唾液的增加加速了含羧甲基壳聚糖口香糖的抗菌效果

目的:本论文采用了含羧甲基壳聚糖的口香糖,咀嚼这种口香糖的机械效果加速了其对口腔细菌的抑制作用,还比较口腔嗽洗液和咀嚼口香糖的抗菌效果,证明了通过咀嚼这种口香糖加速了唾液的分泌.方法:从青岛大学口腔科的老师和学生中选取了12名健康的受试者.在测试前取受试者的唾液测试细菌含量.在测试口香糖的试验中,受试者咀嚼5分钟口香糖然后休息5分钟.在测试口腔嗽洗液时,受试者用10ml嗽洗液漱口30秒后,休息9分30秒.同一天中这些测试步骤在50分钟内连续不断的进行了5次.5次测试后分别在0、30和60min收集被试者的唾液测试细菌含量.在测试唾液分泌的试验中,受试者每天咀嚼三次口香糖持续两天.结果:与使用口腔嗽洗液相比,咀嚼含羧甲基壳聚糖口香糖的受试者,在三个取样时间内口腔细菌的含量基本都明显减少,但是在60分钟的取样时间结果有点差异.咀嚼含羧甲基壳聚糖的口香糖明显提高了唾液的分泌量.结论:咀嚼含羧甲基壳聚糖的口香糖具有明显的抗菌效果.目前的研究结果强有力的证明了:使用像壳聚糖以及其衍生物这样的天然物质,对我们的口腔健康以及生活质量都有很大的帮助.     

Medication in elderly people: its influence on salivary pattern,signs and symptoms of dry mouth

doi:10.1111/j.1741‐2358.2009.00293.x
Medication in elderly people: its influence on salivary pattern, signs and symptoms of dry mouth Objective: To compare stimulated and non‐stimulated salivary flow, pH, buffering capacity and presence of signs and symptoms of hyposialie and xerostomia in elderly patients, with senile dementia using medication and healthy elderly subjects not using medication. Methods: Forty individuals (mean age: 68.5 years) were divided into two groups, according to the use (G1) or non‐use (G2) of medication and the presence (G1) or absence (G2) of senile dementia. Data with reference to the general health condition, use of medication and the patient’s complaints were collected during anamnesis. Clinical examination identified signs associated with hyposialie and xerostomia. Stimulated and non‐stimulated saliva flow, pH and buffering capacity were verified. Results: The stimulated saliva flow in both groups was below normal parameters. The drugs used by individuals in G1 showed xerostomic potential. Individuals with a higher consumption of xerostomic medication presented with dry and cracked lips. A significant negative relationship was found between drugs consumption and the buffering capacity (p < 0.001), and the resting saliva flow rate (p = 0.002). Conclusion: The use of medication increases the chance that an elderly person may present signs related to xerostomia and alterations in stimulated saliva flow and buffering capacity.     

Major salivary gland output differs between users and non-users of specific medication categories

Background: The intake of medications is a major aetiologic factor of xerostomia. The purpose of this study was to investigate the selective influence of medication categories on flow rates of individual major salivary glands. Methods: The effect of each medication category on salivary flow rates was determined by dichotomy comparisons between users and non‐users. A total of 246 patients were included, 79 males and 167 females aged 13–92 years (mean 63 years). Of these, 200 used medications, which were grouped according to their category. A comprehensive medical and oral examination was performed. Both unstimulated and stimulated saliva was collected separately from the parotid and submandibular/sublingual glands. Results: Parotid flow rate was decreased among users of tranquillisers and sedatives (unstimulated flow), cardiovascular drugs and gastrointestinal drugs (stimulated flow). Submandibular/sublingual unstimulated output was lower in patients taking cardiovascular drugs, antihistamines, tranquillisers/sedatives and antidepressants, while the stimulated flow, in those taking cardiovascular drugs, antihistamines, tranquillisers/sedatives and gastrointestinal drugs. Conclusions: Users of many common medication categories display significantly reduced unstimulated and/or stimulated salivary flow rate from the major salivary glands compared with non‐users. A larger number of medication categories are associated with reductions in salivary flow rate from submandibular/sublingual glands than parotid glands.     

Significance of saliva for the denture‐wearing population

This paper summarises a series of studies already published in German and presents new data related to the aetiology of the dry mouth' and its associated problems. Aims: to study factors affecting mucous and serous salivary gland secretion, the aetiology of the ‘dry mouth’ and its associated problems, causative factors for hyposalivation and it's treatment Setting : two university dental hospitals. Subjects: 587 denture wearers and 521 control subjects, and autopsy material Interventions : exercise, chewing, water, oestrogen, pilocarpine, and anetholtrithion theiapy, biopsy of the minor glands Main outcome measures : Palatal secretion (PAL, μL/cm²/min) and parotid salivary flow (PAR), subjective complaints and clinical findings. Results: resting flow rates for PAL between 0 and 65 μl/cm²/min were seen in every age group. The flow rates of PAR (0 to 3.7 ml/10 min) were not correlated with PAL. Most patients with a resting flow rate of PAL≤6.0 μl/cm² suffer from a ‘dry mouth’ and Burning Mouth Syndrome (BMS) or oral dysaesthesia (OD) with or without chronic lesions of the oral mucosa. Etiological factors for the incidence of reduced PAL and associated problems include xerostomic drugs, oestrogen deficiency, ladiotherapy, thyroid dysfunction, smoking or continuous wearing of complete upper dentures. PAL also correlated with the retention of upper complete dentures. PAL was correlated with the water content of epithelial tissues. PAL and PAR were both increased by drinking ample fluid, improving their circulation by physical exercises, chewing intensively, or taking oestrogens, pilocarpine, anetholtrithion. Conclusions: Variation in palatal salivary secretion occurs and is clinically important.     

The salivary flow rate and composition of whole and parotid resting and stimulated saliva in young and old healthy subjects

Resting and stimulated whole and parotid salivary composition and flow rate were examined in 63 healthy volunteers. No significant differences were found between the young and old in secretion rates and salivary concentrations of sodium, potassium, calcium, magnesium, and total protein. The activity of amylase in the resting and stimulated parotid saliva was significantly lower in the old.     

Whole saliva and the diagnosis of Sjögren's syndrome: an evaluation of patients who complain of dry mouth and dry eyes. Part 1: Screening tests

Sjögren's Syndrome (SS) is a common autoimmune disorder characterised by generalised desiccation, exocrine hypofunction and serologic abnormalities, More than 90% of the patients are women. Objective : to determine if whole saliva could be used to diagnose this disease. Setting: The study was conducted at the School of Dental Medicine, SUNY, at Stony Brook. Patients : There were 49 subjects (48F; 1M), the mean age was 54 ± 13 years. In order to be admitted into the study, they had to complain of dry mouth and dry eyes. Tests : Whole saliva was collected by the spitting method. “Screening Tests'” were employed to measure the salivary flow rate, pH, buffer capacity; lactobacillus and yeast concentrations. Chemical tests were performed to determine protein, albumin, sodium and amylase activity. Lacrimal dryness was assessed by the Schirmer and Rose-Bengal methods. Results: Based on the sialometric findings, the patients were divided into 3 groups: Group 1: those with abnormally low resting (RFR) and stimulated (SFR) flow rates; Group 2: those with a low RFR but normal SFR; and Group 3: those with normal salivary flow rates. The group 1 patients were unique: their saliva demonstrated a low pH and buffer capacity, high lactobacillus and yeast concentrations, decreased protein output and amylase activity, and elevated albumin and sodium. Moreover, virtually all of them had abnormally low lacrimal flow rates. Conclusions : The findings suggested that whole saliva could be used to provisionally diagnose SS. Critical to this diagnosis was an abnormally low stimulated whole saliva flow rate. Other requisites included a low resting flow rate, the presence of dry mouth and dry eyes and evidence of lacrimal hypofunction. All of these attributes can easily be obtained by dentists in their clinics.     

Salivary gland hypofunction in elderly patients attending a xerostomia clinic

Objectives: To investigate the aetiological factors and the prevalence of salivary gland hypofunction (SGH) in patients complaining of xerostomia. Design Prospective, clinical study. Setting Xerostomia clinic in the Department of Oral Medicine at Liverpool University Dental Hospital. Subjects 100 consecutive patients, aged 60 years or older, referred for investigation of xerostomia. Interventions Patients were asked specific questions concerning their complaint of oral dryness and associated orofacial symptoms. A detailed medical history was recorded and patients underwent a systematic examination of the head, neck and oral structures. All patients underwent haematological, biochemical, immunological investigations, urinalysis and sialometry. Further investigations and referrals to other specialists were undertaken when appropriate. Main outcome measures The causes of xerostomia were established on the basis of clinical and laboratory findings and SGH was defined as an unstimulated whole salivary flow rate of <0.2ml/min, Results: The causes of xerostomia were identified as: Sjögren's Syndrome (40), iatrogenic (22), psychogenic (14), idiopathic (19), diabetes (1), candidosis (3) and alcohol (1). Sixty five percent of the patients studied had SGH. Conclusions This study has shown that 65% of patients whose presenting complaint was xerostomia had objective evidence of SGH. Several aetiological factors were identified, the most common of which was Sjögren's Syndrome. The possibility of associated systemic diseases should be considered when establishing the aetiology of SGH.     

Masticatory function in patients with xerostomia

The effects of reduced salivary output in patients suffering from xerostomia on masticatory function has not been previously studied. This study compares masticatory performance and kinematic activity of patients suffering from xerostomia with age-, sex-, and number of occluding pairs-matched healthy controls. Masticatory function was evaluated by assessment of chewing motion and muscle activity during chewing an artificial food (CutterSil®), chewing gum and swallowing a bolus of almond. Chewing motion was recorded with the Optotrak® computer system. Bilateral muscle activity of both masseter and anterior temporalis was recorded using surface electrodes. Results of this study revealed significant differences between patients and controls in their ability to process food and masticatory muscle activity. The majority of patients could not break down the artificial food, others had a larger median particle size than the controls. A significant difference was also observed in the number of chewing cycles required to swallow almonds, the patients required more than twice as many chews as the controls, P<0.001. The right masseter muscle displayed significantly less activity for the patient than the controls. These findings suggest that patients with xerostomia exhibit reduced ability to process food. The observed decline in masticatory performance is probably due to reduced activity of the muscles of mastication.     

The development of a simple objective test of mastication suitable for older people,using chewing gums

Aims: To develop and assess a simple test for evaluating the mastication of visco‐elastic foods and prosthodontic success subsequent to treatment of older people. Method: The weight lost from chewing gum during mastication tests and the saliva secreted is weighed. The percentage of the original gum weight that is chewed out in a defined number of strokes is termed the Masticatory Effectiveness (ME) Material: Five edentate and three dentate volunteers were selected to provide a range of dental states and age. Four commercially available chewing gums of different origins and perceived hardness were tested, one without sweetener acted as a control for salivary stimulation. Intervention: Pre‐weighed samples of each gum were chewed, each for defined numbers of strokes. The saliva secreted was collected and weighed. The chewed gum was desiccated and the total weight loss of sweeteners chewed out provided an objective measure of chewing performance. Results: Weight loss showed large differences between gums, between subjects and the number of strokes. ME was significantly correlated with salivary secretion rates for two subjects. The interaction between subject and gum was statistically significant, established by an ANOVA model, the value of which is shown for multivariate studies. Differential success between gums of different thickness may provide evaluation of denture stability. Conclusions: Measuring the weight lost from gums during chewing provides a simple test of masticatory effectiveness of visco‐elastic foods. This has particular value both in functional assessment of older people and in physiological research.     

Prevalence of xerostomia and hyposalivation in the nursing home and the relation with number of prescribed medication

In nursing homes, the number of patients with their own dentition increases. Many of them, however, are unable to perform oral hygiene procedures. Medication is considered to be an important cause of hyposalivation, which may lead to oral alterations and loss of teeth. The aim of the present study was to investigate the prevalence of xerostomia and hyposalivation in a Dutch nursing home and to examine the possible relation with medication usage. Between January and March 2001, the salivary flow rates were measured in 50 patients residing in a nursing home in Amsterdam. Unstimulated saliva, parafilm-stimulated saliva and citric acid stimulated saliva were determined. Xerostomia was determined by the question "My mouth feels dry" and the medication used was examined. The data were analysed with (M)ANOVA. The average age of the patients was 78.1 +/- 9.7 years. Forty-eight % of the patients had an unstimulated flow rate of less then 0.20 ml/min and 24% had a flow rate even lower than 0.10 ml/min (reference values: 0.25-0.50 ml/min). The flow rate of women was significantly lower than that of men (p < 0.01), even after correction for age, smoking and the number of prescribed medications. Salivary flow rates decreased significantly with age (p < 0.05). The number of prescribed medication was significantly higher in patients over the age of 70 (p < 0.01, n = 42) and also in women (p < 0.01). The prevalence of xerostomia was 52% with no difference between men and women. In nursing homes, the prevalence of hyposalivation and xerostomia is high. The number of xerogenic medications used seems to be an important factor. Women and patients aged over the age of 70 years need special attention with respect to oral health.     

Marrow-Derived Autologous Stromal Cells for the Restoration of Salivary Hypofunction (MARSH): Study protocol for a phase 1 dose-escalation trial of patients with xerostomia after radiation therapy for head and neck cancer: MARSH: Marrow-Derived Autologous Stromal Cells for the Restoration of Salivary Hypofunction

BackgroundXerostomia, or dry mouth, is a common side effect of head and neck radiation. Current treatment options for radiation-induced xerostomia are generally supportive in nature. Adult stem cells are the ultimate source for replenishment of salivary gland tissue. Bone marrow–derived mesenchymal stromal cells (BM-MSCs) are a viable cell-based therapy for xerostomia. We have undertaken studies enabling U.S. Food and Drug Administration Investigational New Drug status, demonstrating the normal phenotype, intact functionality, and pro-growth secretome of interferon-γ (IFNγ)-stimulated BM-MSCs taken from patients with head and neck cancer who have undergone radiation ± chemotherapy. Here we present the protocol of MARSH, a first-in-human clinical trial of bone marrow–derived, IFNγ-activated BM-MSCs for the treatment of radiation-induced xerostomia.MethodsThis single-center phase 1 dose-escalation with expansion cohort, non–placebo-controlled study will assess the safety and tolerability of BM-MSCs for the treatment of radiation-induced xerostomia in patients who had head and neck cancer. The phase 1 dose-escalation study will be a 3 + 3 design with staggered enrollment. A total of 21 to 30 subjects (9 to 18 in phase 1 study, 12 in expansion cohort) will be enrolled. The primary endpoint is determining the recommended phase 2 dose (RP2D) of IFNγ-stimulated BM-MSCs to enable further studies on the efficacy of BM-MSCs. Patients’ bone marrow will be aspirated, and BM-MSCs will be expanded, stimulated with IFNγ, and injected into the submandibular gland. The RP2D will be determined by dose-limiting toxicities occurring within 1 month of BM-MSC injection. Secondary outcomes of saliva amounts and composition, ultrasound of salivary glands, and quality of life surveys will be taken at 3-, 6-, 12-, and 24-month visits.DiscussionAutotransplantation of IFNγ-stimulated BM-MSCs in salivary glands after radiation therapy or chemoradiation therapy may provide an innovative remedy to treat xerostomia and restore quality of life. This is the first therapy for radiation-induced xerostomia that may be curative.Trial registrationWorld Health Organization International Clinical Trials Registry Platform: NCT04489732     

The Rapalogue,CCI-779, Improves Salivary Gland Function following Radiation

The standard of care for head and neck cancer typically includes surgical resection of the tumor followed by targeted head and neck radiation. However depending on tumor location and stage, some cases may not require surgical resection while others may be treated with chemoradiation. Unfortunately, these radiation treatments cause chronic negative side effects for patients. These side effects are associated with damage to surrounding normal salivary gland tissue and include xerostomia, changes in taste and malnutrition. The underlying mechanisms of chronic radiation-induced salivary gland dysfunction are unknown, however, in rodent models persistently elevated proliferation is correlated with reduced stimulated salivary flow. The rapalogue, CCI-779, has been used in other cell systems to induce autophagy and reduce proliferation, therefore the aim of this study was to determine if CCI-779 could be utilized to ameliorate chronic radiation-induced salivary gland dysfunction. Four to six week old Atg5^f/f; Aqp5-Cre, Atg5^+/+; Aqp5-Cre and FVB mice were treated with targeted head and neck radiation. FVB mice were treated with CCI-779, chloroquine, or DMSO post-radiation. Stimulated salivary flow rates were determined and parotid and submandibular salivary gland tissues were collected for analyses. Mice with a defect in autophagy, via a conditional knockout of Atg5 in the salivary glands, display increased compensatory proliferation in the acinar cell compartment and hypertrophy at 24-72 hours following radiation. FVB mice treated with post-therapy CCI-779 have significant improvements in salivary gland physiology as determined by stimulated salivary flow rates, proliferation indices and amylase production and secretion. Consequently, post-radiation use of CCI-779 allows for improvement of salivary gland function and reestablishment of glandular homeostasis. As CCI-779 is already FDA approved for other uses, it could have a secondary use to alleviate the chronic side effects in head and neck cancer patients who have completed anti-tumor therapy.     

Xerostomia in the Elderly: Prevalence,Diagnosis, Complications and Treatment1

The prevalence of xerostomia was evaluated in 259 volunteers 70 ± 4.5 years old. Seventy–two (27.7%) complained of dry mouth. In 31 (11.8%) salivary secretion was under 0.1 ml/min. The xerostomic patients were compared to an age–matched control group. The main complaints of xerostomia were dry mouth during the day, dry throat, burning sensation of the tongue, difficulty in swallowing, and taste disturbances. Systemic diseases frequent in the xerostomic patients were heart failure and hypertension. Chronic renal failure, depression, rheumatoid arthritis, and hypothyroidism were also encountered. The medications most frequently used by the xerostomic patients were parasympatholytics, sympatholytics, and diuretics. A higher frequency of active caries, gingivitis, and dryness of the mucosa was detected in the xerostomic patients. A significantly higher response to stimulation, elevated salivary calcium, and lowered oral pH were found in this group. Xerostomia was found to be related o t systemic diseases, medications, or a combination of these factors. The importance of saliva for maintaining oral health was also observed. Twenty–nine patients suffering from xerostomia were treated with an artificial saliva. On reexamination after one month, most of them reported improvement, and a significant increase in salivary flow rate was found.     

Mouthdryness Among Patients in Longterm Hospitals

The purpose of this investigation was to determine the mean salivary flow rate and the prevalence of mouthdryness and its relation to some background variables, such as oral condition, state of health and drug intake, among patients in somatic longterm hospitals. From 154 randomly selected patients salivary samples were taken from both parotid glands with Lashley cannules and 5 min stimulation with citric acid 2%. The sampling was repeated 3 times at a few days interval. The mean parotid flow rate among women was 0.28 ml/min and among men 0.47 ml/min. Forty-three% of the patients had a rate ≤ 0.2 ml/min and 44% of these reported an almost constant sensation of dryness of mouth. Background factors with a significant effect on salivary flow rate could be found only among men taking tricyclic antidepressents especially in combination with diuretics. The flow rates among these institutionalized, old patients as a group were found to be consistently lower than rates found in earlier investigations among healthy old people.     

Factors That Influence the Extensional Rheological Property of Saliva

The spinnbarkeit of saliva reflects the ability of saliva to adhere to surfaces within the mouth, thereby serving as a protective role and aiding in lubrication. Therefore, alterations in the extensional rheology of saliva may result in the loss in adhesiveness or the ability to bind onto surfaces. Mucin glycoproteins and their structures are known to be important factors for the extensional rheological properties of saliva. The conformation of mucin depends on factors such as pH and ionic strength. Chewing is one of the main stimuli for salivary secretion but creates significant sheer stress on the salivary film which could influence mouthfeel perceptions. The current study investigates the possible factors which affect the extensional rheological properties of saliva by comparing submandibular/sublingual saliva with different oral stimuli within the same group of subjects. Unstimulated and stimulated saliva (chew, smell and taste) salivas were collected primarily from submandibular/sublingual glands. The saliva samples were measured for Spinnbarkeit followed by the measuring mucin, total protein, total calcium and bicarbonate concentrations. The results indicated correlations between rheological properties and mucin/ion concentrations. However, chewing stimulated submandibular/sublingual saliva is shown to have significantly lower Spinnbarkeit, but factors such as mucin, protein and calcium concentrations did not account for this variation. Analysis of the concentration of bicarbonate and pH appears to suggest that it has a prominent effect on extensional rheology of saliva.     

Relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth in menopausal women

doi: 10.1111/j.1741‐2358.2010.00403.x Relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth in menopausal women Objectives: To evaluate the relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth (DM) in menopausal women. Background: A feel of DM is a major complaint for many elderly individuals and strongly associated with the menopause. The exact mechanisms that mediate sensation of DM in menopausal women have not been firmly established. Methods: A case–control study was carried out on 104 selected menopausal women with/without a feeling of DM, conducted at the Clinic of Oral Medicine, Tehran University of Medical Sciences. Xerostomia Inventory (XI) score was used as an index of DM severity. Stimulated whole saliva cortisol concentration (stimulated by chewing standard‐sized paraffin for 60 s) was measured by ELISA. Statistical analysis by Student’s t‐test and Spearman correlation was used. Results: The mean cortisol concentration of saliva, but not saliva cortisol output, was significantly higher in the cases than in the controls. There was significant positive correlation between XI score and concentration (r = 0.357, p = 0.000) or output (r = 0.223, p = 0.017) of stimulated whole saliva cortisol. Conclusions: It appears that stimulated whole saliva cortisol is high in menopausal women with a feeling of DM.     

Variability of zinc concentrations in human stimulated parotid saliva

The objective of this study was to determine the effect of sample collection conditions on the zinc concentrations in stimulated parotid (SP) saliva. The variability of zinc levels in SP saliva was determined on the basis of different times within a single day, from day-to-day, from one month to the next month, and between subjects. Ten healthy subjects, half of each sex, consumed 15–22 mg Zn/day in their diet. No significant difference in the mean zinc concentration of SP saliva on a day-to-day or month-to-month basis was demonstrated. Three subjects had significantly different SP saliva zinc levels than the other seven subjects. A significant diurnal variation in the mean SP salivary zinc levels was found. Changes of SP saliva flow rates suggested a training effect.     

The effectiveness of 10% chlorhexidine varnish treatment on dental caries incidence in adults with dry mouth

Objectives: This study compared a 10% chlorhexidine varnish treatment with placebo and sham treatments for preventing dental caries in adult patients with xerostomia (dry mouth). Design: The study was a multicentred, randomized, parallel group, double blind, placebo‐controlled clinical trial. Setting: All examinations and procedures were performed at Tuft's University, Boston, MA, the University of British Columbia, Vancouver, BC or the University of Western Ontario, London, ON. Subjects: Subjects were adults with recent or current dental caries experience, high salivary levels of cariogenic microorganisms and low salivary flow rates. Results: 236 subjects completed at least one post‐treatment examination. There were 697 new carious lesions diagnosed, 446 (64%) located on coronal surfaces and 251 (36%) located on root surfaces. The mean attack rate was 0.23 surfaces/100 surfaces at risk. A treatment difference observed between the Active and Placebo groups was statistically significant for root caries increment (p=.02) and total caries increment (p=.03). A treatment difference observed between the Active and Sham groups was not statistically significant for coronal, root or total caries increment. Analysis of variance of treatment group differences was performed using mutans streptococci counts, salivary flow rates, age, sex, caries prevalence, medications, time to first event and early withdrawal as co‐variables. These factors did not meaningfully alter the findings. Conclusions: The difference between the 10% chlorhexidine varnish and placebo treatments is considered to be highly clinically significant for root caries increment (41% reduction) and for total caries increment (25% reduction) but only for coronal caries increment (14%).     

Zinc concentrations in hair,plasma, and saliva and changes in taste acuity of adults supplemented with zinc

The effect of zinc supplementation as zinc acetate (15 mg Zn/day for 5 weeks) was determined on stimulated parotid salivary zinc levels and taste acuity. In addition, zinc and copper levels of hair and plasma in 10 healthy subjects (five male and five female) between the ages of 17 and 37 years were studied. Presupplementation and 5 weeks postsupplementation levels were evaluated as well. Taste acuity for sweet improved with zinc supplementation and returned to presupplementation levels after supplementation ceased. No changes in plasma copper or salivary zinc levels were found with zinc supplementation although stimulated parotid saliva flow rate increased. Plasma zinc levels increased significantly while hair copper increased slightly with supplementation. All indices returned to presupplementation levels by 5 weeks after cessation of supplementation.