Associations between oral and ocular dryness, labial and whole salivary flow rates, systemic diseases and medications in a sample of older people

Smidt D, Torpet LA, Nauntofte B, Heegaard KM, Pedersen AML. Associations between oral and ocular dryness, labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol 2011; 39: 276–288. © 2010 John Wiley & Sons A/S Abstract – Objective: To investigate the associations between age, gender, systemic diseases, medications, labial and whole salivary flow rates and oral and ocular dryness in older people. Methods: Symptoms of oral and ocular dryness, systemic diseases, medications (coded according to the Anatomical therapeutic chemical (ATC) classification system), tobacco and alcohol consumption were registered, and unstimulated labial (LS) and unstimulated (UWS) and chewing‐stimulated (SWS) whole salivary flow rates were measured in 668 randomly selected community‐dwelling elderly aged 65–95. Results: Presence of oral (12%) and ocular (11%) dryness was positively correlated. Oral dryness was associated with low UWS, SWS and LS, and ocular dryness with low UWS and SWS. Oral and ocular dryness was related to female gender, but not to age. Only four persons in the healthy and nonmedicated subgroups reported oral and ocular dryness. The numbers of diseases and medications were higher in the older age groups and associated with oral and ocular dryness, low UWS, SWS and LS. On average, women were slightly older, reported more oral and ocular dryness and had lower UWS, SWS, LS and higher numbers of diseases and medications. High prevalence and odds ratios for oral dryness were associated with metabolic, respiratory and neurological diseases and intake of thyroid hormones, respiratory agents (primarily glucocorticoids), psycholeptics and/or psychoanaleptics, antineoplastics, proton pump inhibitors, antidiabetics, loop diuretics, antispasmodics, quinine and bisphosphonates. Ocular dryness was especially associated with neurological diseases and intake of psycholeptics and/or psychoanaleptics. Intake of magnesium hydroxide, antithrombotics, cardiac agents, thiazides, beta‐blockers, calcium channel blockers, ACE inhibitors/angiotensin II antagonists, statins, glucosamine, paracetamol/opioids, ophthalmologicals and certain combination therapies was related to oral and ocular dryness. Conclusions: In older people, oral and ocular dryness are associated with low salivary flow rates, specific as well as high number of diseases and medications, but neither with age and gender per se nor with tobacco and alcohol consumption. New detailed information concerning associations between medications and oral and ocular dryness has been obtained using the ATC classification system.     

Oral pilocarpine HCl stimulates labial (minor) salivary gland flow in patients with Sjögren's syndrome

Pilocarpine HCl has been shown to stimulate parotid and submandibular gland salivary flow. The purpose of this study was to determine whether this cholinergic-muscarinic drug also stimulates labial (minor) salivary gland (LSG) flow and to relate that with whole unstimulated salivary (WUS) flow rateS. Subjects diagnosed with primary Sjögren's syndrome (SS-1; n = 9) or secondary Sjögren's syndrome (SS-2; n = 9) were enrolled in this study after meeting stringent enrollment criteria. An age-gender matched control group was also enrolled. The labial saliva was collected in a standardized manner on Per-iopaper® for 5 min and the volume was analysed by the Periotron®.Whole unstimulated salivary samples were collected for 5 min by the method of Mandel and Wot-man (1976).Each subject was dosed with pilocarpine HCl (5 mg; tablets; p.o.).After 60 min the LSG flow as well as the WUS flow was determined again as previously. The results indicated a significant (>180%) increase in both labial salivary gland flow as well as whole salivary flow in the SS-1 and SS-2 subjects (mean ± S. e.m.): [SS-1: WUS = 0.1080 ± 0.03 vs 0.2242 ± 0.03 ml per 5 min; LSG = 93.1 ± 22.2 vs 167.8 ± 15.9 μl/5 min; P < 0.001; SS-2: WUS = 0.1384 ± 0.02 vs 0.2775 ± 0.09 ml per 5 min; LSG = 97.7 ± 20.2 vs 182.8 ± 17.9 μl per 5 min; P < 0.001]. These results indicate a significant increase in labial salivary gland flow as well as whole salivary flow as stimulated by pilocarpine HCI in Sjögren's syndrome patients.     

A method of measuring salivary flow rate in the lower labial mucosal region

To measure resting whole saliva, draining and spitting methods have been commonly used. However, these methods require the patients' understanding and cooperation. The aim of this study was to establish a method for measuring the salivary flow rate that does not rely on patient's cooperation or the state of the mouth and does not cause any discomfort to patients when performing the measurements. The salivary flow rate in the lower labial mucosal region was measured by means of strips that incorporated the iodo-starch reaction. The salivary flow rate was then calculated on the basis of the number of spots and area of discoloration on the strip. In order to test the validity of these methods, the correlation between these results and resting whole saliva measured by the draining method was also investigated. A positive correlation was found between the salivary flow rate estimated from the area of discoloration on the strip and the resting whole saliva (r=0.678, P=0.01). Therefore, these findings indicate that this is a valid method of measuring the salivary flow rate in the lower labial mucosal region.     

Medication and dry mouth: findings from a cohort study of older people

OBJECTIVES: The aim of this study was to examine the association between medication exposure and (1) unstimulated whole-salivary flow rate and (2) the severity of xerostomia among older people while adjusting for multiple medication use. METHODS: Data were obtained from participants remaining at the five-year follow-up phase of a cohort study of community-dwelling older South Australians. Medication exposure information was available at baseline and at five years, enabling examination of the effects on dry mouth of long-term exposure to medications. At the five-year follow-up, unstimulated salivary flow was estimated using the spit method, and xerostomia severity was estimated using the 11-item Xerostomia Inventory. Because of the potential difficulties posed by polypharmacy, a two-stage analytical approach was employed: (1) Classification and Regression Tree (CART) analysis was used as an exploratory device to elucidate the relationships among the dependent and independent variables, and (2) linear regression analysis was used as a complementary procedure. RESULTS: Unstimulated flow rate was lower among individuals who were female or taking antidepressants at both baseline and five years, and higher among smokers or people who were taking hypolipidemic drugs. Xerostomia severity was higher among females, or individuals taking: (1) an anginal at baseline and five years, (2) an anginal without a concomitant betablocker at five years, (3) thyroxine and a diuretic at five years, or (4) antidepressants or antiasthma drugs at both baseline and at five years. CONCLUSIONS: These results suggest that polypharmacy can be accounted for to a certain extent by using CART analysis in conjunction with more conventional approaches; and that the relationship between medications and dry mouth is a complex one, and differs according to which aspect of dry mouth is being examined.     

Salivary buffer capacity,pH, and stimulated flow rate of crack cocaine users

Aim: Crack cocaine is the freebase form of cocaine that can be smoked. The use of this drug has been considered a public health problem in many countries. The aim of this study was to assess the stimulated salivary flow rate (SSFR), pH, and the buffer capacity of saliva in crack cocaine users. Methods: Stimulated whole saliva was collected from 54 selected crack cocaine users and 40 non‐users. All samples were analyzed for SSFR, pH, and buffer capacity. SSFR was analyzed by gravimetric method. The buffer capacity and pH were determined using a digital pH meter. Results: The crack cocaine users demonstrated higher buffer capacity than the control group (P > 0.05). Salivary pH was lower in crack cocaine users (P < 0.05). Mean values of the SSFR for the experimental and control groups were 1.1 and 1.3 mL/min, respectively (P > 0.05). Conclusion: Crack cocaine users might exhibit a significant decrease in salivary pH, but not in salivary flow rate or buffer capacity.     

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涎腺疾病包括涎腺肿瘤及非肿瘤性涎腺疾病.涎腺主要依靠其分泌液--唾液发挥功能.近些年来,涎腺疾病和唾液的研究方面取得了明显的进展,本文对其中部分进展作一概述.     

Ultrastructural localization of salivary mucins MUC5B and MUC7 in human labial glands

Piras M, Hand AR, Tore G, Ledda GP, Piludu M. Ultrastructural localization of salivary mucins MUC5B and MUC7 in human labial glands. Eur J Oral Sci 2010; 118: 14–18. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci
As a result of their presence throughout the mouth in the submucosa or between muscle fibers, minor salivary glands secrete directly and continuously into the oral cavity, providing mucosal surfaces with highly glycosylated proteins that are active in bacterial aggregation and in oral tissue lubrication. In this study, we investigated the ultrastructural localization of the MUC5B and MUC7 mucins in human labial glands by means of a postembedding immunogold technique. Thin sections of normal human labial glands, obtained during surgery, were incubated with polyclonal antibodies to human salivary mucins MUC5B and MUC7, and then with gold-labeled secondary antibodies. Specific MUC5B reactivity was found in the secretory granules of mucous cells of all glands examined, and was associated with the luminal membrane of duct cells. MUC7 labeling was observed in the granules of both mucous and seromucous secretory cells of the glandular parenchyma. Quantitative analyses demonstrated that seromucous granules have higher immunogold labeling densities for MUC7 than mucous granules. Our immunohistochemical data extend the results of previous light microscopic studies of MUC5B and MUC7 localizations, pointing out the significant contribution of human labial glands in the secretion process of these two mucins.     

Detection of cytomegalovirus and Epstein-Barr virus in labial salivary glands in Sjogren's syndrome and non-specific sialadenitis

To investigate the role of herpes viruses in Sjogren's syndrome, minor (labial) salivary gland tissues from Sjogren's syndrome and from non-specific sialadenitis were examined for Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) DNA by the polymerase chain reaction. Almost half of all salivary glands studied contained EBV and/or HCMV. There was, however, no significant difference between the detection of EBV or HCMV in salivary glands from patients with Sjogren's syndrome or non-specific sialadenitis. The findings are consistent with the persistence of EBV and HCMV in minor salivary glands following primary infection, but do not indicate a direct role for either virus in the aetiology of Sjogren's syndrome, and do not exclude reactivation of the viruses in this disease.     

Salivary gland 99mTc-scintigraphy: a grading scale and correlation with major salivary gland flow rates

Sequential salivary gland scintigraphy with 99mTc-technetium pertechnetate (Tc-99) is a safe, minimally invasive test for study of major salivary glands. However, its relationship to salivary function has not been investigated in detail. We have investigated the relationship between major salivary gland flow rates and Tc-99 scans and developed a new rating scale using scans of a control group with normal salivary function. Salivary flow rates and Tc-99 scans were obtained from healthy, non-medicated subjects (n = 33) and from xerostomic patients (n = 22). There were significant differences between the groups for salivary flow rates and Tc-99 ratings. Significant correlations were found between salivary flow rates and Tc-99 ratings in the control and xerostomic groups. The Tc-99 rating scale proved reliable in assessing salivary dysfunction, and showed a high inter-examiner correlation. These results demonstrate the usefulness of salivary gland scintigraphy in assessing major salivary gland flow rates and the utility of a new rating scale.     

Effect of clodronate on macrophage depletion and adenoviral-mediated transgene expression in salivary glands

Expression of transgenes from adenoviral vectors is short-lived in salivary glands, in part because of immune responses to the virus and/or transgene product. Previous studies demonstrated that depletion of macrophages with multilamellar liposomes containing clodronate (Cl2MBP) increases adenoviral-mediated transgene expression in the liver. This technique was tested in salivary glands. Rats were treated with Cl2MBP-liposomes or control liposomes by femoral vein, intraperitoneal, or carotid artery injections. Thereafter, a recombinant adenovirus, AdCMVluciferase, was instilled intraductally in submandibular glands (SMGs), or delivered to the liver via femoral vein injection. Marked depletion (>94%) of liver macrophages and increased levels of luciferase activity in the liver (45-fold higher than controls) were present in animals receiving Cl2MBP-liposomes. In contrast, the same treatment never depleted more than 41% of SMG macrophages nor increased luciferase activity in SMGs, regardless of the route of administration. In conclusion, while macrophage depletion with Cl2MBP-liposomes is associated with markedly increased adenoviral-mediated transgene expression, this strategy was ineffective for salivary glands.     

Relationship between salivary immunoglobulin a,lactoferrin and lysozyme flow rates and lifestyle factors in Japanese children: a cross-sectional study

Objective: The antimicrobial substances in saliva contribute to the maintenance of both oral health and overall health of the body. Therefore, the associations among immunoglobulin A (IgA), lactoferrin and lysozyme flow rates in the saliva of children, and their relationships with the physical attributes and lifestyle factors of children, were examined.

Materials and methods: Saliva was collected from 90 children who visited the Kanagawa Dental University Hospital Pediatric Dentistry, and questionnaires were completed by guardians. IgA, lactoferrin and lysozyme concentrations were measured in the saliva samples using enzyme-linked immunosorbent assays (ELISAs).

Results: The IgA flow rate in saliva increased as age, height and weight increased. A correlation was found between lactoferrin and lysozyme flow rates. When the antimicrobial substance flow rates in the saliva were divided into two groups of 22 children each based on the highest and lowest quartiles, children with either a low or high IgA flow rate also had a high or low lactoferrin flow rate, respectively. The same pattern was observed for lactoferrin and lysozyme flow rates.

Conclusions: There is a high probability that the IgA flow rate in the saliva of children reflects and corresponds to the developmental status of immune function as the child ages and increases in height and weight. The flow rates of lactoferrin and lysozyme were correlated in children. In addition, regarding lifestyle factors, the duration of sleep and lactoferrin flow rate were also related.     

Stimulated parotid salivary flow rates in normotensive, hypertensive, and hydrochlorothiazide-medicated African-Americans

Stimulated parotid salivary flow rates were compared in elderly normotensive, hypertensive, and controlled hypertensive African–Americans, the latter group taking hydrochlorothiazide (HCTZ). The normotensive group consisted of 15 healthy unmedicated subjects with systolic blood pressures of less than 150 mm Hg and diastolic pressures less than 90 mm Hg. The hypertensive group consisted of 10 unmedicated subjects with systolic pressures greater than 160 mm Hg and diastolic pressures greater than 100 mm Hg. The controlled hypertensive group consisted of 20 subjects taking HCTZ (50 mg, daily) with controlled blood pressures similar to the normotensive control group. Stimulated parotid salivary samples were collected from each subject. A 2% citrate solution applied to the dorsum of the tongue was used for stimulation. The results showed no significant differences in stimulated parotid flow rates between normotensive and uncontrolled hypertensive subjects. However, the medicated, controlled hypertensive subjects had a significant reduction of stimulated parotid salivary flow rates compared to both the normotensive and hypertensive groups.     

The flow rate of whole and submandibular/sublingual gland saliva in patients receiving replacement complete dentures

Provision of complete dentures to a new denture wearer increases the salivary flow rate is well known. The new dentures act as an additional mechanical stimulus to the salivary reflexes, thus increasing the flow rate. The purpose of this study was to determine whether replacing complete dentures would elicit the same response. Unstimulated and stimulated whole and submandibular/sublingual (SM/SL) saliva were collected before inserting complete replacement dentures and again after 2 days and after 3 weeks of denture wearing. Unstimulated whole salivary flow rate increased significantly 2 days after inserting replacement dentures, decreasing at 3 weeks but remaining significantly above the baseline. Stimulated whole salivary flow rate increased significantly after 2 days but decreased to normal after 3 weeks. Stimulated and unstimulated SM/SL salivary flow rate increased significantly after 2 days, decreasing at 3 weeks while remaining significantly above the values found before denture insertion.     

Oral health,general health,and quality of life in older people

The purpose of this report is to review the interrelationship between poor oral health conditions of older people and general health. The impact of poor oral health on quality of life (QOL) is analyzed, and the implications for public health intervention and oral health care are discussed. Findings from the current research may lead to the following conclusions: The available scientific evidence is particularly strong for a direct relationship between diabetes and periodontal disease; the direct relationship between periodontal disease and cardiovascular disease is less convincing. General and associated oral health conditions have a direct influence on elder people's QOL and lifestyle. The growing number of elderly people challenges health authorities in most countries. The evidence on oral health–general health relationships is particularly important to WHO in its effort to strengthen integrated oral health promotion and disease prevention around the globe.