The influence of medication on salivary flow of the elderly: preliminary study

doi:10.1111/j.1741‐2358.2009.00326.x
The influence of medication on salivary flow of the elderly: preliminary study Objective: This study was to evaluate the influence of medications on unstimulated and stimulated salivary flow in elderly men and women. Background: Several diseases and conditions are associated with decreasing salivary flow. Medications can be risk factors for hyposalivation due to the effect particular drug categories. Methods: Seventy‐five elderly of both gender (sixty years old or over) from the Geriatric Dental Clinic at the Federal Fluminense University Dental School, were interviewed about their health status and chronic use of medication. After the interview, unstimulated and stimulated saliva were collected from each subject. The collection time was five minutes, and the flow rate was calculated as ml/min. Results: The mean unstimulated salivary flow was 0.25 ml/min for women and 0.30 ml/min for men, while the mean for stimulated salivary flow was 1.23 ml/min for women and 1.31 ml/min for men, without both differences being non‐significant (p > 0.05). The difference between the mean production of unstimulated and stimulated salivary flow was statistically significant, regardless of gender (p < 0.01). A significant reduction of stimulated salivary flow was observed with the usage of cardiovascular agents (p < 0.05). Conclusion: Drugs used in cardiovascular disease influence the flow of stimulated saliva.     

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.     

Acute Short-Term Mental Stress Does Not Influence Salivary Flow Rate Dynamics

Background: Results of studies that address the influence of stress on salivary flow rate and composition are controversial. The aim of this study was to reveal the influence of stress vulnerability and different phases of stress reactivity on the unstimulated and stimulated salivary flow rate. We examined that acute mental stress does not change the salivary flow rate. In addition, we also examined the salivary cortisol and protein level in relation to acute mental stress stimuli. Methods: Saliva of male subjects was collected for five minutes before, immediately, 10, 30 and 120 min after toothbrushing. Before toothbrushing, the subjects were exposed to acute stress in the form of a 2 min public speech. Salivary flow rate and total protein was measured. The physiological stress marker cortisol was analyzed using enzyme-linked immunosorbent assay. To determine the subjects'' psychological stress reaction, the State-Trait-Anxiety Inventory State questionnaire (STAI) data were obtained. The subjects were divided into stress subgroup (S1) (psychological reactivity), stress subgroup (S2) (psychological and physiological reactivity) and a control group. The area under the curve for salivarycortisol concentration and STAI-State scores were calculated. All data underwent statistical analysis using one-way analysis of variance. Results: Immediately after stress exposure, all participants exhibited a psychological stress reaction. Stress exposure did not change the salivary flow rate. Only 69% of the subjects continued to display a physiological stress reaction 20 minutes after the public talk. There was no significant change in the salivary flow rate during the psychological and the physiological stress reaction phases relative to the baseline. Conclusions: Acute stress has no impact on the salivary flow rate; however, there may be other responses through salivary proteins that are increased with the acute stress stimuli. Future studies are needed to examine specific proteins and their possible roles in acute stress responses.     

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.     

Association of salivary steroid hormones and their ratios with time-domain heart rate variability indices in healthy individuals

BackgroundStress system consists of the hypothalamicpituitary-adrenal (HPA) axis and the locus caeruleus/norepinephrine-autonomic nervous system (ANS). Traditionally, HPA axis activity is evaluated by measuring its end-product cortisol, while the activity of ANS is assessed using heart rate variability (HRV) indices. Alterations in cortisol levels and HRV measures during laboratory-based stress tasks were extensively studied in previous research. However, scarce data exist on the associations of HRV measures with the levels of other adrenal steroid hormones under baseline conditions. Thus, we aimed to evaluate the activity of the HPA axis by measuring salivary cortisol, cortisone, dehydroepiandrosterone (DHEA) levels, and their ratios and to examine its association with HRV measures in a sample of healthy young and middle-aged adults.MethodsFor each participant (n=40), three data collection sessions taking place at the same time of the day were scheduled within five working days. Participants completed a self-reported questionnaire on sociodemographic and lifestyle characteristics, filled out t h e Perceived Stress Scale and State-Trait Anxiety Inventory. Also, saliva samples were collected, and physiological measures, including resting HR and HRV, were recorded during three data collection sessions.ResultsStatistically significant associations between diminished parasympathetic vagal tone evaluated by time domain HRV measures and higher salivary cortisol, lower DHEA levels, as well as decreased DHEA to cortisol ratio, were found. Also, physiological stress indicators (i.e., HRV) showed greater intraindividual stability compared with biochemical biomarkers (i.e., salivary steroid hormones) within five days.ConclusionsOur findings suggest that both cortisol and DHEA mediate the link between two stress-sensitive homeostatic systems.     

Psychological and hormonal features of smokers at risk to gain weight after smoking cessation--results of a multicenter study

Preclinical and clinical data suggest modulating effects of appetite-regulating hormones and stress perception on food intake. Nicotine intake also interferes with regulation of body weight. Especially following smoking cessation gaining weight is a common but only partially understood consequence. The aim of this study was to examine the interaction between smoking habits, the appetite regulating hormone leptin, negative affectivity, and stress vulnerability on eating behavior in a clinical case-control study under standardized conditions.In a large population-based study sample, we compared leptin and cortisol plasma concentrations (radioimmunoassay) between current tobacco smokers with high cognitive restraint and disinhibition in eating behavior and smokers scoring low in both categories as assessed with the Three Factor Eating Questionnaire (TFEQ; Stunkard & Messick, 1985). As a measure for smoking effects on the stress axis, the saliva cortisol concentrations were compared before and after nicotine smoking. Additionally, stress perception was assessed with the Perceived Stress Scale (PSS), symptoms of depression and anxiety with the Beck Depression Inventory (BDI) and the State Trait Anxiety Inventory (STAI).In smokers showing high cognitive restraint and disinhibition we found significantly higher leptin concentrations than in the group of smokers scoring low in both categories. Furthermore there was a significant group difference in saliva cortisol concentrations after nicotine intake. Smokers showing high cognitive restraint and disinhibition were also characterized by significantly higher scores in the STAI, the PSS and the BDI.Our results suggest that smokers with a pathological eating behavior show an impaired neuroendocrine regulation of appetite and are prone to experience higher levels of stress and negative affectivity. This interaction of behavioral and neuroendocrinological factors may constitute a high risk condition for gaining weight following smoking cessation.     

Effect of environmental enrichment and herbal compound supplementation on physiological stress indicators (chromogranin A,cortisol and tumour necrosis factor-α) in growing pigs

Stress response induces physiological, behavioural, immunological and biochemical changes that directly affect health and well-being. Provision of environmental enrichment and herbal compounds may reduce stress in current commercial pig husbandry systems. The aim of this study was to evaluate the effect of providing different environmental enrichment materials (EE) and a herbal compound (HC) on physiological indicators of acute and chronic stress in growing pigs (salivary cortisol and chromogranin A (CgA), hair cortisol and tumour necrosis factor-α (TNF-α)). Salivary cortisol and CgA have been reported as biomarkers basically of acute stress, whereas hair cortisol and TNF-α have been more related to chronic stress. For this purpose, eight groups of seven pigs each (14 pigs/treatment, 56 pigs in total) were used: (a) two EE groups, (b) two groups supplemented with HC, (c) two groups provided both with EE and HC and (d) two control groups. Samples of hair, saliva and blood were taken to measure cortisol (in hair and saliva), CgA (in saliva) and TNF-α (in blood) at three different times: before starting the experiment (T0), and after 1 (T1) or 2 months (T2) of providing the materials and herbal compound. No differences were found at T0 in salivary or hair cortisol, CgA or TNF-α, whilst at T2, the control group showed significant increased concentrations of CgA and hair cortisol, when compared with the rest of the treatments (P<0.001). These differences were significant at T1 only for CgA (P<0.001). Furthermore, an overall correlation was reported between hair cortisol and salivary CgA (r=0.48, P<0.001). These results support that providing enrichment material or an herbal compound may reduce stress in growing pigs. Furthermore, the results support that hair cortisol and CgA may be proper non-invasive tools to detect stress, specially associated with factors of chronic exposure.     

Salivary flow rate and risk of malnutrition – a study among dentate,community‐dwelling older people

doi: 10.1111/j.1741‐2358.2012.00679.x Salivary flow rate and risk of malnutrition – a study among dentate, community‐dwelling older people Objective: To analyse the relation between unstimulated and stimulated salivary secretion and the risk of malnutrition among home‐dwelling elderly people. Background: Saliva has an important role in eating. Despite this, there are only a few studies on the role of salivary secretion in the development of malnutrition among elderly people. Materials and methods: The study population consisted of 157 subjects aged 75 or older. This was a part of GeMS study carried out in Kuopio, in eastern Finland. The data used in this study were collected by means of interviews and geriatric and oral clinical examinations. The risk of malnutrition was measured using the Mini Nutritional Assessment Short‐Form. Logistic regression models were used to estimate odds ratios (OR) and their 95% Confidence Intervals (CI). Results: Subjects with a low unstimulated salivary flow rate (<0.1 ml/min) or stimulated salivary flow rate (<1.0 ml/min) had no statistically significant increase in risk of malnutrition, OR: 1.3, CI: 0.5–3.9, OR: 1.5, CI: 0.5–4.2, respectively, when compared with those with a normal unstimulated and stimulated salivary flow rate. Conclusion: Our results do not support the concept that low salivary secretion is an important risk factor for malnutrition among community‐dwelling elders.     

Relationships between the amount of saliva and medications in elderly individuals

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2009.00358.x
Relationships between the amount of saliva and medications in elderly individuals Objective: To investigate medications that are related to volume of saliva in the elderly. Background data: In the elderly, many cases of mouth dryness may represent side effects of medication. Materials and methods: The volume of unstimulated saliva was measured for 30 s (cotton roll test), and with stimulation for 3 min (gum test) in 368 subjects 79–80 years old (177 men, 191 women). Medications were investigated using subject’s medication notebooks. Results: Mean volumes of unstimulated and stimulated saliva were 0.14 ± 0.13 and 4.30 ± 2.54 ml respectively. Significant differences were seen between gender and mean volume of saliva. The volume of unstimulated saliva was 0.16 ± 0.15 ml for men and 0.11 ± 0.10 ml for women. The volume of stimulated saliva was 4.99 ± 2.67 ml for men and 3.67 ± 2.25 ml for women. The percentage of subjects taking medication was 64.7% (238/368). Mean number of medications was 2.08 ± 2.26, with no significant difference with gender (2.01 ± 2.37 for men, 2.16 ± 2.16 for women). In a stepwise multiple regression analysis with volume of saliva as the objective variable and number of drugs by category as explanatory variables, significant explanatory variables in addition to gender and number of medications were blood‐coagulating agents, Ca antagonists and peptic ulcer drugs for volume of unstimulated saliva, and diabetes medications and peptic ulcer drugs for volume of stimulated saliva. Conclusion: These findings suggest that differences exist between gender in volume of saliva for elderly individuals, and that the volume of saliva is affected by the number and type of medications.     

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.     

Salivary concentration of progesterone and cortisol significantly differs across individuals after correcting for blood hormone values

Between‐individual variation of salivary progesterone (P4) and cortisol levels does not always closely reflect blood hormone concentrations. This may be partly a function of individual differences in salivary hormone excretion. We tested whether time of day at sampling and ethnicity contributed to individual variation in salivary hormones after adjusting for blood hormone levels. Forty‐three Caucasian and 15 Japanese women (18–34 years) collected four sets of matched dried blood spot (DBS) and saliva specimens across a menstrual cycle (N = 232 specimen sets). Linear fixed‐effects (LFE) models were used to estimate the effects of diurnal variation and ethnicity on salivary P4 and cortisol while adjusting for DBS levels. For each hormone, women with exclusively positive or negative residuals (unexplained variance) from the LFE models were categorized as high‐ or low‐saliva‐to‐DBS hormone ratio (SDR; high or low salivary secretors), respectively. We found that salivary P4 (P < 0.05) was significantly higher in early morning compared to the afternoon, after controlling for DBS levels, ethnicity, and BMI. After further adjusting for this diurnal effect, significant individual variation in salivary P4 and cortisol remained: sixteen and nine women, respectively were categorized as low or high salivary secretors for both hormones (P < 0.001), suggesting systematic individual‐specific variation of salivary hormonal concentration. We conclude that when saliva is used to quantify P4 or cortisol levels, time of day at sampling should be controlled. Even with this adjustment, salivary P4 and cortisol do not closely mirror between‐ individual variation of serum P4 and cortisol in a substantial proportion of individuals. Am J Phys Anthropol 149:231–241, 2012. © 2012 Wiley Periodicals, Inc.     

Diurnal variation of salivary cortisol in captive African elephants (Loxodonta africana) under routine management conditions and in relation to a translocation event

The present study assessed the diurnal variation in salivary cortisol in captive African elephants during routine management (baseline) and in relation to a potential stressor (translocation) to evaluate to what extent acute stress may affect diurnal cortisol patterns. Under baseline conditions, we collected morning and afternoon saliva samples of 10 animals (three zoos) on different days in two study periods (n = 3–10 per animal, daytime and period). Under stress conditions, we sampled the transported cow (newcomer) and the two cows of the destination zoo before and after the transport in the morning and afternoon (n = 3–9 per animal, daytime and transport phase), as well as after the first introduction of the newcomer to the bull (n = 1 per animal). Cortisol was measured in unextracted samples by enzyme immunoassay. Under baseline conditions, we observed the expected diurnal variation with higher cortisol levels in the morning than in the afternoon. Under stress conditions, neither a significant difference between pre- and posttransport, nor between morning and afternoon levels was found. The percentage difference between morning and afternoon cortisol after the transport, however, was remarkably lower than before the transport in the newcomer potentially indicating a stress response to familiarization. Saliva samples taken immediately after the introduction of the newcomer to the bull revealed a marked cortisol increase. Our findings indicate that stressors may disturb the diurnal cortisol rhythm. Furthermore, provided that samples can be collected promptly, salivary cortisol is a useful minimally invasive measure of physiological stress in the African elephant.     

Methods of collection for salivary cortisol measurement in dogs

Salivary cortisol has been increasingly used as a measure of stress response in studies of welfare, reaction to stress and human-animal interactions in dogs and other species. While it can be a very useful measure, there are a number of saliva collection issues made evident through studies in the human and animal fields which have not been investigated in the canine species. Collection materials and the volume of saliva that is collected; the use of salivary stimulants; and the effect of food contamination can all dramatically impact cortisol measurement, leading to spurious results. In order to further examine the limitations of the collection method and the effects of collection material and salivary stimulant on salivary cortisol levels, a series of clinical, in vitro and in vivo studies were performed. It was found that there is a large amount of inter- and intra-individual variation in salivary cortisol measurement. Beef flavoring of collection materials leads to unpredictable variability in salivary cortisol concentration. Using salivary stimulants such as citric acid also has the potential to affect cortisol concentration measurement in saliva. Hydrocellulose appears to be a useful collection material for salivary cortisol determination. Recommendations for collection materials and use of salivary stimulants are presented.     

Validation of a cortisol enzyme immunoassay and characterization of salivary cortisol circadian rhythm in chimpanzees (Pan troglodytes)

Monitoring concentrations of stress hormones is an important tool for behavioral research and conservation for animals both in the wild and captivity. Glucocorticoids can be measured in mammals as an indicator of stress by analyzing blood, feces, urine, hair, feathers, or saliva. The advantages of using saliva for measuring cortisol concentrations are three-fold: it is minimally invasive, multiple samples can be collected from the same individual in a short timeframe, and cortisol has a relatively short response time in saliva as compared with other materials. The purpose of this study was to: (1) conduct an adrenocorticotropic hormone (ACTH) challenge as a physiological validation for an enzyme immunoassay to measure salivary cortisol in chimpanzees and (2) characterize the circadian rhythm of salivary cortisol in chimpanzees. We determined that salivary cortisol concentrations peaked 45 min following the ACTH challenge, which is similar to humans. Also, salivary cortisol concentrations peaked early in the morning and decreased throughout the day. We recommend that saliva collection may be the most effective method of measuring stress reactivity and has the potential to complement behavioral, cognitive, physiological, and welfare studies.     

Occupational Status,Cortisol Secretory Pattern,and Visceral Obesity in Middle‐aged Men

Objective: Despite several studies indicating that social gradients are predictive of cardiovascular mortality, the pathogenetic mechanisms remain incompletely understood. Research Methods and Procedures: A population sample of 51‐year‐old men (N = 284) was divided into a socioeconomic gradient with manual laborers, civil servants, and university graduates. Anthropometric measurements were registered. Cortisol concentrations were measured in saliva, collected repeatedly during an ordinary working day, and a low‐dose dexamethasone suppression test was performed. Results: Lower socioeconomic status was associated with visceral obesity and higher cortisol values in relation to perceived stress. However, total cortisol secretion over the day of study was not elevated. The regulation of cortisol secretion showed less plasticity and dexamethasone inhibition was less efficient in the men in the lower socioeconomic status group than in those with a higher socioeconomic status. These are known consequences of long term stress. Longer duration in low socioeconomic conditions seemed to worsen these phenomena. Discussion: It was concluded that a low socioeconomic status is associated with perturbed cortisol secretion, which is elevated in relation to perceived stress. When the hypothalamic‐pituitary‐adrenal axis is subjected to prolonged increases in cortisol elicited by chronic stress, the regulation of cortisol secretion is affected, indicating neuroendocrine dysregulations. These observations may provide a means for understanding the association of socioeconomic impairments with visceral obesity and the social inequality in risk for prevalent and serious diseases.     

Biopsychosocial Factors and Cognitive Function in Cat Ownership and Attachment in Community-dwelling Older Adults

ABSTRACT

Few studies consider the health benefits of pet ownership from a biopsychosocial perspective, and a paucity of studies investigate cat ownership. The current study was designed to determine if psychosocial factors (stress, loneliness, and depression), biological levels of stress and inflammation (salivary cortisol, interleukin-1β, and C-reactive protein [CRP]), and cognitive function were associated with companion cat ownership/attachment in community-dwelling older adults. Community-dwelling older adults (n = 96, mean age = 76.6 years) who either owned a cat and no dog (n = 41) or owned neither a cat nor a dog (n = 55) completed questionnaires (Perceived Stress Scale, Revised–UCLA Loneliness Scale, Geriatric Depression Scale-Short Form, Montreal Cognitive Assessment, and Lexington Attachment to Pets Scale) and provided saliva specimens which were assayed for stress and inflammatory biomarkers. The majority of participants screened positive for mild cognitive impairment, reported low levels of stress, loneliness, and depression, and the biomarkers reflected fairly low levels of stress and inflammation. Binary logistic regression analysis revealed that psychosocial factors, salivary biomarkers, and cognitive function were not significantly associated with cat ownership. Age was the only significant predictor of cat ownership (OR = 0.92, p < 0.01) with the odds of cat ownership decreasing by 8.3% per year of advancing age. On average, cat owners were “somewhat attached” to their cats; however, 26% were “strongly attached” to their cats. Correlation analyses revealed the level of attachment to cats was not associated with study outcomes. These results show that cat ownership declined with each advancing year, which lessens the opportunity for older adults to form attachment bonds. The level of pet attachment supports the consideration of cats as a source of an attachment relationship for older adults, including those with cognitive impairment.     

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.     

Rheological Behavior of Food Emulsions Mixed with Saliva: Effect of Oil Content, Salivary Protein Content, and Saliva Type

In this paper, we studied the effect of saliva on the rheological properties of β-lactoglobulin- and lysozyme-stabilized emulsions, prepared at pH = 6.7 in relation to variation of emulsions- and saliva-related parameters. The effect of oil–volume fraction (2.5% w/w to 10% w/w), salivary protein concentration (0.1 to 0.8 mg ml⁻¹), and the use of both stimulated and unstimulated saliva was investigated. Viscosity and storage modulus were measured before (η _emul and G′_emul, respectively) and after addition of saliva (η _mix and G′_mix). To better estimate the changes due to saliva-induced flocculation of the emulsions, the ratios η _mix/η _emul, G′_mix/G′_emul were calculated. In addition, tan δ (=the ratio of the loss and storage moduli) was investigated to evaluate the viscoelastic behavior of the emulsion/saliva mixtures. Increasing the oil–volume fraction and salivary protein concentration resulted in an increase in η _mix/η _emul and G′_mix/G′_emul, while a decrease in tan δ of the emulsion/saliva mixtures is occurring. When compared with unstimulated saliva, mixing β-lactoglobulin-stabilized emulsions with stimulated saliva led to a reduction in η _mix/η _emul and G′_mix/G′_emul, and an augment of tan δ at all measured deformations. In case of lysozyme-stabilized emulsions, the use of stimulated saliva increased G′_mix/G′_emul for γ < 3 when compared to unstimulated saliva. The effect of stimulated saliva on the η _mix/η _emul and tan δ in this mixture is similar to that of unstimulated saliva. These results indicate that the influence of stimulated saliva on the rheological parameters of emulsion/saliva mixtures largely depends on the type of emulsions. To conclude, our findings demonstrate that the rheological behavior of emulsions upon mixing with saliva is greatly affected by both saliva and emulsion properties.     

Chronic Stress Induces a Hyporeactivity of the Autonomic Nervous System in Response to Acute Mental Stressor and Impairs Cognitive Performance in Business Executives

The present study examined the incidence of chronic stress in business executives (109 subjects: 75 male and 34 female) and its relationship with cortisol levels, cognitive performance, and autonomic nervous system (ANS) reactivity after an acute mental stressor. Blood samples were collected from the subjects to measure cortisol concentration. After the sample collection, the subjects completed the Lipp Inventory of Stress Symptoms for Adults and the Stroop Color-Word Test to evaluate stress and cognitive performance levels, respectively. Saliva samples were collected prior to, immediately after, and five minutes after the test. The results revealed that 90.1% of the stressed subjects experienced stress phases that are considered chronic stress. At rest, the subjects with chronic stress showed higher cortisol levels, and no gender differences were observed. No differences were found between the stressed and non-stressed subjects regarding salivary amylase activity prior to test. Chronic stress also impaired performance on the Stroop test, which revealed higher rates of error and longer reaction times in the incongruent stimulus task independently of gender. For the congruent stimulus task of the Stroop test, the stressed males presented a higher rate of errors than the non-stressed males and a longer reaction time than the stressed females. After the acute mental stressor, the non-stressed male group showed an increase in salivary alpha-amylase activity, which returned to the initial values five minutes after the test; this ANS reactivity was not observed in the chronically stressed male subjects. The ANS responses of the non-stressed vs stressed female groups were not different prior to or after the Stroop test. This study is the first to demonstrate a blunted reactivity of the ANS when male subjects with chronic psychological stress were subjected to an acute mental stressor, and this change could contribute to impairments in cognitive performance.