Lactoferrin and the development of salivary stones: a pilot study.

Salivary stones (sialoliths) are calcified structures located in the ductal system of the major salivary glands. Their exact cause is not clear but in general they are characterized by concentric inorganic (hydroxyapatite) layers. The formation is a slow intermittent process which may result in enlargement of the sialolith causing obstruction of saliva secretion resulting in mealtime related pain and swelling of the affected salivary gland. Various studies reported the presence of organic material such as proteins and lipids in the core of sialoliths. In the present study the protein composition of twenty submandibular sialoliths was analyzed. It was found that proteins contributed on average 5% to the dry weight of submandibular stones whereby small salivary stones contained more extractable proteins than large salivary stones. Using a combination of SDS-PAGE gel electrophoresis and Western blotting, we identified α-amylase (in all stones; 100%), lysozyme (95%), lactoferrin (85%), secretory-IgA (75%), MUC7 (60%), complement C4 (60%) and C-reactive protein (35%). The presence, and the combinations, of lactoferrin, lysozyme, s-IgA and α-amylase in sialoliths was confirmed by ELISA. The gradually increasing size of a sialolith might provoke a local inflammatory response in the duct of the submandibular gland whereby the relatively low concentrations of lactoferrin and lysozyme may originate from neutrophils. The interaction of lactoferrin with s-IgA could contribute to the accumulation of lactoferrin in sialoliths. In summary, these results suggest a new pathophysiological role for lactoferrin, in the formation of sialoliths.

Relationship between volume of submandibular salivary stones in vivo determined with Cone-Beam Computer Tomography and in vitro with micro-Computer Tomography / Relación entre el volumen de cálculos salivales submandibulares in vivo determinado con tomografía computarizada de haz cónico e in vitro con microtomografía computarizada

Background: Successful removal of salivary stones depends on exact pretreatment information of the location, thesize and shape of the stones. This study aimed to compare the volume of submandibular sialoliths determined bypreoperative Cone-Beam Computer Tomography (CBCT) scans with the volume of the removed stones on micro-Computer Tomography (micro-CT) scans.Material and Methods: In this study, using twenty-one submandibular sialoliths, the pretreatment volumes in-vivomeasured on CBCT were compared to the volumes of removed stones determined by micro-CT scans. The volumemeasured on micro-CT scans served as the gold standard. Pre-operative CBCT’s and in-vitro micro-CT’s wereconverted into standard tessellation language models (STL-models) using an image segmentation software pack-age. The CBCT and micro-CT images of the stones were subsequently metrologically assessed and compared toeach other using reverse engineering software.Results: Volumes of submandibular sialoliths determined by CBCT’s correlated significantly with volumes mea-sured on micro-CT’s (Spearman’s coefficient r = 0.916). The interquartile range (IQR) for the volume measuredwith micro-CT was 117.23. The median is 26.41. For the volume measured with CBCT the IQR was 141.3 and themedian 36.61. The average volume on micro-CT is smaller than on CBCT.Conclusions: When using CBCT-scans for the detection of submandibular sialoliths one should realize that in-vivothose stones are actually a fraction smaller than assessed on the preoperative scan. This is important when cut-offvalues of sizes of stones are used in the pretreatment planning of stone removal.(AU)

Biochemical composition of salivary stones in relation to stone- and patient-related factors

BACKGROUND: Salivary stones are calcified structures most often found in the main duct of the submandibular or parotid salivary gland. They contain of a core surrounded by laminated layers of organic and inorganic material. MATERIAL AND METHODS: Submandibular and parotid sialoliths (n=155) were collected at the department of Oral and Maxillofacial surgery of a general hospital between February 1982 and September 2012. The weight of the sialo-liths was determined and the consistency was subjectively classified. Subsequently, the biochemical composition of the stones was determined by wet chemical methods or FT-IR spectrometry. Age and gender of the patients were retrieved from their medical records. Data were statistically analyzed using Fisher's exact tests. RESULTS: Sialoliths are mainly composed of inorganic material. Carbonate apatite was identified in 99% of the stones, phosphate in 88%, calcium in 87%, magnesium in 68%, struvite in 44%, oxalate in 38% and carbonate in 35%. Solid salivary stones contain more frequently struvite than stones with a soft consistency (p = 0.05). Larger stones (> 100 mg) contain more frequently carbonate (p = 0.05). Stones from older patients (≥ 38 years) showed an almost significant trend towards more frequent presence of phosphate (p = 0.083). CONCLUSIONS: The biochemical composition of submandibular and parotid sialoliths is related to stone-related factors, probably to age but not to the gender of the patient

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Systemic diseases and the risk of developing salivary stones: a case control study.

OBJECTIVE: To investigate the possible relationship between the presence of salivary stones and systemic diseases, medication, smoking, and alcohol consumption. STUDY DESIGN: A retrospective, case control study. Medical records of patients with salivary stones and those of control patients without salivary stones were retrospectively reviewed. Data regarding the affected salivary gland, the presence of systemic disease, and the use of medication, tobacco, and alcohol were recorded. Statistical analysis was performed using the Fisher Exact tests. RESULTS: Medical records of 208 patients with salivary stones and those of 208 control patients were reviewed. Of the patients diagnosed with salivary stones, the submandibular gland was affected in 85.6% of the patients, the parotid gland in 9.6%, and the sublingual gland in 2.4% of the patients. None of the recorded systemic diseases was more prevalent in patients with salivary stones. Patients with salivary stones used significantly more antibiotics compared with the control group (P = .037). No significant differences were observed for other types of medication. There was no correlation between salivary stone formation, smoking, and alcohol consumption. CONCLUSIONS: The present study suggested that systemic diseases, medication, smoking, and alcohol consumption play no or only a limited role in the onset of salivary stones.