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.     

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.     

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.     

A prospective study on oral microbial flora and related variables in dentate dependent elderly residents

doi: 10.1111/j.1741‐2358.2011.00599.x
A prospective study on oral microbial flora and related variables in dentate dependent elderly residents Objective: Oral microorganisms and related variables were followed over a 1‐year period in dentate dependent elderly. Background: For nursing personnel, oral hygiene for the dependent elderly is demanding. It requires good knowledge of how to carry out preventive oral health measures and to judge when help is needed. Previous studies indicate low levels of knowledge, which might be reflected in the oral health of dentate residents. Material and methods: Twenty‐one subjects participated at baseline and 14 one year later. Microbial samples were analysed using cultivation technique. The labial minor gland secretion rate was measured using the Periotron^® method, and oral clinical data were registered. Results: Low labial mucosal flow rates were seen for 95% of the participants. At baseline, visibly thick plaque was seen in 48% and 1 year later in 57%. Both frequency and number of bacteria associated with caries and frequency of microorganisms associated with oral soft tissue infections were high. One year later, a decrease in bacteria associated with good oral health and a tendency to an increase in aciduric microorganisms were seen. Conclusion: Poor oral health, tending to further deteriorate over time, advocates regular professional supplementary support when elderly dentate dependent residents need assistance with their oral care.     

Relationships of anti-PAc (361-386) peptide salivary IgA antibody, eosinophils and basophils with periodontal status in the elderly

The amino acid residues 361-386 of Streptococcus mutans PAc includes an important region associated with the interaction between S. mutans and salivary components. We investigated the relationships between levels of the anti-PAc (361-386) peptide antibody (PPA) in saliva and periodontal status in 281 elderly subjects (mean age 77 years; 118 females, 163 males) by assessing dental calculus (CA), attachment loss (AL), pocket depth (PD), bleeding on probing (BOP) and various blood parameters. Enzyme-linked immunosorbent assay results revealed that subjects with a PPA level of greater than 0.1 (PPA detected group) showed a lower average value for number of sites with more than 6 mm of AL/6 points x 100/tooth (rAL6) than those with a PPA level of less than 0.1 (PPA not detected group). Furthermore, average values for rAL6 were significantly lower in the PPA detected group, and BOP, AL and rAL6 correlated positively and significantly with the percentage of eosinophils present in leukocytes in female subjects in both groups. PPA level had a negative correlation with percentages of basophils and eosinophils. The results indicate that systemic increases in numbers of eosinophils and basophils are associated with the development of periodontal diseases, while PPA level may be a useful indicator of periodontal status.     

Enhancing the quality of life in elderly women through a programme to improve the condition of salivary hypofunction

doi: 10.1111/j.1741‐2358.2011.00594.x Enhancing the quality of life in elderly women through a programme to improve the condition of salivary hypofunction Objective: The purposes of this study were to examine the effects of oral exercise intended to improve the function of the oral cavity in the elderly and their quality of life to pave the way for the development of oral‐health promotion programmes geared towards the elderly. Methods: The subjects were 78 female Koreans who resided in Seoul and were aged 65 years and older. During a 3‐month period, an oral function promotion programme was conducted twice a week, between 10.00 am and 12.00 pm , applying oral exercise suggested by a Japanese public health centre. A survey was conducted by interviewing the selected women to determine the state of their subjective dry mouth, quality of life related to oral health and jaw functional limitation. Their opening, unstimulated whole saliva and pronunciation speed were measured before and after the oral function exercise programme. Results: The subjects showed a significant improvement in subjective dry mouth symptoms, relevant behaviour, the level of discomfort caused by dry mouth and subjective jaw functional limitation during mastication and swallowing and emotional expression after receiving the oral exercise. After the oral exercise, there was a significant increase in mouth opening, unstimulated whole saliva and speaking speed (‘patakala’ pronunciation) after oral exercise. There was also significant progress in their quality of life related to oral health. Overall improvement in subjective dry mouth symptoms and relevant behaviour over time after oral exercise had a positive correlation with the level of improvement in discomfort triggered by dry mouth and mastication. The level of improvement in OHIP‐14 had a positive correlation with the level of overall improvement in dry mouth symptoms and behaviour, the level of improvement in discomfort by dry mouth and that in mastication and swallowing. Conclusion: This study showed the effects of the oral function promotion programme and correlation of oral condition and oral health‐related quality of life. It is suggested that this oral function promotion programme has positive effects on both objective and subjective oral conditions. It is strongly recommended that this programme, along with other oral health promotion programmes, be implemented to improve oral function and oral health‐related quality of life for the elderly.     

Genetic polymorphism of human salivary proline-rich proteins: Further genetic analysis

Electrophoresis of concentrated parotid saliva on slab polyacrylamide gels negatively stained with 3,3-dimethoxybenzidine and hydrogen peroxide (DMB stain) showed nine phenotypes among the proline-rich proteins. These phenotypes are the expression of four autosomal codominant alleles. Gene frequencies are, for Caucasians, Pr ¹=0.640, Pr ¹=0.005, Pr ²=0.080, Pr ²=0.275; for Negroes, Pr ¹=0.700, Pr ¹=0.050, Pr ²=0.080, Pr ²=0.170; for Chinese, Pr ¹=0.770, Pr ¹=0, Pr ²=0, Pr ²=0.230. The presence or absence of another pair of proteins giving the same negative staining is inherited as an autosomal dominant trait (Db). Homozygous Db + + and heterozygous Db + – individuals could not be distinguished. The genetic determinant (Db) for this pair of proteins is either closely linked to or part of the Pr locus. Gene frequencies are, for Caucasians, Db ⁺=0.12, Db ^–=0.88; for Negroes, Db ⁺=0.56, Db ^–=0.44; for Chinese, Db ⁺=0.07, Db ^–=0.93.This study was supported by a grant from the National Institutes of Dental Research (9-R01-DE-03685-08) and in part by grant GM 15422 from the National Institutes of Health.     

Histology and ultrastructure of the salivary glands and salivary pumps in the scorpionfly Panorpa obtusa (Mecoptera: Panorpidae)

Liu, S. and Hua, B. 2009. Histology and ultrastructure of the salivary glands and salivary pumps in the scorpionfly Panorpa obtusa (Mecoptera: Panorpidae). —Acta Zoologica (Stockholm) 91 : 457–465. The morphology, histology and ultrastructure of the salivary glands and salivary pumps in the scorpionfly Panorpa obtusa Cheng 1949 were investigated using light microscopy and scanning and transmission electron microscopy. The salivary glands display a distinct sexual dimorphism. The female has only two small sac‐like glands located in the prothorax, while the male possesses six long tubular glands extending into the sixth abdominal segment. The male salivary glands can be divided into five distinct regions. The apical long, thin secretory region possesses numerous secretory cells containing large secretory vesicles; the salivary reservoir expands in diameter, accumulating and temporarily storing the saliva in addition to secreting saliva; the constricted region contains prismatic cells with complex infolded plasma membrane; the sac has an internal brush border to absorb water and ions; the common salivary duct contains longitudinal muscles in the male, but not in the female. The salivary pump possesses independent strong dorsal muscles and abundant internal palm spines near its orifice. The anatomy and ultrastructure of the salivary glands and the salivary pump of scorpionflies as well as their possible functions are briefly discussed.     

Pilot study on binding of bovine salivary proteins to grit silicates and plant phytoliths

Mostly fed with grass in fresh or conserved form, cattle and other livestock have to cope with silicate defence bodies from plants (phytoliths) and environmental silicates (grit), which abrade tooth enamel and could additionally interact with various salivary proteins. To detect potential candidates for silicate-binding proteins, bovine whole saliva was incubated with grass-derived phytoliths and silicates. Interactions of salivary proteins with pulverized bovine dental enamel and dentine were additionally analysed. After intense washing, the powder fractions were loaded onto 1D-polyacrylamide gels, most prominent adhesive protein bands were cut out and proteins were identified by mass spectrometry within three independent replicates. All materials were mainly bound by bovine odorant-binding protein, bovine salivary protein 30×103 and carbonic anhydrase VI. The phytolith/silicate fraction showed additional stronger interaction with haemoglobin β and lactoperoxidase. Conceivably, the binding of these proteins to the surfaces may contribute to biological processes occurring on them.     

Cephalometric study of elderly with nearly intact dental arches

Objective: The purpose of this study was to investigate the craniofacial morphology of elderly people with many remaining teeth using cephalometric analysis. Subjects and methods: The subjects were 30 Japanese elderly who participated in the ‘8020 campaign 2001’ in Bunkyo Ward, Tokyo, organised by The Dental Association of Tokyo, as well as 30 Japanese young adults with normal occlusion. Lateral cephalograms of all subjects were analysed using the Coben method. Results: In the female elderly group, the lower face depth was smaller than in the younger adults. In the male elderly group, the height and depth of both the total face and the lower face were longer than in the younger group. In comparing the 8020 achievers with the younger group, the proportion of the lower facial height was greater than the upper facial height, and this finding was more pronounced in women than in men. Conclusion: For the lateral facial pattern of the elderly, a reduction of lower facial height because of tooth occlusal reduction was not apparent. It was clear that there are age differences for males and females; in addition, differences in the total face and lower face area of the elderly group were due to their having many remaining teeth over a long time period. Also, these changes were more apparent in women than in men, and it is clear that there is a male–female difference in ageing.     

The influence of cartilage surface topography on fluid flow in the intra-articular gap

Self-lubrication of a diarthrodial joint is largely attributed to interstitial fluid pressurisation. However, the retention of synovial fluid within the intra-articular gap may also contribute to lubrication. Fluid flow in the intra-articular gap between two micro-rough cartilage surfaces was simulated with a three-dimensional numerical model. Representative surface roughness parameters were incorporated and their relative influence on gap flow resistance was quantified. Resistance changes with decreasing gap height were explored. Cartilage surface micro-topography improves the retention of viscous synovial fluid in the gap, through increased resistance to tangential flow. Local asperity contact greatly increases resistance through tortuosity of the flow path.     

Characterization of apyrase activity from the salivary glands of the cat flea ctenocephalides felis

Apyrase activity (ATP diphosphohydrolase, EC 3.6.1.5) was detected in salivary glands of the cat flea Ctenocephalides felis. Whole extracts of salivary glands contain approximately 21 ng of protein, 145 U/mg ADP′ase and 158 U/mg ATP′ase activity; AMP is not hydrolysed by salivary gland extracts. DEAE-Sepharose CL-6B anion exchange chromatography, and Cibacron Blue affinity chromatography each give a single coincident peak of ADP/ATP′ase activity. Biogel P-100 gel filtration of salivary gland homogenates made in buffer containing Triton and protease inhibitors, separated enzymatic activity into 57 kD and 44 kD peaks of ADP/ATP′ase activity. Partially purified ADP/ATP′ases are dependent on divalent cations and activation increases between 0.125 mM and 5.0 mM calcium. At 5 mM, magnesium is almost equally effective as calcium in activating ADP/ATP′ase but manganese and zinc are less so, and EDTA abolishes activity. ADP/ATP′ases have a pH optima of 7–9. The K_m for ADP hydrolysis by whole extracts and partially purified enzyme is approximately 66 μM ADP. The co-purification of ADP′ase and ATP′ase activity by three physiochemical techniques and parallelism between ADP and ATP hydrolysis under varying conditions of pH and activating cation indicates enzymatic activity is attributable to true apyrase(s).     

A longitudinal study of medication exposure and xerostomia among older people

Objective: To describe the incidence of xerostomia among a population of older people over a 6‐year period, with particular attention to medications as risk factors. Background: Understanding the natural history of xerostomia requires longitudinal epidemiological research, but only one study has examined changes in xerostomia over time. While medication is a recognised risk factor for dry mouth, the role of particular medication categories continues to be controversial. Materials and methods: Older South Australians (aged 60+) underwent an interview and dental examination at baseline, and these assessments were repeated 2, 5 and 11 years afterward. Medication data were collected at baseline, 5 and 11 years. Xerostomia data were collected at 5 and 11 years using the Xerostomia Inventory (XI) and a standard question. Results: Of the 1205 dentate participants assessed at baseline, 669 remained after 5 years, and 246 were assessed at 11 years. Medication prevalence increased over the observation period, such that 94.8% of the cohort were taking at least one medication by 11 years. The prevalence of xerostomia increased from 21.4% to 24.8% between 5 and 11 years (p > 0.05), and the mean XI score increased from 20.0 (SD, 6.7) to 21.5 (SD, 7.9; p < 0.001). Some 14.7% of participants were incident cases of xerostomia, while 11.4% were remitted cases; 10.1% were cases at both 5 and 11 years. After controlling for gender and ‘baseline’ xerostomia severity (represented by the XI score at 5 years), participants who commenced taking daily aspirin after 5 years had over four times the odds of becoming incident cases, while those who commenced taking a diuretic after 5 years had nearly six times the odds of doing so. Conclusions: While the overall prevalence of xerostomia increased during the observation period, there was considerable instability, with one‐quarter of the cohort changing their status. Medication exposure was strongly associated with the incidence of the condition, with recent exposure to diuretics or daily aspirin strongly predicting it.     

Evaluation of compressive strength in the first premolars between young and elderly people: ex vivo study

doi: 10.1111/j.1741‐2358.2011.00583.x Evaluation of compressive strength in the first premolars between young and elderly people: ex vivo study Objective: This study evaluated the compressive strength of first maxillary premolars from young and elderly people. Background: Findings have revealed that changes happening on dental structure lead to a higher susceptibility of tooth fracture. Materials and methods: Thirty teeth were divided into four groups as follows: G I (n = 7) premolars of elderly patients with fused roots, G II (n = 8) premolars of elderly with separate roots, G III (n = 7) pre‐molars of young people with fused roots and G IV (n = 8) premolars of young people with roots separated. The roots were placed in polyvinyl chloride (PVC) cylinder and embedded in acrylic resin. Afterward, the samples were subjected to fracture by compressive strength in a universal testing machine. Loads were applied in continuous and progressive speed of 0.5 mm/min until the moment of fracture. The values found underwent statistical analysis (anova α = 0.05). Results: With regard to age, there was a statistical difference, the teeth of the elderly being more susceptible to fracture (p < 0.05). With regard to root morphology, no significant differences between both groups were observed (p > 0.05). Conclusion: It was concluded that with the methodology employed, the age factor was important with regard to fracture resistance to compression.     

Development of oral home telecare programme for the home-dwelling elderly: a pilot study

Objectives: The aim of the pilot study was to develop and evaluate a telecare programme for home‐dwelling elderly to provide education on oral and general health care. Design: A field trial with a computer system linking a university with a structured network. Subjects: A group of home‐dwelling elderly males with a mean age of 73.3 years. Methods: Qualitative assessment following videophone interviews with clients and their families. Results: Clients and families were able to gain a better understanding and knowledge of oral health care particularly the skills required to perform new oral care procedures. Conclusions: Preventive oral homecare via videophone offers the potential for providing a long‐term structure for maintaining oral health particularly with limited social resources.     

Pulsatile flow filtration of yeast cell debris: influence of preincubation on performance

The recovery of proteins from yeast cell debris suspension was investigated using a vortex mixing technique based on the combination of oscillatory flow and a baffled flat-sheet microfiltration system. For this system, increased protein transmission was obtained through the use of low transmembrane pressures and the preincubation of the yeast cell debris feed suspension at 30 degrees C. Furthermore, a plateau in the flux-time curve was observed. In the absence of baffles and pulsations, preincubation had a little effect. (c) 1993 Wiley & Sons, Inc.     

From fate to function: the Drosophila trachea and salivary gland as models for tubulogenesis

Tube formation is a ubiquitous process required to sustain life in multicellular organisms. The tubular organs of adult mammals include the lungs, vasculature, digestive and excretory systems, as well as secretory organs such as the pancreas, salivary, prostate, and mammary glands. Other tissues, including the embryonic heart and neural tube, have requisite stages of tubular organization early in development. To learn the molecular and cellular basis of how epithelial cells are organized into tubular organs of various shapes and sizes, investigators have focused on the Drosophila trachea and salivary gland as model genetic systems for branched and unbranched tubes, respectively. Both organs begin as polarized epithelial placodes, which through coordinated cell shape changes, cell rearrangement, and cell migration form elongated tubes. Here, we discuss what has been discovered regarding the details of cell fate specification and tube formation in the two organs; these discoveries reveal significant conservation in the cellular and molecular events of tubulogenesis.     

Fine needle aspiration cytology of minor salivary gland tumours of the palate

Fine needle aspiration cytology of minor salivary gland tumours of the palate This retrospective study was carried out to review aspirates from minor salivary gland tumours of the palate and to assess the problems encountered in their diagnosis, especially the cytological diagnosis of newer entities such as polymorphous low grade adenocarcinoma (PLGA). Fifty-five cases of palatal salivary gland tumours aspirated over a period of 16 years were reviewed. Histology was available in 26 cases. Pleomorphic adenoma (27 cases) was the most common benign cytodiagnosis. Eleven aspirates were malignant tumours of which eight cases were adenoid cystic carcinoma and three cases were mucoepidermoid carcinoma. Seven cases were diagnosed on fine needle aspiration as suggestive of PLGA. However histological confirmation was available in only one of these cases. Concordance between the initial and revised typings of the tumours was seen in only 28 cases (54%) in the present study. Initially 18 of the 51 tumours (35.3%) could not be typed; and after review, only three could not be typed. Three cases of oncocytoma could be diagnosed on review only. Palatal salivary gland tumours, although relatively uncommon, are difficult to diagnose cytologically. This is more so in cases of newer entities such as PLGA, as their cytological diagnosis is still not well characterized.