values of 0.60 ml/minute). The mean unstimulated salivary flow rate 24 hours after denture insertion was higher than 7 days after denture insertion. The mean stimulated salivary rate was lowest before denture insertion (mean values of 0.59 ml/minute). The highest flow rate was recorded during denture insertion (mean values of 0.93 ml/minute). There was a declining trend in salivary flow rate after denture insertion i.e. 0.86 ml/minute to 0.75ml/min after 24 hours and 7 days of denture insertion. A gradual decrease in salivary flow rate with an increase in age was noted but the association of age with salivary flow rates was not statistically significant.Conclusion: There was an increase in both unstimulated and stimulated salivary flow rate after insertion of complete denture and age does not affect salivary flow rates before, during (immediately after), 24 hours after, and 7 days after denture insertion.

Effect of Oral Health Education Using a Mobile App (OHEMA) on the Oral Health and Swallowing-Related Quality of Life in Community-Based Integrated Care of the Elderly: A Randomized Clinical Trial.

This study investigated the effect of oral health education using a mobile app (OHEMA) on the oral health and swallowing-related quality of life (SWAL-QoL) of the elderly population in a community-based integrated care project (CICP). Forty elderly individuals in the CICP were randomized into intervention and control groups. OHEMA provided information on customized oral health care management, oral exercises, and intraoral and extraoral massage methods for 50 min/session, once a week, for 6 weeks. Pre- and post-intervention surveys assessed the unstimulated salivary flow rate, subjective oral dryness, tongue pressure, and SWAL-QoL, which were analyzed using ANCOVA and repeated measures ANOVA. In the intervention group, tongue pressure increased significantly from pre- (17.75) to post-intervention (27.24) (p < 0.001), and subjective oral dryness decreased from pre- (30.75) to post-intervention (18.50). The unstimulated salivary flow rate had a higher mean score in the intervention group (7.19) than in the control group (5.04) (p < 0.001). The SWAL-QoL significantly improved from pre- (152.10) to post-intervention (171.50) in the intervention group (p < 0.001) but did not change significantly in the control group (p > 0.05). OHEMA appears to be a useful tool for oral health education for the elderly as it improved the SWAL-QoL, with increased tongue pressure and reduced oral dryness.

Ultrasonographic characteristics of major salivary glands in anti-centromere antibody-positive primary Sjögren's syndrome.

To investigate salivary gland ultrasonography (SGUS) findings in primary Sjögren's syndrome (pSS) patients positive for the anti-centromere antibody (ACA) and compare these with those in ACA-negative pSS patients. We analyzed demographic, clinical, laboratory, and SGUS data of pSS patients who fulfilled the 2002 American-European Consensus Group classification criteria for pSS. SGUS findings of four major salivary glands (bilateral parotid and submandibular glands) were scored in five categories and compared between ACA-positive and ACA-negative pSS patients. Linear regression analysis was performed to elucidate the factors associated with SGUS score. In total, 121 pSS patients were enrolled (19, ACA-positive). The ACA-positive patients were older (67.0 vs 58.0 years, P = 0.028), whereas anti-Ro/SSA and anti-La/SSB positivity was more prevalent in the ACA-negative group (89.2% vs 21.1%, P < 0.001, and 47.1% vs 10.5%, P = 0.007, respectively). The total SGUS and hypoechoic area scores were lower in ACA-positive patients (16.0 vs 23.0, P = 0.027, and 4.0 vs 7.0, P = 0.004, respectively). In univariate regression analysis, being positive for unstimulated salivary flow rate (USFR < 1.5 ml/15 min), anti-Ro/SSA, and rheumatoid factor were positively associated whereas ACA positivity was negatively associated with the SGUS score. In multivariate regression analysis, being positive for USFR, anti-Ro/SSA, and rheumatoid factor showed significant association with the SGUS score. ACA-positive pSS patients showed a lower SGUS score than ACA-negative patients, which was especially prominent in the hypoechoic area component.

Characterization of clinical, laboratory, IL-6 serum levels, and IL-6-174 G/C genetic polymorphisms in patients with rheumatoid arthritis and Sjögren's syndrome.

This study aimed to characterize the clinical (disease activity and exocrine gland function), laboratory, interleukin 6 (IL-6) serum levels, and IL-6-174G/C (rs1800795) genetic polymorphisms among rheumatoid arthritis (RA), RA plus Sjögren's syndrome (RA+SS), and control subjects. A case-control study enrolling 137 women (52±11 years old) were divided into three groups as follows: RA (n=70), RA+SS (n=29), and healthy control (C, n=38). Individuals underwent clinical evaluation composed of Schirmer's test, unstimulated salivary flow rate, and evaluation of disease activity and functional capacity (Disease Activity Score [DAS28] and Health Assessment Questionnaire [HAQ]). IL-6 serum levels and IL-6-174G/C polymorphisms were assessed. RA and RA+SS presented higher serum levels of IL-6 than controls (p<0.001). Also, higher IL-6 levels were related to swollen joints (p=0.038), limited functional capacity (p=0.004), and disease activity (p≤0.001). However, neither IL-6-174G/C genetic polymorphism nor its allele frequency was associated with RA or RA+SS. IL-6 serum is an important marker of RA activity and functional incapacity, but IL-6-174G/C genetic polymorphism did not differ among healthy controls and cases.

Assessment of Oral Health in Elders with and without Alzheimer’s Disease: A Cross-Sectional Study

Objective: Assessment and comparison of oral health status in elders with and without Alzheimer's disease.&#x0D; Methods: This age and gender matched cross-sectional study included participants from an Alzheimer’s day care center, and a nursing home. Mental state, oral and periodontal health, Geriatric Oral Health Assessment Index (GOHAI), unstimulated salivary flow rate (USFR), and other dry mouth conditions were examined. Group comparisons, and correlation analysis were performed. &#x0D; Results: Thirty-six elders with AD and 37 elders without AD were included. Elders had similar GOHAI scores, USFR level (p&gt;0.05). Elders with AD had lower probing depth (PD) and clinical attachment loss (CAL), and higher presence of no periodontitis than the elders without AD (p

Evaluation of demographic and clinical risk factors for high interdialytic weight gain.

Xerostomia and hyposalivation are highly prevalent in hemodialysis (HD) patients and this is effective in increased fluid intake. The aim of this study is to determine the demographic and clinical risk factors associated with high interdialytic weight gain (IDWG) in nondiabetic HD patients. In total, 52 eligible HD patients were recruited in this cross-sectional study. Patients were divided into two groups according to % IDWG: Group 1: High IDWG (≥3%) and Group 2: normal IDWG (<3%). Plasma osmolarity (POsm), unstimulated salivary flow rate (USFR), xerostomia inventory (XI), and dialysis thirst inventory (DTI) were evaluated. The mean age of the patients was 53.7 ± 15.7 years. The prevalence of xerostomia was 53.8%, and hyposalivation was in 40.3% in the patients. High IDWG was positively correlated with XI and DTI while it was negatively correlated with POsm and USFR. The area under the receiver-operating characteristics curve for POsm for high IDWG was 0.661, with sensitivity of 63.8% and specificity of 72.7% for a cut-off point of 297.4mOsm/L. Logistic regression analysis showed that advanced age odds ratio (OR: 1.215, p= 0.019), pill burden (OR: 1.162, p= 0.031), C-reactive protein (CRP; OR: 1.308, p= 0.042), and low POsm (OR: 0.768, p= 0.046) were independently related to high IDWG. The prevalence of xerostomia and thirst was higher in HD patients with high IDWG compared to the normal IDWG group. Age, CRP, low POsm, and pill burden were independently associated with high IDWG.

The Efficiency of Hydroxychloroquine for the Treatment of Primary Sjögren's Syndrome: A Systematic Review and Meta-Analysis.

Objectives: This meta-analysis was conducted to evaluate the effects of hydroxychloroquine (HCQ) in the treatment of primary Sjögren’s syndrome (pSS).Methods: Nine databases were searched for data collection. We used clinical features, including involvement in superficial tissues and visceral systems, and experimental findings, including Schirmer’s test, unstimulated salivary flow rate (uSFR), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and immunoglobulins (IgG, IgM and IgA) as major outcome measures. The Downs and Black quality assessment tool and RevMan 5.3 were used to assess the methodological quality and statistical analysis, respectively.Results: Thirteen studies with pSS patients, consisting of two randomized controlled studies, four retrospective studies and seven prospective studies were analyzed. Results showed that HCQ treatment significantly improved the oral symptoms of pSS patients compared to non-HCQ treatment (P = 0.003). Similar trends favoring HCQ treatment were observed for uSFR (p = 0.05), CRP (p = 0.0008), ESR (p < 0.00001), IgM (p = 0.007) and IgA (p = 0.05). However, no significant improvement was observed in other clinical features, including ocular involvement, fatigue, articular lesions, pulmonary, neurological and lymphoproliferative symptoms, renal organs and other experimental parameters in the HCQ treatment group compared to the non-HCQ treatment group.Conclusion: HCQ treatment showed moderate efficacy to improve oral symptoms, uSFR, ESR, CRP, IgM and IgA. However, HCQ could not alleviate organ-specific systemic involvement.Systematic Review Registration:We have registered on the PROSPERO [https://www.crd.york.ac.uk/PROSPERO/], and the registration number is identifier [CRD42020205624]