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.

Hiposialia y Xerostomía Post Irradiación: Terapias Innovadoras en el Campo Biomolecular / Hyposialia and Xerostomy Post Irradiation: Innovative Therapies in the Biomolecular Field

Las glándulas salivales humanas pueden ser gravemente lesionadas por la radioterapia utilizada contra neoplasias de cabeza y cuello, produciendo hiposialia y xerostomía, las cuales afectan la salud oral y sistémica, mermando la calidad de vida de la persona. Los tratamientos convencionales actuales están diseñados para disminuir los síntomas, sin actuar sobre los cambios fisiopatológicos que se dan a nivel glandular. Esta revisión intenta analizar aquellas terapias preventivas y/o curativas que están desarrollándose en el campo biomolecular y que tienen un futuro prometedor por sus características innovadoras: terapia génica, terapia con células madre y terapia con factores de crecimiento. Se evidencia un aporte adicional de la nanotecnología, la cual está mejorando las vías de aplicación de los tratamientos.

Human salivary glands can be seriously injured by the radiotherapy used against head and neck neoplasms, producing hyposialia and xerostomy, which affect oral and systemic health, diminishing the person's quality of life. Current conventional treatments are designed to reduce symptoms, without acting on the pathophysiological changes that occur at the glandular level. This review attempts to analyze those preventive and /or curative therapies that are developing in the biomolecular field and that have a promising future due to their innovative features: Gene therapy, stem cell therapy and growth factor therapy. An additional contribution of nanotechnology is evident, which is improving the routes of treatment application.

Amifostine reduces inflammation and protects against 5-fluorouracil-induced oral mucositis and hyposalivation

Oral mucositis (OM) is a common and dose-limiting side effect of cancer treatment, including 5-fluorouracil (5-FU) and radiotherapy. The efficacy of the therapeutic measures to prevent OM is limited and disease prevention is not fully observable. Amifostine is a cytoprotective agent with a described anti-inflammatory potential. It is clinically used to reduce radiotherapy and chemotherapy-associated xerostomia. This study investigated the protective effect of amifostine on an experimental model of OM. Hamsters were divided into six groups: saline control group (5 mL/kg), mechanical trauma (scratches) of the right cheek pouch; 5-FU (60 and 40 mg/kg, ip, respectively, administered on days 1 and 2); amifostine (12.5, 25, or 50 mg/kg) + 5-FU + scratches. Salivation rate was assessed and the animals were euthanized on day 10 for the analysis of macroscopic and microscopic injury by scores. Tissue samples were harvested for the measurement of neutrophil infiltration and detection of inflammatory markers by ELISA and immunohistochemistry. 5-FU induced pronounced hyposalivation, which was prevented by amifostine (P<0.05). In addition, 5-FU injection caused pronounced tissue injury accompanied by increased neutrophil accumulation, tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1β) tissue levels, and positive immunostaining for TNF-α, IL-1β, and inducible nitric oxide synthase (iNOS). Interestingly, amifostine prevented the inflammatory reaction and consequently improved macroscopic and microscopic damage (P<0.05 vs 5-FU group). Amifostine reduced inflammation and protected against 5-FU-associated oral mucositis and hyposalivation.

Salivary stimulation by prolonged release of pilocarpine in sjõgren’ syndrome

Introduction: Prolonged drug delivery in the oral cavity offers many advantages, such as reducing adverse effects. Pilocarpine is an FDA-approved parasympathomimetic drug for the treatment of glandular hypofunction; however, its adverse effects limit its use. Objective: To evaluate the stimulation of salivary flow by the use of pilocarpine-releasing films, as well as their effects on the symptoms of xerostomia and adverse effects in patients with Sjõgren’s syndrome (SS). Materials and methods: Hydroxypropylmethylcellulose (Methocel K4MCR) films were prepared in 1 percent acetic acid and pilocarpine was added under magnetic stirring. The pH and thickness, as well as diffusion uniformity and kinetics of drug release per cm2 were evaluated by spectrophotometry. The films were tested sublingually in 40 patients with Sjõgren’s syndrome for a period of two weeks. Changes in their salivary flow were evaluated by analyzing samples of total saliva. Additionally, patients were screened for symptoms of xerostomia and adverse effects. Results: The films had a pH of 2.91 +/- 0.035, a thickness of 0.06866 +/- 0.00152μm, and a diffusion uniformity of 91 percent per cm2. Use of the films resulted in an increase in salivary flow in both primary and secondary Sjõgren’s syndrome, but this increase was only significant in primary SS. Conclusion: Films showed optimal physicochemical properties for their administration, and proved effective in stimulating salivary flow without causing adverse effects during their administration.

Does Cimicifuga racemosa have the effects like estrogen on the sublingual gland in ovariectomized rats?

BACKGROUND: Cimicifuga racemosa is one of the herbs used for the treatment of climacteric syndrome, and it has been cited as an alternative therapy to estrogen. Apart from hectic fevers, dyspareunia and so on, dry mouth also increase significantly after menopause. It has not yet been reported whether C. racemosa has any impact on the sublingual gland, which may relate to dry mouth. In an attempt to determine this, we have compared the effects of estrogen and C. racemosa on the sublingual gland of ovariectomized rats. RESULTS: HE staining showed that the acinar cell area had contracted and that the intercellular spaces were broadened in the OVX (ovariectomized rats) group, while treatment with estradiol (E2) and iCR (isopropanolic extract of C. racemosa) improved these lesions. Transmission electron microscopy showed that rough endoplasmic reticulum expansion in mucous and serous acinar epithelial cells and apoptotic cells was more commonly seen in the OVX group than in the SHAM (sham-operated rats) group. Mitochondria and plasma membrane infolding lesions in the striated ducts were also observed. These lesions were alleviated by both treatments. It is of note that, in the OVX + iCR group, the volume of mitochondria in the striated duct was larger than in other groups. Immunohistochemical staining showed that the ratio of caspase-3 positive cells was significantly increased in the acinar cells of the OVX group compared with the SHAM group (p < 0.05); and the MA (mean absorbance) of caspase-3 in the striated ducts also increased (p < 0.05). Estradiol decreased the ratio of caspase-3 positive cells and the MA of caspase-3 in striated ducts significantly (p < 0.05). ICR also reduced the ratio of caspase-3 positive cells and the MA in the striated ducts (p < 0.05), but the reduction of the MA in striated ducts was inferior to that of the OVX + E2 group (p < 0.05). CONCLUSION: Both estradiol and iCR can inhibit subcellular structural damage, and down-regulate the expression of caspase-3 caused by ovariectomy, but their effects were not identical, suggesting that both drugs confer a protective effect on the sublingual gland of ovariectomized rats, but that the specific location and mechanism of action producing these effects were different.

Alzheimer’s disease: oral manifestations, treatment and preventive measures / Enfermedad de Alzheimer: manifestaciones orales, tratamiento y medidas preventivas

In the treatment of patients with dementia Alzheimer's type non-current and are facing tough situations. Treatment should be tailored to each stage of the disease and for each patient. In this type of disease is very important to involve families and caregivers to improve the quality of life of patients. The main goal with these patients is prevention. Patients should be all oral manifestations caused by the lack of inadequate oral hygiene, xerostomia and manifestations derived by taking drugs. The aim of this review is to describe the main oral manifestations that can result from this disease and the best treatment options taking into account the clinical stages in which patients are found.

En el tratamiento a pacientes con demencias tipo Alzheimer se afrontan situaciones infrecuentes y comprometidas. El tratamiento debe personalizarse para cada estadio de la enfermedad y para cada paciente. En este tipo de enfermedades es muy importante involucrar a los familiares y cuidadores para mejorar la calidad de vida del enfermo. El principal objetivo con estos pacientes es la prevención. Se deben controlar todas las manifestaciones orales provocadas por la falta de una inadecuada higiene oral, la xerostomía y las manifestaciones derivadas por los fármacos que consumen. El objetivo de esta revisión es describir cuáles son las principales manifestaciones orales que pueden derivar de esta enfermedad y las mejores opciones de tratamiento teniendo en cuenta las etapas clínicas en las que se encuentran los pacientes.

Effects of 4% Hypertonic Saline Solution Mouthwash on Oral Health of Elders in Long Term Care Facilities

PURPOSE: This study was done to examine the effects of 4% hypertonic saline solution mouthwash and tooth brushing education on the oral health of elders living in long term care facilities. METHODS: In this quasi-experimental study, the participants were assigned to a 2% experimental group (n=20), a 4% experimental group (n=20), and a control group (n=20). Data were analyzed using ANOVA, repeated measures ANOVA, Fisher exact test, Chi-square test, Kruskal-Wallis test and multiple response analysis with the SAS program. RESULTS: Regular tooth brushing and use of 4% hypertonic saline solution mouthwash by elders provided better oral health by decreasing xerostomia, oral tongue plaque, halitosis, and the number of oral bacteria. CONCLUSION: The results indicate that regular tooth brushing with continuous 4% hypertonic saline solution mouth washing education promotes oral health for elders in long term care facilities, thus the dental care described in this study is recommended for elders in long term facilities.

Evaluation of the efficacy of zinc sulfate in the prevention of chemotherapy-induced mucositis: a double-blind randomized clinical trial

Oral mucositis is a serious complication of chemotherapy that results in painful debilitating inflammation, necessitating the administration of analgesics. There is no cure for mucositis. Some studies have evaluated the effect of zinc sulfate on mucositis. The present study aims to evaluate the effect of oral zinc sulfate on prevention of mucositis, xerostomia, and pain induced by chemotherapy. This double-blind, randomized controlled trial was carried out on 50 adult patients who underwent chemotherapy during 2008-2009. Patients were divided in two groups. Patients in the intervention group were administered three, 220 mg zinc sulfate capsules daily until the end of their chemotherapy treatment. Patients in the placebo group received three placebo capsules daily, which were similar in shape, taste, and color to the zinc sulfate capsules. Data were analyzed by SPSS version 17 software, using the independent samples t-test, Mann-Whitney U and Friedman tests. The incidence of grade 3 mucositis was lower in the zinc sulfate group. In the first follow up, grade 3 mucositis was detected in 10% of patients. In the placebo group, grade 3 mucositis was seen in 46.6% of patients. By the fourth follow up, grade 3 mucositis was detected in 3.33% of patients in the intervention group and in 20% of patient in the placebo group. At the end of the study there was no grade 3 mucositis detected in the zinc sulfate group, whereas there were 3.57% of patients in the placebo group with grade 3 mucositis. The results also showed that zinc sulfate decreased the effects of xerostomia and pain in patients under chemotherapy treatment. It can be concluded that zinc sulfate might decrease the intensity of mucositis

Acupuncture for the prevention of radiation-induced xerostomia in patients with head and neck cancer

The aim of this study was to evaluate the effectiveness of acupuncture in minimizing the severity of radiation-induced xerostomia in patients with head and neck cancer. A total of 24 consecutive patients receiving > 5000 cGy radiotherapy (RT) involving the major salivary glands bilaterally were assigned to either the preventive acupuncture group (PA, n = 12), treated with acupuncture before and during RT, or the control group (CT, n = 12), treated with RT and not receiving acupuncture. After RT completion, clinical response was assessed in all patients by syalometry, measuring the resting (RSFR) and stimulated (SSFR) salivary flow rates, and by the visual analogue scale (VAS) regarding dry mouth-related symptoms. Statistical analyses were performed with repeated-measures using a mixed-effect modeling procedure and analysis of variance. An alpha level of 0.05 was accepted for statistical significance. Although all patients exhibited some degree of impairment in salivary gland functioning after RT, significant differences were found between the groups. Patients in the PA group showed improved salivary flow rates (RSFR, SSFR; p < 0.001) and decreased xerostomia-related symptoms (VAS, p < 0.05) compared with patients in the CT group. Although PA treatment did not prevent the oral sequelae of RT completely, it significantly minimized the severity of radiation-induced xerostomia. The results suggest that acupuncture focused in a preventive approach can be a useful therapy in the management of patients with head and neck cancer undergoing RT.

Criterios de evaluación odontológica pre-radioterapia y necesidad de tratamiento de las enfermedades orales post-radioterapia en cabeza y cuello / Pre-radiotherapy dental evaluation criteria and treatment needs of oral side effects after head and neck radiotherapy

El objetivo de esta revisión es presentar criterios de evaluación odontológica pre-radioterapia y cuáles son las principales necesidades de tratamiento de estos pacientes después del tratamiento de radiación. Fueron revisados artículos en inglés, español y portugués entre 1995 y 2009 indexados en Pubmed y Scielo. Las palabras claves fueron: cáncer oral y radioterapia, complicaciones de la radioterapia en cabeza y cuello, evaluación oral pre-radioterapia. Los efectos colaterales de la radioterapia en la región de cabeza y cuello pueden ser temporales o tardíos. Aquellos que son tardíos, como la caries de radiación y la osteorradionecrosis pueden estar directamente relacionados con el hecho de no haber realizado una evaluación odontológica previa y pueden afectar severamente la calidad de vida del paciente.La participación del cirujano-dentista en el equipo multidisciplinario y la evaluación odontológica de los pacientes que serán sometidos a radioterapia en la región de cabeza y cuello son de vital importancia en mejorar la calidad de vida post-operatoria de estos pacientes.

The objective of this review is to present pre-radiotherapy evaluation criteria and the main needs for treatment of these patients after the radiation therapy. Were revised articles in English, Spanish and Portuguese language between 1995 and 2009 indexed in Pubmed and Scielo. The keywords were oral cancer and radiotherapy, complications in head and neck radiotherapy, oral pre-radiotherapy evaluation.The adverse complications of radiotherapy in head and neck area could be temporary or late. The late effects, such as radiation caries and osteorradionecrosis could be directly associated with the fact that previous dental evaluation was not performed and can severely affect the post-operatory quality of life. The participation of the dentist in the multidisciplinary team and dental evaluation of the patients that will receive radiotherapy in the head and neck area are of vital importance to improve the post-operatory quality of life of these patients.

Prevenção da xerostomia e da mucosite oral induzidas por radioterapia com uso do laser de baixa potência / Low level laser therapy in the prevention of radiotherapy-induced xerostomia and oral mucositis

OBJETIVO: Verificar se o uso do laser de InGaAlP com comprimento de onda de 685 nm pode reduzir a incidência de xerostomia, gravidade da mucosite oral e da dor associada à mucosite em pacientes portadores de câncer de cabeça e pescoço submetidos a radioterapia. MATERIAIS E MÉTODOS: Sessenta pacientes portadores de carcinoma de cabeça e pescoço foram submetidos a radioterapia com dose diária de 1,8 a 2,0 Gy e dose final de 45 a 72 Gy. O volume salivar foi medido nos dias um, 15, ao final do tratamento e após 15 e 30 dias, e a mucosite oral em avaliações semanais. Vinte e nove pacientes se submeteram a radioterapia sem laser e 31 foram submetidos a radioterapia e laser com dose diária de 2 joules/cm² em pontos pré-determinados da mucosa oral e glândulas parótida e submandibular. RESULTADOS: No grupo submetido a radioterapia e laser, a incidência de mucosite (p < 0,001) e dor (p < 0,016) foram significativamente menores e o volume salivar se manteve maior (p < 0,001) durante e após o tratamento. CONCLUSAO: Os pacientes submetidos à associação de radioterapia e laser tiveram menor incidência de xerostomia, mucosite oral e dor quando comparados ao grupo de radioterapia sem laser, com resultados com significância estatística.

Fluxo salivar e consumo de medicamentos em diabéticos idosos / Salivary flow and consumer of drugs in elderly diabetic patients

O ojetivo deste estudo foi avaliar a função das glândulas salivares e consumo de medicamentos em diabéticos idosos. Foram selecionados 50 indivíduos diabéticos e 50 não diabéticos, com 60 anos ou mais de idade. Determinou-se a taxa de fluxo salivar total de repouso e estimulado, presença de xerosstomia e tipos de medicamentos consumidos. Utilizou-se teste T de Student e Coeficiente de Pearson, com nível de significância para p<0,05. A média de idade foi 68+ou- 6,6 anos nos diabéticos e 66+ou- 5,6 anos nos controles. 26 por cento dos pacientes eram homens e 74 por cento mulheres, em ambos grupos. Os diabéticos apresentaram média de fluxo salivar em repouso de 0,27+ou- 0,26 ml/min e os controles de 0,32+ou- 0,27ml/min. Nos diabéticos a média do fluxo salivar estimulado foi 1,58+ou- 0,84 ml/min e nos controles foi 1,91+ou- 0,98ml/min, não houve diferrenças estatisticamente significantes. 22 por cento dos diabéticos e 14 por cento dos controles apresentaram hipossalivação. 81,8 por cento dos diabéticos e 42,8 por cento dos controles apresentaram hipossalivação e xerostomia de forma concomitante. Nos diabéticos houve correlação estatisticamente significante do fluxo salivar em repouso com xerostomia e com o consumo de hipotensores/diuréticos. Os resultados sugerem que os pacientes diabéticos estudados não apresentaram disfunção das glândulas salivares; a hipossalivação estava correlacionada ao consumo de hipotensores/diuréticos; e o fluxo salivar em repouso estava relacionado com xerostomia e consumo de hipotensores/diuréticos