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Unstimulated whole salivary flow in Sjögren's Syndrome: systematic literature review and meta-analysis.
Martínez-Ceballos, MA, Aguilera, N, Garzón-González, KC, Cajamarca-Baron, J, Alzate-Granados, JP, Rojas-Villarraga, A
Advances in rheumatology (London, England). 2021;(1):8
Abstract
BACKGROUND Sjögren'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). METHODS A 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. RESULTS Thirty-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). CONCLUSION For 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 REGISTRATION PROSPERO CRD42020211325 .
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Oral health and salivary function in ulcerative colitis patients.
Goldinova, A, Tan, CX, Bouma, G, Duijvestein, M, Brand, HS, de Boer, NK
United European gastroenterology journal. 2020;(9):1067-1075
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BACKGROUND Although ulcerative colitis primarily involves the colon, extra-intestinal manifestations are common and oral and dental complaints are no exception. OBJECTIVE This study aims at evaluating oral and dental health problems and salivary function and composition in ulcerative colitis patients and its correlation with disease activity. METHODS Xerostomia Inventory score, (unstimulated/stimulated) salivary flow rates, salivary amylase and mucin/ Mucin 5B levels, self-reported oral and dental complaints, the oral health related quality of life, Simple Clinical Colitis Activity Index and inflammatory bowel disease-specific health related quality of life were determined. RESULTS The cohort consisted of 51 ulcerative colitis patients. Hyposalivation was experienced by 16% of patients under resting conditions and 24% under chewing-stimulated conditions. Xerostomia was not correlated with salivary flow rates. Disease activity did not influence salivary amylase and Mucin 5B concentrations. The Xerostomia Inventory score was correlated with the Simple Clinical Colitis Activity Index (p = 0.042) and inflammatory bowel disease-specific health related quality of life (p = 0.001). Most reported oral health problems were halitosis (29%) and aphthae (28%). Frequently reported dental problems were cavities (35%) and gum problems (31%). Patients with active disease experienced significantly more oral and dental complaints. The number of oral problems was positively correlated with the Simple Clinical Colitis Activity Index (p = 0.045) and negatively correlated with the inflammatory bowel disease-specific health related quality of life (p = 0.005). CONCLUSION The subjective feeling of a dry mouth (xerostomia) is related to disease activity and disease activity-associated quality of life in ulcerative colitis patients, whereas the objective saliva secretion rate is not. Oral and dental health problems are frequently observed in patients with ulcerative colitis, especially during active disease.
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Evaluation of photobiomodulation in salivary production of patients with xerostomy induced by anti-hypertensive drugs: Study protocol clinical trial (SPIRIT compliant).
Varellis, MLZ, Gonçalves, MLL, Pavesi, VCS, Horliana, ACRT, de Fátima Teixeira da Silva, D, Motta, LJ, Barbosa Filho, VF, Bezerra, CDS, Silva, FGD, Bussadori, SK, et al
Medicine. 2020;(16):e19583
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INTRODUCTION Hypertension (systemic arterial hypertension [SAH]) is a systemic condition that affects about 30% of the world population, according to data from the World Health Organization (WHO). Drugs used to control this disease have the potential to induce xerostomia, an oral condition in which the decrease of the salivary flow is observed and whose presence leads to the increase of the index of caries, periodontal disease, loss of the teeth, dysgeusia, difficulty of mastication, dysphagia, bad breath and oral burning and impairment of prothesis installed in the buccal cavity, including retention of removable and total dentures. METHODS This is a randomized, placebo-controlled, blind clinical protocol that aims to analyze the impact of phobiomodulation (PBM) on salivary glands of patients with antihypertensive drug induced xerostomia. Patients will be divided into 2 groups: G1: older adults with xerostomia induced by antihypertensive drugs and treatment with PBM (n = 30); G2: placebo PBM (n = 30). The irradiation will be made using a diode laser emitting at 808 nm with 100 mW and 40 seconds of exposure per site at the salivary glands. Twenty sites will be irradiated weekly for 4 weeks. Non-stimulated and stimulated salivary flow will be analyzed before and after the treatment. RESULTS This protocol will determine the effectiveness of photodynamic therapy regarding the reduction of xerostomia in older adults using antihypertensive drugs. CONCLUSION This protocol will determine the effectiveness of photodynamic therapy regarding the reduction of xerostomia in older adults using antihypertensive drugs. TRIAL REGISTRATION Clinicaltrials.gov - NCT03632096.
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Effects of lingual exercises on oral muscle strength and salivary flow rate in elderly adults: a randomized clinical trial.
Lee, KH, Jung, ES, Choi, YY
Geriatrics & gerontology international. 2020;(7):697-703
Abstract
AIM: The present study investigated the effects of two types of lingual exercise (tongue-hold swallowing and tongue-pressure resistance training) on oral muscle strength, salivary flow rate and subjective oral health of the elderly. METHODS We randomly assigned 74 elderly adults (≥65 years) to three groups (tongue-hold swallowing, tongue-pressure resistance training and control groups). Each group participated in 8 weeks of their appropriately prescribed intervention. We measured anterior tongue strength, posterior tongue strength, lip strength, salivary flow rate and Oral Health Impact Profile-14 score before and after 8 weeks. Differences before and after intervention were observed with a paired sample t-test. Moreover, analyses of covariance and variance were performed to determine the differences in the measured values between the groups. RESULTS The tongue-hold swallowing group showed improvement in both anterior and posterior tongue strength, while the tongue-pressure resistance training group showed a significant increase in only anterior tongue strength. Both the tongue-hold swallowing and tongue-pressure resistance training groups showed increased salivary secretion, with the tongue-pressure resistance training group showing a higher level of salivary secretion. However, the difference in the subjective oral health scores before and after the intervention was not significant. CONCLUSIONS The two lingual exercises strengthened some aspects of tongue muscles and increased the salivary flow rate, with more salivary secretion in the tongue-pressure resistance training group than in the tongue-hold swallowing group. Any evidence of the lingual exercises being able to enhance subjective oral health could not be found. Geriatr Gerontol Int 2020; ••: ••-••.
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Repetitive Saliva Swallowing Test: Norms, Clinical Relevance and the Impact of Saliva Secretion.
Persson, E, Wårdh, I, Östberg, P
Dysphagia. 2019;(2):271-278
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Screening tests can be performed to identify stroke patients who require further assessment of swallowing function. The Repetitive Saliva Swallowing Test (RSST) is a screening test during which the patient is asked to swallow saliva as many times as possible for 30 s, while deglutition is counted through palpation of the larynx. This study aimed to establish normative values for three age groups of non-patients (total N = 120) on RSST. One patient group (N = 40) was also recruited from a geriatric stroke unit to assess whether RSST scores predicted outcomes on the Standardised Swallowing Assessment-Svenska (SSA-S), a clinical screening tool here used as a reference test. Since the RSST involves the swallowing of saliva, this study also measured the participants' saliva secretion in order to examine its effect on RSST performance. This study showed that RSST results vary with age (lower among older) and gender (higher for men than women), while the number of doctor-prescribed medications, objective saliva secretion and self-assessed dryness of mouth did not affect the performance significantly. In comparison to a more extensive clinical screening procedure (SSA-S), the RSST correctly predicted 93% of negative cases and 69% of positive cases. This suggests that patients who show signs of aspiration according to SSA-S have a lower probability of detection with RSST.
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Effect of ingesting yogurt fermented with Lactobacillus delbrueckii ssp. bulgaricus OLL1073R-1 on influenza virus-bound salivary IgA in elderly residents of nursing homes: a randomized controlled trial.
Yamamoto, Y, Saruta, J, Takahashi, T, To, M, Shimizu, T, Hayashi, T, Morozumi, T, Kubota, N, Kamata, Y, Makino, S, et al
Acta odontologica Scandinavica. 2019;(7):517-524
Abstract
Objective: The purpose of this study was to clarify the influence of consuming yogurt fermented with Lactobacillus delbrueckii ssp. bulgaricus OLL1073R-1 (1073R-1-yogurt) on influenza virus-bound salivary immunoglobulin A (IgA) levels, in the elderly residents of nursing homes. Methods: A double-blind, parallel-group, randomized controlled trial was conducted with 96 elderly volunteers residing in 2 nursing homes. During the trial, participants consumed 100 g of 1073R-1-yogurt every morning for 12 weeks, whereas the control participants consumed yogurt fermented with a different Lactobacillus strain (control yogurt). Saliva was collected before the trial and after 4, 8 and 12 weeks of yogurt ingestion. Results: Our data indicated that consumption of 1073R-1-yogurt affected influenza A virus subtype H3N2-bound IgA levels in saliva (p = .001). In addition, saliva flow rate and total IgA levels increased in response to the yogurt intake period in both the 1073R-1 and control yogurt groups (p = .04). Conclusions: Our study suggests that continuous daily ingestion of 1073R-1-yogurt may help prevent infection with influenza A virus subtype H3N2 in elderly subjects with weakened immunity, by increasing the production of influenza A virus subtype of H3N2-bound salivary IgA.
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Impact of food odors signaling specific taste qualities and macronutrient content on saliva secretion and composition.
Morquecho-Campos, P, Bikker, FJ, Nazmi, K, de Graaf, K, Laine, ML, Boesveldt, S
Appetite. 2019;:104399
Abstract
Olfactory food cues can induce appetite for similar food products in humans. Odors may thus signal essential information about a foods' composition such as taste or even macronutrient content and may stimulate specific physiological responses in anticipation of food intake. Several studies have shown that sensory food cues could stimulate saliva secretion. However, potential differences between food odors in their effect on saliva secretion, or the effects of olfactory stimulation on changes in saliva composition remain to be elucidated. To gain more insight, we conducted two studies to determine the influence of various odors, representing different taste qualities (study 1) and macronutrients (study 2), on salivary biomarkers. In study 1, 36 participants were randomly exposed to no-odor, non-food, and odors signaling sweet, savory, and sour taste. In study 2, 60 participants were randomly exposed to no-odor, non-food, and odors signaling carbohydrates, protein, fat, and low-calorie food. For each condition, whole-mouth saliva was collected and saliva secretion rate determined. Furthermore, we determined mouth-watering perception (subjective salivation), visco-elasticity (study 1 only), mucin concentration, α-amylase and lingual lipase activity (study 2 only). For both studies, linear mixed model analyses showed that saliva secretion rate significantly increased by food odor exposure compared to no-odor and non-food conditions. However, no changes in salivary composition were observed. These findings indicate that food odors play a crucial role in anticipatory saliva responses and can thereby affect subsequent eating behavior.
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Assessment of Risk of Xerostomia After Whole-Brain Radiation Therapy and Association With Parotid Dose.
Wang, K, Pearlstein, KA, Moon, DH, Mahbooba, ZM, Deal, AM, Wang, Y, Sutton, SR, Motley, BB, Judy, GD, Holmes, JA, et al
JAMA oncology. 2019;(2):221-228
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IMPORTANCE Whole-brain radiation therapy (WBRT) delivers a substantial radiation dose to the parotid glands, but the parotid glands are not delineated for avoidance and xerostomia has never been reported as an adverse effect. Minimizing the toxic effects in patients receiving palliative treatments, such as WBRT, is crucial. OBJECTIVE To assess whether xerostomia is a toxic effect of WBRT. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study enrolled patients from November 2, 2015, to March 20, 2018, at 1 academic center (University of North Carolina Hospitals) and 2 affiliated community hospitals (High Point Regional Hospital and University of North Carolina Rex Hospital). Adult patients (n = 100) receiving WBRT for the treatment or prophylaxis of brain metastases were enrolled. Patients who had substantial baseline xerostomia or did not complete WBRT or at least 1 postbaseline questionnaire were prospectively excluded from analysis and follow-up. Patients received 3-dimensional WBRT using opposed lateral fields covering the skull and the C1 or C2 vertebra. Per standard practice, the parotid glands were not prospectively delineated. MAIN OUTCOMES AND MEASURES Patients completed the University of Michigan Xerostomia Questionnaire and a 4-point bother score at baseline, immediately after WBRT, at 1 month, at 3 months, and at 6 months. The primary end point was the 1-month xerostomia score, with a hypothesized worsening score of 10 points from baseline. RESULTS Of the 100 patients enrolled, 73 (73%) were eligible for analysis and 55 (55%) were evaluable at 1 month. The 73 patients included 43 women (59%) and 30 men (41%) with a median (range) age of 61 (23-88) years. The median volume of parotid receiving at least 20 Gy (V20Gy) was 47%. The mean xerostomia score was 7 points at baseline and was statistically significantly higher at each assessment period, including 21 points immediately after WBRT (95% CI, 16-26; P < .001), 23 points (95% CI, 16-30; P < .001) at 1 month, 21 points (95% CI, 13-28; P < .001) at 3 months, and 14 points (95% CI, 7-21; P = .03) at 6 months. At 1 month, the xerostomia score increased by 20 points or more in 19 patients (35%). The xerostomia score at 1 month was associated with parotid dose as a continuous variable and was 35 points in patients with parotid V20Gy of 47% or greater, compared with only 9 points in patients with parotid V20Gy less than 47% (P < .001). The proportion of patients who self-reported to be bothered quite a bit or bothered very much by xerostomia at 1 month was 50% in those with parotid V20Gy of 47% or greater, compared with only 4% in those with parotid V20Gy less than 47% (P < .001). At 3 months, this difference was 50% vs 0% (P = .001). Xerostomia was not associated with medication use. CONCLUSIONS AND RELEVANCE Clinically significant xerostomia occurred by the end of WBRT, appeared to be persistent, and appeared to be associated with parotid dose. The findings from this study suggest that the parotid glands should be delineated for avoidance to minimize these toxic effects in patients who undergo WBRT and often do not survive long enough for salivary recovery.
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Improvements in oral functions of elderly after simple oral exercise.
Kim, HJ, Lee, JY, Lee, ES, Jung, HJ, Ahn, HJ, Kim, BI
Clinical interventions in aging. 2019;:915-924
Abstract
Purpose: Conventional oral exercises in previous studies are considered impractical for continuous use in the elderly because of the extended duration needed for effective outcomes. Therefore, in the present study, a simple oral exercise (SOE) was developed to reduce performance time, focusing on improvements in mastication, salivation, and swallowing functions. The aim of this study was to determine the short-term effects of the SOE with respect to improving mastication, salivation, and swallowing function in elderly subjects ≥65 years of age. Patients and methods: The study included 84 subjects, all of whom performed the SOE 2 times per day for 1 week. Masticatory performance was assessed using the mixing ability index (MAI). Unstimulated saliva and the degree of moisture of the tongue/buccal mucosa were evaluated, and the repetitive saliva swallowing test was performed. On the basis of each of these four measurements, subjects were dichotomized into two groups with high (good) and low (poor) conditions. The same evaluations were conducted before and immediately after intervention, as well as after 1 week of intervention. A subjective evaluation with questionnaires was performed after 1 week of intervention. The changes were analyzed using repeated-measures ANOVA, Cochran's Q test, and McNemar's test. Results: The mean MAI increased by 6% immediately after the intervention, and by 16% in the poor-chewing group. Similarly, the amount of unstimulated saliva increased by 0.1 ml/min immediately after the SOE, and by 29% in the poor-salivation group. The degree of tongue moisture increased by 3% and was maintained. In the poor-swallowing group, 25% and 40% of the subjects were upgraded to the good-swallowing group immediately after intervention, as well as after 1 week of intervention, respectively. The subjects experienced less discomfort as their oral function improved. Conclusion: The SOE was effective in immediately improving oral functions, and improvement was maintained for 1 week.
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Association between Salivary Hypofunction and Food Consumption in the Elderlies. A Systematic Literature Review.
Muñoz-González, C, Vandenberghe-Descamps, M, Feron, G, Canon, F, Labouré, H, Sulmont-Rossé, C
The journal of nutrition, health & aging. 2018;(3):407-419
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OBJECTIVES This systematic literature review aims to summarize the existing scientific evidence about the association between a reduced salivary function and food consumption in elderly people. METHODS A validated search strategy in two databases (PubMed and ISI Web of Knowledge) was carried out and retrieved papers together with their reference lists were screened by two independent reviewers. The quality of the included studies was critically appraised via the Quality Assessment Criteria for Evaluating Primary Research Papers. RESULTS From the originally identified studies (n=391), only 15 articles (all cross-sectional studies) met the pre-fixed inclusion/exclusion criteria. The methodological quality of the included studies was in general good, although only 3 from 15 obtained the maximum score. The control of confounding factors was the quality variable more poorly rated in the selected studies. Salivary hypofunction was associated with a decrease of the objective chewing and swallowing abilities and taste perception. Moreover, most of the selected studies showed a relationship between salivary hypofunction and food consumption (in terms of appetite loss, unbalanced dietary intake and malnutrition), although no causality could be established. CONCLUSIONS This study highlights the fact that salivary hypofunction definition and measurements are different across the studies. Therefore, future research efforts should focus on establishing a gold standard to define and identify salivary hypofunction throughout life and on performing longitudinal studies controlling for confounding factors to establish causality.