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.     

Oral distribution of Candida species and presence of oral lesions in Brazilian leprosy patients under multidrug therapy

Objective:  The aim of this study was to evaluate the prevalence of Candida spp. and presence of oral lesions in Brazilian leprosy patients under multidrug therapy (MDT).
Methods:  Thirty-eight individuals (18 males and 20 females, median age 53 years) clinically and microbiologically diagnosed as leprosy (lepromatous variant), and under MDT for at least 45 days were studied. The control group constituted by 38 healthy individuals (median age 53.5), matched to the test group in relation to age, gender and oral conditions. Oral rinses were collected and the Candida identification was performed by phenotypic tests. The existence of Candida dubliniensis among the isolates was analyzed using a validated multiplex PCR assay. Twenty-nine leprosy patients were examined intra-orally for the presence of lesions. Data were analyzed by z- and Mann–Whitney tests (α = 5%).
Results:  Yeast carriage rate between leprosy patients (65.8%) and controls (47.4%) was similar ( P  = 0.099), and no significant difference between yeast counts was observed ( P  = 0.1004). Candida albicans was the most frequently isolated species in both groups. In the leprosy group, Candida tropicalis and Candida parapsilosis were also identified. In the control group, we additionally identified Candida tropicalis , Candida glabrata and Candida kefyr. Candida dubliniensis was not detected. No leprosy-related oral lesion was registered.
Conclusion:  Within the limits of the study, we concluded that Brazilian leprosy patients under MDT showed similar levels of carriage and Candida species distribution in relation to the controls.     

Association of salivary flow rates with maximal bite force

Mean salivary secretion and bite force decrease with advancing age. Previous studies have shown that salivary flow rates are influenced by mastication. In the present study, we examined the relationship between salivary flow rates and maximal bite force in a community-based sample of men and women 35 years of age or older. Salivary flow rates for unstimulated whole and unstimulated submandibular/sublingual (SMSL) saliva as well as citrate-stimulated parotid and SMSL saliva were measured in 399 subjects. Bite force was assessed with a bilateral force transducer. Pearson correlation analysis yielded significant positive correlations between bite force and flow rates for unstimulated whole saliva (r = 0.24, p < 0.0001), stimulated parotid saliva (r = 0.13, p < 0.03), unstimulated SMSL (r = 0.14, p < 0.0001), and stimulated SMSL (r = 0.16, p < 0.003). When adjusted for age and gender, the partial correlations between bite force and salivary flow rates remained significant for unstimulated whole saliva (r = 0.10, p < 0.05), stimulated parotid saliva (r = 0.13, p < 0.02), and stimulated SMSL saliva (r = 0.14, p < 0.006). Subjects were divided into four groups based on their maximal bite force score (low, medium low, medium high, and high). For each saliva type, the flow rate of the high-bite-force group was significantly greater than that of the low-bite-force group as well as that of the medium-high-bite-force group. These results confirm an age-related decrease in bite force and salivary flow rates and show that, regardless of age or gender, bite force is correlated with salivary flow.     

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.     

Enamel defects and salivary methylmalonate in methylmalonic acidemia

Introduction and objective:  To characterize enamel defects in patients with methylmalonic acidemia (MMA) and cobalamin (cbl) metabolic disorders and to examine salivary methylmalonate levels in MMA.
Subjects and methods:  Teeth from patients ( n  = 32) were evaluated for enamel defects and compared with age- and gender-matched controls ( n  = 55). Complementation class ( mut , cblA , cblB and cblC ) and serum methylmalonate levels were examined. Primary teeth from two patients were examined by light and scanning electron microscopy and salivary methylmalonate levels from two patients were analyzed.
Results:  Enamel defects were significantly more prevalent per tooth in the affected group than the control group, across complementation types ( P  <   0.0001). The mut MMA subgroup had a significantly higher prevalence per individual of severe enamel defects than controls ( P  =   0.021), and those with enamel defects exhibited higher serum methylmalonate levels than those without ( P  = 0.017). Salivary methylmalonate levels were extremely elevated and were significantly higher than controls ( P  =   0.002). Primary teeth were free of enamel defects except for two cblC patients who exhibited severe enamel hypoplasia. One primary tooth from a cblC patient manifested markedly altered crystal microstructure.
Conclusion:  Enamel anomalies represent a phenotypic manifestation of MMA and cbl metabolic disorders. These findings suggest an association between enamel developmental pathology and disordered metabolism.     

Estimation of sCD14 levels in saliva obtained from patients with various periodontal conditions

Aim:  To assess the concentration of soluble CD14 receptor in saliva of people with periodontal disease and healthy patients and its relationship with periodontal status.
Subjects and Methods:  Unstimulated whole saliva samples from patients with chronic periodontitis ( n  =   34), aggressive periodontitis ( n  =   19) and healthy controls ( n  =   17) were obtained for the study. The periodontal status of each subject was assessed by criteria based on probing depth, clinical attachment loss and the extent of periodontal breakdown. The levels of sCD14 were measured in saliva samples with an enzyme-linked immunosorbent assay (ELISA).
Results:  Although no significant difference ( P  >   0.05) was found for salivary sCD14 levels between periodontitis groups, they were significantly greater ( P  <   0.05) than those detected for healthy controls. Furthermore, Spearman's correlation analysis showed statistically significant correlations ( P  <   0.01) between data from salivary sCD14 levels and clinical measurements.
Conclusion:  The findings of the present study re-emphasize the importance of whole saliva as sampling method in terms of immunological purposes in periodontal disease and suggest that the elevated sCD14 concentration may be one of the host-response components associated with the clinical manifestations of periodontal disease.     

Patterns of secretion of mucins and non-mucin glycoproteins in human submandibular/sublingual secretion

The present investigation has characterised the influence of gustatory stimulation and duration of stimulation on the secretion pattern of salivary mucins MG1 and MG2 and non-mucin glycoproteins in submandibular/sublingual secretion (SMSL). Resting SMSL was collected for three 2 min intervals and stimulated SMSL was collected for ten 1 min intervals from six healthy subjects. Flow rates and total protein were significantly different under the two conditions. The secretion patterns of these proteins under resting and stimulated conditions was examined on periodic acid-Schiff reagent (PAS)-stained polyacrylamide gels using a Kodak Digital-Science Image Station. Image analyses revealed that the level of MG1 increased and the level of MG2 remained nearly the same after stimulation. Six other major glycoproteins (designated Band 1-6) were identified on the basis of their electrophoretic mobilities and immuno-reactivity on Western blots. After stimulation the intensity of Band 1 (lactoferrin and peroxidase) and Band 2 (amylase) decreased whereas the intensity of Band 3 (carbonic anhydrase), Band 4 (proline-rich glycoprotein) and Bands 5 and 6 (basic glycosylated proline-rich proteins) increased. These patterns probably reflect secretion from preformed vesicles since de novo synthesis would be unexpected within the time frame of these experiments. The variable patterns observed suggest that mucins and non-mucin glycoproteins in SMSL derive from different subsets of secretory vesicles, some of which may originate in mucous and others in serous acini, as well as in ductal cells. Quantification of mucins was performed by image analysis technology using purified MG1 and MG2 standards. Finally, the present investigation has shown that the secretory patterns of mucins and non-mucin glycoproteins from submandibular/sublingual glands are complex and represent an important aspect of salivary gland physiology.     

Hyposalivation, xerostomia and oral health status of HIV-infected subjects in Thailand before HAART era

J Oral Pathol Med (2010) 39 : 28–34
Background:  The aims of this study were to determine hyposalivation, xerostomia, and oral health status of HIV-subjects in Thailand before highly active antiretroviral therapy era.
Methods:  Oral examination and measurement of saliva flow rate of both unstimulated and wax-stimulated whole saliva were performed in 135 subjects (56 HIV-subjects, mean age: 34.5 years, and 79 non-HIV controls, mean age: 29.5 years). Presence of oral candidiasis, cervical root caries, and number of existing teeth were recorded. Microbiological investigation of oral Candida was conducted using oral rinse technique. Risk factors associated with hyposalivation and xerostomia were analysed.
Results:  The unstimulated flow rates in HIV-subjects and non-HIV controls were 0.19 and 0.33 ml/min ( P  = 0.0024). For stimulated flow rates, the corresponding figures were 1.45 and 1.62 ml/min ( P  = 0.31). The unstimulated flow rate was significantly higher in the asymptomatic HIV-subjects: 0.17 ml/min, when compared with the symptomatic/AIDS group 0.11 ml/min ( P  = 0.003). No significant difference between the groups could be found with respect to stimulated flow rate. Hyposalivation was significantly associated with the colony forming unit of Candida . Smoking and alcohol consumption were significantly associated with hyposalivation, but not xerostomia. The following factors were significantly associated with both hyposalivation and xerostomia; sex, stage of HIV infection, risk group of HIV infection, systemic disease, and medication use.
Conclusions:  Salivary flow rate of HIV-subjects in Thailand was affected by HIV infection. The rate was significantly decreased with advanced stage of the disease. Various factors including medication use were associated with hyposalivation and xerostomia among the subjects.     

Association of asymptomatic oral candidal carriage, oral candidiasis and CD4 lymphocyte count in HIV-positive patients in China

OBJECTIVES: To compare the prevalence of asymptomatic oral candidal carriage in healthy volunteers with human immunodeficiency virus (HIV)-positive patients in China, as well as to investigate the relationship between CD4+ lymphocyte count and oral candidal colonization or oral candidiasis. METHODS: Oral candidal carriage and oral candidiasis were investigated in 101 patients with HIV-infection seen at Youan Hospital, Beijing, China. Two hundred and seventeen healthy volunteers were involved as a control. Culture from saliva was used to test for the presence of oral Candida. CD4+ lymphocyte count was measured by flow cytometry. All data were analyzed statistically by SAS. RESULTS: Asymptomatic oral candidal carriage rate (28.6%) in HIV-positive group was similar to that in the healthy group (18.0%; P = 0.07). No significant difference in CD4+ lymphocyte count was found between oral Candida carriers and non-carriers among HIV-positive subjects (P = 0.89). However, the frequency of oral candidiasis increased with the decrease in CD4+ lymphocyte count (P < 0.0001), and pseudomembranous candidiasis was predominant in HIV-positive patients with CD4+ <200 cells microl(-1) (66.7%). CONCLUSIONS: In HIV-positive subjects, asymptomatic oral candidal colonization is not related to CD4+ lymphocyte count of blood, and the carriage rate is similar to that in the healthy population. Oral candidiasis is more likely to be observed in HIV-positive patients who have a low CD4+ lymphocyte count.     

Effects of gustatory stimulants of salivary secretion on salivary pH and flow: a randomized controlled trial

Objectives:  To compare salivary pH changes and stimulation efficacy of two different gustatory stimulants of salivary secretion (GSSS).
Setting:  Portuguese Dental Faculty Clinic.
Design:  Double blind randomized controlled trial.
Subjects:  One hundred and twenty volunteers were randomized to two intervention groups. Sample sized was calculated using an alpha error of 0.05 and a beta of 0.20.
Materials and methods:  Participants were randomly assigned to receive a new gustatory stimulant of secretory secretion containing a weaker malic acid, fluoride and xylitol or a traditionally citric acid-based one. Saliva collection was obtained by established methods at different times. The salivary pH of the samples was determined with a pH meter and a microelectrode.
Main outcome measures:  Salivary pH variations and counts of subjects with pH below 5.5 for over 1 min and stimulated salivary flow were the main outcome measures.
Results:  Both GSSS significantly stimulated salivary output without significant differences between the two groups. The new gustatory stimulant of salivary secretion presented a risk reduction of 80 ± 10.6% (95% CI) when compared with the traditional one.
Conclusions:  Gustatory stimulants of salivary secretion with fluoride, xylitol and lower acid content maintain similar salivary stimulation capacity while reducing significantly the dental erosion predictive potential.     

Candidal carriage in the oral cavity of human immunodeficiency virus-infected subjects

OBJECTIVES. We sought to assess asymptomatic oral carriage of Candida species and relative density in human immunodeficiency virus-infected (HIV+) subjects, as well as to determine whether yeast carriage is associated with CD4+ cell count, HIV-1 RNA quantity, gender, route of HIV transmission, antiretroviral therapy, or smoking. STUDY DESIGN. A cross-sectional analysis of oral rinses from HIV+ and healthy subjects was undertaken. Oral candidal carriage and relative species were investigated in 42 HIV+ and 41 healthy individuals, all of whom were seen at the Palermo University Department of Oral Sciences, Italy. Data were managed and analyzed by means of the computer software package StatView 5.0.1. RESULTS. Carriage rate was 61.9% and 29.3% (P =.003) among HIV+ and healthy subjects, respectively. Similarly, density carriage in the HIV+ group was found to be significantly higher than in the control group (P = .0002). Among HIV+ subjects, Candida carriage was significantly associated with smoking, whereas density was not. Oral candidal carriage and relative density were not significantly associated with the other 4 parameters evaluated. Candida albicans was the most frequently recovered species. CONCLUSIONS. Asymptomatic candidal carriage and relative density were found to be significantly higher in the oral cavity of HIV+ subjects-but not associated with CD4+ counts or HIV-1 RNA quantities.     

Periodontitis lesions are the main source of salivary cytomegalovirus

Background:  Herpesviruses play causal or cooperative roles in childhood infections, tumorigenesis, ulcerogenesis, and periodontitis. Saliva is a common vehicle of herpesvirus horizontal transmission, but the source of salivary herpesviruses remains obscure. To evaluate the significance of periodontal disease in shedding of oral herpesviruses, this study determined the genome-copy counts of human cytomegalovirus (HCMV) and Epstein–Barr virus (EBV) in whole saliva of subjects with periodontitis, gingivitis, or no natural teeth.
Methods:  Whole saliva was collected from 14 periodontitis patients, 15 gingivitis patients and 13 complete denture wearers. The study subjects were systemically healthy and had not received periodontal treatment in the past 3 months. Real-time TaqMan polymerase chain reaction was used to determine the salivary load of HCMV and EBV.
Results:  Salivary HCMV was detected in seven (50%) periodontitis patients, but not in any gingivitis or edentulous subjects ( P  < 0.001). Salivary EBV was detected in 11 (79%) periodontitis patients, in five (33%) gingivitis patients, and in seven (54%) edentulous subjects ( P  = 0.076). Salivary samples showed copy counts of HCMV in the range of 3.3 × 10³–4.2 × 10⁴/ml and of EBV in the range of 3.6 × 10²–1.6 × 10⁹/ml.
Conclusions:  HCMV and EBV are commonly present in the saliva of periodontitis patients. Periodontitis lesions of systemically healthy subjects seem to constitute the main origin of salivary HCMV, but do not comprise the sole source of salivary EBV.     

Serum and salivary antibodies to a mycobacterial 65-kDa stress protein are elevated in HIV-positive patients and modified by oral candidiasis

Serum immunoglobulin G (IgG) and IgA, and salivary IgA antibodies to a mycobacterial stress protein (mSP65) were determined in human immunodeficiency virus (HIV)-positive patients, acquired immunodeficiency syndrome (AIDS) patients and HIV-negative controls with or without oral candidiasis. Serum IgG antibodies were elevated in patients with HIV infection and AIDS and especially in subjects with candidiasis compared with controls (P < 0.02, P < 0.005). This was not apparent with serum IgA. In the absence of candidiasis, salivary IgA antibodies were elevated in HIV-positive patients compared with AIDS (P < 0.005) patients and healthy controls (P = 0.001). The relative avidity of serum IgG antibodies to mSP65 in controls with candidiasis was lower than healthy controls (P < 0.0001). In saliva there was a decrease in the relative avidity of IgA antibodies in AIDS patients with candidiasis compared with HIV patients (P < 0.03). In patients without candidiasis, the relative avidity was higher in HIV patients than healthy controls (P = 0.02). The results suggest that HIV infection leads to raised serum and salivary antibodies to heat shock proteins. Concurrent Candida infection may modify both the titer and relative avidity differently for serum and saliva.     

Asymptomatic oral Candida albicans carriage in HIV-infection: frequency and predisposing factors

Many studies have focused on the epidemiology and pathogenesis of oral candidiasis in HIV infection. Little is known on the incidence and predisposing factors of asymptomatic oral Candida carriage in this setting, obviously an important issue in view of prophylaxis. To address this question. 261 consecutive HIV-infected individuals without clinical evidence of candidiasis were investigated. C. albicans was isolated from cultured oral cavity swabs of 63 subjects (24%). Colonization was significantly more frequent in IV drug users. CDC groups IV. and in subjects with lymphocytopenia. CD4+ cell depletion, or elevated beta-2 microglobulin. These data further suggest that oral candidiasis occurs in HIV infection as a result of C. albicans overgrowth and raise the question of primary antifungal prophylaxis in subjects with low CD4 counts and asymptomatic oral Candida carriage.     

Fungal load and candidiasis in Sjögren's syndrome

OBJECTIVE: We sought to investigate the prevalence of Candida carriage and the relationships between salivary flow rates and oral Candida load in patients with Sj?gren's syndrome (SS). METHODS: The oral Candida load of patients with SS was evaluated by culturing oral rinse (swish and spit) samples. Culture, Gram stain, and wet-mount test results were reported. RESULTS: One hundred three patients (96 women) met European criteria for SS (91 with primary SS and 12 with secondary SS). The mean age (95% confidence interval) was 55 years (range, 51-57 years). Oral rinse cultures were positive in 77% of subjects. The total stimulated salivary flow rate was inversely correlated with oral Candida load (r = -0.47; P 相似文献   

Immunoquantification of human salivary mucins MG1 and MG2 in stimulated whole saliva: factors influencing mucin levels

While more and more is known about the structure and function of human salivary mucins, there is relatively little information on quantification of these glycoconjugates in whole saliva and on factors influencing their secretion. The goal of the present work was to develop capture ELISAs that would allow for rapid, inexpensive, and reliable measurement of the salivary mucins MG1 and MG2, and to use these immunological procedures to investigate the significance of age, gender, flow rate, and protein concentration on mucin levels in whole saliva. Previously, we described a rabbit polyclonal antibody against MG1 (Troxler et al., 1995) and a rabbit polyclonal peptide antibody against an epitope in the N-terminal region of MG2 (Liu et al., 1999) which were used to develop the capture ELISAs. We verified the accuracy and specificity of these assays by showing correct measurement of known quantities of purified MG1 or MG2 added to whole saliva and lack of cross-reactivity between mucins and heterologous antisera on Western blots or in ELISAs. Whole saliva was collected from 60 subjects under conditions of masticatory stimulation, flow rates were recorded, and mucin concentrations were determined. The results showed that the mean concentration of MG1 and MG2 was 23.3 +/- 14.6 mg% and 13.3 +/- 11.6 mg%, respectively, and that mucins constitute approximately 16% of the total protein in whole saliva. No significant correlations were found between mucin levels and age or flow rate; however, a significant correlation was found between MG2 levels and total protein concentration. Furthermore, there were statistically significant gender differences in flow rate and MG1 levels, but not in MG2 levels. The availability of these immunoassays for quantification of MG1 and MG2 will help to elucidate the role of mucin in oral health and disease.     

The effects of orthodontic appliances on Candida in the human mouth

Background.  Candida is an opportunistic pathogen present in about 50–60% of the healthy human population, and becomes pathogenic when the host immune defence is undermined such as in HIV infection. Adhesion and colonization of the oral cavity by Candida albicans is an initial step in candidosis, and the presence of orthodontic and other oral appliances seems to alter the oral ecological environment, hence may tip the balance to favour the candidal presence.
Objective.  The purpose of this paper was to review the literature with specific attention to prevalence; intra-oral density of the candidal organisms; and Candida carriage status in orthodontic patients before, during, and after treatment.
Conclusions.  The limited amount of literature demonstrated that the density of Candida increases; the most common Candida species isolated in the orthodontic patients was C. albicans ; and that there seems to be a direct relationship between the presence of a removable appliance, Candida , and low salivary pH levels. No healthy patients developed Candida infection from the orthodontic appliances. However, there seems to be a trend that some non- Candida carriers converted to Candida carriers following the insertion of the appliances by unknown mechanism. This may indicate a more cautious approach when providing orthodontic treatments to immunocompromised children concerning the possible increased risk of candidal infection.     

Relation of bone turnover markers to periodontal disease and jaw bone morphology in elderly Japanese subjects

Objective:  The purpose of this study was to evaluate the relation of bone turnover markers such as bone formation and resorption to periodontal disease and jaw bone morphology in elderly Japanese subjects.
Subjects and methods:  We selected 148 subjects for participation in this study. All subjects were aged 77 years. The periodontal examination included the assessment of clinical attachment level (CAL). Biochemical parameters of bone turnover measured included urinary deoxypyridinoline, serum osteocalcin (S-OC), and serum bone-specific alkaline phosphatase. In addition, to evaluate the jawbone, we used the mandibular inferior cortex classification (MIC).
Results:  Serum osteocalcin had significantly higher (males: P  =   0.038, females: P  =   0.041) tendency for MIC Class (ANOVA). Multiple linear regression results showed that the number of remaining teeth and S-OC were negatively associated with the percentage of sites with ≥6 mm CAL ( R ² = 0.322, P  < 0.001). Coefficients and betas were −0.71, −0.46 ( P  <   0.001) and −1.11, −0.28 ( P  =   0.002), respectively.
Conclusion:  In conclusion, this study suggests that there is a significant relation of bone turnover markers to periodontal disease and jaw bone morphology in elderly Japanese subjects.     

Oral yeast carriage in patients with advanced cancer

The aim of this study was to investigate oral yeast carriage amongst patients with advanced cancer. Oral rinse samples were obtained from 120 subjects. Yeasts were isolated using Sabouraud's dextrose agar and CHROMagar Candida, and were identified using a combination of the API 20 C AUX yeast identification system, species-specific PCR and 26S rDNA gene sequencing. Oral yeast carriage was present in 66% of subjects. The frequency of isolation of individual species was: Candida albicans, 46%; Candida glabrata, 18%; Candida dubliniensis, 5%; others, < 5%. The increasing isolation of non-Candida albicans species is clinically important, since these species are often more resistant to antifungal drugs. Oral yeast carriage was associated with denture wearing (P = 0.006), and low stimulated whole salivary flow rate (P = 0.009). Identification of these risk factors offers new strategies for the prevention of oral candidosis in this group of patients.     

Effect of restorations on pulpal blood flow in molars measured by laser Doppler flowmetry

Aim  To: (i) compare laser Doppler pulpal blood flow (PBF) signals from restored and unrestored first molar teeth, (ii) investigate PBF in teeth with large and small restorations, and (iii) to relate PBF to pulp chamber dimensions on radiographs.
Methodology  Bitewing radiographs of young adults with restored first molars were obtained and pulp chamber dimensions measured. Subjects were divided into 2 groups: group A with a restored tooth and an unrestored contralateral (43 subjects) and group B, those with a molar with a small (usually occlusal) restoration whilst the contralateral tooth had an extensive occlusal restoration (or restorations) or restored proximal surface(s) and/or cuspal overlay (31 subjects). The 148 teeth responded to electric pulp testing, and their PBF was recorded using a laser Doppler flowmeter. Data were analysed using Student's t -test.
Results  In group A the PBF in the restored teeth was significantly lower than in unrestored contralaterals ( P  =   0.028) and the total pulp chamber area and that in the clinical crown were smaller ( P  =   0.039 and 0.021 respectively). The group B molars with large restorations had significantly lower PBF than contralaterals with small restorations ( P  =   0.001), and their total pulp chamber area and pulp chamber width at cervix were reduced significantly ( P  =   0.003 and 0.032 respectively).
Conclusions  In molars the size of the pulp chamber was influenced by the presence of restorations and the PBF was reduced when restorations were present. Size and extent of restorations had a significant effect on PBF.