Evaluation of unstimulated flow rates of whole and palatal saliva in healthy patients wearing complete dentures and in patients with Sjogren's syndrome

STATEMENT OF PROBLEM: The palate and upper lip are the regions of oral mucosa covered with the least amount of saliva. These areas are important for maxillary denture retention and stability. Thus, patients with xerostomia or hyposalivation may have problems with the stability of maxillary complete dentures. PURPOSE: The purpose of this study was to compare the unstimulated whole saliva (UWS) and palatal saliva (PS) flow rates of healthy patients wearing complete dentures and patients with Sjogren's syndrome (SS) and to determine whether xerostomia or hyposalivation has a negative influence on maxillary complete denture stability. A further aim was to determine the influence of new complete dentures on UWS and PS flow rates in healthy individuals. MATERIAL AND METHODS: Thirty-five complete denture wearers, 24 healthy individuals (controls) and 11 patients who fulfilled the diagnostic criteria for primary Sjogren's syndrome (as proposed by the European Community Study Group) were investigated. All participants were questioned about possible subjective oral complaints (xerostomia or instability of the dentures) through use of a standardized questionnaire. In the first part of the study, UWS and PS flow rates of the healthy subjects (controls) and of the SS patients were measured at the initial visit. The flow rate of UWS (mL/min) was collected by the "spitting" method; saliva was collected into preweighed vessels for 5 minutes while subjects were seated in an upright position. Patients were asked to refrain from smoking, eating, and drinking for 2 hours prior to the test session, to avoid swallowing, and to make as few movements as possible during the procedure. The PS flow rate (microL/min/cm2) was measured using previously weighed filter paper discs placed bilaterally in the region of the maxillary second molars, 15 mm palatally from the edentulous ridge, for 30 seconds. The measuring vessels and paper discs were weighed before and after each collection. In the second part of the study, new complete dentures were fabricated for healthy patients. Flow rates of UWS and PS were measured 7 days after the insertion to compare data with prefabrication values. Mann-Whitney and Wilcoxon rank sum tests and chi-square test were used to analyze the data (alpha=.05). RESULTS: The UWS flow rates were significantly lower in SS patients compared to healthy controls (0.36 +/- 0.33 vs 0.09 +/- 0.11 mL/min, P<.05), yet the PS flow rate for both groups was not significantly different. Although every SS patient had xerostomia, and 8 out of 11 had hyposalivation, no patient complained about denture instability. Neither UWS flow rate (0.36 +/- 0.33 mL/min and 0.39 +/- 0.35 mL/min) nor PS flow rate (1.66 +/- 0.99 microL/cm2/min and 1.86 +/- 0.45 microL/cm2/min) was different from the preinsertion values after 1 week of new denture insertion in healthy patients. CONCLUSION: Palatal mucous saliva may help stabilize the maxillary complete denture in patients with hyposalivation. The results suggest that neither UWS or PS flow rate are influenced by the placement of new dentures in complete denture wearers.     

Hyposalivation and Xerostomia in Dentate Older Adults

BackgroundOlder adults are susceptible to reduced saliva production related to certain medications, radiation and chronic conditions. Many of these people have many physical and oral health problems and limited access to dental care. The use of effective screening tools for xerostomia and hyposalivation would be helpful in identifying those at risk. The authors conducted a study to investigate the association between three measures of oral dryness: hyposalivation (low unstimulated salivary flow), self-reported xerostomia and clinically assessed dry mouth.MethodsThe authors included a convenience sample of 252 nondemented and dentate West Virginia participants 70 years and older who were part of a larger study on oral health and cognition among older adults. Participants completed a self-reported xerostomia index, provided an unstipulated salivary sample and underwent an oral assessment for the study.ResultsTwenty-eight participants (11.1 percent) had hyposalivation, eight of whom reported having xerostomia (sensitivity = 28.6 percent). Of the 43 participants who reported having xerostomia, only eight had hyposalivation (positive predictive value = 18.6 percent). Hyposalivation and self-reported xerostomia were not significantly related. Clinically assessed dry mouth correlated modestly, but significantly, with hyposalivation and self-reported xerostomia.ConclusionsObtaining routine unstimulated salivary flow rates in addition to self-reported information and oral evaluations may increase early detection of oral dryness, which would assist in implementing early interventions to improve patients' quality of life.Clinical ImplicationsVisually inspecting oral tissues for dryness and asking a patient if his or her mouth is dry are insufficient measures for clinicians to use to determine if the patient has hyposalivation. The authors recommend that clinicians determine the patient's unstimulated salivary flow rate.     

A mouse model linking viral hepatitis and salivary gland dysfunction

Objective:  Viral hepatitis is known to cause xerostomia in humans, but this has not been reported in an animal model. We report a severe, acute, highly reproducible saliva deficiency occurring in BALB/c mice as a result of experimental viral hepatitis.
Materials and Methods:  BALB/c mice, splenectomized or carrying genetic mutations to detect immunological contributions to the saliva deficiency syndrome, were infected intraperitoneally with a non-lethal dose of murine cytomegalovirus. Pilocarpine-stimulated saliva volumes were determined between 0 and 15 days after infection. Salivary gland, liver, spleen, and sera were analyzed for the presence of virus, cytokines, inflammatory infiltrates, and tissue damage.
Results:  Saliva deficiency was detectable 2 days after cytomegalovirus infection, peaked at 88% below normal by day 7, and resolved partially in all mice by 15 days postinfection as sialoadenitis increased. Neither salivary gland viral titers, sialoadenitis, splenectomy, nor systemic inflammatory markers correlated with hyposalivation severity. Elevated liver enzymes did correlate with hyposalivation, and mice genetically resistant to murine cytomegalovirus-induced hepatitis were significantly protected.
Conclusions:  Murine cytomegalovirus-induced salivary gland dysfunction is biphasic, with an acute hepatitis-associated phase and a later sialoadenitis-associated phase. Acute murine cytomegalovirus infection of BALB/c mice may provide a model for investigation of hepatitis-associated xerostomia.     

Effect of HAART on salivary gland function in the Women's Interagency HIV Study (WIHS)

Objective:  To determine the impact of highly active antiretroviral therapy (HAART) on salivary gland function in human immunodeficiency virus (HIV) positive women from the Women's Interagency HIV Study (WIHS).
Design:  Longitudinal cohort study.
Subjects and methods:  A total of 668 HIV positive women from the WIHS cohort with an initial and at least one follow-up oral sub-study visit contributed 5358 visits. Salivary gland function was assessed based on a dry mouth questionnaire, whole unstimulated and stimulated salivary flow rates, salivary gland enlargement or tenderness and lack of saliva on palpation of the major salivary glands.
Main outcome measures:  Changes in unstimulated and stimulated flow rates at any given visit from that of the immediate prior visit (continuous variables). The development of self-reported dry mouth (present/absent), enlargement or tenderness of salivary glands (present/absent), and absence of secretion on palpation of the salivary glands were binary outcomes (yes/no).
Results:  Protease Inhibitor (PI) based HAART was a significant risk factor for developing decreased unstimulated ( P  =   0.01) and stimulated ( P  =   0.0004) salivary flow rates as well as salivary gland enlargement ( P  =   0.006) as compared with non-PI based HAART.
Conclusions:  PI-based HAART therapy is a significant risk factor for developing reduced salivary flow rates and salivary gland enlargement in HIV positive patients.     

Self-reported oral and general health related to xerostomia,hyposalivation, and quality of life among caries active younger adults

Abstract

Objective: The aim was to study prevalence of xerostomia, hyposalivation and quality of life among caries active younger adults.

Materials and methods: A questionnaire regarding oral and general health, xerostomia and quality of life was mailed to 134 caries active (CA) and 40 caries inactive (CI) patients, 25–50 years of age (mean age 39.9?±?6.2 years) treated at a Swedish Public Dental Service clinic, regarding oral and general health, xerostomia and quality of life. Caries data and unstimulated whole salivary flow rates were obtained from dental records.

Results: The overall response rate was 69%. Dental records confirmed that CA patients had more decayed teeth over time than CI patients (p?<?.001). The CA group reported worse oral health (p?<?.001) and general health (p?<?.01), more xerostomia (p?<?.001) and lower salivary flow rate (p?<?.01) compared to CI patients. Xerostomia was inversely related to unstimulated whole salivary flow rates as well as to oral and general health (p?<?.01). There were no differences between groups in quality of life.

Conclusion: Younger caries active adult patients reported significantly more xerostomia and hyposalivation compared to caries inactive patients. Xerostomia and hyposalivation were inversely related to perceptions of oral and general health, but not to quality of life.     

Type 1 diabetes mellitus, xerostomia, and salivary flow rates

OBJECTIVE: The Oral Health Science Institute at the University of Pittsburgh has completed a cross-sectional epidemiologic study of 406 subjects with type 1 diabetes and 268 control subjects without diabetes that assessed the associations between oral health and diabetes. This report describes the prevalence of dry-mouth symptoms (xerostomia), the prevalence of hyposalivation in this population, and the possible interrelationships between salivary dysfunction and diabetic complications. STUDY DESIGN: The subjects with diabetes were participants in the Pittsburgh Epidemiology of Diabetes Complications study who were enrolled in an oral health substudy. Control subjects were spouses or best friends of participants or persons recruited from the community through advertisements in local newspapers. Assessments of salivary function included self-reported xerostomia measures and quantification of resting and stimulated whole saliva flow rates. RESULTS: Subjects with diabetes reported symptoms of dry mouth more frequently than did control subjects. Salivary flow rates were also impaired in the subjects with diabetes. Regression models of potential predictor variables were created for the 3 self-reported xerostomia measures and 4 salivary flow rate variables. Of the medical diabetic complications studied (ie, retinopathy, peripheral and autonomic neuropathy, nephropathy, and peripheral vascular disease), only neuropathy was found to be associated with xerostomia and decreased salivary flow measures. A report of dry-mouth symptoms was associated with current use of cigarettes, dysgeusia (report of a bad taste), and more frequent snacking behavior. Xerogenic medications and elevated fasting blood glucose concentrations were significantly associated with decreased salivary flow. Resting salivary flow rates less than 0.01 mL/min were associated with a slightly higher prevalence of dental caries. Subjects who reported higher levels of alcohol consumption were less likely to have lower rates of stimulated salivary flow. CONCLUSIONS: Subjects with type 1 diabetes who had developed neuropathy more often reported symptoms of dry mouth as well as symptoms of decreased salivary flow rates. Because of the importance of saliva in the maintenance and the preservation of oral health, management of oral diseases in diabetic patients should include a comprehensive evaluation of salivary function.     

Frequency of oral candidiasis in stem cell transplant patients

This study included 80 persons with haematological malignancies receiving stem cell transplantation (SCT) who were followed up for a period of 24 months. Authors focused on the patients' oral health state and on the correlation between the fungal colonisation of the oral cavity and the unstimulated whole saliva flow rate, before and after the stem cell transplantation. Carious teeth could be detected in 20 out of the 80 persons, although all of them were examined and treated by their dentists before taking part in the SCT program. Fungal colonization could be shown in 16 patients before the conditioning phase and in 19 subjects during the aplasia phase of SCT. Hyposalivation (unstimulated whole saliva flow rate < or = 0.1 mI/min) was detected in 28 patients. In conclusion there was a higher incidence of Candida albicans and other fungal colonization in SCT patients suffering from hyposalivation than in those of normal saliva flow rate.     

The relation between xerostomia and hyposalivation in subjects with rheumatoid arthritis or fibromyalgia

Aim of this study was to evaluate the relation between xerostomia and hyposalivation in 100 subjects with either rheumatoid arthritis or fibromyalgia, and further, to evaluate the predictive value of xerostomia on hyposalivation. Unstimulated and chewing stimulated whole saliva was collected in the morning with the subjects in a strict fasting condition and then about 2 hours later, after intake of a standardised breakfast. All participants filled in a questionnaire, mainly dealing with xerostomia. Forty subjects demonstrated a pathological fasting unstimulated whole saliva secretion rate, the corresponding number for fasting stimulated secretion being 39. For unstimulated, but not for stimulated saliva, the fasting secretion rate was significantly lower than the non-fasting. Xerostomia was reported by 74 subjects, this group having significantly lower both unstimulated and stimulated secretion rates than the non-xerostomic group. On the individual level, the predictive value of xerostomia on hyposalivation showed high sensitivity but unsatisfactory specificity. In conclusion, this study underlines the importance of applying strictly standardised procedures when collecting saliva, and that fasting unstimulated whole saliva is the diagnostic salivary secretion of choice. Finally, xerostomia was found to predict hyposalivation on a group, but not on an individual level.     

Low unstimulated salivary flow and subjective oral dryness: association with medication, anxiety, depression, and stress

Medication and psychological processes may affect salivary flow and cause subjective oral dryness. The importance of these factors is unclear. The aim of this study was to evaluate the association of medication, anxiety, depression, and stress with unstimulated salivary flow and subjective oral dryness. We studied 1,202 individuals divided into three groups, and controls. Intake of medication was evaluated. Anxiety, depression, and stress were assessed. Unstimulated salivary flow < 0.1 mL/min and subjective oral dryness were significantly associated with age, female gender, intake of psychotropics, anti-asthmatics, and diuretics. Unstimulated salivary flow < 0.1 mL/min and no subjective oral dryness were significantly associated with age, intake of antihypertensives, and analgesics. Subjective oral dryness and unstimulated salivary flow > 0.1 mL/min were significantly associated with depression, trait anxiety, perceived stress, state anxiety, female gender, and intake of antihypertensives. Age and medication seemed to play a more important role in individuals with hyposalivation, and female gender and psychological factors in individuals with subjective oral dryness.     

Use of essential oil-containing mouthrinses by xerostomic individuals: determination of potential for oral mucosal irritation

PURPOSE: To assess the irritation potential of an essential oil-containing mouthrinse (Listerine Antiseptic) in a population with objectively documented xerostomia (hyposalivation) using an exaggerated-exposure clinical model. METHODS: Following a baseline oral soft tissue examination, 19 qualifying female subjects with a mean age of 61 years and a mean unstimulated baseline salivary flow of 0.06 mL/min were randomly assigned either the essential oil mouthrinse or a negative control rinse. They rinsed under supervision with 20 ml of their assigned rinse for 30 seconds and 5 minutes later a second salivary flow rate was determined. They then rinsed unsupervised with 20 ml for 30 seconds three times daily for the next 14 days, and received soft tissue examinations on days 7 and 14. After a 1-week interim period, subjects switched to the alternate rinse and the examination and rinsing regimens were repeated during the subsequent 2 weeks. RESULTS: The oral irritation potential of the essential oil mouthrinse was minimal. Oral mucosal abnormalities attributable to the test rinses were seen in only 2 subjects, both at the 7-day examination. These subjects were both using the essential oil mouthrinse. The abnormalities consisted of an asymptomatic "whitish slough" which was readily wiped off leaving a normal appearing, non-erythematous mucosa. In both subjects, the oral mucosa appeared normal at the 14-day examination.     

Oral lesions in HIV and HCV co-infected individuals in HAART era

Background:  During recent years, a new population of HIV and HCV co-infected subjects has emerged presenting particular oral problems. The aim of our study was to determine the prevalence of oral lesions in HIV+ subjects and HIV and HCV co-infected subjects, to assess whether co-infection is a risk factor for the presence of oral lesions.
Methods:  200 HIV+ subjects were consecutively enrolled, divided into two groups: Group 1 (130 HIV+ subjects) and Group 2 (70 HIV–HCV co-infected subjects) and visited by two oral medicine specialists. Epidemiological, laboratory and clinical parameters were gathered to determine the possible risk factors for oral lesions.
Results:  52 on 200 subjects (26%) presented oral lesions: in Group 1, 25 on 130 subjects (19.23%) presented oral lesions, whereas in Group 2, 27 on 70 subjects (38.57%) presented oral lesions. Multivariate analysis showed that the following variables are statistically associated with the presence of oral lesions: HIV–HCV co-infection (OR = 2.32; 95% CI = 1.01–5.33: P  < 0.05) and the use of drugs for the treatment of systemic diseases not associated with HIV (OR = 4.34; 95% CI = 1.78–5.33: P  = 0.005).
Conclusions:  It is possible to assess, on the basis of our results, that co-infected patients are more prone than HIV mono-infected patients to develop oral lesions and thus should undergo strict oral medicine monitoring.     

Oral lesions and dental caries status in perinatally HIV-infected children in Northern Thailand

Summary. Objective. To describe the prevalence of oral lesions and dental caries status in perinatally HIV-infected children.
Design. A cross-sectional study.
Setting. Paediatric HIV outpatient department at the Nakornping Provincial Hospital, Chiang Mai, Thailand.
Patients and methods. Forty children with perinatal HIV infection, from early infancy to 12 years of age, were included in the study. These children were examined for oral lesions and dental caries. A number of children receiving antifungal and antiretroviral (ART) therapy were recorded.
Results. The mean DMFT and DMFS scores were both 2·1 (SD = 2·3). The dft and dfs scores were 4·1 (SD = 5·0) and 10·9 (SD = 14·8), respectively. A total of 57·5% of the children had one or more oral lesions. Oral candidiasis and hairy leukoplakia were the most common oral lesions. Only 12·5% of children had received ART. A total of 22·5% of the children had a history of receiving antifungal therapy.
Conclusions. Oral lesions and dental caries were relatively high in this study. Consequently, treatment and prevention for oral lesions and dental caries are inevitably required for children with HIV infection in Northern Thailand. Furthermore, ART should be made available for all HIV-infected children to decrease the prevalence of HIV-associated oral lesions.     

The prevalence of xerostomia and salivary gland hypofunction in a cohort of HIV-positive and at-risk women

The association of xerostomia and salivary gland hypofunction with HIV infection has been established for men but not for women. We investigated the prevalence of these conditions in a national cohort (n = 733) of HIV-positive and at-risk HIV-negative women. Participants in this prospective cross-sectional study were recruited from the Women's Interagency HIV Study (WIHS) at five outpatient USA clinics. Xerostomia was assessed based on "yes" responses to a dry-mouth questionnaire. Samples of unstimulated whole and chewing-stimulated whole saliva were collected under standardized conditions. The major salivary glands were also evaluated clinically. The prevalence of dry-mouth complaint, the absence of saliva upon palpation, and zero unstimulated whole saliva (flow rate = 0 mL/min) were significantly (p = 0.001) higher in HIV-positive women. Adjusted odds of zero unstimulated whole saliva were significantly (p = 0.02) higher in HIV-positive women vs. HIV-negative women (OR = 2.86; 95% CI, 1.23 to 6.63). Significant (p = 0.03) univariate association was found between zero unstimulated whole saliva and CD4 counts. Adjusted odds of zero unstimulated whole saliva were significantly (p = 0.02) higher for HIV-positive women with CD4 < 200 compared with those with CD4 > 500 (OR = 2.61; 95% CI, 1.17 to 5.85). Chewing-stimulated flow rates were not significantly different between seropositive and seronegative women. The prevalence of xerostomia and salivary gland hypofunction appears to be significantly higher in HIV-positive women relative to a comparable group of at-risk seronegative women. Immunosuppression levels measured by CD4 cell counts are significantly associated with xerostomia and salivary gland hypofunction in a population of HIV-positive women.     

Evaluation of saliva flow rates, Candida colonization and susceptibility of Candida strains after head and neck radiation

Hyposalivation is a long-term effect in patients receiving head and neck radiation. Radiotherapy can predispose oral colonization by Candida species of the mucosa. This study aims to evaluate the correlation between hyposalivation, measured by unstimulated saliva flow rates (SFR) and fungal colonization of the oral cavity, and also the resistance of isolated Candida strains to antimicrobial therapy. Fifty-three consecutive patients with radiotherapy were examined for late radiation damage on dental hard tissue and the salivary glands (SFR over a period of 5 min). The SFR were divided into three different values of hyposalivation: grade I (SFR 0.1-0.25 ml/min), grade II (SFR ≤0.1 ml/min), and grade III (SFR = 0.0 ml/min). Candidal colonization was defined using Sabouraud agar and identified using API 20C AUX (biomerieux) in the patients' rinsing water. Susceptibility was tested with Etest (amphotericin B, ketoconacole, voriconacole, and fluconacole). Hyposalivation grade I was detected in 23% (9.1 × 10(1) colony forming units (cfu); range, 200-5,900 cfu), hyposalivation grade II in 26% (4.3 × 10(1) cfu; range, 110-3,300 cfu), and hyposalivation grade III in 51% (2.0 × 10(3) cfu; range, 300-19,475 cfu) of patients. A significant correlation between the SFR and candidal colonization and clinical presentation (European Organization for Research and Treatment of Cancer (EORTC) score) was detected (Mann-Whitney test, p = 0.031). Twenty Candida albicans and 27 non-albicans species were identified. The resistance of C. albicans was higher than that of non-albicans strains against antimicrobial agents. By comparison, amphotericin B showed the greatest and fluconazole the least effect. A higher value of hyposalivation correlates with a higher risk of candidal colonization in patients who have received radiotherapy and also with a higher EORTC score. The spectrum of Candida is wide and susceptibility against antifungal therapy differs. In long-term examinations of patients with xerostomia after radiotherapy, the EORTC score can be used to measure hyposalivation. Reduced susceptibility of C. albicans might introduce complications to therapy. Findings of more non-albicans strains show a change in colonization which should be examined in further studies.     

Relationships between medication intake, complaints of dry mouth, salivary flow rate and composition, and the rate of tooth demineralization in situ

The aim of this study was to describe the relationships between the rate of tooth demineralisation and medication intake, subjective feeling of dry mouth, saliva flow, saliva composition and the salivary level of lactobacilli. The study group consisted of 28 subjects that were divided into three groups according to their unstimulated whole saliva flow rate. Group 1 had an unstimulated saliva low rate < or =0.16 ml/min (n=10), group 2 had one from 0.17--0.30 ml/min (n=9), and group 3 had one >0.30 ml/min (n=9). The rate of tooth demineralization was determined as mineral loss assessed by quantitative microradiography of human root surfaces, exposed to the oral environment for 62 days in situ. The unstimulated and stimulated saliva flow rates, pH, bicarbonate, calcium, phosphate, and protein concentrations, as well as the degree of saturation of saliva with hydroxyapatite and the saliva buffer capacity were determined. The results showed that almost all subjects developed demineralization, albeit at highly varying rates. Eighty-five percent of the subjects in group 1, 33% of the subjects in group 2, and 0% of the subjects in group 3 developed mineral loss above the mean mineral loss for all the root surfaces in this experiment. Futhermore, group 1 differed significantly from groups 2 and 3 in having a higher medication intake, a more pronounced feeling of dry mouth, lower stimulated saliva flow rate, lower stimulated bicarbonate concentration, lower unstimulated and stimulated compositional outputs (bicarbonate, calcium, phosphate, and protein), and a higher Lactobacillus level. The best explanatory variable for high mineral loss in this study was a low unstimulated saliva flow rate. In conclusion, our results suggest that an unstimulated salivary flow rate < or =0.16 ml/min as described by Navazesh et al. (1992), is a better indicator of increased caries risk due to impaired salivation, than the currently accepted definition of hyposalivation (unstimulated saliva flow rate < or =0.10 ml/min), which relates to the function of the salivary glands (Sreebny, 1992).     

Association of salivary flow rate with oral function in a sample of community-dwelling older adults in Japan

OBJECTIVE: The purpose of this study was to determine the association of stimulated salivary flow rate with perceived salivary flow and various oral symptoms among a group of independently living elderly persons. STUDY DESIGN: The subjects were 351 persons (189 men and 162 women) with a mean age of 66.7 +/- 4.3 years. Stimulated whole saliva was collected with the mastication method. Self-assessed chewing ability and satisfaction with oral function also were evaluated. A multiple logistic regression analysis was used to determine whether an independent variable was statistically significant. RESULTS: Hyposalivation (< 0.5 mL/min) was significantly associated with gender (odds ratio, 1.67; P < .05). Hyposalivation (odds ratio, 3.40; P <.05) and low perceived salivary flow (odds ratio, 5.35; P <.05) were significantly associated with dissatisfaction with tasting. Low perceived salivary flow was also significantly associated with self-assessed chewing ability (odds ratio, 3.32; P <.01). CONCLUSION: This study suggested that hyposalivation and low perceived salivary flow were related to chewing ability and satisfaction with tasting foods.     

Xerostomia and hyposalivation among a 65‐yr‐old population living in Oslo,Norway

This study aimed to describe the prevalence and associated factors for xerostomia and hyposalivation in a young‐elderly population. A random sample of 460 65‐yr‐old people living in Oslo, Norway, answered a questionnaire and underwent a clinical examination (237 men and 223 women; response rate 58%). Ten percent of respondents reported xerostomia. The median Summated Xerostomia Index was 6 (interquartile range [IQR]: 5–7) and the median Clinical Oral Dryness Score was 2 (IQR: 1–3). The median unstimulated whole saliva (UWS) secretion rate was 0.34 (IQR: 0.20–0.53) mL min^–1 and the median stimulated whole saliva (SWS) secretion rate was 1.74 (IQR: 1.24–2.38) mL min^–1. In 8% of the study participants the UWS secretion rate was ≤0.1 mL min^–1 and in 4% the SWS secretion rate was ≤0.7 mL min^–1. Three percent of the study participants had both xerostomia and hyposalivation with respect to UWS. Xerostomia was significantly associated with medication use, having rheumatic disease, and having received radiation therapy to the head/neck region. Hyposalivation with respect to UWS and SWS was significantly associated with medication use and type II diabetes. Even though xerostomia and hyposalivation were not prevalent conditions in this population, clinicians should be especially aware of the salivary conditions in patients taking four or more medications, patients diagnosed with type II diabetes, and those who have undergone radiation therapy to the head/neck region.     

Oral manifestations in patients with gastro-oesophageal reflux disease: a single-center case–control study

Objective:  To assess the occurrence of oral pathological changes and symptoms in patients affected by gastro-oesophageal reflux disease (GERD).
Patients and methods:  200 patients with GERD and 100 matched healthy controls were studied. Thorough visual examination of the dental and oral mucosal tissues was performed and medical history relevant to oral symptoms was collected. The primary outcome was defined as a statistically significant difference, between the study group and controls, in the presence of the following indicators: soft/hard palate and uvula erythema, tooth wear, xerostomia, oral acid/burning sensation, subjective halitosis and dental sensitivity. Statistical analysis included chi-squared test, and crude odds ratio with 95% CI.
Results:  Univariate analysis showed that xerostomia, oral acid/burning sensation, subjective halitosis, and soft and hard palate mucosa and uvula erythema were more common in patients with GERD than matched controls ( P  < 0.05).
Conclusions:  This study failed to find any significant association between GERD and dental erosions, whereas some symptoms and other objective oral mucosal changes were found to be significantly associated with GERD.     

Initial comparison of proteomic profiles of whole unstimulated saliva obtained from generalized aggressive periodontitis patients and healthy control subjects

Background and Objective:  Salivary proteomics technology can be used to evaluate the disease progession of periodontitis and the systemic screening of proteomes of saliva from subjects with aggressive periodontitis has not been available. The objective of this preliminary study was to compare the proteomic profile of whole unstimulated saliva of subjects with generalized aggressive periodontitis (GAgP) with that of healthy volunteers to identify proteins, the levels of which were significantly altered between the two groups.
Material and Methods:  Whole unstimulated saliva was obtained from five subjects with GAgP and five healthy subjects, and proteins were separated using two-dimensional gel electrophoresis. Proteins, the levels of which were significantly different between the two groups, were identified by computer image analyses and subsequent electrospray ionization tandem mass spectrometry.
Results:  Eleven proteins that exhibited a different level in the GAgP group vs. the control group were identified. Compared with whole saliva of healthy control subjects, the levels of serum albumin, immunoglobulin (Ig) γ2 chain C region, Ig α2 chain C region, vitamin D-binding protein, salivary α-amylase and zinc-α2 glycoprotein were increased in whole unstimulated saliva of GAgP subjects, while those of lactotransferrin, elongation factor 2, 14-3-3 sigma, short palate, lung and nasal epithelium carcinoma-associated protein 2 precursor and carbonic anhydrase 6 were decreased.
Conclusion:  Comparison of the proteomic profile of whole unstimulated saliva of GAgP subjects with that of healthy control subjects revealed at least 11 differential proteins. The approach applied herein might be helpful to aid understanding of the etiology of GAgP.     

Oral Candida infection and colonization in solid organ transplant recipients

Introduction:  Oral Candida carriage and infection have been reported to be associated with a greater risk for systemic infection in transplant recipients; however, a systematic analysis of the oral Candida titers and species has not been previously conducted. The objectives of this study were to determine the prevalence of oropharyngeal candidiasis, the oral carrier status, Candida titers and species in this population.
Methods:  Ninety kidney and heart transplant subjects and 72 age-matched healthy controls were included. Swabs from the oral mucosa and a standardized amount of unstimulated saliva were plated on Chromagar™ Candida , and colony-forming units per millilitre were calculated. Initial speciation was based on colony color and was confirmed by standard germ tube, biotyping, or polymerase chain reaction assays.
Results:  Infection with C. albicans was detected in seven transplant subjects and none of the controls. The transplant group had significantly higher oral Candida titers than the control group. There were no statistically significant relationships between the dose or type of immunosuppressants and oral Candida titers or infection. A significantly higher percentage of transplant subjects were colonized by more than one species, compared with control subjects. The most frequent species combination in transplant subjects was C. albicans and C. glabrata . C. glabrata was isolated from 13.5% of transplant carriers and none of the controls.
Conclusions:  Increased oral Candida infection and carriage titers were found in the transplant population. Although the majority of transplant patients were colonized by C. albicans , C. glabrata appears to emerge as the second most prevalent species.