Increased levels of interleukin-10 in saliva of Sjögren's syndrome patients. Correlation with disease activity

The aim of the study was to determine the levels of interleukin (IL)-10, IL-2, IL-4, and interferon-gamma in the saliva of patients with Sj?gren's syndrome and to correlate them with laboratory and clinical parameters of disease activity. The levels of IL-2, IL-4, IL-10, and interferon-gamma were measured in salivary samples, obtained directly from the Stenone duct of 14 Sj?gren's syndrome patients and 26 healthy controls by ELISA. A significant elevation of IL-10 was found in salivary fluids of Sj?gren's syndrome patients compared with healthy controls (P=0.007). Elevated interferon-gamma levels were found in some patients. IL-2 and IL-4 were undetectable in all saliva samples. In patients, IL-10 levels significantly correlated with the degree of xerophthalmia and xerostomia (P=0.02 and P=0.01, respectively) and with the erythrocyte sedimentation rate (P=0.006). Our data suggest that elevated IL-10 levels are detectable in the saliva of Sj?gren's syndrome patients and correlate with the severity of the disease.     

Comparison of Dry Mouth in Women Treated with Extended-Release Formulations of Oxybutynin or Tolterodine for Overactive Bladder

The incidence, severity and tolerability of dry mouth was compared in 790 women with overactive bladder who were treated with extended-release oxybutynin chloride 10 mg/day or extended-release tolterodine tartrate 4 mg/day for 12 weeks in a multicenter, double-blind, parallel-group study. Dry mouth was the most common adverse event associated with treatment, with an incidence rate of 28.1% in the oxybutynin group and 21.6% in the tolterodine group (P = 0.039). The majority of dry mouth events were mild in both treatment groups. Severe dry mouth occurred in 1.5% and 0.5% of patients in the oxybutynin and tolterodine groups, respectively (P = 0.173). Seven patients on extended-release oxybutynin and 4 patients on extended-release tolterodine discontinued treatment due to dry mouth (P = 0.380). The results of this analysis showed that dry mouth was common with both treatments, but most events were mild; there was no difference in the rate of severe dry mouth or in the rate of withdrawal due to dry mouth.     

Some factors influencing salivary function when treating with radiotherapy

Salivary flow rate (FR) was studied in 29 patients treated with external irradiation to bead and neck areas. “Resting” saliva samples were collected before, during the radiotherapy course and follow-up. Several parameters were investigated: field arrangement, amount of salivary glands irradiated, dose to these glands, initial FR, its recovery during and after irradiation, and influence of therapy interruption (split course) in FR. We found that the level of the upper border of the field is a critical factor when using parallel-opposed lateral fields to the upper neck area and lateral face. More than 50% of the parotids have to be outside the fields to prevent severe dryness. Neck fields which do not encompass salivary glands do not decrease salivary secretion. There is some relation between the initial FR and the dose necessary to produce dryness: patients with high initial salivary FR require higher doses. FR recovery occurs during weekend interruptions before xerostomia develops. Interruptions of therapy for more than two weeks during the radiotherapy course prior to development of dryness might decrease late xerostomia, at least in patients with high initial FR. Objective recovery of the FR has not been observed after treatment in spite of the subjective improvement in the sensation of dryness of some patients.     

Salivary hypofunction: An update on aetiology,diagnosis and therapeutics

Saliva is of paramount importance for the maintenance of oral and general homeostasis. Salivary hypofunction predispose patients to disorders such as dysgeusia, pain and burning mouth, caries and other oral infectious diseases, dysphagia and dysphonia. The aim of this study was to provide an update on the aetiology, diagnostic methods and therapeutic strategies for the management of hyposalivation and xerostomia. The present paper describes subjective and objective methods for the diagnosis of salivary dysfunctions; moreover a number of drugs, and systemic disorders associated with decreased salivary flow rate are listed. We also focused on the underlying mechanisms to radiotherapy-induced salivary damage. Therapeutics for hyposalivation and xerostomia were discussed and classified as preventive, symptomatic, topical and systemic stimulants, disease-modifying agents, and regenerative. New therapeutic modalities have been studied and involve stem cells transplantation, with special attention to regeneration of damage caused by ionizing radiation to the salivary glands. More studies in this area are needed to provide new perspectives in the treatment of patients with salivary dysfunctions.     

唾液腺动态显像对口干患者唾液腺功能受损的诊断评价

目的探讨唾液腺动态显像（salivary gland scintigraphy, SGS）对疑为干燥综合征口干患者唾液腺功能受损的诊断评价,并探讨定量功能参数的临床意义。方法疑为干燥综合征口干患者22例行Tc99mO4- SGS,通过肉眼影像、时间-放射性曲线和功能参数定量分析（前3min的初始摄取率UR1-3min、第18分钟最大摄取比值UR18 min,最小排泌时间Tmin）评价唾液腺功能受损情况,对照组8例。功能受损程度不同组与对照组间各功能参数的比较采用方差分析;并依据抗SSA/SSB抗体、抗ANA抗体、抗ds-DNA抗体和RF（类风湿因子）是否阳性,比较唾液腺功能受损情况。结果（1）SGS显示唾液腺功能受损为82%（18/22）,左右侧腮腺或颌下腺基本同步受损;功能正常为18%（4/22）。功能重度受损组与其他组间UR1-3 min、UR18 min均有统计学差异;功能正常组、中度受损组与对照组间UR18 min有统计学差异;功能正常组与对照组Tmin无统计学差异,功能中及重度受损组无或极少量排泌。（2）抗ds-DNA抗体均阴性,抗SSA/SSB抗体、抗ANA抗体及RF阳性分别为8、10和8例,抗SSA/SSB抗体阳性组和阴性组在唾液腺功能受损程度不同组间具有统计学差异。结论（1）SGS能敏感的发现口干患者唾液腺功能受损情况,但应将摄取和排泌功能分开评价;UR1-3 min、UR18 min和Tmin分别是评价唾液腺摄取和排泌功能不同程度受损的灵敏指标。（2）SSA/SSB自身抗体阳性者,唾液腺功能受损程度较重。     

Prosthodontic Management of HIV/AIDS Subjects: An Overview

Provision for high standard of oral health care is a fundamental requirement for any individual and dentists constantly strive to provide optimal treatment to their patients. However, when it comes to treating subjects with infectious diseases particularly those attached with social stigma like HIV/AIDS, there remains doubts and hesitations. This may lead the practitioners to breach the ethical responsibility by denying or not providing adequate treatment to these patients. Such situations can easily be avoided with thorough knowledge and awareness among the oral health care providers including prosthodontists regarding the disease process, its implications and measures to be taken during their treatment. This article summarises key points in prosthodontic management of HIV/AIDS patients which in the opinion of the author may be easily incorporated in routine dental practice.