Salivary stimulation by chewing gum and lozenges in rheumatic patients with xerostomia

The effect of chewing gum and lozenges in relieving the signs and symptoms of xerostomia was studied in a 2-wk cross-over clinical trial in 18 rheumatic patients with dry mouth symptoms and low salivary flow rates. Resting flow was measured before (PRESTIM) a chewing stimulated flow rate test (STIM), and also 5 min after (POSTSTIM). STIM flow (mean 1.0 ml/min) was not affected by the test regimens. In the lozenge regimen, mean PRESTIM flow in the group increased from 0.11 to 0.14 ml/min and POSTSTIM from 0.10 to 0.13. In the chewing gum regimen, PRESTIM flow (mean 0.13 ml/min) did not change, whereas POSTSTIM flow increased from 0.13 to 0.16 ml/min. In terms of patients' preferences, chewing gum and lozenges were ranked equal. Both these physiologic stimuli had few side-effects. Subjective symptoms were relieved in about one-third of the subjects, but relief was not always verified by improved flow rates. The regimens were not found to influence buffering capacity; salivary counts of mutans streptococci, lactobacilli, and Candida; or oral sugar clearance time.     

The effect of commercially available saliva substitutes on predemineralized bovine dentin in vitro

OBJECTIVE: The objective of this study was to evaluate the effects of various saliva substitutes (Artisial; Glandosane; Oralube; Saliva medac; Oralbalance) on the lesion depth and the mineral content of predemineralized bovine dentin in vitro. MATERIALS AND METHODS: Ninety-six dentin samples were prepared from 24 freshly extracted bovine incisors. The samples were predemineralized (pH 5.5; 10 days), and subsequently exposed to the various artificial salivas. A carbonate-reduced mineral water (Hirschquelle) as well as the mouthwash solutions Meridol and biotène served as controls. Lesion depth and mineral loss were evaluated from microradiographs of thin sections (110 microm) by a dedicated software package (TMR 1.24). RESULTS: After storage in Glandosane and biotène, the results indicated a significant mineral loss and an increase in lesion depth (P < 0.01; Wilcoxon). In contrast, specimens stored in Oralube showed a decrease in lesion depth and an increase in mineral content (P < 0.05; Wilcoxon). CONCLUSIONS: Thus, the use of neither Glandosane nor biotène can be recommended in dentate patients with severe xerostomia.     

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.     

Salivary gland parameters and clinical data related to the underlying disorder in patients with persisting xerostomia

This study assessed salivary gland parameters and clinical data in patients referred to our clinic because of persisting xerostomia of unknown origin, in order to facilitate early diagnosis and recognition of the underlying disorder. Most patients were referred for diagnostic analysis of a possible Sjögren's syndrome (SS). A complete diagnostic work‐up was available in all patients (n = 176), including data on salivary gland function, saliva composition, sialography, salivary gland swelling, pattern of complaints, general health, and medication. Patients were diagnosed with SS (n = 62), sialosis (n = 45), sodium retention syndrome (n = 30), or medication‐induced xerostomia (n = 9). In 30 patients no disease related to salivary gland pathology was found. Unstimulated whole salivary flow was decreased in all patients, except in patients with sodium retention syndrome and in patients without salivary gland pathology. Submandibular/sublingual salivary flow was lowest in SS patients. SS and sialosis patients had increased salivary potassium concentrations, whereas only SS patients had increased sodium concentrations. About half of the sialosis patients mainly complained of persistent parotid gland swelling. Xerostomia‐inducing medication was used by most patients. It was concluded that gland‐specific sialometry and sialochemistry is useful in discriminating between the various disorders causing persisting xerostomia.     

Tramadol-induced oral dryness and pilocarpine treatment: effects on total protein and IgA

Pilocarpine induces a profuse flow of saliva, and it may re-establish saliva production in cases of drug-induced oral dryness. The aim of the study (a sub-study to the previous trial investigating the pilocarpine fluid effects in individuals suffering from drug-induced dry mouth) was to search for saliva quality changes induced by the treatments. Sixty-five individuals were enrolled in a randomized, double-blind, placebo-controlled trial. The subjects received tramadol to induce oral dryness. Secretion rate was measured before and after tramadol, and then after pilocarpine, placebo, or no treatment. All saliva was analyzed for its protein and IgA content in the pilocarpine (n = 15) and placebo groups (n = 12). At baseline, the flow of saliva was 0.47 ± 0.05 ml/min, the protein output 0.17 ± 0.2 mg/min and the IgA output 0.022 ± 0.002 mg/min. After tramadol treatment (50 mg 3×/day over two days), the flow was reduced by 64%, protein output by 52% and the IgA output by 38%. While placebo treatment did not affect any of the variables, the flow was 120%, the protein output 193% and the IgA output 83% of the baseline characteristics after pilocarpine treatment (5 mg). Thus, the pilocarpine-induced increase in the flow rate in the state of tramadol-induced oral dryness results in saliva with a well preserved protein concentration but with a decrease in IgA concentration. However, compared to baseline, there was neither a decrease in output nor in concentration of IgA.     

The effect of electronic health records on the use of clinical care guidelines for patients with medically complex conditions

BackgroundThe emergence of health information technology provides an opportunity for health care providers to improve the quality and safety of dental care, particularly for patients with medically complex conditions.MethodsThe authors randomized each of 15 dental clinics (HealthPartners, Bloomington, Minn.) to one of three groups to evaluate the impact of two clinical decision support (CDS) approaches during an 18-month study period. In the first approach—provider activation through electronic dental records (EDRs)—a flashing alert was generated at the dental visit to identify patients with medically complex conditions and to direct the dental care provider to Web-based personalized care guidelines. In the second approach—patient activation through personal health records—a secure e-mail was generated or a letter was mailed to patients before dental visits encouraging them to ask their dental care provider to review the care guidelines specific to their medical conditions.ResultsThe authors evaluated the rate of reviewing care guidelines among 102 providers. Participants in the provider and patient activation groups increased their use of the system during the first six months, which had a generalized effect of increasing use of the guidelines for all patients, even if they were not part of the study (P < .05). The study results showed that provider activation was more effective than was patient activation. However, providers did not sustain their high level of use of the system, and by the end of the study, the rate of use had returned to baseline levels despite participants' continued receipt of electronic alerts.ConclusionsThe study results demonstrated that review of clinical care guidelines for patients with medically complex conditions can be improved with CDS systems that involve the use of electronic health records.Clinical ImplicationsAs the U.S. population ages, dentists must be vigilant in adapting care for patients with medically complex conditions to ensure therapeutic safety and effectiveness. Expanded use of CDS via EDRs can help dental care providers achieve this objective.     

Dry mouth and dietary quality in older adults in north Carolina

OBJECTIVES: To quantify prevalence of dry mouth, association between dry mouth and beverage intake and dietary quality, and association between dry mouth and self‐reported dietary accommodations to oral health deficits. DESIGN: Cross‐sectional study; data from self‐reports. SETTING: Rural North Carolina counties with substantial African‐American and American Indian populations. PARTICIPANTS: Six hundred twenty‐two participants aged 60 and older. MEASUREMENTS: Data included the 11‐item Xerostomia Inventory (higher scores connote greater effect from dry mouth), a food frequency questionnaire (converted into Health Eating Index–2005 scores), and survey items on foods modified before consumption or avoided because of oral health problems. RESULTS: Dry mouth was associated with being female, lower education, and income below the poverty level. Although overall beverage consumption did not vary with dry mouth, consumption of certain sugar‐sweetened beverages was positively associated with dry mouth. Overall dietary quality did not differ with dry mouth, but more‐severe dry mouth was associated with lower intake of whole grains and higher intakes of fruits. Dry mouth was strongly associated with self‐reported modification and avoidance of foods. Those in the highest tertile of dry mouth were more likely to modify several foods than those in the lowest tertile and were more likely to avoid three or more foods. CONCLUSION: Older adults appear to modify foods or selectively avoid foods in response to perceived dry mouth. Despite these behaviors, dry mouth does not result in poorer dietary quality.     

A mouse model linking viral hepatitis and salivary gland dysfunction

Objective:  Viral hepatitis is known to cause xerostomia in humans, but this has not been reported in an animal model. We report a severe, acute, highly reproducible saliva deficiency occurring in BALB/c mice as a result of experimental viral hepatitis.
Materials and Methods:  BALB/c mice, splenectomized or carrying genetic mutations to detect immunological contributions to the saliva deficiency syndrome, were infected intraperitoneally with a non-lethal dose of murine cytomegalovirus. Pilocarpine-stimulated saliva volumes were determined between 0 and 15 days after infection. Salivary gland, liver, spleen, and sera were analyzed for the presence of virus, cytokines, inflammatory infiltrates, and tissue damage.
Results:  Saliva deficiency was detectable 2 days after cytomegalovirus infection, peaked at 88% below normal by day 7, and resolved partially in all mice by 15 days postinfection as sialoadenitis increased. Neither salivary gland viral titers, sialoadenitis, splenectomy, nor systemic inflammatory markers correlated with hyposalivation severity. Elevated liver enzymes did correlate with hyposalivation, and mice genetically resistant to murine cytomegalovirus-induced hepatitis were significantly protected.
Conclusions:  Murine cytomegalovirus-induced salivary gland dysfunction is biphasic, with an acute hepatitis-associated phase and a later sialoadenitis-associated phase. Acute murine cytomegalovirus infection of BALB/c mice may provide a model for investigation of hepatitis-associated xerostomia.     

Methamphetamine abuse and dentistry

Methamphetamine is a highly addictive powerful stimulant that increases wakefulness and physical activity and produces other effects including cardiac dysrhythmias, hypertension, hallucinations, and violent behavior. The prevalence of methamphetamine use is estimated at 35 million people worldwide and 10.4 million people in the United States. In the United States, the prevalence of methamphetamine use is beginning to decline but methamphetamine trafficking and use are still significant problems. Dental patients who abuse methamphetamine can present with poor oral hygiene, xerostomia, rampant caries ('Meth mouth'), and excessive tooth wear. Dental management of methamphetamine users requires obtaining a thorough medical history and performing a careful oral examination. The most important factor in treating the oral effects of methamphetamine is for the patient to stop using the drug. Continued abuse will make it difficult to increase salivary flow and hinder the patient's ability to improve nutrition and oral hygiene. Local anesthetics with vasoconstrictors should be used with care in patients taking methamphetamine because they may result in cardiac dysrhythmias, myocardial infarction, and cerebrovascular accidents. Thus, dental management of patients who use methamphetamine can be challenging. Dentists need to be aware of the clinical presentation and medical risks presented by these patients.