Índice de Placa Bacteriana, Índice Gingival y Prueba de Silometría en Pacientes con Síndrome de Sjögren Primario y Secundario

RESUMEN: El síndrome de Sjögren (SS) es una enfermedad crónica autoinmune presente en el 0.1 - 3.0 % de la población, en la que se encuentran involucradas las glándulas salivales, trayendo consigo manifestaciones orales como caries dental y enfermedad periodontal. El objetivo de este trabajo fue evaluar el índice de placa, el índice gingival y la prueba de sialometría en pacientes con síndrome de Sjögren primario y secundario. Fueron evaluados clínicamente 40 pacientes con SS primario (n=20) y SS secundario (n=20), ambos grupos diagnosticados con periodontitis crónica. Se registró el índice de placa de Quigley-Hein modificado por Turesky, el índice gingival de Löe y la prueba de silometría estimulada, recolectando saliva parotídea con el dispositivo Carlson-Crittenden. Los pacientes con SS primario tuvieron un índice de placa de (3,53±0,5954) e índice gingival (2,41±0,2608). En pacientes con SS secundario el índice de placa fue (1,62±0,3795) y el índice gingival (1,48±0,3994), con diferencia significativa (p=0,0001) entre ambos grupos. El flujo salival se elevó en pacientes con SS secundario. El presente estudio concluye que el índice de placa y el índice gingival fueron mayores en pacientes con SS primario comparados con pacientes con SS secundario. La prueba de sialometría fue mayor en pacientes con SS secundario.

ABSTRACT: Sjögren's syndrome (SS) is a chronic autoimmune disease present in 0.1 - 3.0 % of the population, in which the salivary glands are involved, bringing with it oral manifestations such as dental caries and periodontal disease. The aim of the present study was to evaluate the plaque index, gingival index and the sialometry test in patients with primary and secondary Sjögren's syndrome. Forty patients with primary SS (n = 20) and secondary SS (n = 20), both groups diagnosed with chronic periodontitis, were evaluated clinically. The Quigley-Hein plaque index modified by Turesky, the gingival index of Löe and stimulated sialometry test collected from parotid gland by using Carlson-Crittenden device were recorded. The patients with primary SS had plaque index (3.53 ± 0.5954) and gingival index (2.41 ± 0.2608). The patients with secondary SS had a plaque index (1.62 ± 0.3795) and gingival index (1.48 ± 0.3994), with significant difference between both groups. The present study concludes that plaque index and gingival index were higher in patients with primary SS than patients with secondary SS. Sialometry test were higher in patients with secondary SS.

Xerostomía en pacientes con fibromialgia: Estudio epidemiológico / Xerostomia in fibromyalgia patients: Epidemiologic study

Introducción: Dentro de los fenómenos clínicos estudiados asociados a la Fibromialgia (FM) se ha descrito el Síndrome Sicca, cuyo término engloba xeroftalmia, xerostomía, xerodermia y xerovagina. El objetivo de este estudio fue estimar la frecuencia de xerostomía en pacientes con diagnóstico de fibromialgia y describir las características clínicas de dichos pacientes. Material y métodos: Se incluyeron pacientes con diagnóstico de FM según criterios ACR 1990 y 2010, en quienes se evalúo la presencia de xerostomía mediante las preguntas correspondientes al dominio de los criterios clasificatorios 2002 ACR-EULAR de Sjögren y se realizó sialometría no estimulada para medición de flujo salival. Resultados: Se reclutaron 50 pacientes, el 100% fueron mujeres. La media de edad fue 47 años (DS+-8,5), siendo la media tiempo de evolución de la FM de 6 años (DS+-4,5). En total 29 pacientes (51%) refirieron xerostomía y de este grupo sólo 4 sialometrías fueron positivas. El tabaquismo fue más prevalente en las pacientes con FM que no referían xerostomía con respecto a las que sí referían xerostomía (31,8 % vs 6,9%, p 0,02), sin encontrarse diferencias estadísticamente significativas en las características clínicas evaluadas. Conclusión: La prevalencia de xerostomía fue del 51%. No se demostró una disminución del flujo salival objetiva en la mayoría de los pacientes con FM.

Introduction: The aim of this study was to determinate the frecuency of xerostomia in patients with diagnosis of Fibromyalgia (FM) and describe their clinical characteristics. Material and methods: Patients were included according 1990 and 2010 ACR Classification criteria. All of them were evaluated for xerostomia and a sialometry was performed in order to determinate the decrease of salival flow. Results: Fifty patients were recruited during the study. The 100% of them were women. The mean age was 47 years old (DS+-8.5), while the mean time of evolution of FM was 6 years (SD +-4.5). Twenty nine patients reported xerostomia of which 4 presented positive sialometry. Smoking was more prevalent in patients with FM who did not report xerostomia with respect of those who reported xerostomia (31.8% vs 6.9%, p 0.02). Conclusion: The frequency of xerostomia was 51%. No statistically significant associations were found in patients who reported xerostomia. A decrease in objective salivary flow was not demonstrated in patients with FM.

Sialometria: aspectos de interesse clínico / Sialometry: aspects of clinical interest

A saliva total é um complexo de secreções multiglandulares composto de fluido gengival, células epiteliais descamadas, microrganismos, produtos do metabolismo bacteriano, resíduos alimentares, leucócitos, muco da cavidade nasal e da faringe. A saliva possui diversas funções, incluindo reparação tecidual, tamponamento, proteção, digestão, gustação, ação antimicrobiana, manutenção da integridade do dente e sistema de defesa antioxidante. A redução do fluxo salivar (hipossalivação) é um distúrbio comum, e estima-se que cerca de 20% da população geral tenham esta alteração. A hipossalivação pode ser decorrente de diabetes mellitus, hipotireoidismo, desidratação, comprometimento do parênquima glandular por processos infecciosos, doenças granulomatosas ou condições autoimunes e inflamatórias (como a síndrome de Sjögren e a artrite reumatoide), radioterapia da região cefálica e/ou cervical, bem como pode estar associada a distúrbios do humor, efeitos adversos ocasionados pelo uso de algumas medicações ou, ainda, ser de causa idiopática. As terapias convencionais para o tratamento da redução do fluxo salivar, com o uso de sialogogos gustatórios e químicos, ainda apresentam restrições. Contudo, novas alternativas têm mostrado grande perspectiva no tratamento deste problema. Diagnosticar um paciente como hipossalivador crônico é um desafio na prática clínica, e os métodos de avaliação do fluxo salivar são pouco conhecidos pelos reumatologistas. A avaliação seriada do fluxo salivar é importante para o correto diagnóstico e prognóstico de determinadas condições bucais e sistêmicas. Esta revisão aborda alguns aspectos relacionados à função da saliva, às consequências da hipossalivação e aos métodos de medição da taxa de fluxo salivar, conceitos úteis na prática diária do reumatologista.

Whole saliva is a multiglandular secretion complex consisting of gingival fluid, desquamated epithelial cells, microorganisms, products of bacterial metabolism, food debris, leukocytes mucus from the nasal cavity and the pharynx. Saliva has many functions, including tissue repair, tamponage, protection, digestion, taste, antimicrobial action, maintaining tooth integrity and antioxidant defense system. A decrease in salivary flow (hyposalivation) is a common disorder and it is estimated that approximately 20% of the general population have this alteration. Hyposalivation may be due to diabetes mellitus, hypothyroidism, dehydration, impaired glandular parenchyma by infectious processes, granulomatous diseases or autoimmune and inflammatory conditions (such as Sjogren's syndrome and rheumatoid arthritis), radiotherapy of head and/or neck region, or it may be associated with mood disorders, adverse effects caused by the use of some medications or even be idiopathic. Conventional therapies for the treatment of reduced saliva flow with the use of chemical and gustatory secretagogues are still limited. However, new alternatives have shown great perspective in the treatment of this disorder. To diagnose a patient as having chronic hyposalivation is a challenge in clinical practice and methods of salivary flow assessment are little known by rheumatologists. The serial evaluation of salivary flow is important for the diagnosis and prognosis of certain oral and systemic conditions. This review addresses some aspects related to the role of saliva, the consequences of hyposalivation and methods of salivary flow rate measurement, useful concepts in the daily practice of rheumatology.

Estudio de confiabilidad de la prueba de sialometría para flujo no estimulado en sujetos adultos clínicamente sanos / Study of reliability of the sialometry test for non-stimulated flow in clinically healthy adult individuals

Introducción: En personas sanas, la velocidad de flujo salival o sialometría (VFS) puede afectarse por la edad, género y ritmo circadiano. No existe evidencia de la reproducibilidad de VFS no estimulada determinada en 5 minutos, en distintos momentos del día en un mismo individuo. Objetivos: Determinar confiabilidad de VFS no estimulada medida en 5 minutos, reproducibilidad en el tiempo y relación con rango etario y género. Metodología: Se determinó VFS durante 15 minutos en 42 individuos clínicamente sanos, con una mediana de 45.5 (30-65) años, entre 9 y 11 AM durante dos mañanas y entre 3 y 5 PM durante la tarde del segundo día de medición. La saliva se colectó en tubos separados durante 5 minutos y durante los 10 minutos restantes. El peso de las muestras fue expresado en ml/min. Los valores entre los grupos de estudio, se compararon mediante test t de Student, ANOVA y coeficiente de correlación de Spearman. Resultados: VFS promedio fue de 0.623 +/- 0.329 y de 0.551 +/- 0.289 a los 5 y 15 minutos respectivamente (p=0.001). VFS fue mayor en hombres a los 5 y 15 minutos (p=0.001). VFS en mujeres, disminuyó al aumentar la edad. No hubo diferencias en VFS a los 5 minutos (p=0.375) y a los 15 minutos (p=0.825), en distintos días y momentos del día, en un mismo individuo. Conclusión: VFS colectada durante 5 minutos, en un mismo individuo, presenta valores constantes en distintos días y momentos del día.

Introduction: In healthy persons, the salivary flow rate (VFS) or sialometry can be affected by the age, the gender and the circadian rhythm. There is no evidence of the reproducibility of the non-stimulated VFS determined in 5 minutes, in different moments of the day in the same individual. Aim: To determine the reliability of the non-stimulated VFS measured in 5 minutes, its reproducibility over time and its relation with the age range and the gender. Methodology: VFS was determined for 15 minutes in 42 clinically healthy individuals, with a median age of 45.5 (30-65), between 9 and 11 AM in two mornings and between 3 and 5 PM in the evening of the second day of measurement. The saliva was collected in 2 separated pipes, one for the first 5 minutes and one for the 10 remaining minutes. The weight of the samples was expressed in ml/min. The values between the groups of study were compared by means of the Student’s t-test, ANOVA and the Spearman’s correlation coefficient. Results: The average VFS was of 0.623 +/- 0.329 and of 0.551 +/- 0.289 after 5 and 15 minutes respectively (p=0.001). VFS was higher in men after 5 and 15 minutes (p=0.001). VFS in women diminished as the age increased. There were no differences in VFS after 5 minutes (p=0.375) and after 15 minutes (p=0.825), in different days and moments of the day, in the same individual. Conclusion: VFS collected for 5 minutes in the same individual presents constant values in the different days and moments of the day.