Intraoral Acupuncture for Sialorrhea in Stroke Patients: a Study Protocol for a Randomized Controlled Trial.

Background: Post-stroke sialorrhea (PSS) refers to excessive saliva flowing out of the lip border after a stroke. PSS negatively affects patient self-image and social communication and may lead to depression. Commonly used treatments for reducing salivation have various adverse effects and may be unsuitable for stroke patients. Additionally, limited evidence supports the link between excessive salivation and PSS. Intraoral tongue acupuncture is an alternative therapeutic approach for decreasing sialorrhea in children. However, no large-scale, strictly controlled randomized controlled trials have shown the effectiveness of acupuncture in treating PSS patients. We aim to compare the effects of intraoral and sham acupuncture in PSS patients and explore the relationships among salivation and drooling severity, frequency, and swallowing function in stroke patients. Methods: We will recruit 106 PSS patients for this prospective, single-center, randomized, and sham-controlled trial, randomly assigned to receive 4-week intraoral or sham acupuncture. Additionally, 53 stroke patients without PSS will undergo a conventional 4-week treatment program to compare salivation between PSS and non-PSS patients. Follow-up will be conducted for 4 weeks post-intervention. The main evaluation index will be the 3-minute saliva weight (3MSW), comparing changes in 3MSW from baseline to weeks 4 and 8. Secondary assessment indices will include the "Drooling Severity and Frequency Scale" and "Functional Oral Intake Scale." Discussion: Comparing effects of intraoral and sham acupuncture in PSS patients, this study may contribute important evidence for future PSS treatment and provide valuable insights into whether salivation issues in stroke patients are attributed to heightened salivary secretion or dysphagia.

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.

Immediate effects of photobiomodulation on saliva production. / Efeitos imediatos da fotobiomodulação na produção de saliva.

PURPOSE: To verify the immediate effects of photobiomodulation on the production of salivary flow and the correlation of demographic, anthropometric and medication use data. METHODS: The study included 100 healthy individuals, aged between 18 and 76 years (mean 27.2 years), randomly split into an experimental group and a placebo group. Assessments of anthropometric measurements, self-perception of saliva production and sialometry were performed. Next, LASER irradiation was carried out at an infrared wavelength (808 nanometers) with 100 milliwatts (mw) of power at five intraoral points: on the sublingual glands and bilaterally on the submandibular and parotid glands, at doses of 9, 18 and 24 joules (J). Sialometry was repeated after each application. The control group received the same procedures with placebo equipment. RESULTS: There was a statistical association in the self-perception of reduced saliva in the experimental group for the 24J dose and in sialometry and in the reduction in salivary flow for the 18J and 24J doses and an increase to 9J, in both groups. There was no association when comparing the experimental and placebo groups. Multiple multinomial regression analysis revealed that the reduction or increase in salivary flow is independent of demographic, anthropometric and medication use variables. CONCLUSION: The bioinhibitory action of photobiomodulation on healthy salivary glands occurred at a dose of 18J and 24J, while the biostimulant action happened at a dose of 9J, regardless of demographic, anthropometric variables and medication use. The self-perception of reduced salivary flow occurred at 24J.

OBJETIVO: Verificar os efeitos imediatos da fotobiomodulação na produção do fluxo salivar e a correlação dos dados demográficos, antropométricos e de uso de medicamentos. MÉTODO: Participaram do estudo 100 indivíduos saudáveis, com idade entre 18 e 76 anos (média 27,2 anos), divididos de forma randomizada em grupo experimental e grupo placebo. Foram realizadas as avaliações das medidas antropométricas, autopercepção da produção de saliva e a sialometria. Na sequência, realizou-se a irradiação do LASER no comprimento de onda infravermelho (808 nanômetros) com 100 miliwatts (mw) de potência em cinco pontos intraorais: nas glândulas sublingual e bilateralmente nas submandibulares e parótidas, nas doses 9, 18 e 24 joules (J). A sialometria foi repetida após cada aplicação. O grupo controle recebeu os mesmos procedimentos com equipamento placebo. RESULTADOS: Houve associação estatística na autopercepção de redução da saliva no grupo experimental para a dose de 24J e na sialometria e na redução do fluxo salivar para as doses 18J e 24J e aumento para 9J, em ambos os grupos. Não houve associação quando comparado entre os grupos experimental e placebo. A análise de regressão multinomial múltipla revelou que a redução ou o aumento do fluxo salivar independe das variáveis demográficas, antropométricas e uso de medicamentos. CONCLUSÃO: A ação bioinibitória da fotobiomodulação sobre as glândulas salivares saudáveis ocorreu em dose de 18J e 24J, já ação bioestimulante na dose 9J, independe das variáveis demográficas, antropométricas e uso de medicamentos. A autopercepção da redução do fluxo salivar ocorreu em 24J.

Effect of lozenge surface texture, taste and acidity on salivary flow rate: A crossover preclinical trial in healthy subjects.

Dry mouth is a multifaceted condition which is caused by reduced salivary secretion. This study aimed to evaluate and compare the effects of different lozenge surface textures, tastes and acidity levels on stimulated salivary secretion for increased oral moistening in participants without hyposalivation. This randomized, double-blind, clinical crossover trial with before and after comparison involved 33 healthy volunteers. Five lozenges, including a baseline control (C), apple (A), sour (S), sour apple (SA) and granular pectin (P) were tested on five different days with all the subjects. Salivary flow, pH value, and subjective feeling (visual analog scale) were measured before and after consuming the lozenge each day. Throughout all trial days the unstimulated whole salivary flow (UWSF) averaged 0.65 ± 0.26 ml/min. Lozenges S, SA, and P showed higher stimulated whole salivary flow (SWSF) than C (P < 0.001) by more than 0.5 ml/min. Lozenge P, with a rough surface, demonstrated the highest difference between UWSF and SWSF, 2.41 ± 0.69 ml/min. The stimulated saliva with the lozenges containing acidifiers (S, SA and P) was more than 1.4 pH units lower compared to lozenges C and A (P < 0.001). Subjects reported the strongest subjective feeling of increased saliva with lozenges SA and P. Overall lozenges SA and P provided the best objective results in enhancing salivary flow rate and subjective feeling of increased salivary flow.

Evaluation of photobiomodulation in the salivary production of patients with hyposalivation induced by antihypertensive drugs - A blind, randomized, controlled clinical trial.

BACKGROUND: Arterial hypertension is a systemic condition that affects about 35% of the world population. The drugs that are used for its control can produce hyposalivation. This work evaluated the effect of photobiomodulation on salivary flow rate, salivary pH, total protein concentration, and calcium concentration in individuals using antihypertensive medications. MATERIAL AND METHODS: 41 subjects were randomly allocated in one of two groups: control (placebo) and photobiomodulation. The subjects had their salivary glands (20 sites) irradiated with a laser emitting at 808 nm, 4J/site once a week for 4 weeks and had their salivary flow measured before and after the whole treatment. RESULTS: The intragroup analysis (before and after treatment) shows a significant difference for both non-stimulated and stimulated salivary flow in the photobiomodulation group (p = 0.0007 and p = 0.0001, respectively). Comparing the placebo with the photobiomodulation group, significant differences were found for both non-stimulated (p = 0.0441) and stimulated salivary flow (p = 0.0441) after the treatment. No significant differences were found in pH, total protein concentration, calcium concentration. CONCLUSION: Despite the usage of drugs that influence the nervous system and typically result in a reduction of saliva production, photobiomodulation demonstrated a remarkable ability to enhance saliva production by a significant 75%.

Parotid hypersalivation after inferior salivatory nucleus glutamate/NMDA receptor excitation in the rat.

Although salivation is essential during eating behavior, little is known about the brainstem centers that directly control the salivary glands. With regard to the inferior salivatory nucleus (ISN), the site of origin of the parasympathetic preganglionic cell bodies that innervate the parotid glands, previous anatomical studies have located it within the rostrodorsal medullary reticular formation. However, to date there is no functional data that shows the secretory nature of the somas grouped in this region. To activate only the somas and rule out the activation of the efferent fibers from and the afferent fibers to the ISN, in exp. 1, NMDA neurotoxin was administered to the rostrodorsal medullary region and the secretion of saliva was recorded during the following hour. Results showed an increased secretion of parotid saliva but a total absence of submandibular-sublingual secretion. In exp. 2, results showed that the hypersecretion of parotid saliva after NMDA microinjection was completely blocked by the administration of atropine (a cholinergic blocker) but not after administration of dihydroergotamine plus propranolol (α and ß-adrenergic blockers, respectively). These findings suggest that the somata of the rostrodorsal medulla are secretory in nature, controlling parotid secretion via a cholinergic pathway. The data thus functionally supports the idea that these cells constitute the ISN.

Effectiveness of atropine in managing sialorrhea: A systematic review and meta-analysis.

OBJECTIVES: To describe the efficacy of atropine in controlling salivary flow in patients with sialorrhea or drooling. MATERIALS AND METHODS: We included randomized controlled studies, quasi-randomized trials, case reports, clinical trials, systematic reviews, and meta-analyses assessing the use of atropine in patients with sialorrhea or drooling. The endpoints were reduction in salivary flow rate, amount of saliva secreted, reduction in clinical symptoms of sialorrhea, death rattle intensity, or reduction in drooling intensity as measured by an objective scale such as the drooling intensity scale. RESULTS: A total of 56 studies with 2,378 patients were included in the systematic review. The underlying disease states included brain injury, amyotrophic lateral sclerosis, cerebral palsy, clozapine- and perphenazine-induced sialorrhea, Parkinson's disease, and terminal illness. The routes of atropine administration included sublingual, intravenous, subcutaneous, oral tablet or solution, and direct injection of atropine into parotid glands or at the base of the tongue. The generalized estimated equation regression models showed that sublingual administration is superior to oral and subcutaneous routes. CONCLUSION: Atropine is efficacious in managing sialorrhea in most disease states. Sublingual administration of atropine is superior to other routes of administration in reducing salivary flow in patients with sialorrhea.

Whole unstimulated salivary flow rate decreases during acute stressful condition.

OBJECTIVE: To examine the influence of acute stress on salivary flow using a validated stressor paradigm. STUDY DESIGN: This uniform crossover study consisted of 40 healthy adults who underwent the Trier Social Stress Test, consisting of a 5-minute mental arithmetic task (MAT), and a nonstressful task (NST), consisting of a 5-minute free speech task. The order of the tasks was counterbalanced and unstimulated whole saliva (UWS) was measured in 2 groups of 20 participants during each 5-minute task condition, with a 10-minute washout period between tasks. At baseline, mathematical ability was self-reported and psychological distress was measured using the Symptom Checklist-90-Revised. Heart rate (HR) and breathing rate (BR) were recorded during each task. RESULTS: Age, sex, HR, BR, and psychological distress were similar between groups at baseline (P > .05). During the MAT, HR increased significantly and mean UWS flow rate decreased significantly compared with the NST (P < .001). CONCLUSIONS: An acute psychobiological stressor task was associated with a rapid decrease in salivary flow in adults. Thus, stress can contribute to reduced salivary flow and should be considered as a factor during the diagnostic workup of patients who complain of a dry mouth.

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.

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.

Salivary Electrostimulation in the Treatment of Radiation Therapy-Induced Xerostomia (LEONIDAS-2): A Multicenter, Randomized, Double-Masked, Sham-Controlled, Phase 3 Trial.

PURPOSE: Radiation therapy-induced xerostomia significantly affects quality of life in head and neck cancer survivors. Neuro-electrostimulation of the salivary glands may safely increase natural salivation and reduce dry mouth symptoms. METHODS AND MATERIALS: This multicenter, double-masked, randomized, sham-controlled clinical trial assessed the long-term effects of a commercially available intraoral neuro-electrostimulating device in lessening xerostomia symptoms, increasing salivary flow, and improving quality of life in individuals with radiation therapy-induced xerostomia. Using a computer-generated randomization list, participants were assigned (1:1) to an active intraoral custom-made removable electrostimulating device or a sham device to be used for 12 months. The primary outcome was the proportion of patients reporting a 30% improvement on the xerostomia visual analog scale at 12 months. A number of secondary and exploratory outcomes were also assessed through validated measurements (sialometry and visual analog scale) and quality-of-life questionnaires (EORTC QLQ-H&N35, OH-QoL16, and SF-36). RESULTS: As per protocol, 86 participants were recruited. Intention-to-treat analyses showed no statistical evidence of a difference between the study groups with respect to the primary outcome or for any of the secondary clinical or quality-of-life outcomes. Exploratory analyses showed a statistically significant difference in the changes over time of the dry mouth subscale score of the EORTC QLQ-H&N35 in favor of the active intervention. CONCLUSIONS: LEONIDAS-2 did not meet the primary and secondary outcomes.

The Mechanism of Core Chinese Medicine Combination in Treating Salivation.

OBJECTIVE: To analyze the regularity of modern Chinese herbal compound in the treatment of salivation based on data mining technology, and to study the potential mechanism of core Chinese herbal medicine in the treatment of salivation using network pharmacology and molecular docking. METHODS: CNKI, VIP and Wanfang literature databases were searched.Choose a prescription for salivation.Excel2019 was used to establish a database of formulas for the treatment of salivation.The included TCM compounds were analyzed by frequency statistics and association rules using the ancient and modern medical record cloud platform to obtain the core drug pairs.TCMSP and Uniprot were used to search the components and targets of the core drug pairs, and intersected with the disease targets obtained from Genecards, OMIM, TTD, PharmgKb, and DrugBank platforms.Complex networks were constructed by cytoscape3.9.1; PPI networks were completed by STRING platform; GO and KEEG pathway enrichment analysis was performed by R language; finally molecular docking validation was performed using AutoDockTools software; and the results were visualized by Pymol software. RESULTS: 122 prescriptions were obtained, 194 herbs were used, the total frequency was 1047, and the top ten drugs used were Atractylodes macrocephala Koidz, Poria cocos, Glycyrrhiza uralensis, Yizhiren, Citrus sinensis, Codonopsis pilosula, Yam, Pinellia ternate, Zingiber officinale, and Coptis chinensis.After association rule analysis, the core drug pair Codonopsis pilosula - Atractylodes macrocephala Koidz was obtained.Twenty-seven effective active components of core drug pairs were screened, corresponding to 62 targets for the treatment of salivation, and four core targets were MAPK1, TP53, MAPK14, and ESR1.GO enrichment analysis yielded 1789 biological process entries, 81 cellular component entries and 111 molecular function entries.KEGG enrichment analysis resulted in 157 pathways, and the first 30 were selected for visualization.Molecular docking of luteolin, 7-Methoxy-2-methyl isoflavone, Stigmasterol, 3ß-acetoxyatractylone, Frutinone A, 3betaHydroxymethyllenetanshiquinone, glycitein to the core target showed that the key active components had good binding activity to the core target. CONCLUSION: The key active components of Codonopsis pilosula and Atractylodes macrocephala Koidz in the treatment of salivation act on MAPK1, TP53, MAPK14 and ESR1 through Calcium, PI3K Akt and IL-17 signaling pathways to regulate the physiological processes of nerve, muscle, endocrine and reproductive systems and the physiological functions of nerve cells, providing a theoretical reference for the later study of integrated traditional Chinese and western medicine in the treatment of salivation.

Probing behavior of the leafhopper analyzed through DC electropenetrography and microscopy.

Yamatotettix flavovittatus Matsumara is a new leafhopper species vector of sugarcane white leaf (SCWL) phytoplasma that causes sugarcane chlorosis symptoms. The effects of probing behavior of Y. flavovittatus on sugarcane and its implication for SCWL phytoplasma transmission are yet to be studied. In this research, we used DC electropenetrography (EPG) to define waveforms produced by adult and fifth-instar nymphal Y. flavovittatus on sugarcane and correlated them with salivary sheath termini (likely stylet tip locations) via light and scanning electron microscopy. The following six waveforms and associated activities are described: (NP) non-probing, (Yf1) stylet probing into epidermal cells, (Yf2) stylet probing through mesophyll/parenchyma, (Yf3) stylet contact with phloem and likely watery salivation, (Yf4) active ingestion of sap from phloem, probably sieve elements, and (Yf5) unknown stylet activity in multiple cell types. Study findings reveal that the Y. flavovittatus vector ingests sieve tube element more frequently and for longer durations than any other cell type, supporting that Y. flavovittatus is primarily a phloem feeder. Adult Y. flavovittatus show a longer total probing duration and produces a high density of puncture holes on sugarcane leaves. Moreover, probing behaviors revealed that adults typically ingest phloem sap more frequently and for longer durations than fifth-instar nymphs, enhancing sap ingestion. Furthermore, we propose that adults are more likely to acquire (during Yf4) and inoculate (during Yf3) higher amounts of phytoplasma than fifth-instar nymphs. This information on the penetration behavior of leafhopper Y. flavovittatus serves as a basis for advanced studies on the transmission mechanism of SCWL phytoplasma.

Botulinum toxin in the treatment of sialorrhea in severe neurological patients with tracheotomy.

OBJECTIVE: To observe the clinical effect of botulinum toxin type A (BTA) injection into the salivary glands of the severe neurological patients with tracheotomy METHODS: Seven patients with severe neurological disorders after tracheotomy and obvious drooling symptoms were enrolled. BTA was injected into bilateral parotid glands and submandibular glands under the guidance of ultrasound. Unstimulated salivary flow rate (uSFR) and Drooling Severity and Frequency Scale (DSFS) were used to evaluate drooling before injection, 1 week, and 4 weeks after injection. We compared the extubation time, time of changing from balloon cannula to metal cannula, hospitalization time and incidence of recurrent pulmonary infection between these patients and other patients accepted conventional curation. RESULTS: (1) The drooling severity scale (DSFS-S), the drooling frequency scale (DSFS-F), the drooling frequency and severity scale total score (DSFS-T) were significantly lower at 4 weeks after BTA injection compared to prior-treatment (p < .001). (2) uSFR of 1 week and 4 weeks were both statistically decreased than the untreated condition (p < .001). (3) Compared with the conventional group, the time of changing from balloon cannula to metal cannula was shortened obviously (p < .05) and incidence of recurrent pulmonary infection was clearly decreased (p < .05) after BTA treatment CONCLUSION: Ultrasound-guided BTA injection into salivary glands can effectively reduce saliva secretion. We also found that the time of changing cannula was shortened obviously and the incidence of recurrent pneumonia infection was reduced. BTA injection of salivary glands to cure drooling could advance to the clinical therapy in severe neurological patients after tracheotomy.

An effective salivation-facilitating method for COVID-19 testing: An experimental study.

BACKGROUND: Simple tools, such as antigen test kits, are readily available for determining coronavirus disease 2019 infection at hospitals and homes. However, it is challenging for elderly people who are prone to dry mouth and other diseases. The main objective of this study was to investigate whether the presence or consumption of a plum pickle can facilitate salivation during coronavirus disease 2019 testing. METHOD: Twenty healthy adult women participated in the study. The participants were allocated to 2 groups: presentation and non-presentation (n = 10; with and without presentation of a plum pickle, respectively), and eating and non-eating (n = 10; with and without consumption of plum pickle, respectively). We recorded the number of saliva swallows in 1 minute under each condition, using a swallowing test device, which attached film sensors to the hyoid bone and thyroid cartilage. RESULTS: There was a significant difference in the number of swallows between the non-presentation and presentation groups ( P < .01, r = 0.89, Z = -2.82) as well as between the non-eating and eating groups ( P < .01, r = 0.85, Z = -2.68). CONCLUSIONS: The strength of 3 factors, namely: direct stimulation with citric acid, saliva buffer capacity, and motor learning, may have affected the results. Our study suggests that saliva collection using the plum pickle is an effective complementary method for facilitating salivation. This technique may be useful in avoiding the risk associated with citric acid intake and for efficient specimen collection during coronavirus disease 2019 testing. In the future, we need to verify this method in elderly participants in a clinical setting.

The effect of gum chewing on xerostomia and salivary flow rate in elderly and medically compromised subjects: a systematic review and meta-analysis.

BACKGROUND: Xerostomia negatively affects quality of life. Symptoms include oral dryness; thirst; difficulty speaking, chewing, and swallowing food; oral discomfort; mouth soft tissue soreness and infections; and rampant tooth decay. The objective of this systematic review and meta-analysis was to investigate if gum chewing is an intervention that results in objective improvements in salivary flow rates and subjective relief from xerostomia. METHOD: We searched electronic databases including Medline, Scopus, Web of Science, Embase, Cochrane Library (CDSR and Central), Google Scholar and the citations of review papers (last searched 31/03/23). The study populations included: 1) elderly people with xerostomia (> 60 years old, any gender, and severity of xerostomia), and 2) medically compromised people with xerostomia. The intervention of interest was gum chewing. Comparisons included gum chewing vs. no gum chewing. The outcomes included salivary flow rate, self-reported xerostomia, and thirst. All settings and study designs were included. We conducted a meta-analysis on studies where measurements of unstimulated whole salivary flow rate for both a gum chewing, and no gum chewing intervention (daily chewing of gum for two weeks or longer) were reported. We assessed risk of bias using Cochrane's RoB 2 and ROBINS-I tools. RESULTS: Nine thousand six hundred and two studies were screened and 0.26% (n = 25) met the inclusion criteria for the systematic review. Two of the 25 papers had a high overall risk of bias. Of the 25 papers selected for the systematic review, six met the criteria to be included in the meta-analysis which confirmed a significant overall effect of gum on saliva flow outcomes compared to control (SMD = 0.44, 95% CI: 0.22-0.66; p = 0.00008; I2 = 46.53%). CONCLUSIONS: Chewing gum can increase unstimulated salivary flow rate in elderly and medically compromised people with xerostomia. Increasing the number of days over which gum is chewed increases the improvement in the rate of salivation. Gum chewing is linked with improvements in self-reported levels of xerostomia (although it is noted that no significant effects were detected in five of the studies reviewed). Future studies should eliminate sources of bias, standardise methods to measure salivary flow rate, and use a common instrument to measure subjective relief from xerostomia. STUDY REGISTRATION: PROSPERO CRD42021254485.

Effects of interferential current electrical stimulation (IFCS) on mastication and swallowing function in healthy young adults: A preliminary study.

OBJECTIVES: This study aimed to investigate the effects of interferential current electrical stimulation (IFCS) on masticatory and swallowing function. MATERIALS AND METHODS: Twenty healthy young adults were enrolled. The measurement items were spontaneous swallowing frequency (SSF), voluntary swallowing frequency (VSF), saliva secretion volume (SSV), glucose elution volume (GEV), and velocity of chew (VOC). All participants underwent both IFCS and sham stimulation (without stimulation, sham). Two sets of independent IFCS electrodes were placed on the bilateral neck. The precise location of the upper electrodes was just below the angle of the mandible, while the lower electrodes were placed at the anterior border of the sternocleidomastoid muscle. The intensity of IFCS was determined to be one level below the perceptual threshold that all participants felt discomfort. Statistical analysis was performed using a two-way repeated measures analysis of variance. RESULTS: For IFCS, the results of each measurement before and during stimulation were SSF: 1.16 and 1.46, VSF: 8.05 and 8.45, SSV: 5.33 and 5.56 g, GEV: 171.75 and 208.60 mg/dL, and VOC: 87.20 and 95.20, respectively. SSF, GEV, and VOC during stimulation were significantly increased by IFCS (SSF, p = .009; GEV, p = .048; and VOC, p = .007). Following sham stimulation, the results were SSF: 1.24 and 1.34, VSF: 7.75 and 7.90, SSV: 5.65 and 6.04 g, GEV: 176.45 and 187.35 mg/dL, and VOC: 91.35 and 88.25, respectively. CONCLUSION: While no significant differences were observed in the sham group, our findings suggest that IFCS of the superior laryngeal nerve may impact not only the swallowing function but also the masticatory function.

The effect of botulinum neurotoxin A on soft-tissue complications in intraoral reconstructions.

BACKGROUND: Intraoral reconstruction has become more common in recent years. Patients may suffer from complications because of hypersalivation. This issue can be overcome with an aid aimed at reducing saliva production. In this study, patients who underwent flap reconstruction were examined. The aim was to compare the complication rates between those who were administered with botulinum neurotoxin type A (BTXA) to the salivary glands before the reconstruction and those who were not. METHODS: Patients who underwent flap reconstruction between January 2015 and January 2021 were included in the study. The patients were divided into 2 groups. BTXA was applied to the parotid and submandibular glands in the 1st group at least 8 days before the operation to reduce the salivary secretion. BTXA application was not applied to the patients in the 2nd group before the operation. RESULTS: A total of 35 patients were included in the study. There were 19 patients in group 1 and 16 patients in group 2. The tumor type in both groups was squamous cell carcinoma. For patients in the 1st group, salivary secretion decreased in an average of 3.84 days. In the statistical analysis, no significant difference was found between the groups in terms of age, comorbidity, smoking-complication development, and comorbidity-complication development. When infection was excluded, there was a significant difference in the development of complications between the groups. CONCLUSIONS: BTXA application before the operation is beneficial to minimize complications in patients who plan to undergo elective intraoral reconstruction.

Ganoderma lucidum polysaccharides ameliorates D-galactose-induced aging salivary secretion disorders by upregulating the rhythm and aquaporins.

Longer-term deterioration in saliva secretion has been observed to occur in response to aging. The functional deterioration of the salivary gland damages swallowing and chewing abilities and consequently reduces life quality of the elderly. There are, however, only a few proven effective treatments for aging salivary secretion disorders. Ganoderma lucidum polysaccharide (GLP) has been applied to treat various diseases because of its safety, efficacy, and low cost. We investigated the protective effect of GLP on the submandibular gland (SMG) during aging. D-galactose (D-gal) was used to treat the aging mice, and the body weight, water consumption, saliva secretion, and flow rate were measured after 6 weeks of modeling. Micromorphological changes of the SMG were assessed by hematoxylin-eosin staining and transmission electron microscopy. RT-qPCR and Western blot were used to detect the expression of apoptotic proteins and inflammatory cytokines. Aquaporins (AQPs) and rhythmic protein expression were analyzed by immunohistochemistry and immunofluorescence. The results showed that GLP effectively promoted the expression of AQP5, AQP4, and AQP1, inhibited the release of TNF-α, IL-6, and Bax, and reduced inflammation and apoptosis. Further experiments showed that GLP promoted the up-regulation of core clock genes and proteins and restored the co-localized expression of CLOCK and AQP5 that were weakened during aging, helping to attenuate aging-induced weight loss, decreased salivation, and structural and functional damage. The findings of this work contribute to understanding the nature of age-related modifications in SMG by identifying changes in AQP5 expression and regulatory mechanisms linked to SMG dysfunction during aging. GLP is a potential drug for maintaining healthy salivary gland (SG) status and preventing SG deficiency in the elderly.

Salivary gland bioengineering - yesterday, today, tomorrow!

Salivary glands are specialized structures developed as an extensively compact, arborized design through classical embryogenesis, accompanied by a cascade of events channelized by numerous growth factors and genetic regulatory pathways. Salivary secretions maintain oral homeostasis and, when diminished in certain conditions, present as xerostomia or salivary hypofunction, adversely impacting the patient's quality of life. The current available treatments primarily aim at tackling the immediate symptoms providing temporary relief to the patient. Despite scientific efforts to develop permanent and effective solutions to restore salivation, a significant permanent treatment is yet to be established. Tissue engineering has proven as a promising remedial tool in several diseases, as well as in xerostomia, and aims to restore partial loss of organ function. Recapitulating the physiological cellular microenvironment to in vitro culture conditions is constantly evolving. Replicating the dynamic multicellular interactions, genetic pathways, and cytomorphogenic forces, as displayed during salivary gland development have experienced considerable barriers. Through this review, we endeavour to provide an outlook on the evolution of in vitro salivary gland research, highlighting the key bioengineering advances and the challenges faced with the current therapeutic strategies for salivary hypofunction, with an insight into our team's scientific contributions.