Factors Associated with Hyposalivation in Brazilian Adults

ABSTRACT Objective: To determine the occurrence of hyposalivation in Brazilian adults and its association with individual determinants, such as the use of medications, systemic conditions, smoking, and alcohol consumption. Material and Methods: A cross-sectional study with 402 adults was developed. Information was collected on sociodemographic and general health characteristics, and sialometry was performed with stimulated salivary flow. It indicated low salivary flow when ≤ 0.7 mL/min. Bivariate and multivariate analyses were conducted using a decision tree (p<0.05). Results: The sample was comprised predominantly of women (68.2%) aged ≤ 29 years (25.4%). Most participants did not use medication (56.7%). Among systemic diseases, the most cited was hypertension (25.1%). More than a third of the participants presented hyposalivation (40.3%), being associated with the following variables: age between 50 to 59 years (p=0.011), female sex (p<0.001), menopause (p=0.001), use of alcohol (p=0.033), systemic disease (p=0.002) and medication use (p<0.001). In multivariate analysis, in addition to sex (p<0.001) and hypertension (p=0.005), an association was also found between hyposalivation and diabetes (p=0.014). Conclusion: Factors associated with hyposalivation in adults were sex and the presence of hypertension or diabetes.

Effect of intradermal needling combined with oral motor therapy for salivation in children with cerebral palsy: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the effect of combination of intradermal needling with oral motor therapy and simple oral motor therapy on salivation in children with cerebral palsy.@*METHODS@#A total of 60 children with salivation in cerebral palsy were randomized into an observation group and a control group, 30 cases in each group. The observation group was treated with intradermal needling (kept for 24 hours each time at Jiache [ST 6], Dicang [ST 4], tongue three needles, etc. ) and oral motor therapy, while the control group was only given oral motor therapy. The intradermal needling was performed 3 times a week, and oral motor therapy was performed 5 times a week, 4 weeks as a course, totally 3 courses of treatment were required. The classification of teacher drooling scale (TDS), drooling severity and Kubota water swallow test, dysphagia disorders survey (DDS) score were compared before treatment and after 4, 8 and 12 weeks of treatment in both groups, and the clinical efficacy was evaluated.@*RESULTS@#After 8 weeks of treatment in the observation group and after 12 weeks of treatment in the two groups, the classification of TDS and drooling severity were improved (P<0.05), and the observation group was better than the control group after 12 weeks of treatment (P<0.05). After 8 and 12 weeks of treatment, the DDS scores of oral period in the observation group were lower than those before treatment (P<0.05). The total effective rate in the observation group was 83.3% (25/30), which was higher than 53.3% (16/30) in the control group (P<0.05).@*CONCLUSION@#The combination of intradermal needling with oral motor therapy can improve salivation symptoms and swallowing function in children with cerebral palsy, the effect is better than oral motor therapy alone, and the effect is earlier.

Revisión de la literatura: composición salival y su relación con caries dental en embarazadas / Review of the literature: salivary composition and its relationship with dental caries in pregnant women

La saliva es un fluido complejo muy importante en las funciones de la cavidad bucal. El embarazo es un estado normal en el que el embrión se forma y evoluciona durante nueve meses. En este proceso la mujer sufre una serie de cambios fisiológicos y psicológicos. Entre ellos, tiene modificaciones en la saliva y, por consiguiente, en el flujo, pH y concentración de proteínas salivales, que desempeñan un papel importante en la protección contra la infección en los seres humanos. Su nivel en la cavidad oral está sujeto a constantes fluctuaciones que dependen de numerosos factores. El embarazo genera adaptaciones en la fisiología femenina que pueden repercutir en la salud bucal de la gestante. Las afecciones bucales más frecuentes son la caries dental y la gingivitis. Si estas afecciones no son tratadas a tiempo, pueden repercutir en la salud del futuro bebé. Se realizó una revisión bibliográfica con el objetivo de conocer acerca de los componentes de la saliva y su relación con caries dental en las embarazadas, considerando los tres trimestres de gestación (AU)

Saliva is a complex fluid very important in the functions of the oral cavity. Pregnancy is a normal state in which the embryo forms and evolves for nine months. In this process, women undergo a series of physiological and psychological changes. Among them, it has modifications in saliva and, consequently, in the flow, pH and concentration of salivary proteins, which play an important role in protecting against infection in humans. Its level in the oral cavity is subject to constant fluctuations that depend on numerous factors. Pregnancy generates adaptations in female physiology that can affect the oral health of the pregnant woman. The most common oral conditions are dental caries and gingivitis. If these conditions are not treated in time, they can affect the health of the future baby. A bibliographic review was carried out with the objective of knowing about the components of saliva and its relationship with dental caries in pregnant women, considering the three trimesters of gestation (AU)

Effect of homeopathy in the function and morphology of salivary parotid glands of irradiated rats / Efeito da homeopatia na função e morfologia das glândulas parótidas de ratos irradiados

Objective: To evaluate the radioprotective effect of a homeopathic solution in salivary function and parotid glands morphology of irradiated rats. Materials and Methods: The sample consisted of 150 rats randomly divided into 6 groups. The groups were named based on the substance administered: Control- saline solution; Irradiated Control- saline solution and 15 Gy of X radiation; Alcohol-hydroalcoholic solution dynamized at 15 CH; Irradiated Alcohol- hydroalcoholic solution dynamized at 15 CH and 15 Gy of X radiation; Homeopathy- 0.25 ml (1mL/kg) of the irradiated hydroalcoholic solution and dynamized at 15 CH; Irradiated homeopathy- homeopathic solution and 15 Gy of X radiation. Each group was subdivided into 5 different subgroups, based on the time point of euthanasia: 12 hours, 3, 10, 17, and 24 days. The medication was administered for 7 days before and 7 days after the radiation treatment. On the day of euthanasia, salivation was induced with pilocarpine and collected. The animals were then sacrificed and the parotid glands were removed. Results: Salivary function analysis showed that only group irradiated homeopathy euthanized on day 17 had a statistically significant difference when compared to other irradiated groups, presenting a higher salivation flow rate. The only group that showed a statistically significant difference in the number of acini over time was the irradiated alcohol group, which presented a tendency of reduction. Conclusion: The homeopathic solution presented a late radioprotective effect based on salivary function and morphological analysis of the parotid gland.

Objetivo: Avaliar o efeito radioprotetor de uma solução homeopática na função salivar e na morfologia das glândulas parótidas de ratos irradiados. Materiais e Métodos: A amostra foi composta por 150 ratos divididos aleatoriamente em 6 grupos. Os grupos foram nomeados com base na substância administrada: solução salina controle; Solução salina controle irradiada e 15 Gy de radiação X; Solução álcool-hidroalcoólica dinamizada a 15 CH; Solução hidroalcoólica de álcool irradiado dinamizada a 15 CH e 15 Gy de radiação X; Homeopatia - 0,25 ml (1mL / kg) da solução hidroalcoólica irradiada e dinamizada a 15 CH; Homeopatia irradiada - solução homeopática e 15 Gy de radiação X. Cada grupo foi subdividido em 5 subgrupos diferentes, com base no tempo da eutanásia: 12 horas, 3, 10, 17 e 24 dias. O medicamento foi administrado por 7 dias antes e 7 dias após o tratamento com radiação. No dia da eutanásia, a salivação foi induzida com pilocarpina e coletada. Os animais foram então sacrificados e as glândulas parótidas foram removidas. Resultados: A análise da função salivar mostrou que apenas a homeopatia irradiada por grupo sacrificada no dia 17 apresentou diferença estatisticamente significante quando comparada a outros grupos irradiados, apresentando maior taxa de fluxo de salivação. O único grupo que apresentou diferença estatisticamente significante no número de ácinos ao longo do tempo foi o grupo álcool irradiado, o qual apontou uma tendência de redução. Conclusão: A solução homeopática apresentou efeito radioprotetor tardio baseado na função salivar e na análise morfológica da glândula parótida.

Cárie dentária em pacientes de transplante de células tronco hematopoiéticas, fígado e rim: aspectos clínicos, epidemiológicos e salivares / Dental caries in patients of hematopoietic stem cell, liver and kidney transplants: clinical, epidemiological and salivary aspects

Este estudo objetivou avaliar a experiência de cárie dentária e fatores associados, em indivíduos de transplante de células tronco hematopoiéticas, fígado e rim. Avaliou-se também o impacto da saúde bucal na qualidade de vida desses indivíduos e sua associação com a experiência de cárie e fluxo salivar. Um estudo transversal analítico controlado, com 40 indivíduos de transplante e 40 controles não indicados ao transplante, pareados por idade e sexo, atendidos na Faculdade de Odontologia da UFMG (Brasil) foi conduzido. Dados sociodemográficos e econômicos, medicações em uso e tempo de pós-transplante foram coletados. Avaliou-se a experiência de cárie pelos índices CPOS e COR (superfície). O impacto da saúde bucal na qualidade de vida foi mensurado pelo instrumento Oral Health Impact Profile (OHIP-14). Coletou-se saliva para obtenção do fluxo, pH, composição química e capacidade tampão. Avaliou-se a ingestão de açúcares livres pelo recordatório de 24 horas. A análise de regressão mostrou que o aumento de um indivíduo morador na casa do paciente aumenta as chances de ter alta experiência de cárie (OR = 1,35; IC95% 1,02-1,79). O aumento de um ponto do fluxo salivar diminuiu as chances de alta experiência de cárie dentária (OR = 0,14; IC95% 0,03-0,72). Quanto ao impacto da saúde bucal na qualidade de vida, os indivíduos em condição de transplante de fígado apresentaram valores significativamente maiores de medianas (4,0 [0-7,0]) comparados aos de transplante de rim (0,5 [0-5]) (p=0,043), para o domínio desconforto psicológico. As medianas do número de superfícies perdidas foram significativamente maiores nos indivíduos de transplante de fígado (45,0 [0-81,0]), comparados aos de rim (12,0 [0-65,0]) (p=0,045). Os indivíduos de transplante de rim (32,5 [1,0-58,0]) apresentaram número de superfícies restauradas significativamente maiores, comparados aos de fígado (13,0 [0-32,0]) (p=0,049). A faixa etária entre 56 e 61 anos (13,0 [7,0-25,0]) apresentou maiores valores do OHIP- 14, comparada à faixa de 25 a 40 anos (4,5 [0-29,0]) (p=0,013). Os valores de OHIP-14 apresentaram correlação positiva moderada significativa, com o número de superfícies dentárias perdidas (ρ=0,433; p=0,005). Não houve correlação entre o valor de OHIP-14 e o fluxo salivar. Concluiu-se que o aumento do fluxo salivar diminuiu as chances de o indivíduo apresentar uma alta experiência de cárie. O aumento do número de indivíduos moradores da casa aumentou as chances de ocorrência de alta experiência de cárie. Indivíduos de transplante de fígado apresentaram maior desconforto psicológico e um maior número de superfícies dentárias perdidas, comparados aos de transplante renal. A maior perda dentária foi correlacionada com um pior impacto da saúde bucal na qualidade de vida dos indivíduos de transplante. Indivíduos a partir de 56 anos de idade demonstraram um maior impacto na qualidade de vida relacionada à saúde bucal.

The aim of this study was evaluate the experience of tooth decay and associated factors in hematopoietic stem cell, liver and kidney transplant patients. The impact of oral health on the quality of life of these individuals and its association with the experience of caries and salivary flow were also evaluated. A controlled analytical cross-sectional study with 40 transplant individuals and 40 controls not indicated for transplantation, matched for age and sex, attended at the UFMG School of Dentistry (Brazil) was conducted. Sociodemographic and economic data, medications in use and post-transplant time were collected. The caries experience was evaluated using the CPOS and COR (surface) indexes. The impact of oral health on quality of life was measured using the Oral Health Impact Profile (OHIP-14). Saliva was collected to obtain flow, pH, chemical composition and buffering capacity. The intake of free sugars was evaluated by the 24-hour recall. The regression analysis showed that the increase of an individual living in the patient's home increases the chances of having a high caries experience (OR =1.35; 95% CI 1.02-1.79). The increase of one point in the salivary flow decreased the chances of high experience of dental caries (OR=0.14; 95% CI 0.03-0.72). As for the impact of oral health on quality of life, individuals in conditions of liver transplantation had significantly higher median values (4.0 [0-7.0]) compared to those of kidney transplantation (0.5 [0- 5]) (p = 0.043), for the psychological discomfort domain. The medians of the number of surfaces lost were significantly higher in the liver transplant subjects (45.0 [0-81.0]), compared to the kidney (12.0 [0-65.0]) (p = 0.045). The kidney transplant individuals (32.5 [1.0-58.0]) had significantly higher number of restored surfaces, compared to the liver (13.0 [0-32.0]) (p = 0.049). The age group between 56 and 61 years old (13.0 [7.0-25.0]) presented higher OHIP-14 values, compared to the age group from 25 to 40 years old (4.5 [0-29.0]) (p=0.013). The OHIP-14 values showed a significant moderate positive correlation, with the number of missing dental surfaces (ρ = 0.433; p = 0.005). There was no correlation between the OHIP-14 value and the salivary flow. It was concluded that the increase in salivary flow decreased the chances of the individual having a high experience of caries. The increase in the number of individuals living in the home increased the chances of high caries experience. Individuals with liver transplantation had greater psychological discomfort and a greater number of missing dental surfaces, compared to those of kidney transplantation. The greater tooth loss was correlated with a worse impact of oral health on the quality of life of transplant individuals. Individuals over 56 years of age demonstrated a greater impact on quality of life related to oral health.

Asociación de sialometría, fosfato y calcio en saliva total bajo estímulo y en líquido crevicular gingival con caries dental en escolares / Sialometry and concentration of phosphate and calcium in stimulated whole saliva and gingival crevicular fluid and its association with dental caries in schoolchildren

Resumen Introducción. La capacidad de la saliva para la remineralización contribuye a mantener la integridad fisicoquímica de la estructura mineral de los dientes, lo cual los protege de la aparición y evolución de la caries dentaria. Objetivo. Establecer la relación de la sialometría, la capacidad amortiguadora, la concentración de calcio y fosfato en la saliva total estimulada y en el líquido crevicular gingival, con la gravedad y la actividad de las caries en escolares. Materiales y métodos. Se seleccionaron 36 escolares de 6 años, 18 con caries (International Caries Detection and Assessment System, ICDAS, código 2 o mayor) y 18 sin caries (ICDAS, código 0). En la dentición primaria, se evaluaron la gravedad y la actividad de la caries dentaria en la superficie de oclusión de los molares y en la vestibular de los dientes anteriores, y se codificaron mediante el ICDAS-II. Resultados. Se evidenció una mayor gravedad de las caries en la superficie de oclusión que en la vestibular. Las concentraciones de calcio en la saliva y de fosfato en el líquido crevicular gingival de los dientes sanos, fueron mayores en el grupo con un código ICDAS de 2 o mayor. La concentración de calcio en el líquido crevicular gingival fue mayor en el grupo con código ICDAS 0 que en los dientes cariados del grupo con código ICDAS de 2 o mayor. Se encontró una asociación estadísticamente significativa entre la frecuencia de caries activas y la concentración de fosfato en el líquido crevicular gingival de los dientes afectados, como también entre la gravedad de las caries y la capacidad amortiguadora, por una parte, y la concentración de fosfato en el líquido crevicular gingival de los dientes afectados, por la otra. Conclusión. Se evidenció una asociación entre la caries dental, la capacidad amortiguadora y la química bucal del calcio y el fosfato.

Abstract Introduction: The remineralizing properties of saliva contribute to maintain the physical and chemical integrity of the mineral structure of teeth, which protects it from the installation and evolution of dental caries. Objective: To relate sialometry, buffering capacity, calcium and phosphate concentration in whole stimulated saliva, and in gingival crevicular fluid with school children caries severity and activity. Materials and methods: We selected 36 schoolchildren aged 6 years: 18 with caries (International Caries Detection and Assessment System, ICDAS>1 group) and 18 without caries (ICDAS=0 group). The severity and activity of dental caries were diagnosed in the primary dentition: in the occlusal surface of molars and in the vestibular of the anterior teeth by ICDAS-II. Results: Caries in occlusal surface were more severe than in vestibular surface. The concentration of calcium in saliva and phosphate in healthy teeth gingival crevicular fluid were higher in the ICDAS>1 group. The concentration of calcium in gingival crevicular fluid was higher in the ICDAS=0 group than in the decayed teeth of the ICDAS>1 group. We found a statistically significant association between the frequency of active caries andthe concentration of phosphate in gingival crevicular fluid of teeth with caries, as well as between the severity of caries with buffering capacity and the concentration of phosphate in the gingival crevicular fluid of teeth with caries. Conclusion: We found an association between dental caries with buffering capacity and buccal calcium and phosphate.

Gustatory Stimulations and Their Capacity Influence Buffering of the Saliva

Objective: To evaluate the influence of gustatory stimuli on the buffering capacity of saliva. Material and Methods: The buccal ph of 18 male volunteers aged 18-35 years was measured after a mouthwash with 20 ml of water as a control, and in individual disposable cups they collected the saliva for two minutes. Then, each of chewed bubble gum with sugar for two minutes, discarding the gum and made new collection of saliva, for two minutes in other disposable cups individualized. After collection, each volunteer was again subject to regular brushing with toothpaste and waited another ten minutes. The same procedure was repeated with all other substances. Salivary buffer capacity was determined by Ericsson technique. Data were submitted to analysis of variance and the means were compared by the Scott-Knott grouping test and Mann-Whitney test at 5% probability. Estimates of Pearson correlations were calculated in order to determine possible associations between the variables. Results: It was not found statistically significant differences between the initial pH variation and after eating food (p>0.05), or between gustatory stimulation and variation of salivary buffer capacity (p>0.05). Conclusion: There is no influence of gustatory stimulus aroma and flavor on the variation of salivary buffer capacity.

Recommendations from the Brazilian society of rheumatology for the diagnosis of Sjögren's syndrome (Part I): glandular manifestations (systematic review)

Abstract Background: Primary Sjögren's syndrome (pSS) is a systemic immune-mediated disease whose main characteristic is exocrine gland inflammation and, subsequent reduction in tear and saliva production. A delayed diagnosis is common due to the nonspecific clinical manifestations of disease. The aim of the present study was to develop recommendations for the diagnosis of glandular manifestations of pSS based on evidence and expert opinion. Main body of the abstract: We conducted a systematic literature review to retrieve the best evidence available on the accuracy of diagnostic tests for pSS. We also held two in-person meetings with experts (rheumatologists, pathologists, ophthalmologists and dentists) to establish their level of agreement using the Delphi method. Ultimately, we generated 18 recommendations that aim to facilitate the diagnosis of the glandular manifestations of pSS. Conclusion: The diagnosis of glandular manifestations of pSS is complex and multidisciplinary. It requires specific knowledge in the field of ophthalmology, immunology, pathology and imaging, making it compulsory for the rheumatologist to work with professionals from these different areas in order to improve accuracy and early diagnosis. Glandular dysfunction tests, ANA, RF, Anti-Ro, protein electrophoresis, urinalysis, blood count, C-Reactive protein, complement, testing for syphilis and viruses (HCV, HIV) and SGUS should be investigated when dryness or systemic manifestation are present. Minor salivary gland biopsy is recommended for all anti-Ro negative or incomplete criteria cases.

Protective Effect of Zengye Decoction () on Submandibular Glands in Nonobese Diabetic Mice / 中国结合医学杂志

OBJECTIVE@#To investigate the protective effect of Zengye Decoction (, ZYD) on the submandibular glands (SMGs) in nonobese diabetic (NOD) mice.@*METHODS@#Twenty-seven female NOD mice were randomly equally divided into 3 groups: the model group, the hydroxychloroquine (HCQ) group, and the ZYD group. Nine C57/B6 mice served as the normal group. After 1-week acclimation, the HCQ and ZYD groups were intragastrically administered with HCQ and ZYD, respectively, and the normal and model groups were administered with normal saline. Changes in the salivary flow rate were observed. Mice from all 4 groups were sacrificed at the age of 20 weeks. The serum and SMGs were collected. Serum cytokines gamma-interferon (IFN-γ), interleukin-10 (IL-10) were detected by enzyme-linked immunosorbent assay. Histological changes in the submandibular glands were examined by hematoxylin and eosin staining. The mRNA expression of IFN-γ, IL-10 and vasoactive intestinal peptide (VIP) in the submandibular glands were measured by real-time polymerase chain reaction.@*RESULTS@#Compared with the model group, the salivary flow of the ZYD group significantly increased (P<0.05), the extent of the histological changes was ameliorated (P<0.05), and the Th1/Th2 cytokine imbalance was remedied (P<0.05). In the ZYD-treated mice, the VIP mRNA was up-regulated (P<0.05).@*CONCLUSIONS@#ZYD is beneficial in protecting structure and function of SMGs in NOD mice. The mechanism may be associated with the correction of the Th1/Th2 cytokine imbalance, and with the prevention of a progressive decline of the VIP level.

Long-term dexamethasone treatment diminishes store-operated Ca entry in salivary acinar cells / 国际口腔科学杂志·英文版

Corticosteroids are used in the treatment of many diseases; however, they also induce various side effects. Dexamethasone is one of the most potent corticosteroids, and it has been reported to induce the side effect of impaired salivary gland function. This study aimed to evaluate the effects of dexamethasone on mouse submandibular gland function to gain insight into the mechanism of dexamethasone-induced salivary hypofunction. The muscarinic agonist carbachol (CCh) induced salivary secretion and was not affected by short-term dexamethasone treatment but was decreased following long-term dexamethasone administration. The expression levels of the membrane proteins Na-K-2Cl cotransporter, transmembrane member 16A, and aquaporin 5 were comparable between the control and long-term dexamethasone treatment groups. The CCh-induced increase in calcium concentration was significantly lower in the presence of extracellular Ca in the long-term dexamethasone treatment group compared to that in the control group. Furthermore, CCh-induced salivation in the absence of extracellular Ca and Ca ionophore A23187-induced salivation was comparable between the control and long-term dexamethasone treatment groups. Moreover, salivation induced by the Ca-ATPase inhibitor thapsigargin was diminished in the long-term dexamethasone treatment group. In summary, these results demonstrate that short-term dexamethasone treatment did not impair salivary gland function, whereas long-term dexamethasone treatment diminished store-operated Ca entry, resulting in hyposalivation in mouse submandibular glands.

Autoantibody-Mediated Dysfunction of Salivary Glands Leads to Xerostomia in SKG Mice

Sjögren's syndrome (SS) is a chronic heterogeneous disease that mainly affects exocrine glands, leading to sicca syndromes such as xerostomia. Despite the second highest prevalence rate among systemic autoimmune diseases, its pathophysiology remains largely unknown. Here we report that SKG mice, a cardinal model of Th17 cell-mediated arthritis, also develop a secondary form of SS-like disorder upon systemic exposure to purified curdlan, a type of β-glucan. The reduced production of saliva was not caused by focal immune cell infiltrates but was associated with IgG deposits in salivary glands. Sera from curdlan-injected SKG mice contained elevated titers of IgG (predominantly IgG1), autoantibody to the muscarinic type 3 receptor (M3R) and inhibited carbachol-induced Ca2+ signaling in salivary acinar cells. These results suggest that the Th17 cells that are elicited in SKG mice promote the production of salivary gland-specific autoantibodies including anti-M3R IgG; the antibodies are then deposited on acinar cells and inhibit M3R-mediated signaling required for salivation, finally leading to hypofunction of the salivary glands. This type II hypersensitivity reaction may explain the origin of secondary SS occurring without focal leukocyte infiltrates.

Quantitative Analysis of Parotid Gland Secretion Function in Sjögren's Syndrome Patients with Dynamic Magnetic Resonance Sialography

OBJECTIVE: To evaluate the secretory function of parotid glands by dynamic magnetic resonance (MR) sialography and determine the clinical performance of this technique in diagnosing and evaluating Sjögren's syndrome (SS) patients. MATERIALS AND METHODS: This study enrolled 29 healthy volunteers (25 women and 4 men; mean age, 34.8 ± 6.3 years; age range, 26–47 years) and 25 primary SS (pSS) patients (23 women and 2 men; mean age, 37.7 ± 7.9 years; age range, 25–50 years) with decreased secretory function. The volume of the parotid gland ducts was precisely measured for both groups at single pre- and 6 post-gustatory-stimulated phases. Time-dependent volume change ratio curves were generated, four parameters were derived from the curves: the slope of the increase in the first post-stimulation phase (slope(1st)), the peak value, the time-to-peak, the total saliva secretion post-stimulation. All values were used to quantitatively evaluate the secretory function of the parotid gland. The repeated measurement analysis, Mann-Whitney U test and receiver operating characteristic curve were applied. RESULTS: Time-dependent volume change ratio curves demonstrated that there is a statistically significant difference between the two groups (F = 8.750; p = 0.005). A quickly increasing curve was shown in the volunteer group, whereas a slowly increasing curve was shown in the pSS patient group. The slope(1st), peak value and total saliva secretion post-stimulation of the patient group were significantly lower than those of the volunteer group (p = 0.005, p = 0.003, and p = 0.002, respectively). The time-to-peak between the two groups was not significantly different (p = 0.383). The slope(1st) can be used as a discriminator to diagnose SS patients (p = 0.015; odds ratio = 4.234; area under the curve = 0.726). CONCLUSION: Dynamic MR sialography is proven to be an effective method in evaluating salivary gland function and has a great potential in diagnosing and evaluating pSS patients.

Role and mechanism of muscarinic acetylcholine receptor in the regulation of submandibular gland secretion / 北京大学学报(医学版)

Muscarinic acetylcholine receptors (mAChRs), including M1-M5 subtypes, are classic receptors in regulating water, ion, and solute transport in salivary gland. Our work focuses on the studies on the expression pattern and function of mAChR in the submandibular gland (SMG), and the underlying mechanism involved in the mAChR-regulated secretion, together with the effect of parasympathectomy on the salivary secretion. Microvascular autotransplantation of SMG into the temporal fossa provides a continuous and endogenous source of fluids, and is currently an effective method for treating severe keratoconjunctivitis sicca. By using RT-PCR, Western blotting, and immunofluorescence, our data demonstrated that the expression of M1 and M3 subtypes were decreased in latent period in rabbit SMG autotransplantation model, whereas carbachol stimulation promoted the salivary secretion, as well as M1 and M3 expressions. By contrast, mAChRs were hypersensitive in epiphora SMGs, whereas atropine gel and botulinum toxin A application significantly inhibited the hypersecretion in both animal models and patients. Furthermore, the possible intracellular signal molecules involved in the mAChR-modulated salivary secretion were explored. Activation of mAChR upregulated the expression of aquaporin 5 (AQP5), the main transporter that mediated water secretion through transcellular pathway, and led to AQP5 trafficking from lipid rafts to non-lipid microdomain. Extracellular signal-regulated kinase 1/2 (ERK1/2) was involved in the mAChR-regulated AQP5 content. mAChR activation also modulated the expression, distribution, and function of tight junction proteins, and increased paracellular permeability. ERK1/2/β-arrestin2/clathrin/ubiquitin signaling pathway was responsible for the mAChR-regulated downregulation of tight junction molecule claudin-4. Cytoskeleton filamentous actin (F-actin) was also involved in the distribution and barrier function of epithelial tight junctions. Besides, endothelial tight junctions were opened by mAChR agonist-evoked salivation in the mice. Furthermore, parasympathetic denervation increased resting salivary secretion in the long terminrats and minipigs. Taken together, our work demonstrated that mAChR regulated saliva secretion via transcellular and paracellular pathways in SMG epithelium as well as tight junction opening in SMG endothelium. Modulation of mAChR might be a promising strategy to ameliorate SMG dysfunction.

Effects of diabetes and hypertension on oral mucosa and tgfß1 salivary levels

Abstract The aim of this study was to investigate salivary levels of TGFβ1 and proliferation/ maturation of epithelial mucosa cells in diabetic and hypertensive patients. Design: in this cross-sectional study, whole stimulated saliva and oral mucosa exfoliative cytology specimens were collected from 39 patients that were healthy (control, n=10) or presented history of arterial hypertension (HAS, n=9), diabetes mellitus (DM, n=10) or both (DM+HAS, n=10). Salivary flow rate (SFR), TGFβ1 level in saliva, AgNORs and the epithelial maturation were evaluated. Non-parametric Kruskal-Wallis test, followed by Dunn's multiple comparison post-test and the Spearman test correlation analysis were used. SFR showed a significant decreased in DM and DM+HAS (0.47±0.11 and 0.64±0.43 mL/min) when compared to control (1.4±0.38 mL/min). DM+HAS presented the highest value of TGFβ1 concentration (24.72±5.89 pg/mL). It was observed a positive correlation between TGFβ1 and glycaemia (R=0.6371; p<0.001) and a negative correlation between TGFβ1 and saliva (R=-0.6162; p<0.001) and glycaemia and SFR (R=-0.5654; P=0.001). AgNORs number and status of maturation of mucosa cells were similar for all conditions. DM and DM+HAS presented the lowest SFR, which correlated with increased TGFβ1 levels. Despite the higher TGFβ1 secretion it was not observed changes in the morphology or proliferation of epithelial cells when diabetes or hypertension was present.

Resumo O objetivo deste estudo foi investigar os níveis de TGFβ1 na saliva e a proliferação/maturação das células epiteliais da mucosa em paciente diabéticos e hipertensos. Neste estudo transversal, saliva estimulada e amostras de citologia exfoliativa de mucosa oral foram coletadas de um total de 39 pacientes que se apresentavam saudáveis (controle, n=10) ou com história de hipertensão arterial (HAS, n=9), diabetes mellitus (DM, n=10) ou ambos (DM+HAS, n=10). Taxa de fluxo salivar (SFR), níveis de TGFβ1 na saliva, AgNORs e maturação epitelial foram avaliados. Teste não-paramétrico de Kruskal-Wallis, seguido de comparação múltipla de Dunn e correlação de Spearman foram utilizados para as análises. SFR diminuiu significantemente em DM e DM+HAS (0,47±0,11 e 0,64±0,43 mL/min) quando comparado ao controle (1,4±0,38 mL/min). DM+HAS apresentou os maiores valores de concentração de TGFβ1 (24,72±5,89 pg/mL). Foi observada uma correlação positiva entre TGFβ1 e glicemia (R=0,6371; p<0,001) e uma correlação negativa entre TGFβ1 e saliva (R=-0,6162; p<0,001) e glicemia e SFR (R=-0,5654; p=0,001). Número de AgNORs e o padrão da maturação das células epiteliais foram similares entre os todos grupos. DM e DM+HAS apresentaram os menores valores de SFR, os quais foram correlacionados com o aumento nos níveis de TGFβ1. Apesar da maior secreção de TGFβ1, não foram observadas mudanças na morfologia ou proliferação das células epiteliais quando o paciente apresentava diabetes ou hipertensão.

A novel method to evaluate salivary flow rates of head and neck cancer patients after radiotherapy: a pilot study / Um novo método para avaliar as taxas de fluxo salivar em pacientes com câncer de cabeça e pescoço após radioterapia: estudo piloto

Abstract Introduction The procedure used to evaluate salivary flow rate is called sialometry. It can be performed through several techniques, but none appears to be really efficient for post-radiotherapy patients. Objective To adequate sialometry tests for head and neck cancer patients submitted to radiotherapy. Methods 22 xerostomic patients post-radiotherapy (total radiation dose ranging from 60 to 70 Gy) were included in this study. Ten patients were evaluated using sialometries originally proposed by the Radiation Therapy Oncology Group and twelve were assessed by our modified methods. Unstimulated and stimulated sialometries were performed and the results were classified according a grading scale and compared between both groups. Results There was no statistically significant difference between the salivary evaluations of both groups (p = 0.4487 and p = 0.5615). Also, most of these rates were classified as very low and low. Conclusion This novel method seems to be suitable for patients submitted to radiotherapy.

Resumo Introdução O procedimento utilizado para avaliar a taxa de fluxo salivar é denominado sialometria. Pode ser realizado por meio de várias técnicas, mas nenhuma parece ser realmente eficiente para pacientes pós-radioterapia. Objetivo Adaptar sialometrias para pacientes com câncer de cabeça e pescoço submetidos à radioterapia. Método 22 pacientes xerostômicos pós-radioterapia (dose de radiação total variando de 60-70 Gy) foram incluídos neste estudo. Dez pacientes foram avaliados utilizando sialometrias originalmente propostas pelo Radiation Therapy Oncology Group e doze foram avaliados por nossos métodos modificados. Sialometrias não estimuladas e estimuladas foram conduzidas e os resultados foram classificados de acordo com uma escala de graduação e comparados entre os dois grupos. Resultados Não houve diferença estatisticamente significante entre as avaliações salivares de ambos os grupos (p = 0,4487 e p = 0,5615). Além disso, a maioria dessas taxas foi classificada como muito baixa e baixa. Conclusão Esse novo método parece ser adequado para pacientes submetidos à radioterapia.

Effect of constant light and immobilization stress on rat submandibular saliva secretory response induced by cholinergic and peptidergic agonists

The aim of this work was to analyse the parasympathetic control of submandibular saliva secretory response to cholinergic and peptidergic agonists in rats chronically exposed to constant light or repeated immobilization. Thirty two adult male Wistar rats were used: LL (8 rats exposed to constant light for 20 days), IMO (8 rats submitted to 14:10 h light: dark cycle and immobilized 2 hours daily for 7 days), and control (16 rats not exposed to stress and submitted to 14:10 hours light:dark cycle). Saliva was collected under anesthesia from the salivary ducts of submandibular glands under increasing doses of methacholine and substance P. Secretory responses (µg/saliva/mg dry weight gland) to methacholine were significantly higher in LL and IMO groups compared to control for the following doses (µg/kg body weight): 3 (153±9 versus 46±3, p<0.001 and 76±3 versus 40±3, p<0.001), 10 (379±23 versus 277±8, p<0.001 and 275±19 versus 250±10, p<0.01) and 30 (729±25 versus 695±19, p<0.05 and 1008±39 versus 640±20, p<0.001). Also, responses to substance P were significantly increased in LL and IMO groups compared to control for the following doses: 0.2 (80±3 versus 30±3, p<0.01 and 94±16 versus 31±3, p<0.001), 0.5 (328±20 versus 231±16, p<0.01 and 531±31 versus 219±25,p<0.001), 1 (681±35 versus 547±30, p<0.01 and 1031±63 versus 563±53, p<0.001), and 5 (2222±88 versus 1868±59, p<0.01 and 3230±145 versus 1921±218, p<0.001). In conclusion, supersensitivity of secretory response to both agonists suggests that chronic exposure of rats to stressors capable of activating the sympathetic adrenal system promotes inhibition of the parasympathetic control of salivary secretion.

Study on the Changes in Distributions and Expressions of Aquaporin5 (AQP5) in Salivary Glands of Mice After Alcohol Ingestion

Alcohol intake is known to affect various organs in the human body, causing reduction of salivation in the oral cavity. Hypo-salivation effect of alcohol is a common feature, but the mechanism in salivary glands is still poorly studied. Therefore, in this study, the changes in salivary secretion and water channel protein (aquaporin5, AQP5) in salivary glands of mice were investigated after ethanol administration. Animals were divided in to 4 groups with the control, 4 g/kg ethanol, 8 g/kg ethanol and 16 g/kg ethanol administration groups. One hour after ethanol administration, saliva was collected from the oral cavity, and the animals were killed and parotid and submandibular glands were extracted to analyze the histopathology, AQP5 immunihistochemistry and AQP5 protein level. According to the results, the salivation rate decreased irrespective of the ethanol dose in mice, and viscosities increased with increase in ethanol dose. However, there were no pathological changes in parotid and submandibular glands due to ethanol administration. Expression of AQP5 in parotid and submandibular glands decreased with increase ethanol administration These results indicate that the reduction of salivary secretion due to acute alcohol intake is closely related to decrease of the water channel protein such as AQP5 in parotid glands and submandibular glands, rather than the damage of salivary glands.

Efeito agudo da Transcutaneous Electric Nerve Stimulation (TENS) sobre a hipossalivação induzida pela radioterapia na região de cabeça e pescoço: um estudo preliminar / Transcutaneous Electrical Nerve Stimulation (TENS) on hyposalivation induced by radiotherapy in the head and neck region: a preliminary study

RESUMO Objetivo Verificar o efeito agudo da eletroestimulação sobre o fluxo salivar de pacientes com hipossalivação. Método Ensaio clínico não controlado que avaliou o efeito de uma única aplicação da Transcutaneous Electric Nerve Stimulation (TENS) sobre o fluxo salivar de 15 pacientes com hipossalivação induzida por radioterapia (RT), utilizada no tratamento de câncer de cabeça e pescoço. A média de idade dos pacientes foi de 56,8 ± 6,46 anos e o gênero masculino foi predominante (73%). A TENS foi programada com 50Hz de frequência, 250μs de largura de pulso e a intensidade foi ajustada ao longo dos 20 minutos conforme máxima tolerância. Os eletrodos foram fixados bilateralmente sobre a região das glândulas salivares. A avaliação do fluxo salivar foi realizada por meio de sialometria estimulada, antes e imediatamente após a aplicação da TENS. Resultados Em 80% dos casos, o tratamento oncológico incluiu quimioterapia. A RT foi aplicada em 80% dos casos na região e orofaringe, com intensidade média de 64,6 ± 7,27 Gy. Após a TENS, o fluxo salivar aumentou significativamente (p = 0,0051), passando de 0,05 (0,00; 0,40) mL/min para 0,10 (0,07;0,40) mL/min. A resposta à TENS foi diretamente correlacionada à intensidade da corrente elétrica tolerada (r = 0,553; p = 0,032) e à dose utilizada na RT (r = -0,514; p = 0,050). Conclusão A TENS aumentou significativamente o fluxo salivar de pacientes com hipossalivação induzida pela RT.

ABSTRACT Purpose To verify the acute effect of electrostimulation on the salivary flow of patients with hyposalivation. Methods Uncontrolled clinical trial evaluating 15 patients with hyposalivation induced by radiotherapy (RT) used for head and neck cancer treatment. Mean age of the patients was 56.8 ± 6.46 years. Males outnumbered females (73%). Transcutaneous Electrical Nerve Stimulation (TENS) was adjusted with 50Hz of frequency and 250μs of pulse width. Intensity was adjusted over a 20-minute period according to maximum tolerance. The electrodes were attached bilaterally on the region of the salivary glands. Evaluation of the salivary flow was performed through sialometry before and immediately after application of TENS. Results The most prevalent region for RT was the oropharynx (80.0% of cases). The mean dose used in RT was 64.6 ± 7.27 Gy. After TENS, salivary flow increased significantly (p = 0.0051) from 0.05 (0.00; 0.40) mL/min to 0.10 (0.07: 0.40) mL/min. The response to TENS was directly correlated with the intensity of the tolerated electric current (r = 0.553; p = 0.032) and the dose used in RT (r = -0.514; p = 0.050). Conclusion TENS was able to increase the salivary flow rate of patients with RT-induced hyposalivation.

La saliva en pacientes edéntulos completos / Saliva in totally edentulous patients

La saliva es un fluido biológico importante en la fisiología de la cavidad bucal. El propósito de estarevisión fue considerar las relaciones entre el edentulismo completo y el perfil fisiológico de la saliva. El flujo salival, el pH y la capacidad tampón tienen relación con el número de dientes perdidos, presencia de prótesis dentales y métodos de determinación del flujo (saliva no estimulada o estimulada). Las fracciones de proteínas en muestras de saliva total muestran diferencias entre individuos dentados y pacientes edéntulos. Este conocimiento permitirá a los clínicos, comprender mejor el impacto del edentulismo sobre las propiedades de la saliva y planificar el tratamiento en consecuencia.

Saliva is an important biological fluid in oralphysiology. The purpose of this review wasto consider relationships among complete edentulism and saliva physiological profile. Salivaryflow rate, pH and buffer capacity has a relationwith the number of missing teeth, presence ofdental prostheses and methods of determining flow rate (unstimulated or stimulated saliva). Protein fractions in whole salivary samplesshow differences between dentate individuals and edentulous patients. This knowledge willenable clinicians to better understand the impactof edentulism on salivary properties and plan treatment accordingly.

Terapia farmacológica y avances terapéuticos en xerostomía e hiposalivación / Pharmacological therapy and therapeutic advancesin xerostomy and hyposalivation

La saliva juega un rol determinante en el mantenimiento y función de los tejidos orales, donde un decremento en los niveles del flujo salival conllevan a una hiposalivación o hiposialia, trayendo consigo una serie de características que propician un ambiente ideal para la instalaciónde microorganismos oportunistas y condiciones nocivas para la saludoral y sistémica de los pacientes. Hoy en día existen múltiples causas que conllevan a una hiposialia, entre ellas el síndrome de Sjõgren, la radioterapia de haz externo, entre otras, los cuales se han puesto a prueba mediante sialogogos farmacológicos como pilocarpina, cevimelina, betanecoly carbacolina, además de alternativas terapéuticas para revertir los signos obtenidos por la hiposalivación y mitigar los síntomas de xerostomía. El objetivo del presente es realizar una revisión de literatura sobre el tratamiento farmacológico en hiposalivación y xerostomía ensíndrome de Sjõgren y radioterapia de haz externo.

Saliva plays a determinant role in the maintenance and function of oral tissues, where a decrease in salivary flow levels leads to hyposalivation or hyposialia, bringing with it a series of characteristics that provide anideal environment for the installation of opportunistic microorganisms and conditions harmful to the oral and systemic health of patients.Today there are many causes that lead to hyposialia, including Sjögren’ssyndrome, external beam radiotherapy, among others, which have beentested by pharmacological sialogogs such as pilocarpine, cevimelin, betanecol and carbacoline, in addition to therapeutic alternativesto reverse the signs obtained by hyposalivation and to mitigate the symptoms of xerostomia. The objective of the present is to make a reviewof the literature on the pharmacological treatment in hyposalivation and xerostomia in Sjögren’s syndrome and external beam radiotherapy.