Parotid salivary parameters in bulimic patients - a controlled clinical trial.

OBJECTIVES: The aim of this study was to determine whether patients with purging-type bulimia and/or non-bulimic patients, treated with serotonin reuptake inhibitor SI-5-HT (fluoxetine), have dental erosion and changes in selected buffer components of parotid saliva (bicarbonates, phosphates, urea), compared with the healthy population. METHODS: A controlled clinical trial was designed for three, age-matched, female groups of 94 patients: 1) bulimic patients treated with fluoxetine 40 mg/day (n = 25), 2) non-bulimic patients diagnosed with bipolar affective disorder, treated with fluoxetine 20mg/day (n = 25), and 3) healthy controls (n = 44). Parotid saliva was collected from the subjects by means of Lashley cup at rest and stimulated chemically with a 3% citric acid solution. In clinical examination the dental erosion was determined as non-carious tooth substance loss using the Tooth Wear Index (TWI). The concentrations of inorganic phosphates, bicarbonate, urea and pH in saliva were measured. RESULTS: In the bulimic subjects higher TWI (24%) and lower levels of pH, bicarbonates and phosphates compared with controls were observed. There were no significant differences in urea concentration. CONCLUSIONS: Erosive-abrasive tooth surface loss seems to be a significant diagnostic tool of bulimia nervosa. The presence of pathological changes in teeth structure indicates the loss of protective properties of saliva, which is proved by pH value and concentration of buffer ions. It is advisable to monitor salivary parameters, such as salivary flow rate, pH and the concentration of buffer ions in long-term treatment with SI-5-HT drugs in case of patients with purging-type bulimia. There is also a need for regular dental check-ups of the oral cavity tissues.

Parotid gland flow activity and inorganic composition in purging bulimic patients treated with fluoxetine.

OBJECTIVES: The purpose of this study was to establish whether vomiting bulimic and/or non-bulimic depressive patients, both treated with the serotonin reuptake inhibitor SI-5-HT (fluoxetine), have differing proportions of inorganic components (specifically, sodium, potassium and calcium) in their parotid salivary gland secretions, than in the average population. METHODS: A controlled clinical trial was designed for three age-matched female groups: bulimic patients receiving fluoxetine 40 mg/day (n = 33), non-bulimic patients diagnosed with bipolar affective disorder (fluoxetine 20 mg/day, n = 25) and healthy controls (n = 51). Parotid saliva was collected using a Lashley cap while the subjects were at rest. Stimulation was obtained chemically using a 3% citric acid solution, and physically by instructing the subjects to chew on wax pellets. The concentrations of sodium, potassium and calcium ions were measured using the colorimetric photometry method. RESULTS: The bulimic patients had a reduction in flow and sodium and potassium ions in the parotid saliva and non-bulimic patients had a reduction in flow. Deficits in certain components of saliva were shown to be directly related to salivary flow rate. CONCLUSIONS: The data suggest that detection of inorganic deficits in parotid saliva might serve as a reliable confirmation of reduction in flow amongst purging bulimic patients treated with fluoxetine.

Flow rates and inorganic composition of whole saliva in purging bulimic patients treated with a fluoxetine.

OBJECTIVES: The current study established whether vomiting bulimic and/or non-bulimic depressive patients, both treated with a serotonin reuptake inhibitor (fluoxetine), have changes in their whole salivary secretion and inorganic components: Na(+), K(+), Ca(2+). METHODS: From 108 female subjects, namely bulimics (Group B) (fluoxetine: 40 mg/day) (n=33), non-bulimic depressives (Group D) (fluoxetine: 20 mg/day) (n=25) and a Group C of 50 healthy controls, unstimulated and stimulated saliva was collected. The concentrations of Na(+), K(+), Ca(2+) were determined by colorimetric photometry method (Effox 5053, Eppendorf, Germany). RESULTS: The bulimic group reported significant lower output in salivary flow and sodium concentration. In the group (D) only flow was lower than in healthy controls but not significant. CONCLUSION: This study supports the hypothesis that salivary flow is an unreliable indicator of bulimia, the lack of increase in sodium level in stimulated saliva in bulimic subjects could be a more reliable confirmation of the eating disorder.

Remote noxious stimuli modulate jaw reflexes evoked by activation of periodontal ligament mechanoreceptors in man.

The purpose of the study was to investigate whether jaw reflexes evoked by selective stimulation of periodontal ligament me canoreceptors are susceptible to modulation by remote noxious stimulation. Experiments were performed on 10 volunteer subjects. Skin surface recordings were made from the jaw-closing masseter muscle. The subjects activated the muscle to approximately 10% of maximum by biting on a rubber impression of their molar teeth while they received visual feedback of the electromyogram (EMG) of the muscle. Reflexes were produced by the application of gentle mechanical stimuli to an upper central incisor tooth. The stimuli were in the form of 'ramp and hold' forces with a 5 ms rise-time and a 1.5 N plateau which lasted 350 ma. The resulting reflexes were recorded both under control conditions and while the subjects received a remote noxious stimulus (immersion of a hand in water at 3 degrees C). In all 10 subjects, the stimuli produced a single period of inhibition of masseteric activity (latency, 12.8 t 04 ms; duration, 18.1+/-1.3 ms; means +/- S.E.M.), which was usually followed by a period of increased masseteric activity. The period of inhibition constituted a downward wave in full-wave rectified, averaged signals. The integrals of such waves were significantly smaller (by 17+/- 6.5 %; P = 0.027; Student's t test) when the reflex was evoked during remote noxious stimulation rather than under control conditions. As such reflexes are beLieved to play a modulatory role during normal oral function this finding maybe relevant to disorders of mastication associated with pain.