Unstimulated Salivary Flow Research Articles

Application of the OMERACT Grey-scale Ultrasound Scoring System for salivary glands in a single-centre cohort of patients with suspected Sjögren’s syndrome

AimTo describe salivary gland involvement in patients suspected of Sjögren’s syndrome (SS) using the OMERACT Ultrasound Scoring System for SS. Next, using different ultrasound cut-offs, to assess the performance of...

Evaluation of Halitosis and Sialometry in Emirati Diabetic Patients before and after Periodontal Treatment

Halitosis is an important social complaint which affects both healthy and periodontally diseased individuals.Oral malodor is mainly caused by a microbial degradation of both sulfur-containing and nonsulfur-containingamino acids into volatile, bad-smelling gases. Anaerobic gram-negative bacteria, the same species that havebeen linked to periodontal diseases, are especially involved in this process, explaining the link between oralmalodor with periodontitis. The following study was done to investigate the parameters of halitosis andsialometry of Emirati diabetic patients in correlation with oral concentration of volatile sulfur compounds(VSC), salivary flow rate before and after non-surgical periodontal treatment (scaling & root planning) forpatients having moderate Generalized and/localized chronic periodontitis.Subjects and Methods: Eighty-one (81) Emirati subjects volunteers were recruited from the dental hospital,with average age 38-49 years. They have been divided into in three groups: Group I (negative control),Group II, and Group III and Group IIIa. Halitosis measurements for all volunteers had been recorded usingGas Chromatography. For group III samples were collected before periodontal treatment, and subsequentlyat two- & four-weeks following start of non-surgical periodontal treatment (Scaling & root planning).Results: There were 54 patients participated in this study. Of the 54, 27 were control and the remainingwere controlled DM. The mean and SD of all variables before and after the intervention showed that thevalues of all variables reducing after the intervention. All the difference observed was statistically significant(P<0.001). This study observed that the mean value of unstimulated salivary flow rate and stimulated salivaryflow rate was less in the controlled DM group compared to control group, but for probing picker depth, CALand average bone loss was more in controlled DM group compared to control group.Conclusion: Based on the findings, it can be stated that diabetes is a major risk factor for periodontitis, andthe risk of periodontal disease increases if glycemic control is poor; it was also proved beyond doubt thatpeople with poorly controlled diabetes are at an increased risk of periodontal disease and loss of alveolarbone. Controlling diabetes by successfully improving glycemic control will reduce the risk and severity ofperiodontal diseases.

Unstimulated whole salivary flow in Sj\xf6gren\u2019s Syndrome: systematic literature review and meta-analysis

BackgroundSjögren’s Syndrome compromises the exocrine function, producing xerostomia and xerophthalmia. It can appear as an isolated condition or associated with other autoimmune diseases (polyautoimmunity). The Unstimulated Salivary Flow rate (UWSF) is used to quantify saliva production. There is no objective evidence to differentiate the values in patients with Sjögren’s versus healthy people or patients with non-Sjögren’s sicca. The objective of the present review was to evaluate the UWSF in patients with Sjögren’s syndrome in comparison to controls (healthy and non-Sjögren’s sicca patients).MethodsA systematic literature review was carried out (PRISMA guidelines). Analytical observational studies of cases and controls, cross-sectional studies, cohort studies and randomized clinical trials (including healthy controls) were considered. The Medline/OVID, Lilacs, Embase, and Cochrane/OVID databases were consulted. MeSH, DeCS, keywords, and Boolean operators were used. The meta-analysis (RevMan 5.2) was done through the random-effects model [mean difference (MD)]. Level and quality of evidence were evaluated by the Oxford Center Levels of Evidence and Joanna Brigs list respectively.ResultsThirty-two articles were included (20 were case-control studies, 6 were cross-sectional, 2 prospective cohort, 2 retrospective cohort, and 2 studies were abstracts) and 28 were meta-analyzed. The unstimulated whole salivary flow rate in the Sjögren’s group was lower than in controls (healthy and patients with non-Sjögren Sicca syndrome) (MD-0.18 ml/min; 95% CI, − 0.24 to − 0.13; chi2-P-value < 0.00001). Heterogeneity was 97% and there was publication bias (funnel plot). The level of evidence was mostly 3 or 4. The quality of evidence was met (97% of items valued).ConclusionFor the first time, the unstimulated whole salivary flow rate is found to be lower in patients with Sjögren’s syndrome compared to controls (healthy and non-SS sicca) through a meta-analysis.Trial registrationPROSPERO CRD42020211325.

Clinical Characteristics and Relevance of Oral Candida Biofilm in Tongue Smears

Dimorphic Candida exist as commensal yeast carriages or infiltrate hyphae in the oral cavity. Here, we investigated the clinical relevance of Candida hyphae in non-pseudomembranous oral candidiasis (OC) by smears of tongue biofilms. We conducted a retrospective study of 2829 patients who had had tongue smears regardless of OC suspicion. Clinical characteristics were evaluated using a novel method of assessing hyphae. Clinical factors (moderate/severe stimulated pain, pain aggravated by stimulation, tongue dorsum appearance and initial topical antifungal use) were highly significant in the high-grade hyphae group but were statistically similar in the low-grade hyphae and non-observed hyphae group, suggesting low-grade hyphae infection as a subclinical OC state. In addition to erythematous candidiasis (EC), a new subtype named “morphologically normal symptomatic candidiasis” (MNSC) with specific pain patterns and normal tongue morphology was identified. MNSC had a significantly higher proportion of moderate and severe stimulated pain cases than EC. Low unstimulated salivary flow rate (<0.1 mL/min) was found to be a common risk factor in MNSC and EC. In non-pseudomembranous OC, pain patterns were dependent on Candida hyphae degree regardless of tongue dorsum morphology. Morphologic differences seen in high-grade hyphae infection were not associated with systemic diseases or nutritional deficiencies.

Elderly-onset primary Sjögren's syndrome focused on clinical and salivary gland ultrasonographic features.

To assess the clinical, laboratory, and salivary gland ultrasound (SGUS) characteristics of elderly-onset of primary Sjögren's syndrome (EopSS). We included pSS patient from two referral hospitals over a 4-year period. The SGUS scores (0-48) and SG volumes were assessed. Clinical, laboratory, and SGUS data were compared according to age at onset: EopSS (≥65 years), adult-onset (AopSS) (≥40 and <65 years), and young-onset (YopSS) (<40 years). This cross-sectional study included a total of 221 patients, 43 (19.5%) of which had EopSS. Subjective sicca symptoms, results of the Schirmer's test, and unstimulated salivary flow rate revealed no significant differences between the groups. EopSS patients presented a significantly higher frequency of interstitial lung disease (ILD) (EopSS: 51.2% vs. AopSS: 13.5% vs. YopSS: 8.7%, P<0.001) and lower frequency of arthritis (7% vs. 22.6% vs. 39.1%, P<0.01). They also had significantly lower positivity of anti-Ro/SSA (51.2%) and anti-La/SSB (7.0%) and lower levels of rheumatoid factor, C4, and IgG. The EopSS group had significantly lower SGUS positivity (defined as total scores ≥14) (44.2% vs. 64.5% vs. 78.3%, P<0.05), lower SGUS scores, and smaller submandibular gland volume. We report a specific phenotype of EopSS, characterised by high prevalence of ILD, less involvement of the peripheral joint, and low biological activity. SGUS evaluation showed less parenchymal abnormalities but more atrophic changes in major SGs in EopSS patients. Considering the low positivity of anti-Ro/SSA and SGUS in EopSS, SG biopsy remains the only way to confirm the diagnosis of pSS, especially in elderly patients.

Regular maintenance appointments after non-surgical scaling and root planing support periodontal health in patients with or without dry mouth: A retrospective study.

ObjectiveNon‐surgical scaling and root planing (SRP), as an initial form of periodontal treatment, followed by ongoing periodontal maintenance appointments is necessary to manage periodontal disease and prevent tooth loss. Saliva also has an essential role in oral health though the relationship between low salivary flow and periodontal outcomes has not been extensively investigated. This study determined if patients with dry mouth have similar clinical outcomes as patients without dry mouth when receiving regular periodontal maintenance after SRP.Materials and methodsThis is a retrospective study that investigated clinical periodontal outcomes in patients with (n = 34) or without (n = 85) dry mouth who had undergone SRP 1 to 5 years prior and had routine periodontal maintenance. The presence of dry mouth was established based on a patient's unstimulated salivary flow rate.ResultsProbing depth for both patients with or without dry mouth was similar between groups and maintained 1 to 5 years following initial SRP. Improved probing depth achieved post‐SRP was sustained regardless of dry mouth status.ConclusionPatients with or without dry mouth did not exhibit different probing depths.

Selected salivary parameters in children with idiopathic nephrotic syndrome: a preliminary study

BackgroundDisturbances in the levels of serum constituents occurring in chronic renal diseases can be reflected in the saliva composition. The aim of this study was to assess some selected salivary components in children suffering from idiopathic steroid-sensitive nephrotic syndrome (iNS).MethodsA case–control study was performed on iNS and healthy participants. In unstimulated mixed saliva, pH, buffer capacity, total protein, α-amylase, peroxidase, calcium, magnesium, inorganic phosphate, fluoride, urea, uric acid and salivary flow rate were measured. Oral condition was assessed using dmft, DMFT, API and GI indices, usage of fluoride specimens and frequency of tooth brushing. Statistical analysis was performed by Shapiro–Wilk, Brown-Forsythe, Student’s t, ANOVA, Tukey’s and Pearson’s chi-square tests, Pearson’s and Spearman’s correlations, logistic regression and receiver operating characteristic (ROC) curve analysis.ResultsThe study involved 94 participants of both genders aged 4–17 (47 cases in relapse or remission phase of iNS and 47 controls) who were treated in the clinic of pediatric nephrology or outpatient dental clinic. Neither group differed in the number of caries-affected primary and permanent teeth, gingival condition or use of fluoride specimens. The iNS group presented lower levels of magnesium (0.41 ± 0.34 vs. 0.60 ± 0.38 mg/dL, P < 0.05) and fluoride (0.15 ± 0.10 vs. 0.21 ± 0.10 ppm, P < 0.01) and higher contents of urea (35.19 ± 15.55 vs. 25.21 ± 10.78 mg/dL, P < 0.01) and uric acid (2.90 ± 1.23 vs. 2.34 ± 1.04 mg/dL, P < 0.05) than the controls. In the iNS participants with relapse, a higher peroxidase activity and lower magnesium content than in the remission phase were found. ROC analysis showed a weak discriminatory power of these salivary constituents for the differentiation of participants with and without disease (accuracy from 66.0 to 67.0%, area under the ROC curve (AUC) from 0.638 to 0.682) and the relapse and remission phases (accuracy 70.2% and 68.1% and AUC 0.717 and 0.675, respectively).ConclusionsLevels of urea, uric acid, magnesium and fluoride in saliva can be associated with the course of iNS. Salivary levels of peroxidase and magnesium can be related to the phase of the disease. However, the measurements of these parameters cannot be useful as a noninvasive tool in diagnosing iNS and the phase of the disease.

Evaluation of the Effect of Fixed and Removable Appliances on Salivary Parameters (Salivary Flow Rate pH and Buffering Capacity) in Children Aged 5-12 Years: An In Vivo Study.

AimTo evaluate and compare the effect of fixed and removable space maintainers or appliances on salivary factors (“salivary flow rate,” pH, and buffering capacity of saliva) in children aged 5–12 years over a period of 3 months.Materials and methodsSixty children were selected for the study and equally alienated into two groups as group I for fixed appliances and group II for removable appliances). Unstimulated saliva was collected from children wearing fixed and removable space maintainers or appliances at baseline, 1, 2, and 3 months.ResultsAt the end of 3 months, there was a slight decrease in the buffering capacity and pH of saliva, which was not statistically significant in both the groups. An increase in unstimulated salivary flow rate was also seen in both the groups at the end of 3 months.ConclusionFixed and removable space maintainers or appliances act as opportunistic plaque retentive sites in children, necessitating appropriate oral hygiene maintenance and its reinforcement. Failure to adhere to a strict oral hygiene regimen can cause considerable enamel decalcification and plaque retention leading to alteration in oral microflora which has detrimental effects.Clinical significanceThis study paves way for provision of incorporating practice guideline information for both dentists and children undergoing long-term space maintainer or appliance therapy in children.How to cite this articleKukreja P, Hugar SM, Hallikerimath S, et al. Evaluation of the Effect of Fixed and Removable Appliances on Salivary Parameters (Salivary Flow Rate pH and Buffering Capacity) in Children Aged 5–12: An In Vivo Study. Int J Clin Pediatr Dent 2021;14(6):774–778.

Effectiveness of Transcutaneous Electrical Nerve Stimulation Therapy on whole Salivary Flow in Patients with Xerostomia and Healthy Adults

Objective: To evaluate and compare the effectiveness of transcutaneous electrical nerve stimulation (TENS) therapy on whole salivary flow in patients with xerostomia and healthy adults. Material and Methods: Thirty subjects with a history of xerostomia and subjects with unstimulated salivary flow equal to or less than 0.5 ml in 5 min were included in the study group, and 30 healthy subjects were included in the control group. Low forced spitting unstimulated saliva was collected for five minutes in a test tube fitted with a funnel. Then electrode pads of the TENS unit were applied bilaterally on skin overlying the parotid glands and at optimal intensity, stimulated saliva was collected for 5 minutes with the same method in a separate graduated test tube. The salivary flow rate (per minute) was calculated by dividing the amount of collected saliva (volume in mL) by the duration of collection period (5 minutes) and the salivary flow rates prior and after electrostimulation were compared for both groups. The Student’s t-test (unpaired and paired) was performed for group-wise comparisons. Results: In study group, the mean unstimulated salivary flow rate was 0.07 ± 0.01 mL/min. There was an 85.71% increase in salivary flow (0.13 ± 0.03 mL/min) during the TENS application and the difference was highly significant (p 0.05). Conclusion: TENS can be an effective therapy in increasing whole salivary flow rates in patients with xerostomia.

Stimulated whole salivary flow rate: The most appropriate technique for assessing salivary flow in Sjögren syndrome.

Background We sought to determine the most appropriate method for measuring salivary flow to aid the diagnosis of Sjögren's syndrome (SS). Specifically, we compared the unstimulated whole salivary flow rate (UWSFR) with the stimulated whole salivary flow rate (SWSFR).Material and Methods This case-control study comprised one group of 103 patients with SS and a control group of 50 healthy people. We measured the UWSFR and SWSFR in both groups according to the guidelines established by Navacet (1993).Results The UWSFR and SWSFR were significantly lower in the patient group compared with the controls (p < 0.01). Among the participants in the patient group, we found a decreased UWSFR in 84 individuals (81.5%) and a decreased SWSFR in 90 individuals (87.4%). We encountered difficulties obtaining saliva in 37 (35.9%) patients during the UWSFR test, and in 12 (11.7%) patients during the SWSFR test. There was no significant statistical difference in the UWSFR or SWSFR between patients with primary and secondary SS.Conclusions Compared with the UWSFR, the SWSFR is a more suiTable and effective method for measuring salivary flow in patients with SS, as well as for qualitative analysis of the obtained saliva. Key words:Sjögren syndrome, xerostomia, salivary glands.

Oral Health Status of Children Undergoing Hemodialysis and Kidney Transplantation in Mansoura City, Egypt

Purpose: Evaluation of oral health status in children undergoing hemodialysis sessions and kidney transplantation and compared them with healthy children. Materials and Methods: This descriptive study was conducted on 250 children aged 6-18 years old (100 children undergoing hemodialysis, 50 children undergoing kidney transplantation and 100 healthy children as a control group). The oral health status was evaluated regarding to caries experience, gingivitis using PMA index, developmental defects using modified DDE index. Un-stimulated salivary flow rate and pH were also measured. Results: caries experience was significantly lower in both chronic kidney disease (CKD) groups compared to control group. Median PMA was significantly higher in hemodialysis and in transplantation groups compared to control group. The prevalence of developmental enamel defects was 41% in hemodialysis group and 58% in transplantation group compared to 11% in control group (P-value < 0.001). Regarding to saliva analysis, the flow rate was higher among healthy children while the salivary PH was higher among children with CKD. Conclusions: chronic kidney disease may decrease caries experience, increase gingival inflammation, in addition to increase prevalence of developmental defects. Furthermore, children with chronickidney disease have lower salivary flow rate and higher buffering capacity than healthy children.

Effects of Chewing Gum Base on Oral Hygiene and Mental Health: A Pilot Study.

The purpose of the present study was to clarify the long-term effects of frequent chewing of unflavored and odorless gum (hereafter, gum base) on oral hygiene and mental health. This single-arm study, which started with a 4-week control and ended with a 4-week intervention period, was conducted in two phases: one in 2017 and one in 2018. The participants comprised 36 dental hygiene students (17 in 2017, 19 in 2018). During the intervention period, all participants were required to chew a piece of gum base 7 times a day for 10 min each time. The unstimulated salivary flow rate and masticatory efficiency were measured and chewing number counted. Two questionnaires －the Profile of Mood States, second edition (POMS2) and the 30-item General Health Questionnaire (GHQ-30)－ were administered to assess mental health. In both phases, the unstimulated salivary flow rate showed a significant increase after the intervention period (p<0.05). In 2017, the GHQ-30 scores and masticatory efficiency showed a tendency toward a negative correlation after the intervention period (r=－0.4647, p=0.06). In 2018, a significant negative correlation was observed between chewing number and the POMS2 scores after the intervention period (r=－0.6296, p<0.01). These findings suggest that frequent chewing of gum base increases unstimulated salivary flow rate. However, no significant change was observed in the mental health.

Oral and systemic factors in xerostomia

ABSTRACT Objective: The aim of this study was to evaluate the relationship among the following features: hyposalivation, systemic diseases and drug use, oral symptoms, dental condition, salivary flow and salivary pH, as well. Methods: A cross-sectional study was performed with 50 participants diagnosed with xerostomia, randomly selected and distributed in two groups: 25 with hyposalivation and 25 without hyposalivation, paired in age and sex. Unstimulated Salivary Flow Rate (USFR), Decayed, Missing, Filled, Teeth (DMFT) index and salivary pH were determined. The Mann-Whitney test and chi-square test were applied, considering significant for p-values &lt;0.05. Results: Among the participants with hyposalivation, 88% used drugs and 96% presented systemic disease. And among those without hyposalivation, 48% used drugs and 64% presented systemic disease. The ones with hyposalivation showed the highest levels of dysgeusia (60%) and burn mouth (36%). There were statistically significant differences for the medians of USFR (0.08ml/minute / 0.2ml/minute) (p = 0.000), pH (6/7) (p = 0.000) and DMFT (22/17) (p = 0.004) obtained from participants with hyposalivation and without hyposalivation, respectively. Only in the group with hyposalivation there was a statistically significant association of unstimulated salivary flow rate with age (p = 0.035), type of systemic disease (p = 0.049) and pH (p=0.032) and DMFT demonstrated an association with systemic diseases (p = 0.015). Conclusion: The research results have suggested that hyposalivation worsens dental status triggering oral symptoms, and that salivary flow is influenced by the type of systemic disease and age group.

Salivary characteristics may be associated with burning mouth syndrome?

BackgroundBurning mouth syndrome (BMS) it is characterized by burning and uncomfortable sensations with no clinical alterations or laboratory findings. The evaluation of the salivary characteristics of people with BMS can help the understanding of the pathogenesis of this condition. This case-control study aimed to trace the salivary profile of women with burning mouth syndrome (BMS). Material and Methods40 women with BMS and 40 control women were recruited. Unstimulated salivary flow rate (uSFR), pH, salivary cortisol levels, salivary viscosity, and oral health impact profile (OHIP-14 questioner) were determined. P< 0.05 was considered statistically significant. ResultsFor uSFR, mean values obtained for BMS and for control group respectively were 0.35 and 0.61 mL/min; for pH, 7.23 and 7.34; for cortisol levels, 0.36 and 0.15 μg/dL; for viscosity values, 31.1 and 45.01 mPas and for OHIP-14 scores, 21.7 and 5.7. To uSFR, cortisol levels, viscosity values and OHIP-14 scores, differences were statistically significant. Salivary cortisol levels and OHIP-14 scores were correlated positively (rho = 0.624; p< 0.05). ConclusionsBMS women have lower uSFR and salivary viscosity and higher salivary cortisol levels that were associated with worse quality of life, compared with the control group. Key words:Xerostomia, Burning mouth syndrome, Viscosity.

IDENTIFIKASI FAKTOR RISIKO TERJADINYA KOLONISASI SPESIES CANDIDA DI RONGGA MULUT PADA INDIVIDU SEHAT (PENELITIAN PADA MAHASISWA &amp; MAHASISWI FKG UI)

Introduction : Cases of oral candidiasis are commonly found, both in healthy individuals and immunecompromise patients, however publications of Candida carrier in the oral cavity of healthy population and risk factors for colonization in Indonesia are hardly available. Objective : This study was aimed to analyze the type and number of Candida colonies and identify risk factors in the oral cavity of apparenthly health FKG UI students. Material and methods : the specimens were taken from 195 subjects with oral rinse technique for identification using culture medium CHROMagar® and Sabaraoud dextrose agar. Results and discussion : Candida species were found in the 107 subjects oral cavity (54.87%), being Candida albicans was is the predominant species (52.33%). Some 88 subjects (82.24%) was dominant in the number of colonies less than 400 CFU/ml, while the rest had colony of more than 400 CFU/ml (17.76%). Candida colony grew dominantly in single colony (90.65%), and the others showed multi-species colonies (9.34%). Risk factors identified included age; gender; hormonal; blood type O; denture; orthodontic appliances; unstimulated salivary flow; pH of saliva; smoking, alcohol and oral cleaning habit; and oral health status. By using a statistical Pearson chi-square test, no significant relationship was found between risk factors and number of Candida colonies in the oral cavity p less than 0.05. Conclusion : there was no one single risk factor for Candida colonization, but combination of various risk factors for demographis, local and systemic was observed

Salivary Glands and Periodontal Changes in a Population of Sjögren's and Sicca Syndrome Treated by Pilocarpine: A Pilot Study.

IntroductionOral administration of pilocarpine enhances salivary flow in sicca patients but its effect upstream on ultrasound (US) of salivary glands (SG) and downstream on periodontium remain unknown. MethodsSicca patients were prospectively included. Echostructural and vascularization of SG were assessed using B mode and pulsed Doppler (USPD). Vascularization of SG was measured using resistive index (RI) before and after stimulation by lemon juice. Echostructure (measure of glandular length in cm2, evaluation of parotid and submandibular glands parenchymal abnormalities) was assessed at baseline (M0) and after 3 months (M3) of treatment with pilocarpine. A dental consultation was performed at M0 and M3 to evaluate changes in unstimulated salivary flow (USSF), stimulated salivary flow (SSF), and periodontal parameters such as modified gingival index (Lobene), plaque index (Silness), bleeding index, pocket depth, and pH. ResultsNineteen patients were included but only 11 received pilocarpine treatment for 3 months, as six stopped pilocarpine due to side effects and two were excluded for other causes. Among the 11 patients who completed the 3-month follow-up, five had primary Sjögren’s syndrome according to the American-European’s classification criteria. As expected, statistical differences were found concerning SSF (p = 0.018) and USSF (p = 0.027) between M0 and M3 while no statistical change in both SG echostructure and vascularization or periodontal evaluation was shown.ConclusionsPilocarpine improved SSF and USSF measurements in sicca syndrome but no ultrasonography of major salivary glands (SGUS) structural and vascular changes were detected as well as periodontal evaluation.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40744-020-00263-y.

Normal-Appearing Salivary Gland Ultrasonography Identifies a Milder Phenotype of Primary Sjögren's Syndrome.

Objective: Salivary gland ultrasound (SGUS) is emerging as a valid tool in the management of primary Sjögren's syndrome (pSS). This study aimed to investigate whether pSS patients with normal-appearing or pathological SGUS findings showed different clinical, laboratory, and pathologic pSS-related features, and to compare the results by using two different SGUS scores.Methods: Consecutive pSS patients, according to the ACR-EULAR classification criteria, were evaluated. Salivary glands were scored using the early 1992 score by De Vita et al. and the latest 2019 OMERACT score, both being semiquantitative 0–3 scoring systems focused on ultrasonographic parenchymal inhomogeneity (grades 0 and 1, normal-appearing; grades 2 and 3, pathological). The patients were then divided into two groups: “SGUS normal-appearing” if all the salivary glands had normal-appearing parenchyma (grade 0 or 1), or “SGUS pathological” if the grade was 2 or 3 in at least one salivary gland. The associations between SGUS and pSS-related clinical, laboratory, and pathological features were then investigated in the two groups.Results: One hundred pSS patients were evaluated, the mean age (±SD) was 60.9 ± 12.0 years, and mean disease duration was 11.7 ± 7.2 years. Twenty-nine out of 100 (29%) patients were in the “SGUS normal-appearing” group and 71/100 (71%) were in the “SGUS pathological” group. A normal-appearing SGUS was significantly associated with the absence of anti-La/SSB antibodies (p < 0.001) and normal unstimulated salivary flow rate (p = 0.02) by both univariate and multivariate analyses. By univariate analysis, a normal-appearing SGUS was significantly associated also with the absence of rheumatoid factor (p = 0.002) and of serum monoclonal component (p = 0.003), ESSDAI < 5 (p = 0.03), and with a negative lip biopsy (p = 0.029). No associations were found with other items, including anti-Ro/SSA (p = 0.145), Schirmer's test (p = 0.793), ESSPRI (p = 0.47), and demographic data. No differences in these results were observed by using the two SGUS scoring systems.Conclusion: The SGUS allowed the identification of different phenotypes of pSS, and different SGUS scores focused on salivary gland inhomogeneity may be effective to this end.

Oral mucosa involvement in rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis

To estimate the frequency and character of oral mucosal lesions in patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. Furthermore, the relation between oral mucosal involvement and hyposalivation was investigated. Case-control study. Rheumatology Clinic, University Hospital "Mother Theresa" in Tirana, Albania. 124 consecutive hospitalised patients (88 with rheumatoid arthritis, 22 with systemic lupus erythematosus and 14 with systemic sclerosis) and 124 age- and gender- matched healthy controls. Oral lesions were clinically examined and classified according to their morphologic aspects and localisation. Examination included also measurement of unstimulated whole salivary flow. Frequency of oral mucosal lesions and hyposalivation. Oral mucosal lesions were observed in 58.9% of patients, but in only 33.1% of control subjects. Clinical aspects of lesions varied, and palate, buccal and labial mucosa, and tongue were the most affected sites. No significant associations were found between presence of oral lesions and hyposalivation, except oral candidosis which was associated with hyposalivation in controls. Patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis have a higher burden of oral mucosa disease than a healthy population. Collaboration of rheumatology and oral medicine units should allow appropriate management of these patients.

Prevalence of root caries in relation to various risk factors in a sample of subjects aged (25-64) years in Erbil city: A cross sectional study

Backgrounds: Root surface caries is a significant oral public health problem among humans' due to improvements in health care, long life expectancy, and increasing demand to maintain oral health. The objective of this study was to determine the prevalence of root caries in subjects in Erbil city and its relation to various risk factors. Subjects and methods: The study was conducted in twelve primary health care centers in different directions of the city. A total of 2600 subjects (1352 males and 1248 females) attending these centers aged 25-64 years old were examined. The following clinical parameters were evaluated: root caries index, plaque index, gingival index, unstimulated salivary flow rate, other related factors as behavioral habits, oral practices, and educational level were assessed by means of multiple choice questionnaires by direct interview. Results: The results of this study showed that the prevalence of root caries was (22.3%) and the mean value of root caries was (33.650±16.504) in the whole sample with statistically significant age differences of both. Males were more prevalent in root surface caries than females with significant differences. Results showed that the mandibular teeth were more affected than the maxillary teeth, and that mandibular first molars were the mostly affected teeth by root caries. Prevalence of root caries was significantly associated with these risk factors: gingival index, plaque index, unstimulated salivary flow rate, educational level, wearing removable partial dentures, frequency of snacks, tooth brushing and frequency of tooth brushing, systemic disease and use of medication, while the results showed no association between prevalence of root caries and smoking. Conclusions: The results indicate that adults and older aged individuals in Erbil city have a high prevalence of root caries and high experience of root caries as expressed by root caries index and the prevalence of root caries was associates with these risk factors: Gingival index, Plaque index, unstimulated salivary flow rate, educational level, wearing removable partial dentures, frequency of snacks, tooth brushing and frequency of tooth brushing, systemic disease and use of medication while there was no association with smoking. Keywords: Root caries, Risk factors, Root caries index, Unstimulated salivary flow rate, Behavioral habits.

Evaluation of the salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation.

Background Head and neck radiotherapy is typically associated with toxicities that can have profound effects on the patient's quality of life. Xerostomia, which may or may not be related to hypofunction of the salivary gland, leading to negative consequences, mainly in quality of life, leaving patients more susceptible to the development of oral mucositis, dental caries, oral infection and difficulties in speech is one of the most common side effects of such treatment. The aim of the present study was to evaluate salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation. Material and Methods A cross-sectional study with a quantitative approach was carried out in the Dentistry Department of the Hospital de Câncer de Pernambuco between February and September 2019. Results The study sample comprised 23 patients of both genders, treated with radiotherapy for cancer in the head and neck region. The patients were submitted to photobiomodulation with infrared laser, as intraoral applications in order to prevent mucositis and extraoral applications to stimulate salivary glands. The applications were undertaken three times a week on alternate days throughout the radiotherapy period. The following parameters were used: Intraoral 15mW, 12J / cm2, 10s / point, 2.4 J / point, and extraoral 30mW, 7.5J / cm2, 10s / point, 0.3J / point, both with a wavelength of 830nm and area of 0.028cm². Subjective and objective symptoms were evaluated by measuring the unstimulated salivary flow (USF) using the spitting technique before, during and after radiotherapy treatment. For statistical analysis, a significance level of 5% was adopted. Most patients were male (70%) with 60 years of age on average. At the beginning of treatment, 22 patients had USF> 0.2 ml / min (grade 1), at the end of which 15 patients remained unchanged and only 3 patients progressed to grade 3. As for the subjective classification, most (52%) remained in grade 1 (absence of disability) throughout the treatment. Conclusions Based upon the results of this study it was possible to conclude that the use of photobiomodulation did not significantly interfere with the xerostomia complaint of patients in treatment with radiotherapy, however, it does seem to prevent patients from reaching higher degrees of xerostomia taking into account salivary flow measures. Key words:Photobiomodulation, head and neck neoplasms, radiotherapy, xerostomia, saliva.