Evaluation of the salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation

Background Head and neck radiotherapy is typically associated with toxicities that can have profound effects on the patient''s quality of life. Xerostomia, which may or may not be related to hypofunction of the salivary gland, leading to negative consequences, mainly in quality of life, leaving patients more susceptible to the development of oral mucositis, dental caries, oral infection and difficulties in speech is one of the most common side effects of such treatment. The aim of the present study was to evaluate salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation. Material and Methods A cross-sectional study with a quantitative approach was carried out in the Dentistry Department of the Hospital de Câncer de Pernambuco between February and September 2019. Results The study sample comprised 23 patients of both genders, treated with radiotherapy for cancer in the head and neck region. The patients were submitted to photobiomodulation with infrared laser, as intraoral applications in order to prevent mucositis and extraoral applications to stimulate salivary glands. The applications were undertaken three times a week on alternate days throughout the radiotherapy period. The following parameters were used: Intraoral 15mW, 12J / cm2, 10s / point, 2.4 J / point, and extraoral 30mW, 7.5J / cm2, 10s / point, 0.3J / point, both with a wavelength of 830nm and area of 0.028cm². Subjective and objective symptoms were evaluated by measuring the unstimulated salivary flow (USF) using the spitting technique before, during and after radiotherapy treatment. For statistical analysis, a significance level of 5% was adopted. Most patients were male (70%) with 60 years of age on average. At the beginning of treatment, 22 patients had USF> 0.2 ml / min (grade 1), at the end of which 15 patients remained unchanged and only 3 patients progressed to grade 3. As for the subjective classification, most (52%) remained in grade 1 (absence of disability) throughout the treatment. Conclusions Based upon the results of this study it was possible to conclude that the use of photobiomodulation did not significantly interfere with the xerostomia complaint of patients in treatment with radiotherapy, however, it does seem to prevent patients from reaching higher degrees of xerostomia taking into account salivary flow measures. Key words:Photobiomodulation, head and neck neoplasms, radiotherapy, xerostomia, saliva.     

Acupuncture for the prevention of radiation-induced xerostomia in patients with head and neck cancer

The aim of this study was to evaluate the effectiveness of acupuncture in minimizing the severity of radiation-induced xerostomia in patients with head and neck cancer. A total of 24 consecutive patients receiving > 5000 cGy radiotherapy (RT) involving the major salivary glands bilaterally were assigned to either the preventive acupuncture group (PA, n = 12), treated with acupuncture before and during RT, or the control group (CT, n = 12), treated with RT and not receiving acupuncture. After RT completion, clinical response was assessed in all patients by syalometry, measuring the resting (RSFR) and stimulated (SSFR) salivary flow rates, and by the visual analogue scale (VAS) regarding dry mouth-related symptoms. Statistical analyses were performed with repeated-measures using a mixed-effect modeling procedure and analysis of variance. An alpha level of 0.05 was accepted for statistical significance. Although all patients exhibited some degree of impairment in salivary gland functioning after RT, significant differences were found between the groups. Patients in the PA group showed improved salivary flow rates (RSFR, SSFR; p < 0.001) and decreased xerostomia-related symptoms (VAS, p < 0.05) compared with patients in the CT group. Although PA treatment did not prevent the oral sequelae of RT completely, it significantly minimized the severity of radiation-induced xerostomia. The results suggest that acupuncture focused in a preventive approach can be a useful therapy in the management of patients with head and neck cancer undergoing RT.     

A review on the role of salivary MUC5B in oral health

BackgroundThe salivary glycoprotein MUC5B plays a versatile role in maintaining oral health. It contributes to lubrication, pellicle formation, antimicrobial defense, and water retention, and its glycans are an important nutrient for oral bacteria. This review aimed to describe the role of MUC5B in oral health and examine changes in its levels and composition in cases of hyposalivation and xerostomia.HighlightIn cases of hyposalivation, the reduction of total salivary MUC5B levels and MUC5B glycosylation patterns due to Sjögren's syndrome (SS) and medication intake appeared insignificantly limited. In patients with SS, xerostomia was related to reduced MUC5B levels at the anterior tongue. In cases of xerostomia, MUC5B glycosylation might be reduced, yet other factors such as total protein concentration, MUC7 levels and glycosylation, and salivary spinnbarkeit are involved. In contrast to SS- and medication-induced hyposalivation, radiotherapy in the head and neck region leads to a bona fide reduction in salivary MUC5B levels.ConclusionOur findings suggest that MUC5B levels are clearly impaired in hyposalivation and xerostomia related to radiotherapy in the head and neck region versus those related to SS and medication intake. A reduction in glycosylation in the case of dry mouth appears associated with MUC5B and MUC7 as well as other factors.     

Validation of a Portuguese version of the Groningen radiotherapy-induced xerostomia questionnaire

Background The aim of this study was to validate and determine at pretest level the reliability of the Portuguese version of the Groningen radiotherapy-induced xerostomia questionnaire.Material and Methods This study employed 37 head and neck cancer patients. Each patient signed an informed consent and responded to the Portuguese version of the questionnaire in the form of an interview. This was repeated again after 2 weeks. A standard single question provided a validity check. Data were analyzed using Cronbach’s α to test its reliability and total and interitem correlation, and intraclass correlation to determine its internal consistency and test-retest reliability. Construct validity supported by objective measurements as salivary secretion was also investigated. Significance was set at .05.Results Cronbach’s α was 0.91 and 0.89 for the first and second test administrations, respectively, which indicates that the internal consistency was excellent. The intraclass correlation coefficient value for the test-retest reliability was 0.70. The correlation between the total score of the questionnaire and standard single dry mouth question was 0.72 for the first round, indicating a good correlation.Conclusions Demonstrating very good psychometric properties, the Portuguese version of the Groningen radiotherapy-induced xerostomia questionnaire is a valid tool and can be considered a reliable instrument to measure xerostomia in head and neck cancer patients. Key words:Xerostomia, quality of life, xerostomia questionnaire, transcultural validation, head and neck cancer, radiotherapy, saliva.     

头颈癌术后调强放疗后口干症的综合评价

目的:对头颈癌术后调强和常规放疗后的口干症行前瞻性评估,以确定调强放疗预防口干症的效果.方法:82例头颈癌患者(口腔癌71例、口咽癌11例)分别行调强放疗(40例)和常规放疗(42例).在放疗前、后5个时间点,对口干进行综合评估.应用SPSS13.0软件包对数据进行统计学处理.结果:调强组腮腺平均放射剂量(22.21±5.02)Gy显著低于常规放疗组的(50.22±5.86)Gy(P<0.01);调强和常规组在放疗后6个月的中重度田干发生率,分别为RTOG评分法30%和92.9%,上海九院评分法25%和90.5%;口干问卷法15%和83.3%;调强组放疗后6个月时的静态和刺激唾液流为放疗前的51.0%和72.5%,常规组仅为放疗前的3.6%和8.2%(P<0.01);九院口干评分法结果与2种唾液流率均显著相关(r=0.79和0.78,19<0.01).结论:调强放疗后口干症明显减少,推荐上海九院评分法用于口干症评估.     

Dental considerations for head and neck cancer: A clinical review

IntroductionRadiotherapy is one of the treatment modalities for the treatment of head and neck cancer (HNC). However, it leads to the development of chronic and acute side effects. These side effects impact negatively on the patient’s quality of life and oral functioning. This clinical review aims to provide basic information about HNC, understand the impact of radiotherapy on oral health, and explain the role of dental care providers for HNC patients during the pre-and post-radiotherapy time.Materials and MethodsElectronic databases (i.e., PubMed, Scopus, and Google Scholar) were searched using defined keywords. The main inclusion criteria were any studies describing “dental management of patients with head and neck cancer” and “dental management of patients treated with radiotherapy.”ResultsThematic analysis was used to summaries the findings of the included studies (n = 102) into main headings and subheadings. All studies were published between 1970 and 2023.ConclusionThe number of HNC patients is increasing. This necessitates the need for raising the awareness of dental care providers to the side-effects of HNC therapy which includes treatment with radiotherapy, chemotherapy, and/or surgery. Dental care providers should understand the common side-effects and their treatments besides their role in the pre- (i.e., dental extraction of teeth with poor prognosis and maintaining good oral hygiene) and post- (i.e., oral rehabilitation and post-HNC dental care) radiotherapy dental care.     

Managing xerostomia and salivary gland hypofunction: Executive summary of a report from the American Dental Association Council on Scientific Affairs

Background and OverviewXerostomia, also known as “dry mouth,” is a common but frequently overlooked condition that is typically associated with salivary gland hypofunction, which is the objective measurement of reduced salivary flow. Patients with dry mouth exhibit symptoms of variable severity that are commonly attributed to medication use, chronic disease and medical treatment, such as radiotherapy to the head and neck region. Chronic xerostomia significantly increases the risk of experiencing dental caries, demineralization, tooth sensitivity, candidiasis and other oral diseases that may affect quality of life negatively. This article presents a multidisciplinary approach to the clinical management of xerostomia, consistent with the findings of published systematic reviews on this key clinical issue.Conclusions and Practice ImplicationsInitial evaluation of patients with dry mouth should include a detailed health history to facilitate early detection and identify underlying causes. Comprehensive evaluation, diagnostic testing and periodic assessment of salivary flow, followed by corrective actions, may help prevent significant oral disease. A systematic approach to xerostomia management can facilitate interdisciplinary patient care, including collaboration with physicians regarding systemic conditions and medication use. Comprehensive management of xerostomia and hyposalivation should emphasize patient education and lifestyle modifications. It also should focus on various palliative and preventive measures, including pharmacological treatment with salivary stimulants, topical fluoride interventions and the use of sugar-free chewing gum to relieve dry-mouth symptoms and improve the patient's quality of life.     

生津活血中药在头颈部放疗中对涎腺功能影响的研究

目的探讨生津活血中药在头颈部肿瘤患者放疗过程中对涎腺功能的影响。方法将38例首程放疗的患者随机分为实验组(中药加放疗)18例和对照组(单纯放疗)20例。对放疗前及放疗不同剂量时的口干程度、pH值、唾液流率及淀粉酶浓度进行比较。结果随放疗剂量的增加,2组患者口干程度增加,唾液流率与淀粉酶浓度均降低。在放疗至20、40 Gy时实验组的唾液流率和淀粉酶浓度均较对照组高。但在达到60 Gy时,2组数据则趋于接近。另外,患者的主观口干程度与客观的唾液流率下降程度之间并不直接对应。结论①头颈部肿瘤患者在放疗过程中辅以生津活血中药,可在一定程度上改善口干症状,但并不足以预防放射性口干症的发生。②患者的口干严重程度和唾液流率下降程度之间并不严格对应,患者主观的口干程度并不能作为反映唾液腺功能受损程度的可靠指标。     

Involvement of E2f1 deficiency in salivary gland hypofunction: A review of studies of E2f1-deficient NOD/SCID mice

BackgroundSaliva is essential for the preservation of oral health, and disorders of salivary physiology are associated with numerous oral problems. Hyposecretion of saliva, and consequent xerostomia, leads to severe dental caries, periodontal disease, and mucosal infections, which reduce a patient׳s quality of life. Sjögren׳s syndrome, the use of drugs with anticholinergic effects, and radiotherapy for the treatment of head and neck cancers are the most common causes of xerostomia. However, the pathophysiological features of xerostomia are not yet clear.HighlightRecently, we established E2f1-deficient non-obese diabetic/severe combined immunodeficiency disease (NOD/SCID) mice. The mutant mice demonstrated a reduction of salivary fluid secretion following stimulation with a cholinergic agonist, and xerostomia behavior under physiological conditions. In this article, we review the pathophysiology of xerostomia in E2f1-deficient NOD/SCID mice and discuss the involvement of the E2f1 deficiency in salivary gland hypofunction.ConclusionIn E2f1-deficient NOD/SCID mice, the number of duct cells increased while the number of acinar cells decreased. The water channel aquaporin 5, a marker of acinar cells, demonstrated diffuse localization, ubiquitination, and decreased expression in E2f1-deficient NOD/SCID mice. These events seem to trigger salivary gland hypofunction in E2f1-deficient NOD/SCID mice, which suggest that E2f1 is a key factor in the development of xerostomia.     

Evaluation of the xerostomia,taste and smell impairments after Covid-19

Background The purpose of this study was to explore the effects of coronavirus disease 19 (Covid-19) on the oral cavity by evaluating the oral findings in the patients who recovered after treatment.Material and Methods This study involved confirmed Covid-19 patients whose treatment completed at least two weeks ago. A questionnaire consist of eight parts was applied to explore the oral findings after Covid-19. Also stimulated salivary flow rate was evaluated with a salivary flow test.Results 177 patients reached and 107 of them participate in the study. Regarding gender significant differences were found in terms of the presence of taste impairment after treatment (p=0.007), the degree of taste (p=0.021) and smell (p=0.010) impairment. 18 % (5/27) of the patients evaluated were showed hyposalivation. No significant differences were observed regarding salivary flow between males (mean±SD: 1.14±0.65) and females (mean±SD: 1.12±0.43), (p=0.928); among the patients having treatment at home (mean±SD: 1.03±0.48) or hospital (mean±SD: 1.33±0.65), (p=0.187). In some of the patients’ taste [15], smell [23] impairment, and xerostomia [43] still observed at least two weeks after the treatment is completed.Conclusions The most frequent finding in patients after the treatment was xerostomia. Taste and smell impairments were more frequently observed in females. Key words:Saliva, oral findings, hyposalivation, Covid-19.     

Oral health condition and saliva flow in southern Chinese with Sjögren's syndrome

Objective : To investigate the oral health condition and saliva flow of southern Chinese patients with Sjögren's syndrome (SS). Method : 51 SS patients (26 primary and 25 secondary cases) and 29 controls took part in this cross‐sectional study. Stimulated whole and parotid saliva flow rates, pH, and buffer capacity, and xerostomia, oral mucosal lesions, oral hygiene status, dental and periodontal conditions, prosthetic status were assessed and compared between groups. Results : Stimulated whole saliva (SWS) flow was reduced in primary and secondary SS cases (p<0.001), pH and buffer capacity were also reduced in the primary SS group (p<0.05). SS patients had a greater prevalence of xerostomia than controls (p<0.001). Primary SS patients had a higher mean DMFT, more missing teeth, and more prostheses than secondary SS cases and controls (p<0.05). SWS flow correlated negatively with the number of filled teeth in both SS groups (p<0.05) and the number of decayed teeth in the primary SS group (p<0.05). Conclusion : Despite good oral hygiene and regular dental checkups, the oral health of southern Chinese with primary SS was significantly compromised compared with secondary SS cases and controls, most probably due to the combined effect of impaired salivary gland function and poorer saliva buffer capacity.     

Double-blind randomized, placebo-controlled study of pilocarpine to salvage salivary gland function during radiotherapy of patients with head and neck cancer

OBJECTIVE: The efficacy of pilocarpine given during radiotherapy for head-neck cancer to reduce xerostomia was assessed. STUDY DESIGN: 58 patients receiving 5000 cGy radiotherapy (RT) involving salivary glands bilaterally were selected at the Jewish General Hospital, Montreal, Canada. Patients were randomly assigned to pilocarpine (5 mg, PILO, n=29) or placebo group (PLA, n=29). These drugs were taken 5 times daily during radiotherapy (first study phase) and 4 times daily for 5 weeks thereafter (second study phase). Saliva was collected and estimated for not stimulated and stimulated patients using the SAXON method. RESULTS: At the conclusion of the first phase, PILO patients reported a better global quality of life (P=.02) and less oral discomfort (P=.001) when compared to PLA. No significant difference was noted in the level of saliva, xerostomia, and other symptoms between patients in PILO and PLA. At the end of the second phase, a difference between groups was observed only for xerostomia and mucosal pain; both were significantly higher in PILO when compared to PLA (P <.05). CONCLUSION: Pilocarpine 5mg given 5 times daily did not appear to improve the production of saliva and global quality of life assessments, nor to decrease the symptoms of xerostomia 5 weeks after completion of RT in patients who were taking pilocarpine post-RT. There was a slight improvement in the quality of life and a decrease in the level of discomfort noted only after the first study phase. The limitations of this study are discussed.     

Oral health status of 207 head and neck cancer patients before, during and after radiotherapy

The aim of this retrospective study was to describe the oral health status of patients before, during, and after radiotherapy (RT) for the treatment of head and neck cancer (HNC). Before RT, the following data was collected: presence of unrecoverable teeth, residual roots, unerupted teeth, use of dentures, periodontal alterations, caries, candidiasis, and xerostomia. Mucositis, candidiasis, and xerostomia were evaluated during RT. Patients continued to be followed after RT for evaluation of mucositis, candidiasis, xerostomia, radiation caries, and osteoradionecrosis. For statistical analysis, 95% confidence intervals (CI) were determined using sample size, population, and percentages. Before RT, 120 (57.9%) patients presented with alterations in the oral cavity namely, 85 (41.0%) with periodontal disease, 44 (21.2%) with residual roots, 25 (12.0%) with caries, 15 (7.2%) with candidiasis, and 12 (5.8%) had an unerupted tooth present. Xerostomia was a complaint of 19 patients (9.1%). Restorations were indicated for 33 patients (15.9%), whereas extraction was indicated for 104 (50.2%) patients. During RT, mucositis was found in 80 (61.7%) patients, candidiasis in 60 (45.8%), and xerostomia was a complaint of 82 patients (62.6%). After RT, mucositis persisted in 21 patients (19.2%), candidiasis was identified in 23 patients (21.1%), and xerostomia was reported by 58 patients (53.2%). Radiation caries developed in 12 patients (11.0%), whereas six patients (5.5%) developed osteoradionecrosis. The demographic profile herein presented will be useful as baseline data to provide additional epidemiological information and to determine future measures for prevention and treatment of RT-induced complications and sequelae.     

Effect of low level laser therapy in the reduction of oral complications in patients with cancer of the head and neck submitted to radiotherapy

The aim of this study was to assess the effect of low level laser therapy on reducing the occurrence and severity of oral complications in patients with head and neck cancer undergoing radiotherapy. Sixty head and neck cancer outpatients from a cancer hospital receiving radiotherapy were selected and randomly assigned into two groups. The laser group was irradiated with an InGaAlP laser and the control received sham laser. The assessment of complications (oral mucositis, pain) was carried out one week after starting radiotherapy, and at the fifteenth and thirtieth sessions of radiotherapy. All patients from both groups showed some degree of oral mucositis. Better outcomes were observed in the laser group when compared with the control in the follow‐up sessions, indicating lower degrees of oral mucositis, pain and higher salivary flow (p < .05). These findings support the use of laser therapy as an adjuvant treatment for the control of oral complications.     

Oral findings in irradiated edentulous patients

11 edentulous patients (mean age 71.2 years) with oral or oropharyngeal malignancies were examined clinical and microbiologically before, during, and after receiving tumoricidal radiation doses (26.4-74 Gy) towards the head and neck regions. The effect of a supervised oral hygiene program and a saliva substitute (Va-OraLube) was studied. The 9 patients who survived the observation period, showed increased xerostomia and mucositis related to increased radiation. Radionecrosis or oral infections were not observed. The patients wore their dentures throughout the observation period and preferred to use the saliva substitute. The initial number of acidophilic bacteria was high, Candida albicans were present in low numbers and enteric bacteria occurred more frequently than normally. There was a reduction of micro-organisms after introduction of the hygiene program. It is concluded that careful planning of the radiotherapy, pre-radiation oral examination, denture control and instruction and an effective oral hygiene program are essential for the reduction of oral complications in edentulous patients receiving tumoricidal radiotherapy to the head and neck regions.     

Oral conditions and salivary analysis in HIV-uninfected subjects using preexposure prophylaxis

Background New prevention strategies have been advocated to control the progression of HIV/AIDS, such as preexposure prophylaxis (PrEP). The aim of this study is to evaluate the potential changes in the oral and salivary conditions of HIV-uninfected subjects using PrEP.Material and Methods Subjects were evaluated before beginning the medication (T0), at the first follow-up (T1), and at the second follow-up (T2). Xerostomia, presence of untreated cavitated caries, oral hygiene habits, taste, gingival and plaque index, stimulated salivary flow rate (SSFR), and salivary concentrations of calcium, glucose, urea, and total proteins were evaluated. Data obtained were analyzed using statistical tests (p<0.05).Results Forty-seven participants (41 men; 6 women) were evaluated at T0. Thirty (28 men; 2 women) and 17 men were reassessed at T1 and T2, respectively. There was no difference between the SSFR and oral and salivary conditions between T0, T1, and T2 (p>0.05), except for the salivary calcium concentration, that increased at T2 compared to T1 (p=0.02). There was significant difference between taste and xerostomia at T1 (p=0.017), and the need to drink to swallow at T2 (p=0.015). There was significant correlation between the reported amount of saliva and taste (p=0.039, r=-0.378) at T1.Conclusions The prolonged use of PrEP seems to be associated with reports of dry mouth and worsening of taste, possibly associated with increased salivary calcium concentration. Key words:Antiretroviral agents, pre-exposure prophylaxis, saliva, oral health.     

Clinical and biochemical evaluation of the saliva of patients with xerostomia induced by radiotherapy

Clinical aspects and biochemical properties in the saliva of 21 patients prior to and following radiotherapy for head and neck cancer were evaluated (experimental group) and compared with the same properties in a control group of 21 subjects free of cancer. Salivary flow was evaluated by measuring the time necessary, in seconds, for the output of 2 ml of stimulated saliva; and the buffering capacity changes were determined using a simple colorimetric method. Total salivary protein concentration was determined by the Bradford 4 method. Amylase activity was measured by reducing sugars released from a soluble starch substrate, quantified by the dinitrosalicylic method. The electrophoretic profile was evaluated in polyacrylamide gel (12% SDS-PAGE) using samples of 5 mg of salivary protein. A statistically significant reduction (p < 0.01) of the salivary flow was observed, (162.47 s +/- 28.30 before and 568.71 s +/- 79.75 after irradiation), as well as a reduction in the salivary buffering capacity (pH 5.45 +/- 0.14 before and pH 4.40 +/- 0.15 after irradiation). No statistically significant alteration was observed in total salivary protein concentration. A statistically significant reduction (p < 0.01) of salivary alpha-amylase activity (856.6 ng/mg +/- 88.0 before and 567.0 ng/mg +/- 120.6 after irradiation) was observed. Electrophoretic profile differences in salivary protein bands were also observed after radiotherapy, mainly in the range of molecular weight of 72000 to 55000 Daltons. Clinically, patients presenting xerostomia induced by radiotherapy presented an increase in oral tissue injury.     

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.     

Efficacy of pilocarpine lozenge for post-radiation xerostomia in patients with head and neck cancer

BACKGROUND: Patients with radiation-induced xerostomia produce little or no saliva. Several studies have demonstrated the efficacy of systemic administration of pilocarpine hydrochloride in individuals with post-radiation xerostomia. However, analysis of pilocarpine lozenges for treatment of post-radiation xerostomia in patients with head and neck cancer has not been reported. METHODS: The aim of this study was to quantify improvement in clinical symptoms and salivary function after treatment of post-radiation xerostomia with pilocarpine lozenges. In a double-blinded, placebo-controlled trial, 33 head and neck cancer patients were assigned randomly to receive Salagen tablet, pilocarpine hydrochloride lozenge (3 or 5 mg) or placebo lozenge every 10 days. At each visit, a subjective evaluation was undertaken through the use of visual analog scales before and at 180 minutes after treatment. Whole resting saliva was collected before and at 0, 30, 60, 90, 120, 150 and 180 minutes after treatment. RESULTS: The percentage of patients with decreased feeling of oral dryness, sore mouth or speaking difficulties after taking 5-mg pilocarpine lozenge was greater than Salagen or placebo. There were statistically significant increases in salivary production in pilocarpine treatment groups vs. placebo (P < 0.05). CONCLUSION: The 5-mg pilocarpine lozenge produced the best clinical results, but further investigation with a larger group of patients is required.     

Facts and controversies regarding oral health in Parkinson's disease: A case-control study in Spanish patients

Background Parkinson''s disease (PD) is one of the leading neurological disorders, affecting more than 6 million people worldwide. These patients present motor and non-motor symptoms, including oral pathology. The objective of this research is to determine the oral health of patients diagnosed with PD, in order to stablish a specific preventive oral health programme.Material and Methods Case-control study on 104 PD and 106 control patients. The pre-designed clinical protocol included a complete oral examination on general aspects, standardised epidemiological index for caries, periodontal disease and edentulism, analysis of oral hygiene, presence of mucous/ salivary/ functional disorder, and dental treatments.Results A higher number of PD patients consumed daily sweets (p<0.004) and antidepressant drugs (p<0.004). Patients with PD practised less interdental hygiene (p<0.023). The mean plaque index was higher in PD (p<0.003). Drooling (p<0.001), xerostomia (p<0.001), hyposialia (p<0.001), dysphagia (p<0.001), hypogeusia/dysgeusia (p<0.025) and chewing difficulty (p<0.006) were more common in PD.Conclusions Oral disorders are frequent in PD. A good knowledge of these alterations will allow us design a specific preventive protocol. Some oral alterations may be a sign of diagnostic alert or progression of PD. Key words:Parkinson''s disease, oral health, dysgeusia, dysphagia, drooling.