Prospective study on health-related quality of life, oral mucositis and oral health on during treatment of head and neck cancer.

BACKGROUND: Few studies have examined health related Quality of Life (HR-QoL) during the treatment of head and neck cancer (HNC) with even fewer focusing on the impact of oral mucositis (OM) on HR-QoL. Studies performed during treatment of HNC makes it possible to follow fluctuations in HR-QoL, OM and other treatment related side effects. The aim was to prospectively analyze HR-QoL, changes in clinical variables and the impact of OM on HR-QoL during HNC treatment. MATERIALS AND METHODS: Patients were recruited before commencing curative cancer treatment and were given professional oral care weekly during oncologic treatment. HR-QoL was reported before, during (week 2, 4 and 6) and three months after treatment using the EORTC Quality of Life questionnaires C30 and H&N35 and the stimulated whole salivary secretion rate was determined at the same time-points. OM (erythema and ulceration) was registered using the Oral Mucositis Assessment Scale (OMAS), at baseline, weekly during treatment and post treatment. Differences in HR-QoL between different timepoints were analyzed. To analyze the impact of OM on HR-QoL the patients were categorized into two groups: no/mild OM (OMAS ulceration score 0-1) or severe OM (OMAS ulceration score ≥ 2) and HR-QoL was compared between the two OM groups at three timepoints during treatment. RESULTS: Fifty-seven patients (43 men, 14 women), with a mean age of 58 years were included. Patients reported progressively impaired HR-QoL, with peak issues noted at weeks 4 and 6, particularly in social eating, senses, appetite loss, sticky saliva, and decreasing salivary secretion rates were determined. Patients with severe OM reported worse HR-QoL compared to those with no/mild OM. Persistent problems 3 months post treatment were appetite loss, dry mouth, senses (smell and taste) and problems with social eating. CONCLUSION: Patients experienced exacerbated symptoms and problems weeks 4 and 6 of oncological treatment, especially among those with severe OM, stressing the importance of clinically monitoring the patients to reduce and alleviate their symptoms. Persistent problems three months post treatment are likely associated with the reduced salivary secretion rate indicating that patients should be monitored also after completed oncological treatment.

Oral health, dental treatment, and medication related osteonecrosis of the jaw in multiple myeloma - a longitudinal cohort study.

OBJECTIVE: The objective of the present study was to investigate oral health status, oral health related quality of life, and identify risk factors associated with invasive dental treatment and medication related osteonecrosis of the jaw in patients with multiple myeloma. MATERIAL AND METHODS: Patients newly diagnosed with multiple myeloma (n = 144) referred between January 2015 and September 2022 were retrospectively included. The patients underwent a thorough clinical and radiological oral examination and odontogenic infections were treated before the start of bisphosphonate treatment. The patients were followed annually, including clinical and radiological examinations. The oral health related quality of life was investigated by the OHIP-14 questionnaire. RESULTS: Dental treatment (RR = 7.75), receiving combination antineoplastic therapy≥3 (RR =4.13), periodontitis (RR = 4.21), and reduced number of teeth (RR = 2.87) were associated with an increased risk of medication related osteonecrosis of the jaw. The response rate of the OHIP-14 questionnaire was 70.2%. Oral pain or discomfort in the mouth related to the medical treatment was reported by 30.5%. CONCLUSION: Dental screening and treatment planning in patients with Multiple Myeloma may result in fewer oral infections and fewer interruptions of the medical treatment of myeloma.

Dental care professionals' awareness of oral dryness and its clinical management: a questionnaire-based study.

BACKGROUND: Despite the high prevalence of oral dryness and awareness of its complications, there is limited research on the clinical management of patients with oral dryness in general dental care. PURPOSE: To (1) describe and compare awareness among dental care professionals regarding saliva functions, potential causes and complications of oral dryness, and patient management (2) Investigate if the length of professional experience influences these aspects. METHODS: A digital self-administrated survey was sent to 2668 dental care professionals working in the general dental care, Public Dental Service, in Sweden. Twelve dental care professionals reviewed the questionnaire prior to its distribution. The questionnaire comprised 32 questions about patient management, awareness of saliva functions, causes and complications of oral dryness, and self-assessment queries. RESULTS: The response rate was 18.6% (241 dentists and 257 dental hygienists). Older adults (65+) were asked more often about dry mouth (93.0%) compared to those aged 18-23 years (50.0%) and those under 18 years (24.9%). Dental hygienists encountered individuals with oral dryness more frequently (61.1%) than dentists (48.5%) (p < 0.01), and more often asked individuals in the age groups 18-23 years (p = 0.003), 24-40 years (p = 0.045), and 41-65 years (p = 0.031) about dry mouth. A higher proportion of dental hygienists (88.3%) than dentists (51.0%) had measured salivary secretion rate, (p < 0.001) and more often suggested preventive dental care 3-4 times a year, (42.5% vs. 30.5%) (p < 0.007). Dentists had a higher awareness of saliva functions, while dental hygienists had a higher awareness about causes and complications of oral dryness. Higher proportions of dentists and dental hygienists with over 10 years of professional experience had measured salivary secretion rate (69.1% vs. 95.7%) compared to their counterparts with less than 10 years of professional experience (35.9% vs. 79.5%) (p < 0.001 for both). CONCLUSION: Compared to dentists, dental hygienists were more attentive to patients with oral dryness as they encountered these individuals more often, asked more age-groups, suggested frequent preventive measures, and had higher awareness of the causes and complications of oral dryness. Length of professional experience could improve both the management of patients with oral dryness and awareness of its causes, particularly for dental hygienists.

Salivary levels of Osteoprotegerin and receptor activator of nuclear factor-kappa ligand during orthodontic tooth movement-A prospective pilot study.

OBJECTIVES: The aim of this study was to monitor changes in Osteoprotegerin (OPG) and receptor activator of nuclear factor-kappa ligand (RANKL) levels in the saliva during orthodontic tooth movement (OTM). MATERIALS AND METHODS: Nine healthy females (15-20 y of age) with four pre-molar extractions and fixed appliance were included. In total, 134 stimulated and 134 unstimulated saliva samples were collected: at baseline and then every 6-8 weeks at follow-up appointments during the whole orthodontic treatment. Twelve age-matched females with no active orthodontic treatment served as a control group. Saliva samples were analysed by enzyme-linked immunosorbent assay (Elisa). The mean levels of OPG and RANKL were calculated according to the different orthodontic treatment stages: alignment, space closure and finishing. A mixed model analysis was used to compare the means of treatment stages. Baseline OPG levels were compared with the control group using an independent t-test. OPG levels were measured in stimulated saliva due to low levels in unstimulated saliva. RESULTS: No significant difference was observed between baseline OPG values and the control group. OPG increased significantly at all treatment stages: alignment, space closure and finishing compared with baseline (P = 0.002, P = 0.039, P ≤ 0.001, respectively). The salivary levels of OPG increased gradually, except during space closure, reaching peak levels at finishing. RANKL was undetectable in stimulated and unstimulated saliva by sandwich Elisa during OTM. CONCLUSIONS: This novel approach shows the changes in the levels of OPG in OTM and indicates how and when to sample saliva during orthodontic treatment to analyse bone remodelling.

Patients with oral lichen planus display lower levels of salivary acidic glycoproteins than individuals without oral mucosal disease.

OBJECTIVES: Salivary proteins, acidic glycoproteins, and free calcium might take part in oral mucosal defence against inflammation in oral lichen planus (OLP). The study aimed to investigate whether the levels of sulfated and sialylated glycoproteins, total protein, and free calcium in saliva from patients with OLP differ from those of individuals without oral mucosal diseases. MATERIAL AND METHODS: Patients diagnosed with OLP (n = 25) and two control groups without any oral mucosal disease; age- and gender-matched controls (n = 25, 65.6 ± 2.9 years), and younger controls (n = 25, 41.8 ± 2.5 years) were included. Subjective dry mouth (xerostomia) was assessed by asking a single-item question. Chew-stimulated whole saliva was collected to measure sulfated and sialylated glycoproteins by the Alcian Blue method. The total protein was determined spectrophotometrically, and the free calcium measured using an electrode. RESULTS: The output of salivary sulfated and sialylated glycoproteins in the OLP group (21.8 ± 2.4 µg/min) was lower than in the age- and gender-matched controls (43.0 ± 2.9 µg/min, p = 0.0002), whereas the total protein and calcium output did not differ between the three groups (p > 0.05). The prevalence of xerostomia was significantly higher in the OLP group compared to both control groups (p = 0.038). CONCLUSIONS: Patients with OLP showed a high prevalence of xerostomia and lower levels of salivary acidic type glycoproteins compared to the individuals without oral mucosa disease. CLINICAL RELEVANCE: It is relevant to investigate the role of acidic glycoproteins in the pathogenesis of OLP.

Stimulated saliva composition in patients with cancer of the head and neck region.

BACKGROUND: To analyse over time changes in stimulated whole saliva regarding total protein, Immunoglobulin A (IgA), and mucin type O-glycans (mostly MUC5B and MUC7) in head and neck cancer patients. METHODS: 29 dentate patients (20 men and 9 women, 59 ± 8 years) treated with curative radiation therapy and chemotherapy for cancer of the head and neck region were included. The stimulated whole salivary secretion rate was determined and saliva collected at four time-points: at pretreatment, and at 6 months, 1 and 2 years post treatment. The total protein concentration was determined spectrophotometrically by using Bicinchoninic Acid assay and Immunoglobulin A (IgA) by using ELISA technique. Glycosylation pattern of salivary mucins was determined in samples collected pre- and post treatment by using LC/MS electrospray and mucin content quantified using SDS-AgPAGE gels and PAS staining. RESULTS: Compared with pretreatment, the total protein concentration was increased already at 6 months post treatment (p < 0.01), and continued to increase up to 2 years post treatment (p < 0.001). During that period no significant changes in IgA concentration was detected. At pretreatment, the output/min of both total protein and IgA was significantly higher than at all time-points post treatment. Saliva from the cancer patients showed a low abundance/no detectable MUC7, while the MUC5B level remained, compared to saliva from a healthy control. The glycomic analysis showed that the percentage of core 2 O-glycans was increased as core 1, 3 and 4 O-glycans were decreased. The level of sialylation was higher at 6 months post treatment, while sulfation was lower. CONCLUSION: A decreased output per minute of proteins at decreased salivary secretion rate, as well as reduced sulfation of MUC5B at 6 months post treatment tended to correlate with the patients' experience of sticky saliva and oral dryness. At 2 years post treatment, the decreased amount of IgA combined with a lowered salivary secretion rate indicate a reduced oral defense with increased risk of oral infections.

Explorative study on Lactobacillus species and their acid-producing capacity and anti-microbial activity in head and neck cancer patients.

OBJECTIVE: To determine acid-producing capacity and anti-microbial activity of Lactobacillus species collected pretreatment and post treatment in head and neck cancer patients. MATERIAL AND METHODS: Lactobacillus isolates from 21 patients pretreatment and post treatment were identified using molecular methods. The patients' stimulated salivary secretion was determined pretreatment, and 6 and 12 months post treatment and caries lesions/new filled surfaces registered at 24 months post treatment. The acid-producing capacity of the Lactobacillus isolate was analyzed using a colorimetric fermentation test in microtiter plates. The anti-microbial activity of the isolates against Streptococcus mutans associated with caries, and against the mucosal pathogens Staphylococcus aureus, Candida albicans, and Enterococcus faecalis was analyzed by determining inhibitory zones on agar plates. RESULTS: The most frequent species were L. paracasei (n = 21), L. casei/rhamnosus (n = 17) and L. fermentum (n = 10). Sixty-seven percent of the patients harbored L. paracasei either at 6 or 12 months post radiotherapy. The corresponding figures for L. casei/rhamnosus and L. fermentum were 62% and 33%. L. paracasei strains showed the best acid-producing capacity and L. fermentum strains the lowest. Strong acid-producing capacity was most common among isolates collected at 6 months post treatment. Seventy-two percent of the strains showed an anti-microbial activity against S. mutans, one strain against S. aureus and none against C. albicans or E. faecalis. CONCLUSION: The most frequent species isolated from head and neck cancer patients both pretreatment and post treatment were L. paracasei, L. casei/rhamnosus, and L. fermentum. L. paracasei showed the best acid-producing capacity and the highest proportion with anti-microbial activity against S. mutans.

Variations in odontological care routines for patients undergoing treatment for head and neck cancer in county councils/regions of Sweden.

OBJECTIVE: To investigate current odontological care routines for patients treated for head and neck cancers in the county councils/regions (C/Rs) of Sweden. METHODS: An invitation to fill in a web-based questionnaire was sent to dentists/dental hygienists working in dental clinics in the 12 C/Rs, treating and responsible for the odontological care of patients undergoing treatment for cancer of the head and neck. The questionnaire started with two mandatory and one non-mandatory questions, followed by questions regarding routines before (n = 28), during (n = 23), and after (n = 9) treatment, plus two additional questions, totalling 65 questions. RESULTS: Four dental hygienists and six dentists in 10 of the 12 C/Rs answered the questionnaire. Three C/Rs stated that they measure both the unstimulated and stimulated salivary secretion rate, and another C/R stated that they measure the stimulated secretion rate only. Similar recommendations were given regarding oral hygiene, salivary stimulants and substitutes, and extra fluoride. However, great variations were seen regarding recommendations for preventing and relieving oral mucositis. There were also discrepancies regarding information about the importance of avoiding smoking and alcohol. In seven C/Rs, patients visited the dental hygienist once a week during cancer treatment. CONCLUSION: The results suggests that there are great variations in odontological care given to patients undergoing treatment for cancer of the head and neck region in different county councils/regions in Sweden. There is a need to develop and implement evidence-based guidelines to decrease the risk of oral complications and increase both the quality of life and the quality of care.

Explorative study on quality of life in relation to salivary secretion rate in head and neck cancer patients treated with radiotherapy up to 2 years post treatment.

OBJECTIVE: The aim of this study was to analyse quality of life (QoL) pretreatment and up to 24 months post radiation therapy (RT) in patients with head and neck (H&N) cancer. METHODS: Twenty-nine patients (19 men and 10 women) with a mean age of 59 ± 8 years were included. The stimulated salivary secretion was measured and the patients completed the European Organisation for Research and Treatment of Cancer Quality of Life questionnaires (EORTC QLQ-C30 and H&N35) and the Hospital Anxiety and Depression scale (HADS) pretreatment and at 6, 12 and 24 months post RT. RESULTS: At all time-points after RT (6, 12, and 24 months), patients with hyposalivation (stimulated secretion rate ≤0.7 mL/min) reported clinically significant differences (> 10 points) regarding insomnia, swallowing, social eating, dry mouth, and sticky saliva. Statistically significant differences were found for emotional functioning and insomnia at 12 months (P < 0.05 for both) and for sticky saliva at both 12 and 24 months (P < 0.05 and P < 0.01). The number of clinically significant differences increased from 10 at both 6 and 12 months post-RT to 14 functioning/symptom scales and single items at the 24 months follow-up. At 24 months post RT, 21% of patients with hyposalivation had HADS scores suggesting anxiety problems compared to 7% for those with stimulated salivary secretion rates >0.7 mL/min. CONCLUSION: Patients with hyposalivation showed deterioration in health related quality of life (QoL) at 24 months compared with 12 months post RT. Most pronounced were problems with insomnia, swallowing, social eating, dry mouth, and sticky saliva.

Acid-producing capacity from sugars and sugar alcohols among Lactobacillus isolates collected in connection with radiation therapy.

OBJECTIVE: To investigate the acid-producing capacity from sugars and sugar alcohols of oral Lactobacillus collected in connection with radiation therapy (RT) to the head and neck region. DESIGN: Lactobacillus were collected from the tongue, buccal mucosa and supragingival plaque in 24 patients before, during, and after RT. The acid-producing capacity of Lactobacillus isolates (n=211) was analyzed using a colorimetric fermentation test in microtiter plates. Solutions containing 2% sugars (sucrose, glucose, fructose, lactose) or sugar-alcohols (sorbitol and xylitol) were used. After 24h of incubation, bacterial acid-producing capacity was determined as strong (pH<5), weak (pH ≥5-≤ 6) or low/absent (pH>6). Data regarding intake frequency of sugar-rich products and products with sugar-alcohols was collected. RESULTS: The highest acid-producing capacity using the sugars was seen for isolates collected during RT. Sorbitol was fermented to a higher extent during and post RT, especially among isolates from plaque. Lactobacillus fermenting xylitol showed the highest acid-producing capacity during RT (p<0.05). No statistically significant correlations between stimulated whole salivary secretion rate and acid-producing capacity, or between the intake frequency of sugar-rich products or sugar-alcohol containing products and Lactobacillus acid-producing capacity, were found. CONCLUSION: The results suggest that Lactobacillus isolates, collected from the tongue, buccal mucosa and supragingival plaque, have a higher acid-producing capacity using sugars and sugar-alcohols during RT than one year post RT.

Effect of 12-month weekly professional oral hygiene care on the composition of the oral flora in dentate, dependent elderly residents: A prospective study.

OBJECTIVE: To study the effect of weekly professional oral hygiene care on the proportion of micro-organisms associated with good oral health, caries, and periodontal and soft tissue diseases in oral biofilms in dentate, dependent elderly residents. BACKGROUND: Assisted oral hygiene care reduces the plaque score and number of micro-organisms in the oral biofilms in elderly residents. Less is known about the effect on the quality/composition of the remaining oral flora. MATERIALS AND METHODS: Participants comprised 33 residents in the study and 35 in the control group. Dental status (≥10 natural teeth and no removable dentures to be included), plaque score, salivary secretion rate and prescription medicines were recorded. Duplicate samples, collected from supragingival plaque and tongue, were analysed using cultivation technique. Differences between and within groups were analysed using one-way and two-way ANOVA, respectively. RESULTS: At the baseline, the number of teeth in the participants (mean age, 83.7 ± 7.4 years) was 22.0 ± 4.5. The number of prescription medicines was 9.4 ± 4.5. Seventy-six per cent had low salivary secretion rate. Fifty per cent had "visible thick" supragingival plaque. At the 12-month registration, "no visible" or "visible but thin" plaque was recorded in 92% in the study group. The proportions of bacteria associated with good oral health and periodontal diseases were decreased over time, while the frequency and proportions of micro-organisms associated with caries and soft tissue infection were unaffected or increased. CONCLUSION: The results indicate that assisted oral hygiene care alone is not sufficient to regain an oral microbial flora associated with good oral health in dentate, dependent elderly residents.

Oral Care and Mortality in Older Adults with Pneumonia in Hospitals or Nursing Homes: Systematic Review and Meta-Analysis.

The objectives of the study were to compare the effect of intensified oral care interventions given by dental or nursing personnel on mortality from healthcare-associated pneumonia (HAP) in elderly adults in hospitals or nursing homes with the effect of usual oral care. Systematic literature searches were conducted in PubMed, the Cochrane Library, and the Health Technology Assessment database of the National Health Service Centre for Reviews and Dissemination (August 2015). Randomized controlled trials (RCTs) were considered for inclusion. Data were extracted and risk of bias was assessed independently and agreed on in consensus meetings. Five RCTs, with some or major study limitations, fulfilled the inclusion criteria. Based on meta-analyses, oral care interventions given by dental personnel reduced mortality from HAP (risk ratio (RR) = 0.43, 95% confidence interval (CI) = 0.25-0.76, P = .003), whereas oral care interventions given by nursing personnel did not result in a statistically significant difference in mortality from HAP (RR = 1.20, 95% CI = 0.97-1.48, P = .09), in elderly adults in hospitals or nursing homes from usual oral care. Oral care interventions given by dental personnel may reduce mortality from HAP (low certainty of evidence, Grading of Recommendations Assessment, Development and Evaluation (GRADE) ⊕⊕○○), whereas oral care interventions given by nursing personnel probably result in little or no difference from usual care (moderate certainty of evidence, GRADE ⊕⊕⊕○) in elderly adults in hospitals or nursing homes.

Explorative study on quality of life in relation to salivary secretion rate in patients with head and neck cancer treated with radiotherapy.

BACKGROUND: Radiotherapy (RT) to the head and neck region often results in oral complications. In this explorative study, the pretreatment and posttreatment (6 months and 12 months) quality of life (QOL) was analyzed for patients with head and neck cancer. The associations between QOL and salivary secretion rates were analyzed. METHODS: In 29 patients (19 men and 10 women; mean age, 59 ± 8 years), the stimulated whole salivary secretion and buccal minor gland secretion were measured. The patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions (EORTC-QLQ-C30) and Quality of Life Questionnaire-Core 30 Head and Neck 35-questions (EORTC-QLQ-C30-H&N35) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: One year after the completion of RT, patients with hyposalivation (≤0.7 mL/min) reported clinically meaningful, but not statistically significant differences, in cognitive functioning, insomnia, swallowing, social eating, dry mouth, sticky saliva, and use of painkillers. Statistically significant differences were found for emotional functioning, sticky saliva, and dyspnea (p < .05). Thirty-three percent of them had a HADS score suggesting anxiety problems, compared with 8% for those with whole stimulated salivary secretion rates >0.7 mL/min. CONCLUSION: RT in the head and neck region, also using intensity-modulated RT, is associated with many aspects of life, such as cognitive functioning, insomnia, dry mouth, and sticky saliva, especially for those with hyposalivation.

Microflora in oral ecosystems and salivary secretion rates--A 3-year follow-up after radiation therapy to the head and neck region.

OBJECTIVE: Results indicate that late improvements of radiation therapy (RT) in the head and neck region may diminish the long-term effects on salivary glands and oral microflora. The aim was therefore to analyze salivary secretion rates and oral microflora over time in RT subjects. DESIGN: Twelve dentate subjects (28±2 teeth) and 12 controls were included. A clinical examination was performed and the salivary secretion rates were determined. Microbial samples, analyzed using cultivation technique, were collected from the soft tissues, supragingival plaque and gingival crevice region. RESULTS: Compared with the controls, the RT group (n=11) had 3 years post RT higher numbers and proportions of lactobacilli (p<0.001 and p<0.01) and Candida albicans (p<0.01 and p<0.05) in the supragingival plaque, higher numbers of enterococci in the vestibulum in the molar region and on the tongue (p<0.05 for both), a lower total count (p<0.001) and lower numbers of streptococci, Streptococcus salivarius and Fusobacterium nucleatum (p<0.01) on the tongue. Although both stimulated and unstimulated salivary secretion rates were increased over time, the proportion of microorganisms associated with oral health decreased, and microorganisms associated with oral disorders increased. Despite a comparable oral hygiene, it was only the 27% who had a stimulated salivary secretion rate ≥1.0ml/min and a buffering capacity ≥6.0, where a recovery of the flora could be seen. CONCLUSION: The results indicate that regaining a normal, stimulated salivary secretion rate and buffering capacity are prerequisites to regaining an oral flora associated with good oral health.

Fermentation of sugars and sugar alcohols by plaque Lactobacillus strains.

OBJECTIVE: The objective was to analyse the ability of Lactobacillus strains isolated from supragingival plaque of subjects with hyposalivation and from healthy controls to ferment sugars and sugar alcohols. MATERIAL AND METHODS: Fifty strains isolated from interproximal plaque from subjects with radiation-induced hyposalivation (25 strains), subjects with primary Sjögren's syndrome (16 strains) and from subjects with normal salivary secretion rate (9 strains) were tested. Growth and pH were determined after 24 and 48 h of anaerobic incubation in vials containing basal media with 1 % of glucose, fructose, sucrose, mannitol, sorbitol or xylitol. RESULTS: No differences between strains isolated from hyposalivated subjects and controls were detected. All strains lowered the pH to <5.0 from fructose and the majority of the strains from glucose and sucrose. A pH of <5.5 was seen for 52 % of the strains using mannitol, 50 % using sorbitol and 36 % using xylitol. The ability to produce acids from sugars and sugar alcohols was highest among strains of Lactobacillus rhamnosus, Lactobacillus casei and Lactobacillus paracasei and lowest among Lactobacillus fermentum strains. CONCLUSION: A large number of Lactobacillus strains are able to ferment not only sugars but also the sugar substitutes mannitol, sorbitol and xylitol to pH levels critical for enamel demineralisation. CLINICAL RELEVANCE: Our findings suggest that products containing mannitol, sorbitol and/or xylitol may contribute to the acidogenic potential of the dental plaque and especially in hyposalivated subjects with high numbers of lactobacilli.

Virulence factors and antibiotic susceptibility in enterococci isolated from oral mucosal and deep infections.

OBJECTIVE: This study evaluates the presence of virulence factors and antibiotic susceptibility among enterococcal isolates from oral mucosal and deep infections. METHODS: Forty-three enterococcal strains from oral mucosal lesions and 18 from deep infections were isolated from 830 samples that were sent during 2 years to Oral Microbiology, University of Gothenburg, for analysis. The 61 strains were identified by 16S rDNA, and characterized by the presence of the virulence genes efa A (endocarditis gene), gel E (gelatinase gene), ace (collagen binding antigen gene), asa (aggregation substance gene), cyl A (cytolysin activator gene) and esp (surface adhesin gene), tested for the production of bacteriocins and presence of plasmids. MIC determination was performed using the E-test method against the most commonly used antibiotics in dentistry, for example, penicillin V, amoxicillin and clindamycin. Vancomycin was included in order to detect vancomycin-resistant enterococci (VRE) strains. RESULTS: Sixty strains were identified as Enterococcus faecalis and one as Enterococcus faecium. All the virulence genes were detected in more than 93.3% (efa A and esp) of the E. faecalis strains, while the presence of phenotypic characteristics was much lower (gelatinase 10% and hemolysin 16.7%). Forty-six strains produced bacteriocins and one to six plasmids were detected in half of the isolates. CONCLUSIONS: Enterococcal strains from oral infections had a high virulence capacity, showed bacteriocin production and had numerous plasmids. They were generally susceptible to ampicillins but were resistant to clindamycin, commonly used in dentistry, and no VRE-strain was found.

A prospective study on oral microbial flora and related variables in dentate dependent elderly residents.

OBJECTIVE: Oral microorganisms and related variables were followed over a 1-year period in dentate dependent elderly. BACKGROUND: For nursing personnel, oral hygiene for the dependent elderly is demanding. It requires good knowledge of how to carry out preventive oral health measures and to judge when help is needed. Previous studies indicate low levels of knowledge, which might be reflected in the oral health of dentate residents. MATERIAL AND METHODS: Twenty-one subjects participated at baseline and 14 one year later. Microbial samples were analysed using cultivation technique. The labial minor gland secretion rate was measured using the Periotron(®) method, and oral clinical data were registered. RESULTS: Low labial mucosal flow rates were seen for 95% of the participants. At baseline, visibly thick plaque was seen in 48% and 1 year later in 57%. Both frequency and number of bacteria associated with caries and frequency of microorganisms associated with oral soft tissue infections were high. One year later, a decrease in bacteria associated with good oral health and a tendency to an increase in aciduric microorganisms were seen. CONCLUSION: Poor oral health, tending to further deteriorate over time, advocates regular professional supplementary support when elderly dentate dependent residents need assistance with their oral care.

Lactobacillus species in supragingival plaque in subjects with hyposalivation.

UNLABELLED: The aim of the study was to analyse the frequency of different Lactobacillus species in relation to the pH-lowering potential of the plaque. METHODS: Ten subjects with radiation-induced hyposalivation (RT group) and 10 subjects with primary Sjögren's syndrome (pSS group) and matched controls with normal salivary secretion were included. Lactobacillus species were selected from their growth on Rogosa agar and identified by PCR and restriction fragment length polymorphism using HaeIII and HpaII restriction enzymes. RESULTS: Lactobacilli were isolated from 14 subjects (6 RT, 3 pSS, 5 controls). The most prevalent species were Lactobacillus fermentum (7 subjects), Lactobacillus casei (7 subjects) and Lactobacillus rhamnosus (6 subjects). L. fermentum and L. casei were the most prevalent species in anterior sites and L. rhamnosus and L. fermentum in posterior sites. In anterior sites, hyposalivated subjects with high Lactobacillus counts had an increased plaque acidogenicity compared to those with low counts. In posterior sites, subjects with high Lactobacillus counts had a lower final pH compared with those with low counts. CONCLUSION: There were large intra- and inter-individual variations in frequencies of Lactobacillus species and Lactobacillus counts, but no specific species could be related to plaque acidogenicity.

Microflora in oral ecosystems in subjects with hyposalivation due to medicines or of unknown origin.

PURPOSE: To analyse the microbial flora in specific sites in 20 dentate (> or = 16 teeth) subjects with hyposalivation due to medicines or of unknown origin and in 20 controls matched according to age, sex and number of teeth. MATERIALS AND METHODS: The microbial samples were analysed for the following micro-organisms: mutans streptococci, Lactobacillus spp. and Actinomyces spp., associated with the development of caries, Fusobacterium nucleatum and Prevotella intermedia/Prevotella nigrescens, associated with plaque accumulation and gingivitis, Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis, frequently found in elevated numbers in periodontitis sites and Candida albicans, Staphylococcus aureus, enterics and enterococci, associated with mucosal infections. The total microbial count was also registered, together with the total number of streptococci, associated with good oral health. RESULTS: In the hyposalivation group, the mean age was 54 +/- 8 years and the mean number of teeth 25 +/- 3. The unstimulated secretion rate was 0.04 +/- 0.04 mL/min and the stimulated secretion rate 0.98 +/- 0.51 mL/min. Compared with the controls, the hyposalivation group tended to harbour a lower number and proportion of F. nucleatum on the tongue, and an increased number of enterococci in the vestibular region. In the supragingival plaque, the numbers of Strepococcus mutans and Lactobacillus spp. were significantly increased and the number of C. albicans tended to be increased. CONCLUSION: The results indicate that subjects with hyposalivation due to medicines or of unknown origin have a supragingival plaque associated with the development of caries.

Electrolytes in stimulated whole saliva in individuals with hyposalivation of different origins.

There are reasons to believe that changes in the secretion rate of saliva as well as changes in its protein and electrolyte composition promote the growth of micro-organisms associated with oral disorders. Knowledge of the electrolytes in the saliva of those with hyposalivation might therefore be of value in designing oral health-promoting measures. In this study, electrolytes in stimulated whole saliva were analysed in individuals with hyposalivation due to radiation therapy in the head and neck region (RT group), primary Sjögren's syndrome (pSS group), neuroleptic treatment (Neuro group), and to medication or of unknown origin (Unknown group). The bicarbonate concentration was significantly lower in all four hyposalivation groups compared with controls. The bicarbonate concentration, which in normal conditions is positively correlated with the salivary secretion rate, was lower in the Neuro group than in the RT and Sjögren's groups despite a stimulated secretion rate about twice as high. Furthermore, the Neuro group had the highest phosphate concentration. The RT and Sjögren's groups tended to have increased sodium concentrations. For potassium and calcium, the RT group had significantly higher concentrations than the other hyposalivation groups and the controls. The substantial increase in calcium and decrease in bicarbonate suggest that the function of the parotid glands is more affected than that of the other salivary glands. The results also indicate a contribution of plasma to the electrolyte concentrations determined in whole saliva in the RT and Sjögren's groups. In conclusion, in individuals with hyposalivation the concentrations of electrolytes in stimulated whole saliva seem to be more related to the reason for the hyposalivation than to the salivary secretion rate.