Salivary flow and its relationship to oral signs and symptoms in patients with dry eyes

Objectives: The aim of this study was to investigate oral symptoms and clinical parameters in dry eye patients. Subjective reports of the sensation of a dry mouth, salivary flow rates, and clinical parameters of oral disease related to three different types of dry eye patients were examined. Subjects and methods: There were 224 individuals, including dry eye patients and control subjects. The dry eye patients were classified into three types: patients with Sjögren's syndrome (SS‐DE), patients without SS‐DE (non‐SS‐DE), and patients with Stevens–Johnson syndrome (SJS‐DE). Salivary flow rates were measured using two kinds of sialometry. Subjective and objective oral symptoms and signs were also examined. Results and conclusion: Over half of the dry eye patients complained of a dry mouth. The flow rates of their stimulated whole saliva and parotid saliva were significantly lower than those of the control groups (P < 0.05, P < 0.01). The sensation of a dry mouth and changes in oral soft tissues, dental caries, and oral Candida frequently occurred in dry eye patients.     

Drug effects on salivary glands: dry mouth

OBJECTIVE: To identify drugs associated with the complaint of dry mouth. MATERIALS AND METHODS: MEDLINE was searched for papers 1980-2002 using keywords, oral, mouth, salivary, drugs, dry mouth and xerostomia, and relevant secondary references were hand-searched. RESULTS: Evidence was forthcoming for a number of xerogenic drugs, especially antimuscarinic agents, some sympathomimetic agents, and agents affecting serotonin and noradrenaline uptake, as well as a miscellany of other drugs such as appetite suppressants, protease inhibitors and cytokines. CONCLUSION: Dry mouth has a variety of possible causes but drugs--especially those with anticholinergic activity against the M3 muscarinic receptor--are the most common cause of reduced salivation.     

Oral complaints and stimulated salivary flow rate in 1188 adults

J Oral Pathol Med (2010) 39 : 407–419 Background: Recently, oral sensory complaints (OSC) were proposed as a disease entity to represent idiopathic sensory disturbances of dry mouth, burning mouth, and taste disturbance, even though neither the status of OSC in the general population nor its underlying mechanism has yet been elucidated. Moreover, these three OSC‐related complaints have not been assessed in combination by means of a visual analog scale (VAS) in a large‐scale, community‐dwelling population of a broad age range. Methods: In a 1188‐member community‐dwelling adult population, comprised of 373 males and 815 females, aged 20–90 years, the three OSC‐related complaints and stimulated salivary flow rate (SSFR) were assessed by means of a VAS and modified Saxon test, respectively. Association of each complaint with age, gender, SSFR, and other complaints was analyzed. Results: Increases in both prevalence and intensity of subjective dry mouth and burning mouth were associated closely with decreasing SSFR. Even for taste disturbance, which may be affected less significantly by salivation status than the other two complaints, a significant association was suggested between decreasing SSFR and especially severe taste disturbance. However, these oral complaints were found in considerable prevalence even in the individuals with high SSFR. Often overlapping presentation of these complaints and a close association in intensity between the complaints to each other were also found. Conclusions: Hyposalivation may be a significant and common etiology for the three oral complaints, although the considerable prevalence of complaints without hyposalivation suggests other etiologies, including those related to the OSC.     

Depressive symptoms in individuals with idiopathic subjective dry mouth

It has been known for many centuries that there is a relationship between saliva flow rate and emotional status. The significance of psychological processes in the subjective sensation of a dry mouth has been discussed earlier, and this study deals with the presence of depressive symptoms in individuals with idiopathic subjective sensation of a dry mouth. Depressive symptoms in 94 healthy subjects with normal flow rates for unstimulated and stimulated whole saliva but with a subjective sensation of a dry mouth were assessed by the Beck Depression Inventory (BDI) and compared with healthy age- and gender-matched controls. The subjects with a subjective dry mouth condition were significantly more depressive and also had a significantly higher frequency of depressive symptoms. Depression was found in 21.3% of the individuals with a subjective dry mouth sensation and in 3.2% of the controls. The results of this study indicate that, in some cases, subjective dry mouth may be of psychological origin.     

Analysis of residual saliva and minor salivary gland secretions in patients with dry mouth

The importance of oral mucosal wetness in the condition of dry mouth and the role of salivary proteins in proper oral function are acknowledged. A negative correlation between mucosal wetness and the protein concentration of residual saliva has been reported in normosalivators. Here, to examine the suggestion that a reduction in residual salivary volume leads to a concomitant elevation of its protein concentration, the amount of residual saliva and minor salivary gland secretions, and their protein concentrations, were measured in hyposalivators and normosalivator controls. A Periotron 8000 micro-moisture meter was used to measure the thickness of the mucosal film at six selected mucosal surfaces and the minor salivary gland secretion rate at two mucosal surfaces. The unstimulated whole salivary flow rate was measured by the spitting method. The total protein concentration of all salivary samples was measured by bicinchoninic acid assay. The hyposalivators had significantly lower amounts of residual saliva and minor salivary gland secretions than the normosalivators at all selected mucosal sites except the soft palate. In both groups, the site with the thinnest coat of residual saliva was the anterior hard palate and the wettest site was the anterior dorsal mucosa of the tongue. The protein concentration of residual saliva was significantly higher in hyposalivators than normosalivators. In the minor salivary gland secretions there was no significant difference in protein concentration between the normo- and hyposalivators. When the hyposalivators were divided into two subgroups according to their severity of dryness, the reduction of residual salivary volume and the elevation of protein concentration were more apparent in the group with the more severe dry mouth. Collectively, these results indicate that oral mucosal wetness is associated with the flow rate of unstimulated whole saliva. The function of the minor salivary glands was less affected and relatively well preserved in patients with dry mouth. The increased protein concentration of residual saliva in the hyposalivators appeared to be the result of decreased salivary volume.     

Relationship between stressful situations,salivary flow rate and oral volatile sulfur-containing compounds

The relationship between stress, salivary flow rate and oral volatile sulfur-containing compounds (VSCs) is not clearly established. Two stressful situations were studied: psychological stress caused by a biochemistry examination (Study I) and psychophysiological stress caused by premenstrual syndrome (PMS) (Study II). Seventy-one undergraduate dental students took part in Study I and VSCs were measured 1 wk before the examination, on the day of examination and 1 wk after. In Study II, 50 women were selected (23 with and 27 without PMS) and the measurements were made during non-menstrual, premenstrual and menstrual stages. Unstimulated salivary flow was determined in the subjects of both studies. On the day of the biochemistry examination, VSCs significantly increased and salivary flow decreased compared with baseline values. Women with PMS showed higher VSC concentrations during the premenstrual stage than those without PMS (P < 0.05), but the salivary flow was not statistically different. A change in VSCs was observed during different stages of the menstrual cycle for the groups of women, but the salivary flow did not change. The results suggest that a stressful situation can be a predisposing factor for the increase of VSCs in the mouth air, but the mechanism cannot be simply explained by reduction of the salivary flow.     

鼻咽癌放疗后唾液流率和pH值的变化

目的：研究鼻咽癌放疗对涎腺功能造成放射性损害,为尽量减少和预防鼻咽癌放疗后遗症寻求可能的途径。方法：对2002年收治的38例鼻咽癌患者进行分析,38例均为首次接受放疗的鼻咽癌患者,平均年龄41．4岁,分别在放疗前、后检测混合唾液流率和pH值。结果：放疗后多数患者出现口干,唾液流率显著减少,pH值稍微上升。结论：放射治疗使涎腺功能受到极大破坏,唾液的质和量有很大变化;精确设计放射野,改进放疗技术可以预防和减少放射性涎腺损伤。     

Salivary flow rate and clinical characteristics of patients with xerostomia according to its aetiology

Summary The purpose of the present study was to investigate the differences in salivary flow rates and dry mouth‐related subjective symptoms and behaviours in patients with xerostomia according to its aetiology. One hundred and forty patients (24 men and 116 women, mean age, 58·1 ± 13·3 years) with a chief complaint of xerostomia were included. The patients were divided into five groups; Sjögren’s syndrome (n = 34), post‐radiation therapy in the head and neck region (n = 16), antipsychotic medications (n = 30), systemic diseases or medications affecting salivary flow (n = 35), and unknown aetiology (n = 25). The patients were asked a standardized series of questions concerning dry mouth, and their whole salivary flow rates were measured. Patients with a history of radiation therapy displayed the most decreased values of salivary flow rates and the most severe associated symptoms and behaviours while patients with unknown aetiology displayed the least decreased values of salivary flow rates and relatively favourable symptoms and behaviours. A burning sensation in the mouth was the most prevalent in patients with systemic diseases or those who were taking medications while altered taste perception was the most prevalent in patients taking antipsychotics. In conclusion, patients with xerostomia displayed various degrees of discomfort related to the quality of life according to the aetiology of their conditions.     

Comparison between new saliva stimulants in patients with dry mouth: a placebo-controlled double-blind crossover study

Two new saliva stimulants: V6 and a mucin containing chewing gum were tested in this placebo-controlled double-blind crossover study. Forty-three patients (mean age 63 yr) complaining of dry mouth participated. The products were administered in a randomized order, and used for 2 wk each. The effect was evaluated by interviews and by determining changes in stimulated and unstimulated saliva flow rates. A positive effect was reported by 64%, 44%, and 26% of the patients using the mucin chewing gum, V6, and the placebo, respectively. More than 2/3 of the patients found the mucin chewing gum efficient at various times and situations. Sixty-one percent of the patients preferred the mucin chewing gum, 21% V6, and 5% the placebo product. Fifty percent of the patients had an increase in unstimulated salivary secretion rate from all products after 14 days regular use indicating a long-term effect.     

灼口综合征患者静态唾液流速和口干症状的相关研究

目的：探讨不同亚型灼口综合征（BMS）患者静态唾液流速有无差异以及静态唾液流速速与BMS患者口干症状之间有无相关性,方法：采用舌下置纱团浸唾称重法测定52例BMS患者和37例正常对照组的静态唾液流速,结果：BMS组的平均静态唾液流速较对照组低,但统计学上无显著差异。BMS的3个亚型间平均静态唾液流速无统计学上显著差异,具口干症状的BMS患者静态唾液流速与不具口干症状者差异亦不显著,结论：BMS患者口干症状与静态唾液流速之间的相关性不显著。     

Dental erosion and salivary flow rate in cerebral palsy individuals with gastroesophageal reflux

J Oral Pathol Med (2012) 41 : 367–371 Background: A high prevalence of gastroesophageal reflux (GERD) has been observed in individuals with cerebral palsy (CP). One of the main risks for dental erosion is GERD. This study aimed to evaluate the presence of GERD, variables related to dental erosion and associated with GERD (diet consumption, gastrointestinal symptoms, bruxism), and salivary flow rate, in a group of 46 non‐institutionalized CP individuals aged from 3 to 13 years. Methods: Twenty CP individuals with gastroesophageal reflux (GERDG) and 26 without gastroesophageal reflux (CG) were examined according to dental erosion criteria, drinking habits, presence of bruxism, and salivary flow rate. A face‐to‐face detailed questionnaire with the consumption and frequency of acid drinks, gastrointestinal symptoms (regurgitation and heart burn), and the presence of bruxism were answered by the caregivers of both groups. Unstimulated whole saliva was collected under slight suction, and salivary flow rate (ml/min) was calculated. Results: The GERDG presented higher percentages of younger quadriplegics individuals compared to CG. The presence of regurgitation, heart burn, and tooth erosion (Grade 1) was significantly more prevalent in GERDG. It was observed difference in the salivary flow rate between the studied groups. On logistic multivariate regression analysis, the unique variable independently associated with the presence of GERD was dental erosion (P = 0.012, OR 86.64). Conclusion: The presence of GERD contributes significantly to dental erosion in the most compromised individuals with quadriplegics cerebral palsy individuals, increasing the risk of oral disease in this population.     

口干与可摘局部义齿临床关系的相关研究

目的:观测佩戴两种不同材料可摘局部义齿的患者戴牙前后口腔中静态唾液流率,探讨口干与佩戴可摘局部义齿的相关关系。方法:采用舌下置棉球浸唾称重法,选取符合纳入标准的60例钢托排牙的患者(A组)和60例钢网排牙的患者(B组),测量其戴牙前后不同时间点口腔中静态唾液流率,并进行相关分析。结果:经过重复测量分析得出A,B两组患者戴牙前后唾液流率有差别,静态唾液流率有所减少,经t检验分析,P<0.05。结论:戴用可摘局部义齿可以导致患者口腔中静态唾液流率降低,从而引起口干的症状。     

Safety and effectiveness of topical dry mouth products containing olive oil, betaine, and xylitol in reducing xerostomia for polypharmacy-induced dry mouth

Polypharmacy is a common cause of salivary hypofunction, producing symptoms of dry mouth or xerostomia, especially among older populations. As the number of older people continues to increase, polypharmacy-induced salivary hypofunction is becoming an increasing problem. Many over-the-counter products are available for relieving symptoms of dry mouth, but few have been tested in controlled clinical investigations. The purpose of this investigation was to evaluate the safety and efficacy of a group of topical dry mouth products (toothpaste, mouth rinse, mouth spray and gel) containing olive oil, betaine and xylitol. Forty adults were entered into this single-blinded, open-label, cross-over clinical study and 39 completed all the visits. Subjects were randomly assigned at baseline to using the novel topical dry mouth products daily for 1 week, or to maintain their normal dry mouth routine care. After 1 week, they were crossed over to the other dry mouth regimen. The results demonstrated that the use of the novel topical dry mouth products increased significantly unstimulated whole salivary flow rates, reduced complaints of xerostomia and improved xerostomia-associated quality of life. No clinically significant adverse events were observed. These data suggest that the daily use of topical dry mouth products containing olive oil, betaine and xylitol is safe and effective in relieving symptoms of dry mouth in a population with polypharmacy-induced xerostomia.     

Unstimulated whole salivary flow rate and anxiolytics intake are independently associated with oral Candida infection in patients with oral lichen planus

Many factors have been proposed to influence oral infection with yeast. The aim of this study was to determine the prevalence of oral yeasts in oral lichen planus (OLP) patients and control subjects, and to perform a multiple logistic regression analysis to identify factors that influence oral Candida infection in OLP patients. In this cross‐sectional study, 90 new patients with OLP and 90 sex‐ and age‐matched control subjects with no mucosal lesions were interviewed about their health status, use of medication, and smoking and alcohol habits. Swab and unstimulated whole saliva samples were collected and salivary pH was measured. A positive Candida culture was more prevalent among OLP patients (48.9%) than among control subjects (26.7%). Candida albicans was the most frequently isolated species in both groups. By logistic regression analysis, unstimulated whole salivary flow rates of 0.11–0.24 ml min^?1 (OR = 5.90) and 0.25–0.32 ml min^?1 (OR = 3.51) and benzodiazepine anxiolytics intake (OR = 8.30) were independently associated with the presence of Candida among OLP patients. Age, denture wearing, levels of dentition, decreased salivary pH, antihypertensive drugs, and alcohol consumption were not associated with oral Candida infection in OLP patients. The results indicate that data on benzodiazepine anxiolytics intake and evaluation of unstimulated whole salivary flow rate should be considered as part of the clinical evaluation to identify OLP patients at risk for Candida infection.     

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.