A 15-yr longitudinal study of xerostomia in a Swedish population of 50-yr-old subjects

The aim of this study was to determine the changes in prevalence of xerostomia in subjects from 50 to 65 yr of age. Questionnaires were sent to all subjects who were born in 1942 and were living in two Swedish counties in 1992, 1997, 2002, and 2007. The analyses focused on those who answered the questionnaires both in 1992 and in 2007. The response rate was 71.4% ( n  = 6,346) in 1992 and 73.1% ( n  =   6,078) in 2007. Of those who answered the questionnaire in 1992, 74.3% ( n  =   4,714) also responded in 2007. There was an almost linear increase in the prevalence of xerostomia at the four study time-points (i.e. when the subjects were 50, 55, 60, and 65 yr of age). Xerostomia was more prevalent at night than during the day. The pooled prevalence of night-time and daytime xerostomia was 6% at 50 yr of age and 15% at 65 yr of age, and it was higher in women than in men on both occasions. Logistic regression analyses showed that impaired health and smoking were significantly associated with daytime xerostomia but not with night-time xerostomia. Despite the increase in prevalence of xerostomia from 50 to 65 yr of age, there was considerable variation during the observation period. The incidence rate was 13% (507/4,015) and the disappearance rate was 42% (104/250) (dichotomized answers).     

手术联合同步放化疗治疗早期鼻咽癌的前瞻性研究

目的:探讨手术联合同步放、化疗治疗早期鼻咽癌的疗效。方法:将早期鼻咽癌患者按患者意愿分为手术组(31例)和常规组(73例)。手术组采用手术加同步放、化疗方案治疗,常规组采用同步放、化疗方案治疗。观察指标为:①5年生存率、无瘤生存率;②鼻咽部放射剂量;③口干症的发生率。结果:①总的5年随访率为97.12%,其中手术组失访1例,5年随访率为96.77%;常规组失访2例,5年随访率为97.26%;②104例患者的5年生存率为83.65%(87/104),局部复发率及远处转移率均为9.62%(10/104);③5年生存率和无瘤生存率手术组分别为96.77%(30/31)、93.55%(29/31),常规组分别为78.08%(57/73)、73.97%(54/73),2组比较均差异有统计学意义(均P<0.05);④手术组、常规组鼻咽部放射剂量分别为(63.90±5.56)Gy、(71.48±4.18)Gy,2组比较差异有统计学意义(P<0.05);⑤口干症的发生率手术组为22.58%(7/31),明显低于常规组的65.75%(48/73),2组比较差异有统计学意义(P<0.05)。结论:手术联合放、化疗治疗早期鼻咽癌,既可提高患者远期生存率,又可减少鼻咽部的放射剂量,降低放射并发症的发生,是早期鼻咽癌有效的综合治疗方案,值得进一步研究。     

Prevalence of hyposalivation in relation to general health, body mass index and remaining teeth in different age groups of adults

Abstract – Objectives: Several studies have been conducted on the prevalence of hyposalivation in older adults but no population‐based studies in younger adults. Therefore, our aims were to determine the prevalence of very low and low unstimulated (UWSFR) and stimulated (SWSFR) whole salivary flow rates in different age groups between 20 and 69 years, and to analyse the relationship between hyposalivation, subjective oral dryness and predictors of reduced flow rate. Methods: A randomized and stratified cross‐sectional study including 1427 dental patients was conducted. UWSFR and SWSFR were measured, numbers of remaining teeth recorded and a questionnaire answered regarding subjective oral dryness, general diseases, use of drugs, body mass index (BMI) and use of tobacco. Results: The prevalence of very low (<0.1 ml/min) and low (0.10–0.19 ml/min) UWSFR was similar for different age groups up to 50 years, ranging between 10.9–17.8% and 17.3–22.7%, respectively. The prevalence of very low UWSFR was significantly higher for women aged 50–69 years than for younger women. For men, prevalence of very low UWSFR was higher at 60–69 years. The prevalence of very low (<0.7 ml/min) and low (0.70 – 0.99 ml/min) SWSFR was between 0–5.5% and 0.8–8.2%, respectively, for the different age groups 20–69 years. Multiple logistic regression revealed that age above 50 years, female gender, having fewer than 20 teeth, and taking xerogenic drugs significantly increased the risk of very low UWSFR. For very low SWSFR, only having fewer than 20 teeth and taking more than two drugs were significant. In the younger individuals (<50 years) only BMI > 25 for very low UWSFR and diagnosed disease for very low SWSFR were found significant. In this younger subset, female gender combined with having fewer than 27 teeth was significant for low UWSFR. Conclusions: Hyposalivation is prevalent in younger adults, among whom it is associated with diagnosed disease and high BMI, while after age 50 years it is associated with medication. It is also associated with gender and with fewer remaining teeth.     

Polaprezinc prevents oral mucositis associated with radiochemotherapy in patients with head and neck cancer

Oral mucositis is frequent but serious adverse event associated with radiotherapy or radiochemotherapy in head and neck cancer severely impairs health‐related quality of life, leading to poor prognosis due to discontinuation of the therapy. Although a number of compounds have been tested for prophylaxis of oral mucositis, few of them are satisfactory. We investigated the effect of polaprezinc (zinc L ‐carnosine), a gastric mucosal protective drug, on radiochemotherapy‐induced oral mucositis, pain, xerostomia and taste disturbance in patients with head and neck cancer. Patients were randomly assigned to receive polaprezinc (n = 16) or azulene oral rinse as the control (n = 15). The incidence rates of mucositis, pain, xerostomia and taste disturbance were all markedly lower in polaprezinc group than in control. Moreover, the use of analgesics was significantly (p = 0.003) less frequent and the amount of food intake was significantly (p = 0.002) higher in polaprezinc group than in control. On the other hand, tumor response rate in patients with neoadjuvant radiochemotherapy was not significantly affected by polaprezinc, in which the response rate (complete plus partial response) was 88% for polaprezinc and 92% for control (p = 1.000). Therefore, it is highly assumable that polaprezinc is potentially useful for prevention of oral mucositis and improvement of quality of life without reducing the tumor response.     

Salivary gland sparing in the treatment of head and neck cancer

Radiotherapy is an important component of the multimodality treatment of head and neck cancer. Although an effective treatment for many patients, it can have significant long-term sequelae. In particular, xerostomia – or dry mouth – caused by salivary gland injury is a serious problem suffered by most patients and leads to problems with oral comfort, dental health, speech and swallowing. This article explores the mechanisms behind radiation injury to the major salivary glands, as well as different strategies to minimize and alleviate xerostomia. This includes technical approaches to minimize radiation dose to salivary tissue, such as intensity-modulated radiotherapy and surgical transfer of salivary glands, as well as pharmacologic approaches to stimulate or protect the salivary tissue. The scientific literature will be critically examined to see what works and what strategies have been less effective in attempting to minimize xerostomia in head and neck cancer patients.     

Antidepressant xerogenic medications and restoration rates

OBJECTIVES: This report examines the association between xerogenic antidepressant medication use and dental restorations (a proxy for dental caries). METHODS: Data for this study was collected from the electronic databases of two large dental group practices associated with two managed care organizations. The population examined was at least 55-year-old on the reference date and had at least 48 months of concurrent dental, medical and pharmacy coverage. We identified 915 individuals whose only exposure to a xerogenic medication was to an antidepressant. This group was compared with a group not on any medications and to a group on medications without any known xerostomic side effect. RESULTS: Poisson regression was used to compare restoration occurrence and restoration rates among the three groups. The antidepressant medication and the no xerogenic medication groups were more likely to have restorations than the no medication group but there was no difference in restoration rates between the two medication groups. The mean restoration rates were significantly different between the three groups with the antidepressant group having the highest restoration rate. The no xerogenic group also had a higher rate than the no medication group but not as high as the antidepressant group rate. CONCLUSIONS: This study provides objective quantification of the long-term effects that anti-depressant medications have on restoration use.     

三维放疗计划优化技术减少头颈部癌放射性口干症

目的：观察三维放疗计划优化技术减少头颈部癌放射性口干症的效果。方法：对三类头颈部癌（肿瘤位中线、偏一侧、近中线偏一侧）按常规放疗和优化技术分别作三维放疗计划。放疗优化技术包括放射进路优化、多野、适形放疗和加楔形板。对患者的肿瘤、腮腺和脊髓作三维剂量分布和剂量一容积DVH直方图分析。20例头颈部癌放疗患者分成常规放疗组和新技术（优化）组行放射治疗，记录放疗前、放疗中、放疗后及随访期患者的口干症评分和全唾液量。结果：肿瘤位一侧及近中线偏一侧时，常规和新技术放疗时健侧腮腺放射剂量分别为51.8-64.3Gy和0.4-1.4Gy；肿瘤位中线时常规和新技术放疗腮腺放射剂量分别为51.8Gy和24.7Gy；放疗结束时，新技术组口干症发生率1/12（8.3％）。随访4-6月后降为0，放疗结束时常规放疗组口干症发生率7/8（87.5％），随访4-6月后为4/8（50％）。结论：三维放疗计划优化技术可以明显减少头颈部癌患者放疗后口干症的发生。     

Bone marrow-derived mesenchymal stem cells migrate to healthy and damaged salivary glands following stem cell infusion

Xerostomia is a severe side effect of radiation therapy in head and neck cancer patients. To date, no satisfactory treatment option has been established. Because mesenchymal stem cells（MSCs） have been identified as a potential treatment modality, we aimed to evaluate stem cell distribution following intravenous and intraglandular injections using a surgical model of salivary gland damage and to analyse the effects of MSC injections on the recruitment of immune cells. The submandibular gland ducts of rats were surgically ligated. Syngeneic adult MSCs were isolated, immortalised by simian virus 40（SV40） large T antigen and characterized by flow cytometry. MSCs were injected intravenously and intraglandularly. After 1, 3 and 7 days, the organs of interest were analysed for stem cell recruitment. Inflammation was analysed by immunohistochemical staining. We were able to demonstrate that, after intravenous injection, MSCs were recruited to normal and damaged submandibular glands on days 1, 3 and 7. Unexpectedly, stem cells were recruited to ligated and non-ligated glands in a comparable manner. After intraglandular injection of MSCs into ligated glands, the presence of MSCs, leucocytes and macrophages was enhanced, compared to intravenous injection of stem cells. Our data suggest that injected MSCs were retained within the inflamed glands, could become activated and subsequently recruited leucocytes to the sites of tissue damage.