Xerostomia: diagnosis and management in dental practice

Xerostomia is a subjective sensation of oral dryness. It is caused by many factors, among them, hypo/hyper salivation. This article covers the etiology, local and systemic factors related to dryness of the mouth, its diagnosis, and clinical and at-home management of the syndrome. It also reviews the role of dental hygiene intervention to improve and promote the patient's quality of life. It is hoped this review will help dental health care providers better respond to patients afflicted with xerostomia.     

The Ipswich Touch Test: a simple and novel method to identify inpatients with diabetes at risk of foot ulceration

OBJECTIVE

To promote foot screening of inpatients with diabetes, we simplified sensory testing to lightly touching the tips of the first, third, and fifth toes (the Ipswich Touch Test [IpTT]).

RESEARCH DESIGN AND METHODS

Respective performances of the IpTT and 10-g monofilament (MF) were compared with a vibration perception threshold of ≥25 V indicating at-risk feet in 265 individuals. The IpTT and MF were also directly compared.

RESULTS

With ≥2 of 6 insensate areas signifying at-risk feet, sensitivities and specificities, respectively, were IpTT (77 and 90%), MF (81 and 91%); positive predictive values were IpTT (89%), MF (91%); and negative predictive values were IpTT (77%), MF (81%). Directly compared, agreement between the IpTT and MF was almost perfect (κ = 0.88, P < 0.0001). Interrater agreement for the IpTT was substantial (κ = 0.68).

CONCLUSIONS

The IpTT performs well against a recognized standard for ulcer prediction. Simple to teach, reliable, without expense, and always at hand, it should encourage uptake of screening and detection of high-risk inpatients requiring foot protection.Screening for diabetic foot disease in community and outpatient settings successfully predicts those at risk of ulceration (1–4). Hospitalized individuals with diabetes are older, largely bed bound, have more comorbidities, and are at greater risk; screening these patients should be a priority so that foot protection can be targeted. It is disappointing that a recent audit of diabetes care in U.K. hospitals found fewer than one-third of patients had received a foot examination and 3% had developed a new foot lesion during their inpatient stay (5). Admitting doctors commonly cite not being able to find the necessary equipment as a barrier to screening. In community settings, the 10-g monofilament (MF) has gained acceptability as a simple, quick, and inexpensive method that detects a 7.7-fold increased ulceration risk (2,3,6). The MF has potential use in hospitals; however, its use would require training significant numbers of people as well as the initial purchase expense and recurrent expenditure to replace used filaments and lost devices. Furthermore, there is still the obstacle of having to find the device. In the absence of neurologic instruments, many physicians touch the feet with cotton wool or even with their fingers. We have taken this practice and formalized it into a simple, quick, and easily taught procedure that we have named the Ipswich Touch Test (IpTT). This study determines whether the IpTT has sufficient specificity and sensitivity for it to be recommended for inpatient screening when compared with the MF and vibration perception threshold (VPT).     

The expression of the peripheral cannabinoid receptor on cells of the immune system and non-Hodgkin's lymphomas

The peripheral cannabinoid receptor CB2 is expressed highly on normal human B-lymphocytes. C-terminal specific anti-CB2 antibody recognises a non-phosphorylated inactive receptor on na?ve and resting B-lymphocytes. Another, N-terminal specific CB2 antibody, primarily recognises B-cells present in the germinal centres of secondary follicles in lymph nodes. We hypothesise that N-terminal specific CB2 antibody recognises activated CB2 receptors. In this study, we showed using these antibodies, that expression of CB2 is generally absent on T-lymphocytes in reactive, non-malignant human lymphoid tissues. Applying single and dual immunohistochemistry, CD23(+) follicular dendritic cells and a small but significant subpopulation of CD68(+) macrophages showed positive staining with the N-terminal specific CB2 antibody but not with the C-terminal specific CB2 antibody. This may indicate the presence of an active CB2 receptor on these cells with possible involvement in immunomodulation. In contrast to the low expression on normal T-cells, abundant levels of CB2 protein were present on T-non-Hodgkin's lymphomas (NHL). Moreover, in many B-NHL, high CB2 protein expression was found as well. In contrast to the distinct expression patterns in normal immune tissues using the two different CB2 antibodies, NHL specimens in general stained positively with both. We conclude that CB2 receptor expression pattern may be abnormal in NHL.     

Essential role of nitric oxide in VEGF-induced, asthma-like angiogenic, inflammatory, mucus, and physiologic responses in the lung

VEGF, nitric oxide (NO), inflammation, and vascular- and extravascular remodeling coexist in asthma and other disorders. In these responses, VEGF regulates angiogenesis. VEGF also induces inflammation and remodeling. The mechanisms of the latter responses have not been defined, however. We hypothesized that VEGF-induces extravascular tissue responses via NO-dependent mechanisms. To evaluate this hypothesis, we compared the effects of transgenic VEGF165 in lungs from normal mice, mice treated with pan-NO synthase (NOS) or endothelial NOS (eNOS) inhibitors, and mice with null mutations of inducible NOS (iNOS) or eNOS. These studies demonstrate that VEGF selectively stimulates eNOS and iNOS. They also demonstrate that VEGF induces pulmonary alterations via NO-dependent and -independent mechanisms with angiogenesis, edema, mucus metaplasia, airway hyperresponsiveness, lymphocyte accumulation, dendritic cell hyperplasia and S-nitrosoglutathione reductase stimulation being NO-dependent and dendritic cell activation being NO-independent. Furthermore, they demonstrate that eNOS and iNOS both contribute to these responses. NO/NOS-based interventions may be therapeutic in VEGF-driven inflammation and remodeling.     

Psycho-educational interventions for children and young people with Type 1 diabetes.

Background A systematic review of the literature in 2000 revealed numerous methodological shortcomings in education research, but in recent years progress has been made in the quantity and quality of psycho‐educational intervention studies. Summary of contents This review focuses on diabetes education programmes developed for children, young people and their families in the past 5 years. A comprehensive review of the literature identified 27 articles describing the evaluation of 24 psycho‐educational interventions. Data summary tables compare the key features of these, and comparisons are made between individual, group and family‐based interventions. Effect sizes are calculated for nine of the randomized studies. Three research questions are posed: firstly has the recent literature addressed the problems highlighted in the previous review; secondly is there sufficient evidence to recommend adaptation of a particular programme; and, finally, what do we still need to do? Conclusions Progress in the quality and quantity of educational research has not resulted in improved effectiveness of interventions. There is still insufficient evidence to recommend adaptation of a particular educational programme and no programme that has been proven effective in randomized studies for those with poor glycaemic control. To develop a range of effective educational interventions, further research involving larger sample sizes with multicentre collaboration is required.