Unstimulated whole saliva flow rate in relation to sicca symptoms in Hungary.

OBJECTIVE: To assess the prevalence of xerostomia and the related oral and extraoral dryness symptoms in Hungary, to evaluate the association of those symptoms with the unstimulated whole saliva (UWS) flow rate, and to find correlation between the level of UWS flow rate and the oral health status of the questioned patients. SUBJECTS AND METHODS: A total of 600 patients between the age of 18 and 92 years, 265 male, 335 female, were selected in accordance with the current regional age and residence distribution scheme of the Hungarian Statistical Office. A questionnaire was designed to determine the subjective presence or absence of the sicca symptoms. UWS flow rate and the dental and periodontal status were determined. RESULTS: The percentages of subjective symptoms in the questioned subjects were oral dryness, 34%; reduced salivation, 11%; mucous saliva, 15%; dysphagia, 13%; glossopyrosis, 7%; dysphonia, 31%; dysgeusia, 9%; nasal dryness, 32%; ocular dryness, 21%; itching, 40% and xeroderma, 60%. Vaginal dryness was 14%, vaginal itching was 16% in the interviewed women. The grade of xerostomia, dysphagia, tiredness, and additionally the gingival bleeding index showed a negative correlation with the UWS flow rate. After all decayed, missing and filled teeth (DMF-T) mean values, gingival bleeding index and plaque index were significantly higher in hyposalivators, compared with those who had normal flow rates CONCLUSION: This cross sectional study, representative of the Hungarian population, clearly shows that one-third of the adult population suffers from xerostomia. The clinical severity of the xerostomia demonstrated a strong relationship with the lower levels of UWS flow rate. Reduced levels of UWS flow rate in this study were also shown to be associated with dysphagia, fatigue, and increased DMF-T numbers. The data show that oral dryness, its associated desiccation symptoms and its clinical manifestations are significant health problems in Hungary.

Saliva in health and disease: an appraisal and update.

Saliva plays an important role in oral health monitoring, regulating and maintaining the integrity of the oral hard tissues and some soft tissues. This paper reviews the role of saliva, the prevalence of oral dryness and the consequent importance of salivary flow as well as the relationship between xerostomia and salivary gland hypofunction amongst the causes of oral dryness. Other aspects of oral conditions associated with saliva are also reviewed including Sjögren's Syndrome and oesophageal function. Finally, knowledge, and the current use of salivary tests and the utilisation of saliva as a diagnostic fluid are surveyed.

A reference guide to drugs and dry mouth--2nd edition.

Xerostomia (dry mouth) is an uncomfortable and potentially harmful oral symptom which is usually caused by a decrease in the secretion rate of saliva (salivary gland hypofunction, or SGH). It is more prevalent in the elderly population, primarily due to their increased use of drugs and their susceptibility to disease. Many drugs and drug classes have been linked to xerostomia; the xerogenic effect increases when many drugs are taken concurrently. This Reference Guide to Drugs and Dry Mouth is designed to allow the reader to rapidly identify those pharmacologic agents which have the capacity to induce xerostomia and SGH. Xerogenic drugs can be found in 42 drug categories and 56 sub-categories. A guide to the management of drug-induced SGH and xerostomia is also provided.

Whole saliva and the diagnosis of Sjögren's syndrome: an evaluation of patients who complain of dry mouth and dry eyes. Part 1: Screening tests.

UNLABELLED: Sjögren's syndrome (SS) is a common autoimmune disorder characterised by generalised desiccation, exocrine hypofunction and serologic abnormalities, More than 90% of the patients are women. OBJECTIVE: To determine if whole saliva could be used to diagnose this disease. SETTING: The study was conducted at the School of Dental Medicine, SUNY, at Stony Brook. PATIENTS: There were 49 subjects (48 F; 1 M), the mean age was 54 +/- 13 years. In order to be admitted into the study, they had to complain of dry mouth and dry eyes. TESTS: Whole saliva was collected by the spitting method. "Screening Tests" were employed to measure the salivary flow rate, pH, buffer capacity; lactobacillus and yeast concentrations. Chemical tests were performed to determine protein, albumin, sodium and amylase activity. Lacrimal dryness was assessed by the Schirmer and Rose-Bengal methods. RESULTS: Based on the sialometric findings, the patients were divided into 3 groups: Group 1: those with abnormally low resting (RFR) and stimulated (SFR) flow rates; Group 2: those with a low RFR but normal SFR; and Group 3: those with normal salivary flow rates. The group 1 patients were unique: their saliva demonstrated a low pH and buffer capacity, high lactobacillus and yeast concentrations, decreased protein output and amylase activity, and elevated albumin and sodium. Moreover, virtually all of them had abnormally low lacrimal flow rates. CONCLUSIONS: The findings suggested that whole saliva could be used to provisionally diagnose SS. Critical to this diagnosis was an abnormally low stimulated whole saliva flow rate. Other requisites included a low resting flow rate, the presence of dry mouth and dry eyes and evidence of lacrimal hypofunction. All of these attributes can easily be obtained by dentists in their clinics.

Whole saliva and the diagnosis of Sjögren's syndrome: an evaluation of patients who complain of dry mouth and dry eyes. Part 2: Immunologic findings.

UNLABELLED: Sjögren's syndrome (SS) is a multisystem, autoimmune disease characterised by generalised desiccation, exocrine hypofunction and serologic abnormalities. Last year we showed that the antibodies which are quasi-specific for diagnosis of SS, anti SS-A/Ro and anti SS-B/La, were present in the saliva of patients with this disease. OBJECTIVE: To determine their presence in patients who complain of dry mouth and dry eyes. SETTING: The study was conducted at the School of Dental Medicine, SUNY at Stony Brook. PATIENTS: There were 49 patients (Mean Age = 54 +/- 13 years). TESTS: Serum was analysed for the SS and other antibodies with "Western Blot Autoantibody Strips". RESULTS: The findings showed that there was a strong correlation between the presence of the SS antibodies in the serum and the saliva. The SS antibodies were primarily found in the saliva of the patients whose resting and stimulated, whole saliva, flow rates were abnormally low. Antibodies to other autoimmune disease (lupus, scleroderma and mixed connective tissue disease) were also found in whole saliva. CONCLUSIONS: The findings in Part 1 of this study, of patients who had complained of dry mouth and dry eyes, suggest that those patients, who demonstrated low resting and stimulated flow rates and had lacrimal hypofunction, suffered from SS. The observation in this paper, that the whole saliva of these patients contains the SS antibodies, confirms this diagnosis. The data suggest that whole saliva can be used to establish the diagnosis of SS and other autoimmune diseases.

The use of whole saliva in the differential diagnosis of Sjögren's syndrome.

Sjögren's Syndrome (SS) is a chronic, multisystem, autoimmune disorder. It is characterized by (1) generalized exocrine gland dysfunction, (2) serologic abnormalities, and (3) organ-system changes. Oral changes are a prominent feature of this disease. Among these are xerostomia and hypofunction of the salivary glands. Given the intimate relationship between SS and the salivary glands, it is reasonable to postulate that whole saliva (WS) contains the stigmata associated with the presence of this disease. But few studies have been conducted on this secretion. Indeed, WS has largely been neglected and ignored by physicians, dentists, and scientists. Objections to its use have included the fact that it is "impure", that it does not adequately represent what is present in the salivary glands, that no standards have been established for its rate of flow, and that findings based on it lack specificity. Yet, it is this secretion which coats and protects the hard and soft oral tissues, enables us to prepare our food for digestion, and assists our speech. This review will demonstrate that there is a uniqueness and constancy to whole saliva and that it may be used to diagnose the presence of SS. "Screening tests", which include several simple-to-perform sialometric, chemical, and microbiologic procedures, may be conducted in doctors' offices to establish the "profile" of an SS patient. Electrophoretic studies may be used to study the nature of the salivary proteins, and an immunologic test, which is performed on WS and utilizes Western Blot Autoantibody Strips (ImmunoVision, Springdale, AR), may be used to establish the definitive diagnosis of SS.

Sodium dodecyl sulphate-polyacrylamide gel electrophoresis of human whole saliva.

The purpose of this study was to characterize the electrophoretic patterns of human resting and stimulated whole saliva. Pooled and individual, uncentrifuged, unprocessed whole saliva from 20 healthy, unmedicated individuals was run on sodium dodecyl sulphate-polyacrylamide gel electrophoresis and stained with Coomassie blue R-250. Similar and characteristic patterns for whole saliva were observed for all samples, consisting of over 34 blue- and pink-violet-staining bands. Individual differences were usually in the size (or density) of the bands, not in the number. Repeat sampling of stimulated whole saliva over a period of weeks from the same individuals revealed a striking consistency of protein patterns, indicating a profound physiological stability of whole saliva. These results provide baseline data for whole saliva and suggest its use for future studies.

The preparation of an autologous saliva for use with patients undergoing therapeutic radiation for head and neck cancer.

PURPOSE: At the present time there is no general agreement about how to prevent the symptoms and clinical signs that accompany therapeutic irradiation for head and neck cancer. Because saliva is the principal protector of the oral tissues, it is logical to assume that many of these changes are due to the radiation-induced damage to the salivary glands. We have observed that the flow and composition of saliva is normal in most patients before their irradiation. Theoretically, it should, therefore, be possible to collect their saliva before they commence their course of radiation, store it in a "saliva bank," and give it back to them when they undergo radiation. The key to the use of such an autologous saliva is the fabrication of a technique that disinfects or sterilizes the saliva yet preserves its protective properties. The objective of this study was to prepare an autologous saliva that would be used by patients during their irradiation for head and neck cancer. MATERIALS AND METHODS: Stimulated saliva was obtained from healthy subjects; none of the subjects consumed any medications. The saliva was treated by a variety of techniques. Included among them were heat, radiation, filtration, centrifugation, and an antibacterial agent. The samples were analyzed for total protein, amylase, viscosity, and sterility; individual salivary proteins were assessed by sodium dodecylsulfate-polyacrylamide gel electrophoresis. RESULTS: The results showed that beta radiation (> 2.5 kGy) and lyophilization + chlorhexidine (0.03% to 0.12%) could be used to prepare a sterile autologous saliva that retained most of its protective properties.

Xerostomia in diabetes mellitus.

OBJECTIVE: To determine the prevalence of xerostomia in a group of ambulatory diabetic patients and to compare the following in patients with and without xerostomia: 1) flow rates of saliva and lacrimal fluid, 2) the presence of other symptoms suggestive of oral and extraoral dryness, 3) indexes of glycemic control, and 4) noninvasive measures of cardiovagal autonomic nervous system function. RESEARCH DESIGN AND METHODS: Forty adult diabetic patients and an equal number of age- and sex-matched healthy nondiabetic control subjects were studied. Subjects who consumed xerogenic drugs or had other significant diseases were excluded from the study. A questionnaire was administered to all patients, and the following tests were performed: resting and stimulated flow rates on whole saliva; Schirmer's test (lacrimal fluid), serum glucose and HbA1, expiration-inspiration ratio, 30:15 ratio, Valsalva ratio, and the systolic blood pressure response to standing. RESULTS: Forty-three percent of diabetic patients complained of xerostomia, of which 82% were women. The oral dryness was not related to age or the type and duration of diabetes. Symptoms of water loss and oropharyngeal, ocular, and vaginal dryness were much more common in the xerostomic than the nonxerostomic diabetic patients. The salivary flow rates of the diabetic subjects was consistently lower than those of healthy, nondiabetic control subjects. The mean, resting, and whole-saliva flow rate was abnormally low in the diabetic patients who complained of xerostomia; no significant differences were observed for the stimulated salivary and the lacrimal flow rates. Significant inverse relationships were shown between salivary flow and the level of HbA1; none were shown between flow and autonomic function. CONCLUSIONS: Dry mouth is a common complaint among ambulatory diabetic patients. It is strongly associated with objective measurements of poor salivary flow and with other oral and extraoral symptoms of desiccation. The oral dryness is not associated with cardiovagal autonomic system dysfunction but may be due to disturbances in glycemic control.

Management for the highly caries-susceptible patient.

Despite dramatic improvement in caries treatment during the past 30 years, a substantial number of patients remain highly susceptible and do not respond to conventional treatment. It is possible, using simple chairside caries-susceptibility tests, to identify the etiologic factors responsible for the disease and to design a rational approach to treatment that addresses the specific needs of the patient.

Xerostomia. Part II: Relationship to nonoral symptoms, drugs, and diseases.

Five hundred twenty-nine adult outpatients were studied to determine the relationship of xerostomia to other oral symptoms and salivary flow (reported in part I) and to nonoral symptoms, drugs, and select diseases (reported here in Part II). It was observed that dry throat, blurred vision, dry eyes, dry skin, and vaginal itching and fungal infections are prominently associated with oral dryness. These nonoral symptoms were positively correlated with the oral symptoms cited in part I of this study and were inversely related to the flow of resting, but not stimulated, whole saliva. Several classes of drugs were associated with dry mouth. In addition, diabetes mellitus and hypertension were significantly associated with it. Approximately half of the diabetic and hypertensive patients complained of dry mouth. Although a majority of them were taking medications, the association between xerostomia and these diseases cannot be completely attributed to drugs, since many of these patients did not take any xerogenic medicaments. The data show that xerostomia and several other oral symptoms are valid indicators of salivary gland hypofunction. They suggest, moreover, that select nonoral symptoms are an indicator of generalized xerosis.

Recognition and treatment of salivary induced conditions.

Salivary problems, particularly in the aged, are frequent but often not well recognized. Symptomatic dryness (xerostomia) is accompanied by objective evidence of reduced salivary secretion in about half the cases. Dry mouth is not an age change but most often follows salivary gland disturbance of external origin or due to systemic disease. It may herald the presence of widespread symptoms of exocrine gland hypofunction. Resting and stimulated salivary flow rates are useful measures of dryness. Xerostomia may be accompanied by an increase in caries rate, candidosis, cheilitis, dysgeusia or dysphagia. Prominent causes of salivary gland hypofunction are drugs, irradiation, organic diseases, psychogenic factors and decreased mastication. However, a cause cannot always be found and even when identified its effects cannot always be reversed, e.g. in Sjögren's syndrome. Locally acting stimulants of salivary flow or saliva substitutes may alleviate symptoms but systemically acting sialogogues need to be used with caution. The dentist has an important role in identifying xerostomia, an identification that can lead to the diagnosis of previously unrecognized disease.

Xerostomia. Part I: Relationship to other oral symptoms and salivary gland hypofunction.

The prevalence of xerostomia and nine other oral symptoms was studied in 529 subjects (18 years or older) in a family health center. The findings show that (1) dry mouth and several other symptoms are common in an outpatient population and (2) they are a valid indicator of salivary gland hypofunction.

Xerostomia. A neglected symptom.

Xerostomia, the subjective feeling of dry mouth caused by a severe reduction in the flow of saliva, is a common problem that is particularly prevalent among the aged. It has become increasingly evident that dry mouth is associated with a number of serious systemic conditions and diseases. Among these are the intake of commonly prescribed medications, autoimmune diseases, and irradiation to the head and neck. The diminution in the flow of saliva may profoundly affect oral health, disturb digestion and speech, and seriously impair the patient's quality of life. Food avoidance, nonabsorption of sublingually placed drugs, and noncompliance with medication may also result. Sialometry can be used to confirm the presence of dry mouth. Treatment is aimed at increasing the flow of saliva, when possible, or providing oral moisture by other means.