Time-dependent effects of tongue cleaning with mouthwash or mouth moisturising gel on the number of microbes on the tongue surface of elders with care needs.

OBJECTIVE: The purpose of this study was to investigate time-dependent change in the number of microbes on the tongue surface after tongue cleaning using a mouthwash or mouth moisturising gel for elders fed with a feeding tube and with care needs. MATERIALS AND METHODS: Twelve elders fed through a feeding tube and with care needs participated in this prospective crossover study. There were four kinds of tongue cleaning modes as follows: (i) tongue cleaning with a mouthwash; (ii) tongue cleaning with a mouth moisturising gel; (iii) tongue cleaning with water; (iv) no tongue cleaning as a negative control. The total number of microbes on the tongue surface was measured using a rapid oral bacteria detection device at baseline, immediately after cleaning, and at 1, 3 and 5 hours after cleaning to evaluate the time-dependent change for each tongue cleaning mode. RESULTS: There were no significant differences regarding microbial count on every measurement in negative control and tongue cleaning with water. There were significant decreases immediately after cleaning, and at 1, 3 and 5 hours after cleaning compared to baseline when the tongue was cleaned with a mouthwash. There was a significant decrease between baseline and immediately after cleaning when the tongue was cleaned with a mouth moisturising gel. CONCLUSION: Tongue cleaning with mouth moisturising gel decreased the number of microbes on the tongue surface immediately after cleaning, and tongue cleaning with mouthwash decreased it for 5 hours.

In vitro assessment of artificial saliva formulations on initial enamel erosion remineralization.

OBJECTIVES: Various formulations of artificial saliva are present in the literature and little guidance is available on the standardization of type of saliva for use in in vitro protocols for erosive studies. The aim of this study was to evaluate the remineralizing capacity of different formulations of artificial saliva on initial enamel erosive lesion. METHODS: Bovine enamel blocks were subjected to short-term acidic exposure by immersion in citric acid 0.05 M (pH 2.5) for 15s, resulting in surface softening without tissue loss. Then 90 selected eroded enamel blocks were randomly and equally divided into 6 groups according to saliva formulation (n=15): Saliva 1 (contain mucin); Saliva 2 (Saliva 1 without mucin); Saliva 3; Saliva 4; Saliva 5 (contain sodium carboxymethyl cellulose) and control (C) (deionized water). After demineralization enamel blocks were subjected to remineralization by immersion in the saliva's formulations for 2h. Enamel remineralization was measured by superficial hardness test (% superficial hardness change). The data were tested using ANOVA and Tukey's test (p<0.05). RESULTS: All the tested formulations of artificial saliva resulted in significantly higher enamel remineralization compared to control (p<0.001). Saliva 3 showed higher percentage of enamel remineralization than Saliva 5 (p<0.05). CONCLUSIONS: Besides the variety of artificial saliva for erosion in vitro protocols, all the formulations tested were able to partially remineralize initial erosive lesions.

Subjective assessment of a new moisturizing mouth spray for the symptomatic relief of dry mouth.

OBJECTIVE: A randomized clinical trial (Study 1) and consumer usage test (Study 2) were conducted to evaluate the acceptability and efficacy of OASIS Mouth Moisturizing Spray in subjects experiencing dry mouth. METHODOLOGY: Study 1: A randomized, single-blind, four-arm crossover clinical trial was conducted in 24 subjects, ranging from 50-84 years of age, to evaluate OASIS Mouth Moisturizing Spray and two experimental mouth spray formulations, and compare their performance to a reference (marketed) mouth spray, SALIVEZE. Following a three-day acclimatization phase, subjects used all four products at home for three days. Each treatment phase was separated by a three-day washout period. Study 2: One-hundred twenty subjects participated in a three-week home usage consumer test using OASIS Mouth Moisturizing Spray, after which they completed a 52-question online survey exploring sensory, efficacy, and resultant quality of life attributes of the product. RESULTS: Study 1: On average, subjects used the four test products 2-3 times per day. OASIS Mouth Moisturizing Spray was found to be effective in relieving dry mouth in the study population, as evidenced by a statistically significant feeling of coating the mouth (p < 0.05), and statistically significantly longer dry mouth relief (p < 0.005) than the commercial control. The OASIS Mouth Moisturizing Spray was statistically significantly (p < 0.05) better and preferred over the other product tested. All the products used in the study were well-tolerated. Study 2: On a five-point scale, 73% of respondents perceived the OASIS Mouth Moisturizing Spray as "very good" or "excellent," and more than 60% gave the product an "excellent" or "very good" rating on sensory, efficacy, and quality of life attributes. CONCLUSION: These studies show that OASIS Mouth Moisturizing Spray helped provide dry mouth relief and was well liked by the study population.

Extended formulary nurse prescribing--another saliva substitute roadblock.

United Kingdom family physicians, General Practitioners (GPs), are allowed to prescribe from a Department of Health-approved list of non-medicines (the 'ACBS' list) which includes a majority of proprietary saliva substitutes. Independent nurse prescribing, introduced in 2001, has improved patient access to effective remedies for a wide range of common medical problems. Further qualified 'extended formulary nurse prescribers' have access to a limited range of prescription medicines, and all non-prescription medicines that GPs may currently prescribe. Despite their specified role in the management of oral complications encountered in palliative care, a similar anomaly in NHS rules that prevents dental practitioners from prescribing ACBS listed saliva substitutes also prevents nurses from prescribing them. Sadly, patients are suffering poorer access to simple and effective remedies to conditions such as xerostomia - a condition that has recognised impact on their quality of life.

Efficacy and economic evaluation of pilocarpine in treating radiation-induced xerostomia.

Xerostomia, resulting from therapeutic irradiation of the head and neck, can be debilitating and destructively impact the patient's quality of life. The first priority of treatment of radiation-induced xerostomia should be to preserve oral and dental health. Therapeutic doses of fluoride and meticulous dental hygiene are the treatments of choice for this purpose. Measures taken to prevent superinfection with cariogenic bacteria and fungi are also important. In addition to minimising damage to the dentition, it is important to provide palliative therapy to help the patient live a more normal life. Salivary substitutes help some patients but muscarinic, cholinergic sialogogues provide a more physiological replacement in those patients who have measurable residual salivary function. An oral formulation of pilocarpine hydrochloride is approved to treat radiation-induced xerostomia. In such cases, it has been shown to effectively stimulate salivary flow and relieve subjective symptoms associated with oral dryness. Administration of this drug is associated with predictable, but generally tolerable, adverse effects. Similar drugs, approved for other indications, have been shown to produce comparable results. These drugs are generally less expensive than the oral formulation of pilocarpine. As treatment of irradiation-induced xerostomia with muscarinic, cholinergic sialogogues is palliative, not curative, administration of these drugs should be individualised and guided by the patient's willingness to balance symptomatic efficacy with adverse effects and the expense of treatment.

Drug prescription practices of hospital dentists.

Surveys were sent to the membership of the American Association of Hospital Dentists to evaluate their prescribing practices. The 295 surveys that were evaluated revealed that current pharmacological interventions are directed primarily to the elimination of pain and infection. The respondents listed a wide variety of prescribed drug groups as well as numerous drugs within each drug group. Our respondents indicated that the future will necessitate a greater knowledge base in drug groups that today are not as widely used and recognized, such as antiviral and antifungal agents.