Comparison of the effect of the linseed extract Salinum® and a methyl cellulose preparation on the symptoms of dry mouth

The effect of a linseed extract Salinum® and a sodium carboxymethyl cellulose preparation called MAS-84 was compared with regard to its effect on the symptoms of dry mouth. Twenty patients with xerostomia, who had been treated for cancer in the head and neck by radiation were recruited from the clinic for maxillofacial surgery, Malmö University Hospital. Following radiation treatment the salivation was severely reduced. The symptoms of a general feeling of a dry mouth, difficulties in chewing and swallowing, taste disturbances, problems with speech and mouth burning were registered on a subjective verbal rating scale. In addition plaque index and gingival bleeding index were determined. The study design was crossover and performed single blind. The experimental period was 7 weeks. The patients were randomly divided into 2 groups, One group used Salinum® and the other MAS-84 for 3 weeks. The fourth week was a wash out period and for the next three weeks the patients shifted preparation. Each of the preparations was used ad libitium. Registrations of the various parameters were undertaken on days 0, 7 and 21 of the respective period. At the initial examination all patients reported considerable disturbances from mouth-dryness. These symptoms were reduced in 15 patients during the Salinum® period and in 9 during the MAS-84 period. The relief was significantly more pronounced during the use of Salinum® compared to that during the use of the methyl cellulose preparation. On day 21 plaque and gingival bleeding were significantly reduced during the Salinum® period but not during the MAS-84 period. The results of the present study confirm those of a previous pilot study and indicate that the linseed mucilage significantly reduced the symptoms of dry mouth. This effect increased with increasing time of saliva substitute use. The linseed mucilage Salinum® appeared to be a suitable saliva replacement in mouth dry patients.     

Artificial Saliva in the Management of Patients Suffering from Xerostomia

Hyposalivation results in the sensation of a dry mouth “subjective xerostomia.” Besides the sensation of a dry mouth in serious conditions, distressing clinical symptoms are observed, e.g. difficulties in oral functioning, mucositis, progressive dental caries and nocturnal oral discomfort. A mucin-containing artificial saliva to relieve patients'complaints from xerostomia has been developed. Its chemical and physical properties are demonstrated. In a 3-year retrospective study the efficacy of this substitute and a CMC-containing saliva has been evaluated for a total of 137 patients. Patients were free in choosing a mucin- or CMC preparation. Ninety-six patients reported a considerable relief of their complaints with mucin-saliva, one patient wished to continue using the CMC product. To increase efficacy of the saliva substitute on intra-oral saliva reservoir has been developed for dentate and edentulous persons.     

Oral mucous membrane flora in patients using saliva substitutes

Salivary substitutes are sometimes valuable for elderly people and radiotherapy patients, and may be used indefinitely. It is possible that this change in the ecology may effect the oral flora. Objective: To analyse the presence of micro‐organisms on oral mucous membranes during use of saliva substitutes. Design: Cross‐over single‐blind study. Setting: Clinic for Maxillofacial Surgery, Malmö University Hospital and Department of Oral Microbiology, Malmö University. Subjects: 19 patients with low salivary secretion who had been radiated for cancer in the head and neck region. Intervention Two saliva substitutes: linseed extract and a carboxymethyl cellulose preparation (Salinum and MAS‐84) were used for 3 week periods. Measurements: Microbial samples taken, processed and analysed. Results: No differences were observed when comparing baseline values with the results after the saliva substitutes and no significant differences between the use of different agents. Conclusion: The study suggests that use of linseed extract and carboxymethyl cellulose preparation during periods of weeks does not influence flora commonly related to caries, periodontitis or infections in the oral mucous membranes.     

The Efficacy of Mucin-Containing Artificial Saliva in Alleviating Symptoms of Xerostomia

The efficacy of a mucin-coniaining saliva substitute was assessed in terms of changes in oral functioning and the psychic and social implications of these changes. Thirty-nine patients with xerostomia filled out a questionnaire before application of the artificial saliva and after six weeks of usage. The artificial saliva was applied with a spray. From this study it was concluded that: (1) the application of the mucin-containing saliva substitute reduced the sensation of a dry mouth and improved oral functions such as chewing, swallowing and speech (also less nocturnal oral discomfort was observed); (2) the subjects felt better about oral functioning using the saliva substitute; (3) patients using the mucin-containing saliva substitute felt less restricted in their social activities (e.g. communication).     

A preliminary assessment of intra-oral lubricating systems for dry mouth patients

Objective: To provide extended intra-oral delivery of a saliva substitute. Intervention: Three different types of prostheses containing saliva substitute were designed and assessed: a two-part device resembling a mandibular complete denture sealed by cobalt-samerium magnets, a one-part clear resin device for the edentate patients and a flexible mouth guard type of appliance containing a lubricant releasing bubble for the dentate patients. Setting: A teaching hospital Oral Medicine and Rheumatology Clinic. Subjects: 8 edentate and 3 dentate Sjogren Syndrome sufferers. Outcome measures: Subjective dryness after a week of wearing the lubricating appliance. Results: The majority of the subjects wore the appliances for 6–12 hours during each 24 hours. The initial dryness severity diminished after wearing the lubricating prosthesis. The patients preferred to wear the appliance at night. Conclusion: All criteria were fulfilled on designing a saliva substitute lubricating appliance and some of the subjects have worn this prosthesis successfully for up to 3 years. Particular benefit was obtained by night-time wear.     

Pavlov's cockroach: classical conditioning of salivation in an insect

Secretion of saliva to aid swallowing and digestion is an important physiological function found in many vertebrates and invertebrates. Pavlov reported classical conditioning of salivation in dogs a century ago. Conditioning of salivation, however, has been so far reported only in dogs and humans, and its underlying neural mechanisms remain elusive because of the complexity of the mammalian brain. We previously reported that, in cockroaches Periplaneta americana, salivary neurons that control salivation exhibited increased responses to an odor after conditioning trials in which the odor was paired with sucrose solution. However, no direct evidence of conditioning of salivation was obtained. In this study, we investigated the effects of conditioning trials on the level of salivation. Untrained cockroaches exhibited salivary responses to sucrose solution applied to the mouth but not to peppermint or vanilla odor applied to an antenna. After differential conditioning trials in which an odor was paired with sucrose solution and another odor was presented without pairing with sucrose solution, sucrose-associated odor induced an increase in the level of salivation, but the odor presented alone did not. The conditioning effect lasted for one day after conditioning trials. This study demonstrates, for the first time, classical conditioning of salivation in species other than dogs and humans, thereby providing the first evidence of sophisticated neural control of autonomic function in insects. The results provide a useful model system for studying cellular basis of conditioning of salivation in the simpler nervous system of insects.     

Effects of low-level laser treatment on mouth dryness

Mouth dryness (MD) is usually followed by inadequate mechanical cleaning of the mouth and decrease in the levels of salivary antimicrobial proteins (including secretory immunoglobulin A (sIgA)). It is accompanied by difficulties during speaking and food swallowing, with an unpleasant taste, burning sensations in the mouth and higher susceptibility to oral diseases. Low-level laser treatment (LLLT) can intensify cell metabolism and its application on salivary glands could improve salivation. The purpose of this study was to evaluate the effects of LLLT on salivation of patients suffering from MD. The study included 17 patients with MD. Their major salivary glands were treated with low intensity laser BTL2000 on 10 occasions. The whole unstimulated and stimulated saliva quantities were measured just before the 1st, after the 10th and thirty days following the last (10th) treatment. In the samples of unstimulated saliva concentrations of sIgA were estimated by using ELISA method and its quantity in the time unit was calculated. The visual analogue scale (VAS) score was used to assess burning and/or pain intensity at these three time points. Statistical tests revealed significant salivation improvement quantitatively and qualitatively, i.e. increase in the quantity of saliva and sIgA. VAS score was also significantly improved and no side effects were observed. Conclusions: According to the results of this study, application of LLLT to xerostomic patients' major salivary glands stimulates them to produce more saliva with better antimicrobial characteristics and improves the difficulties that are associated with MD. This simple non-invasive method could be used in everyday clinical practice for the treatment of MD.     

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.     

Effects of mouthrinses with linseed extract Salinum® without/with chlorhexidine on oral conditions in patients with Sjögren's syndrome. A double‐blind crossover investigation

Objectives: To study the effect of mouthrinses with salivary replacement substances on oral conditions in patients with primary Sjögren's syndrome. Design: Cross‐over, double‐blind study. Setting: Facilities at the Centre for Oral Health Sciences, Malmö University and at Malmö University Hospital, Malmö, Sweden. Subjects: Twenty‐two patients with Sjögren's syndrome. Intervention: Linseed extract Salinum® alone ( Sal ) or with addition of chlorhexidine ( Sal/Chx ) was used for mouthrinsing during 3‐week periods of rinsings separated by a 3‐week “wash‐out” period. Measurements: Recordings of percentages of sites with dental plaque and bleeding on probing, mirror friction test and microbiological analyses. Questionnaire on oral symptoms due to reduced salivation. Results: Dental plaque and bleeding on probing were reduced after Sal and after Sal/Chx. Friction was reduced after both treatments. No significant differences for counts of studied microbial groups were seen after Sal but the total anaerobically cultured microorganisms and of mutans streptococci fell after Sal/Chx (p<0.05 and p<0.001). Symptoms of oral dryness improved following Sal and Sal/Chx (p<0.05 and p<0.001 respectively). Speaking problems and burning mouth symptoms improved after use of Sal (p<0.05). Conclusions: Positive effects on symptoms in patients with Sjögren's syndrome were seen after use of Salinum® without or with chlorhexidine.     

Salivary secretions by aphids interacting with proteins of phloem wound responses

Successful phloem feeding requires overcoming a number of phloem-related plant properties and reactions. The most important hurdle is formed by the phloem wound responses, such as coagulating proteins in the phloem sieve elements of the plant and in the capillary food canal in the insect's mouth parts, i.e. the stylets. It seems that in order to prevent protein clogging inside a sieve element, ejection of watery saliva plays an important role. This ejection is detected in the electrical penetration graph (EPG) as E1 salivation and always precedes phloem sap ingestion. During this feeding from sieve elements, another regular and concurrent salivation also occurs, the watery E2 salivation. This E2 saliva is added to the ingested sap and, it probably prevents phloem proteins from clogging inside the capillary food canal. Whatever the biochemical mode of action of the inhibition of protein coagulation might be, in some plants aphids do not seem to be able to prevent clogging, which may explain the resistance to aphids in these plants. The relevance of this hypothesis is demonstrated by new experimental results and is related to new EPG results from plants with phloem-located resistance.     

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.     

THE USE OF BANTHINE IN THE TREATMENT OF DIGESTIVE DISTURBANCES

Banthine® was used in the treatment of patients with various diseases, organic and functional, of the gastrointestinal tract. Good response was obtained in a high proportion of cases of duodenal, stomal and gastric ulcer, and of hypertrophic gastritis. In some instances, patients who did not have good response at first were relieved later when the size of doses and the dosage schedule were adjusted to fit their particular needs.Some patients “felt so well” during Banthine therapy that they departed from prescribed diet and violated injunctions against use of alcohol and tobacco, and symptoms recurred.Nine patients with history of recurrent bouts of pain from ulcer for several years took small doses of Banthine constantly, or occasionally at times of stress, as a prophylactic measure after the symptoms were relieved by therapeutic doses. None of them had recurrence while following the prophylactic regimen.In most of the cases of peptic ulcer in which the response was recorded as “poor,” it was because distressing side-effects dictated discontinuance of the drug. Several elderly male patients had severe urinary retention. Paralytic ileus developed postoperatively in one patient who was receiving Banthine. Less severe side reactions—dry mouth, blurring of vision, urinary slowing — were for the most part transient.Few patients with functional indigestion, chronic non-specific colitis or regional enteritis were relieved. Most of the patients with functional indigestion reported exacerbation of symptoms when Banthine was given. This was believed to be based on emotional reaction to the hypomotility induced by the drug.     

TIME-INTENSITY SCALING WITH JUDGES TRAINED TO USE A CALIBRATED SCALE: ADAPTATION, SALTY AND UMAMI TASTES

The Time-Intensity scaling technique was modified for measurements of taste intensity. Instead of using the traditional procedure where intensities were estimated on the judges’ own internalized scales, judges were trained to estimate concentrations directly in millimolar concentration. Such training was seen to increase precision, although the general shapes of the Time-Intensity plots remained the same. The technique was applied to measurement of taste intensity change over time when NaCl or MSG stimuli were held in the mouth. Using this technique, it was possible to measure the relative effects, on taste intensity loss, of stimulus dilution by saliva and sensory adaptation; the latter had the greater effect. Accordingly, the disruption of adaptation was found to be more important than increased salivation when chewing movements were made.     

Pharmacological Activation of the EDA/EDAR Signaling Pathway Restores Salivary Gland Function following Radiation-Induced Damage

Radiotherapy of head and neck cancers often results in collateral damage to adjacent salivary glands associated with clinically significant hyposalivation and xerostomia. Due to the reduced capacity of salivary glands to regenerate, hyposalivation is treated by substitution with artificial saliva, rather than through functional restoration of the glands. During embryogenesis, the ectodysplasin/ectodysplasin receptor (EDA/EDAR) signaling pathway is a critical element in the development and growth of salivary glands. We have assessed the effects of pharmacological activation of this pathway in a mouse model of radiation-induced salivary gland dysfunction. We report that post-irradiation administration of an EDAR-agonist monoclonal antibody (mAbEDAR1) normalizes function of radiation damaged adult salivary glands as determined by stimulated salivary flow rates. In addition, salivary gland structure and homeostasis is restored to pre-irradiation levels. These results suggest that transient activation of pathways involved in salivary gland development could facilitate regeneration and restoration of function following damage.     

Induction and differentiation of adipose-derived stem cells from human buccal fat pads into salivary gland cells

Atrophy or hypofunction of the salivary gland because of aging or disease leads to hyposalivation that affects patient quality of life by causing dry mouth, deterioration of mastication/deglutition, and poor oral hygiene status. Current therapy for atrophy or hypofunction of the salivary gland in clinical practice focuses on symptom relief using drugs and artificial saliva; therefore, there is still a need to develop new therapies. To investigate potential novel therapeutic targets, we induced the differentiation of salivary gland cells by co-culturing human adipose-derived stem cells isolated from buccal fat pads (hBFP-ASCs) with human salivary-gland-derived fibroblasts (hSG-fibros). We examined their potential for transplantation and tissue neogenesis. Following the culture of hBFP-ASCs and hSG-fibros, differentiated cells were transplanted into the submandibular glands of SCID mice, and their degree of differentiation in tissues was determined. We also examined their potential for functional tissue reconstitution using a three-dimensional (3D) culture system. Co-cultured cells expressed salivary-glandrelated markers and generated new tissues following transplantation in vivo. Moreover, cell reconstituted glandular structures in the 3D culture system. In conclusion, coculture of hSG-fibros with hBFP-ASCs led to successful differentiation into salivary gland cells that could be transplanted to generate new tissues.     

Regulation mode of evaporative cooling underlying a strategy of the heat-tolerant FOK rat for enduring ambient heat

Compared with other rat strains, the inbred FOK rat is extremely heat tolerant. This increased heat tolerance is due largely to the animal's enhanced saliva spreading abilities. The aims of the present study were to 1) quantify the heat tolerance capacity of FOK rats and 2) determine the regulatory mode of the enhanced salivary cooling in these animals. Various strains of rats were acutely exposed to heat. In the heat-intolerant strains, saliva spreading was insufficient and the core temperature (Tc) rose rapidly. In contrast, FOK rats maintained an elevated Tc plateau (39.5 +/- 0.7 degrees C) for 5-6 h over a wide range of ambient temperatures (Ta) (37.5-42.5 degrees C). In hot environments the FOK rats secreted copious amounts of saliva and spread it over more than the entire ventral body surface. FOK rats had a low Tc threshold for salivation, and the salivation rate increased linearly in proportion to the Tc deviation from the threshold. No strain difference or temperature effect was observed in the saliva secretion rate from in vitro submandibular glands perfused by sufficient doses of ACh. These results suggest that 1) the ability of FOK rats to maintain a moderate steady-state hyperthermia (39.5 +/- 0.7 degrees C) over a wide Ta range is enabled by a lowered threshold Tc for salivation and functional negative-feedback control of saliva secretion and 2) strain differences in ability to endure heat stress are mainly attributable to changes in the thermoregulatory control system rather than altered secretory abilities of the salivary glands.     

Salivation pattern of Rhodnius prolixus (Reduviidae; Triatominae) in mouse skin

The objective of this work was to study the pattern of salivation of triatomines during feeding in mouse skin. Rhodnius prolixus was fed with a solution of the dye acridine orange or fluorescein. The saliva was efficiently labelled with acridine orange, probably due to the difference in pH between the salivary gland (6.0) and the hemolymph (6.5-7.0). This procedure was not effective at labelling the saliva of Triatoma infestans, however, fluorescent labelling of R. prolixus saliva allowed us to demonstrate that salivation occurs during entire feeding process. The saliva is released soon after the bite. In the probing phase, saliva is pumped continuously in the host skin, including around the blood vessels. During the engorgement phase, saliva is observed in a bolus within the blood vessel and some of it is sucked up by the insect, together with blood. The frequency of saliva emission inside the vessels was low (0.51+/-0.18 Hz). The saliva deposition in the microcirculation is continuous and modulated by the frequency of the cibarial pump because, when functioning at high frequency, cibarial pump sucks almost all saliva to the insect gut. This mechanism would determine the quantity of saliva deposited in the microcirculation as necessary, and consequently minimizing the host's immune response to salivary antigens.     

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.     

Functional transplantation of salivary gland cells differentiated from mouse early ES cells in vitro

Atrophy or hypofunction of the salivary gland because of aging or disease causes hyposalivation and has an effect on the quality of life of patients, for example not only dry mouth but deterioration in mastication/deglutition disorder and the status of oral hygiene. Currently conducted therapies for atrophy or hypofunction of the salivary gland in clinical practice are only symptomatic treatments with drugs and artificial saliva, and therefore it is preferable to establish a radical therapy. At this time, as a fundamental investigation, by co-culturing mouse early ES (mEES-6) cells with human salivary gland-derived fibroblasts (hSG-fibro), differentiation of mEES-6 cells to salivary gland cells has been attempted. Also, the possibility of cell engraftment was examined. After identifying the cells which were co-cultured with GFP-transfected mEES-6 cells and hSG-fibro, the cells were transplanted into the submandibular gland of SCID mice, and the degree of differentiation into tissues was examined. The possibility of tissue functional reconstitution from co-cultured cells in a three-dimensional culture system was examined. Our results confirmed that the co-cultured cells expressed salivary gland-related markers and had an ability to generate neo-tissues by transplantation in vivo. Moreover, the cells could reconstitute gland structures in a three-dimensional culture system. By co-culture with hSG-fibro, mEES-6 cells were successfully differentiated into salivary gland cells which were transplantable and have tissue neogenetic ability.     

Impact of dry mouth conditions on oral health-related quality of life in older people

Objective: The aim of the present study was to evaluate the impact of dry mouth conditions on oral health‐related quality of life in frail old people, residents at community care centers. Further, reliability and validity of a visual analogue scale (VAS) for dry mouth symptoms were determined within the study cohort. Background: In old people functional, social and psychological impacts of oral conditions are associated with an overall sense of well being and general health. Subjective dry mouth and reduced saliva flow are common disorders in old people caused by disease and medication. Thus, dry mouth conditions may be determinants for compromised oral health‐related quality of life in old people. Method: In total, 50 old people living at service homes for the old people were asked to answer questionnaires on subjective dry mouth (VAS) and Oral Health Impact Profile (OHIP14) for oral health‐related quality of life. Saliva flow was estimated by absorbing saliva into a pre‐weighed cotton roll. Results: The final study cohort comprised 41 old people (aged 83–91 years). Significant associations were identified between both objective and subjective dry mouth and overall or specific aspects of oral health‐related quality of life. Conclusion: Dry mouth (objective and subjective) is significantly associated with oral health‐related quality of life strengthening the value of monitoring dry mouth conditions in the care of frail old people.