Características salivales y estado sistémico de sujetos con xerostomía / Salivary characteristics and systemic status of subjects with xerostomia

RESUMEN: Xerostomía o sensación de boca es una afección que afecta severamente la calidad de vida de quienes la padecen. Si bien se relaciona con la reducción del flujo salival (hiposalivación), existe evidencia contradictoria y se sugiere evaluar características cualitativas salivales y estado sistémico de los afectados para comprender su etiología y mejorar terapias asociadas. El objetivo de este estudio fue comparar pH y concentración de proteínas en saliva y estado sistémico entre sujetos xerostómicos con y sin hiposialia. Se midió pH, concentración de proteínas salivales y se consignaron antecedentes sistémicos y uso de fármacos en 27 individuos xerostómicos, que fueron divididos en hiposiálicos y no hiposiálicos. Se compararon las variables mencionadas usando test no paramétrico de Mann-Whitney y test Chi-Cuadrado. Se aceptaron diferencias estadísticamente significativas con error alfa igual o menor a 5 %. Sujetos xerostómicos con hiposialia presentaron mayor prevalencia de Artritis Reumatoide y Síndrome de Sjögren en comparación con xerostómicos sin hiposialia. No se encontraron diferencias estadísticamente significativas en relación a pH, concentración de proteínas y uso de medicamentos, variables que no influirían en el padecimiento de xerostomía, independiente de la existencia de hiposialia. Sujetos con xerostomía e hiposialia presentan mayor frecuencia de Artritis Reumatoide y Síndrome de Sjögren.

ABSTRACT: Xerostomia or mouth feeling is a condition that severely affects the quality of life of thosewho suffer from it. Although it is related to the reduction of salivary flow (hyposalivation),there is contradictory evidence and it is suggested to evaluate qualitative salivarycharacteristics and systemic state of those affected in order to understand its etiology and improve associated terapies. The objective of this study was to compare saliva, pH and protein concentration and systemic status among xerostomic subjects with and without hyposialia. Were measured PH and protein concentration and were recorded systemic antecedents and drug use in 27 xerostomic individuals, who were divided into hyposalic and nonhyposalic individuals. The mentioned variables were compared using non-parametric Mann-Whitney test and Chi-Square test. Statistically significant differences were accepted with alpha error equal to or less than 0.05%. Xerostomic subjects with hyposialia presented higher prevalence of Rheumatoid Arthritis and Sjögren's Syndrome compared to xerostomics without hyposialia. No statistically significant differences were found in relation to pH, protein concentration and drug use, variables that would not influence xerostomia, independent of hyposialia. Subjects with xerostomia with hyposialia present a higher frequency of Rheumatoid Arthritis and Sjögren's Syndrome.

Risk factors, hyposalivation and impact of xerostomia on oral health-related quality of life

Abstract To determine xerostomia-related frequency, factors, salivary flow rates and Oral Health-Related Quality of Life (OHRQoL) of patients attending the Universidad Andrés Bello Dental School Clinic, in the city of Viña del Mar, Chile. The study involved 566 patients assessed with xerostomia, based on a single standardized questionnaire. The severity and impact of xerostomia on OHRQoL was assessed using a visual analogue scale (VAS) and the short version of the Oral Health Impact Profile Questionnaire (OHIP-14sp), respectively. Stimulated and non-stimulated salivary flow rates were obtained from a sample of patients. Xerostomia was reported in 61 patients (10.8%), comprising 50 women (83.3%) and 11 men (16.7%) (p < 0.013). The prevalence was 13% among the women and 6.1% among the men. Gender, age and medication were found to be independent risk factors for the development of xerostomia. Hyposalivation was found in 10 of the 35 patients with xerostomia (28.6%) and in 2 patients without it (p < 0.011). Patients with xerostomia had a reduced OHRQoL, compared with patients without xerostomia, as shown by the total OHIP-14sp score (p < 0.001). Xerostomia was a common, potentially debilitating condition with a major impact on the OHRQoL of a patient population attending a university-based dental clinic. Hyposalivation was present in almost 30% of the patients who complained of xerostomia. It is important that general dentists be aware of this condition, so that they can provide patients with a good diagnosis, treatment and follow-up.

The role of xerostomia in burning mouth syndrome: a case-control study / O papel da xerostomia na sindrome da ardencia bucal: estudo caso controle

Objective : To assess the efficacy of anti-xerostomic topical medication (urea 10%) in patients with burning mouth syndrome (BMS). Method : Thirty-eight subjects diagnosed with BMS according to the International Association for the Study of Pain guidelines were randomized to either placebo (5% sodium carboxymethylcellulose, 0.15% methyl paraben, and 10% glycerol in distilled water qsp 100 g) or treatment (urea 10%) to be applied to the oral cavity 3-4 times per day for 3 months. The patients were evaluated before and after treatment with the following instruments: the EDOF-HC protocol (Orofacial Pain Clinic – Hospital das Clínicas), a xerostomia questionnaire, and quantitative sensory testing. Results : There were no differences in salivary flow or gustative, olfactory, or sensory thresholds (P>0.05). Fifteen (60%) patients reported improvement with the treatments (P=0.336). Conclusion : In conclusion, there were no differences between groups, and both exhibited an association between reported improvement and salivation. .

Objetivo : Avaliar a eficácia do uso de medicação tópica anti xerostomica (ureia 10%) em pacientes com síndrome de ardência bucal. Método : Trinta e oito sujeitos diagnosticados com síndrome de ardência bucal de acordo com os critérios da Associação Internacional para Estudo da Dor foram randomizados para grupo placebo (5% de carboximetilcelulose de sódio, 0,15% de metilparabeno e 10% de glicerol em água destilada qsp 100g) ou grupo tratamento (ureia 10%) para ser aplicada na cavidade oral 3-4 vezes ao dia, durante três meses. Os pacientes foram avaliados antes e depois do tratamento: protocolo EDOF-HC, questionário de xerostomia, testes sensitivos quantitativos. Resultados : Não houve diferenças no fluxo salivar, limiares gustativos, olfativos e somestésicos (Mann-Whitney P>0,05). Quinze (60%) dos pacientes tiveram melhora com o tratamento (P=0,336, oneway ANOVA ). Conclusão : Em conclusão não houve diferenças entre os grupos, ambos apresentaram uma associação entre melhora e salivação. .

Hiposialia por activación de receptores de cannabinoides en la glándula submaxilar: revisión / Hyposialia by cannabinoid receptors activation in the submandibular gland: a review

El presente trabajo aporta evidencia de la presencia de receptores de cannabinoides en la glándula submaxilar de la rata, cuya expresión secircunscribe a componentes acinares y ductales. A su vez, los resultados expuestos confirman la participación de los receptores de cannabinoides en el control de la secreción salival, y por ende aportan una explicación empírica a la hiposialia observada luego del consumo de marihuana

The present study provides evidence for the presence of cannabinoid receptors in rat submandibular gland, whose expression is restricted to acinar and ductal components. In turn, the presented results confirm the involvement of cannabinoid receptors in the control of salivary secretion, and thus provide an empirical explanation to hyposialia observed after marijuana consumption.

Clinical diagnosis of hyposalivation in hospitalized patients

OBJECTIVE: The aim of this study was to evaluate the effectiveness of clinical criteria for the diagnosis of hyposalivation in hospitalized patients. MATERIAL AND METHODS: A clinical study was carried out on 145 subjects (48 males; 97 females; aged 20 to 90 years). Each subject was clinically examined, in the morning and in the afternoon, along 1 day. A focused anamnesis allowed identifying symptoms of hyposalivation, like xerostomia complaints (considered as a reference symptom), chewing difficulty, dysphagia and increased frequency of liquid intake. Afterwards, dryness of the mucosa of the cheecks and floor of the mouth, as well as salivary secretion during parotid gland stimulation were assessed during oral examination. RESULTS: Results obtained with Chi-square tests showed that 71 patients (48.9%) presented xerostomia complaints, with a significant correlation with all hyposalivation symptoms (p <0.05). Furthermore, xerostomia was also significantly correlated with all data obtained during oral examination in both periods of evaluation (p<0.05). CONCLUSION: Clinical diagnosis of hyposalivation in hospitalized patients is feasible and can provide an immediate and appropriate therapy avoiding further problems and improving their quality of life.

Boca seca, mucositis, problemas dentales y del gusto en la alimentación del niño con cáncer / Dry mouth, mucositis, dental problems and taste power in children with cancer

En niños con cáncer, la quimioterapia y la radioterapia de ciertos tumores de cabeza y cuello, reducen la producción de saliva generando sensación de boca seca, ulceraciones bucales y mucositis. Los problemas dentales se resumen en caries, boca seca y endurecimiento de los músculos de la cara. Así mismo, la quimioterapia, la radiación y el cáncer mismo, ocasionan cambios en el sentido del gusto del niño con cáncer. Todos estas circunstancias se reflejan en el bajo consumo de nutrientes y desarrollo a futuro de desnutrición para lo cual es necesario estar alerta y proponer medidas preventivas.

In children with cáncer, chemotherapy and radiotherapy of ceratin tumors of the head and neck, reduce the production of saliva causing dry mouth, mouth ulcers and mucositis. Dental problems of children with cancer are summarized in caries, dry mouth and tightening of the muscles of the face. Likewise, chemotherapy, radiation and the cancer itself, cause changes in taste of the child with cancer. All these circumstances are reflected in the low nutrient intake and future development of malnutrition for which it is necessary to be vigilant and to suggestpreventive measures.

Effects on Salivation, Xerostomia and Halitosis in Elders after Oral Function Improvement Exercises

PURPOSE: The purpose of this study was to investigate effects of Oral Function Improvement Exercises on salivation, xerostomia and halitosis in elderly people. METHODS: The participants in the study were 48 female community-dwelling elders in D city. The Oral Function Improvement Exercises were given 3 times a week, for a total of 24 times from August to October 2011. Spitting method, Visual Analogue Scale, and halimeter (mBA-21) were used to evaluate the effects of Oral Function Improvement Exercises on salivation, xerostomia, and halitosis. The data were analyzed using chi2-test and t-test with the SPSS program. RESULTS: The experimental group had significantly better salivation, and less xerostomia and halitosis than the control group. CONCLUSION: The results indicate that Oral Function Improvement Exercises were effective for salivation, xerostomia and halitosis in the elders. Therefore, it was suggested that Oral Function Improvement Exercise are applicable in a community nursing intervention program to improve the quality of life for elders.

Effect of hyposalivation on mastication and mandibular movements during speech

The aim of this study was to evaluate whether patients with hyposalivation present damaged mastication or mandibular movements during speech. Forty subjects composed 2 groups: control and hyposalivation. Masticatory performance was assessed with a silicon-based artificial material and a 10-sieve method. Mandibular movements during speech were observed with a 3D jaw-tracking device. Data were analyzed with Student's t-test or the Mann-Whitney method (P < 0.05). The masticatory performance (mm) of control and hyposalivation were 4.40 ± 0.62 and 4.74 ± 1.34, respectively. Outcomes for speech movements (mm) were as follows: maximum vertical opening amplitude (10.8 ± 4.2; 9.9 ± 2.7) and displacements to the right (1.0 ± 0.8; 0.5 ± 0.6), left (1.8 ± 1.4; 2.3 ± 1.2), or anterior-posterior (2.8 ± 1.1; 2.9 ± 1.0) for control and hyposalivation, respectively. No statistical difference was found between groups for any variable. The results indicated that hyposalivation did not affect masticatory performance or mandibular movements during speech.

Use of graduated syringes for measuring salivary flow rate: a pilot study

The evaluation of the salivary flow rate is important in several situations of dental practice. However, weighing the collected salivary volume it is not a practical method in public health services. This work evaluated the use of hypodermic graduated syringes as a simpler alternative method to measure the salivary flow rate. Saliva samples were obtained from 50 individuals (31 females and 19 males) aged 8 to 32 years (mean age: 12.4 years), recruited at the outpatient dental clinics of two public health centers. After collection, the saliva was weighed in a graduated scale and the results compared with the volume obtained through its measurement, in mL, in graduated hypodermic syringes. There was a positive and significant relationship between the two methods of measuring salivary flow rates as demonstrated by the Pearson's correlation coefficient (r = 0.996, with p<0.05). Measurement of the salivary flow rate using graduated syringes demonstrated to be a reliable method, with lower cost and more practical than the traditional method of salivary weighing.

A avaliação do fluxo salivar é importante em várias situações da prática odontológica. Porém, sua mensuração é habitualmente realizada através da pesagem do volume coletado, o que não é prático na rede pública de saúde. Esse trabalho teve por objetivo avaliar o uso de seringas hipodérmicas graduadas como alternativa mais simples para mensurar o fluxo salivar. Foram analisadas amostras de saliva de 50 indivíduos (31 mulheres e 19 homens) com idades entre 8 e 32 anos (média:12,4 anos) saudáveis, recrutados no ambulatório de odontologia de dois centros da rede pública de saúde. Após a coleta, a saliva foi pesada numa balança analítica de precisão e comparada com o volume aferido através de sua mensuração em mililitros obtido com o uso de seringas hipodérmicas graduadas. O coeficiente de correlação de Pearson mostrou a existência de uma associação positiva e significativa entre os dois métodos de mensuração do fluxo salivar (r = 0,996; p<0,05). Neste estudo-piloto, a medida do fluxo salivar utilizando seringas graduadas mostrou-se um método confiável, de baixo custo e mais prático que o método tradicional de pesagem salivar.

Alterações de glândulas salivares em pacientes com hepatite C crônica / Salivary glands disorders in patients with chronic hepatitis C

Introdução. O sialotropismo do HCV tem sido relacionado com a patogênese de manifestações extra-hepáticas, como xerostomia e sialoadenite, em pacientes com hepatite C crônica. O objetivo do presente estudo foi investigar a prevalência do HCV RNA na saliva e em glândulas salivares e suas possíveis associações com xerostomia, hipossalivação e sialiadenite em pacientes com hepatite C crônica. Metodologia. 136 pacientes com diagnóstico confirmado de hapatite C crônica (anti- HCV e HCV PCR positivos) foram incluídos neste estudo transversal, sendo critérios de exclusão a co-infecção pelo HIV e/ou HBV e pacientes em tratamento para a hepatite C crônica. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da UFMG. HCV RNA foi investigado por meio de nested-RT-PCR em amostras de saliva de todos os pacientes e em amostras de glândulas salivares de 65 pacientes. A presença de xerostomia foi avaliada, e os fluxos salivares não estimulado (FSNE) e estimado (FSE) foram mensurados. FSNE e FSE ≤ 0,1ml/min e ≤ 0,7ml/min respectivamente, foram considerados como hipossalivação. Sintomas e sinais clínicos de sialoadenite e a presença histológica de infiltrado inflamatório na glândula salivar de lábio inferior foram também avaliados. Exames intra-bucais foram realizados em todos os pacientes. As possíveis associações entre as diferentes variáveis, incluindo dados demográficos e história médica dos pacientes, foram ivestigadas pelas análises uni e multivariada, usando os programas Stata 10.0 e EPIINFO 3.4.3. Resultados. A amostra foi composta por 71 (52,2%) homens e 65 (47,8%) mulheres, com média de idade de 58,1 anos. Xerostomia foi relatada em 48/136 (35,3%) pacientes. Hipossalivação foi observada em 16 (11,8%) amostras de saliva de 53/136 (39.0%) pacientes e nas glândulas salivares de 12/65 pacientes...

Lesiones bucales en niños VIH/Sida y su relación con linfocitos CD4 y carga viral: Valencia / Mouth injuries in children with HIV/AIDS and their relation with CD4 limphocytes and viral load

El 90 por ciento de los pacientes VIH-SIDA presentan lesiones bucales durante el curso de la enfermedad, observándose en la mayoría de los niños en las etapas iniciales, lesiones muchas veces no imputables al VIH. Determinar las manifestaciones bucales y su relación con el porcentaje de linfocitos CD4 y la carga viral, en 40 niños VIH/SIDA que acudieron a la consulta de infectología y odontología pediátrica de la Ciudad Hospitalaria “Dr. Enrique Tejera”. A través de un estudio descriptivo y de campo, se analizaron las variables, edad, género, categoría clínico-inmunológica, manifestaciones en tejidos blandos y duros, porcentaje de linfocitos CD4 y carga viral. El grupo de niños más afectado fue el de 1 a 6 años y el género femenino. La categoría clínica inmunológica más frecuente fue la B2 y la C3. En 65 por ciento hubo caries y en 80 por ciento lesión de tejidos blandos. La lesión bucal más común fue: adenopatías 57.5 por ciento, seguida de candidiasis 30 por ciento, y en igual proporción (17,5 por ciento) afta-úlceras y gingivitis; parotiditis y xerostomía 12.5 por ciento, herpes oral y petequias 10 por ciento, queilitis 7.5 por ciento, leucoplasia vellosa y eritema gingival lineal 2.5 por ciento. Independientemente del porcentaje de CD4 y carga viral, se evidenciaron manifestaciones bucales en tejidos duros y blandos, en una frecuencia relativamente alta, de allí la imperiosa necesidad de institucionalizar los programas de atención odontológica, así como la instrucción, sensibilización y motivación a los padres, representantes y personal de salud en el área pediátrica, sobre la importancia de la salud bucal en los niños VIH/SIDA.

90 percent of the childrens infected with VIH-AIDS may be at increased risk of experiencing oral lesions during the course of the illness, principally at the initial stage, the most of these lesions were not associated to HIV. To determine the oral manifestations and their relation with the percentage of lymphocytes CD4 and the viral load, in 40 children being treated for HIV-infection of the Paediatric Infection and Dentistry Service at the “Ciudad Hospitalaria Dr. Enrique Tejera.”. By means of a descriptive study of field, the variables age, gender, immunological clinical category, soft and hard tissue manifestations, percentage of lymphocytes CD4, and viral load were analyzed. The childrens more affected were the group of 1 to 6 years old and in feminine gender. The most frequent immunological clinical category was the B2 and the C3. In 65 percent there was dental caries, and in 80 percent soft oral lesion. The most common oral manifestation was adenopaty 57,5 percent, followed of candidacies 30 percent, and in equal proportion 17.5 percent aphthous ulcerations, and gingival erythema, parotid en largement and xerostomia 12,5 percent, herpes oral and petechiae 10 percent, cheilitis 7,5 percent, hairy leukoplakia and gingival erythema linear 2.5 percent. Independently of percentage CD4 and the viral load, oral manifestations on hard tissue were recorded as much as in soft tissue. The hard and soft weave injuries were relatively high, consequently, the urgent necessity to institutionalize preventive and therapeutic dental program, and also the education, sensibilization and motivation to parents, representatives and health personnel in the paediatric area; about the importance of oral health in HIV/AIDS children.

Minor salivary glands morphology in xerostomia patients / Morfología de las Glándulas Salivales Menores en Pacientes Xerostomizados

Las glándulas salivales menores son encontradas distribuidas a través de la mucosa oral, especialmente en los labios y en la mucosa del paladar blando. Varios factores pueden causar xerostomía, donde las características histológicas de las glándulas salivales son también consideradas como factores para definir la etiología. Así, las biopsias de las glándulas salivales menores representan una herramienta fundamental para alcanzar los criterios diagnósticos requeridos en la clasificación de pacientes con síndrome de Sjõgren, ya que no representa riesgo para los pacientes. El objetivo de este estudio es determinar las características histológicas de las glándulas mencionadas, obtenidas de biopsias de pacientes con xerostomía y clasificar los aspectos histológicos de las glándulas en el síndrome de Sjõgren. Estudiamos 40 láminas de pacientes con xerostomía, cuyas glándulas salivales menores fueron sometidas a biopsia en el Servicio de Estomatología de la Santa Casa de São Paulo, Brasil. Se observaron las variaciones de su aspecto histológico, desde la normalidad hasta la presencia de focos inflamatorios, los cambios del tejido conjuntivo entre los acinos y conductos, como también el parénquima. En 15 casos, el infltrado de células inflamatorias invadió el foco, es decir, grupos de al menos 50 células inflamatorias alrededor de acinos o conductos, lo cual es un aspecto característico del síndrome de Sjõgren. Por lo tanto, el hallazgo de al menos un foco inflamatorio de 4 mm2 de tejido glandular, representa un buen criterio, aunque no es uno de los criterios a considerar cuando se trata de clasificar a los pacientes con el Síndrome de Sjõgren.

The minor salivary glands are found scattered throughout the oral mucosa, especially in the lips and soft palate mucosa. Several factors can cause xerostomia, whereas the salivary glands histological characteristics are also considered as factors for defining the etiology. Thus, the minor salivary glands biopsy represents an essential tool for attending the required diagnosis criterion in the classification of Sjögren's Syndrome patients, since it does not present risk for the patient. The objective of this study is to determine the histological description of the minor salivary glands obtained from the biopsies of xerostomia patients and to classify the minor salivary gland histological aspect as the Sjögren's Syndrome. Forty laminas of xerostomia patients that were submitted to minor salivary glands biopsy at the Santa Casa de Sao Paulo Stomatology ambulatory were retrospectively studied. The variation in the glands histological aspect was observed, from the normality up to the presence of inflammatory focus, replacing the conjunctive between acini and ducts, as well as the parenchyma. In 15 cases, the infiltrated inflammatory cells amounted to focus, that is to say, groups of at least 50 inflammatory cells around the acini or ducts, which is a characteristic aspect of the Sjögren's Syndrome. Therefore, the finding of at least one inflammatory focus of 4 mm2 of glandular tissue represents a set criterion, although, not the only one in order to classify this patient as having the Sjögren's Syndrome.

Influência da xerostomia na transmissibilidade de Candida albicans na cavidade bucal de ratos / Effects of xerostomia in the transmissibility of Candida albicans in the oral cavity of rats

A xerostomia produzida pela sialoadenectomia em ratos aumenta a colonizaçäo, permanência e patogenicidade da Candida albicans na cavidade bucal destes animais. O objetivo deste trabalho foi verificar se ratos xerostômicos transmitem Candida albicans para ratos normais com maior intensidade. Foram usados 10 ratos normais e 12 sialoadenectomizados que receberam 12 inoculaçöes semanais contendo 10(8) células de Candida albicans desde 10 até sessenta dias de idade. Após as inoculaçöes, os ratos foram emparelhados com 10 (grupo controle) e 12 (grupo experimental) ratos normais de mesma idade respectivamente. A quantidade de ratos que passaram a apresentar Candida foi maior no grupo experimental três a vinte e oito dias após o emparelhamento, apresentado 83,3 por cento de recuperaçäo após 10,75 por cento após quatorze e dezoito dias, e 100 por cento após vinte e um dias. A transmissibilidade de C. albicans foi mais rápida e acentuada portanto, a partir dos animais sialoadenectomizados

III. Xerostomía: cambios estomatológicos funcionales, involutivos y patológicos con la edad / III. Xerostomy: functional, involutive and pathological changes with aging

El presente artículo es el tercero de una serie de investigaciones clínicas sobre los cambios bucales y envejecimiento. Se presentan y se discuten aspectos relacionados con la sensación xerostómica, en relación a diferentes grupos de edad

Imágenes sialográficas parotídeas en pacientes con síndrome de Sicca, síndrome de Sjögren y enfermedades del mesénquima / Sialographic study of parotides in patients with Sicca syndrome, Sjögren syndrome and collagen diseases

Se presenta el estudio sialográfico de 160 pacientes con síndrome sicca, síndrome de Sjögren y enfermedades del mesénquima con el fin de establecer las imágenes de llene glandular parotídeas, cuando se encuentran asociadas y no asociadas entre sí. Mediante sialografía con técnica manual, con medio de contraste liposoluble y sin usar estimulantes de la secreción salival se determina que las enfermedades del colágeno asociadas con síndrome sicca, asociación que constituye el clásico síndrome de Sjögren, presentan las imágenes de esta última afección. Por el contrario, las enfermedades del mesénquima no asociadas a síndrome sicca, tienen imágenes normales.. Sólo la esclerosis sistémica parece tener una sialectasia típica, de tipo fusiforme, ya que dicha alteración morfológica no ha sido descrita en el síndrome sicca ni en las otras enfermedades del colágeno, aunque si en pacientes con esclerosis sistémica asociada con síndrome sicca