Oil-based compositions as saliva substitutes: A pilot study to investigate in-mouth retention.

OBJECTIVES: This pilot study aimed to compare the in-mouth retention of an oil-based saliva substitute (emulsion, consisting of rice bran oil, soy lecithin and water) with water and a 1% w/v methylcellulose suspension (polymer) in healthy volunteers. METHODS: Each formulation was tagged with 1 mmol/L lithium and participants (n=30) rinsed their mouth with one randomly assigned formulation (emulsion, polymer or water) for 30s, before expectorating into a cup. Concentration of lithium expectorated was measured and amount of each formulation remaining in the mouth was estimated. Patient acceptability was investigated using questionnaires, and Fourier-Transform Infrared spectroscopy (FTIR) was used to determine the presence of oil in expectorated samples. RESULTS: Immediately after rinsing, taste was rated lower in the emulsion group compared to the polymer or water groups (p>0.05), although variability was high. Mean retention was highest in the emulsion group, with a difference of 8.34 ± 2.71% (p=0.003) and 4.57 ± 2.71% (p=0.06) compared with the water and polymer groups, respectively. FTIR confirmed the presence of oil in all expectorated emulsion samples. CONCLUSION: The emulsion was not inferior to the polymer in terms of retention immediately after rinsing. The next step is to conduct larger clinical studies over longer time periods in participants with salivary hypofunction.

Erosion protection by calcium lactate/sodium fluoride rinses under different salivary flows in vitro.

This study investigated the effect of a calcium lactate prerinse on sodium fluoride protection in an in vitro erosion-remineralization model simulating two different salivary flow rates. Enamel and dentin specimens were randomly assigned to 6 groups (n = 8), according to the combination between rinse treatments - deionized water (DIW), 12 mM NaF (NaF) or 150 mM calcium lactate followed by NaF (CaL + NaF) - and unstimulated salivary flow rates - 0.5 or 0.05 ml/min - simulating normal and low salivary flow rates, respectively. The specimens were placed into custom-made devices, creating a sealed chamber on the specimen surface connected to a peristaltic pump. Citric acid was injected into the chamber for 2 min, followed by artificial saliva (0.5 or 0.05 ml/min) for 60 min. This cycle was repeated 4×/day for 3 days. Rinse treatments were performed daily 30 min after the 1st and 4th erosive challenges, for 1 min each time. Surface loss was determined by optical profilometry. KOH-soluble fluoride and structurally bound fluoride were determined in specimens at the end of the experiment. Data were analyzed by 2-way ANOVA and Tukey tests (α = 0.05). NaF and CaL + NaF exhibited significantly lower enamel and dentin loss than DIW, with no difference between them for normal flow conditions. The low salivary flow rate increased enamel and dentin loss, except for CaL + NaF, which presented overall higher KOH-soluble and structurally bound fluoride levels. The results suggest that the NaF rinse was able to reduce erosion progression. Although the CaL prerinse considerably increased F availability, it enhanced NaF protection against dentin erosion only under hyposalivatory conditions.

Lecithin-based emulsions for potential use as saliva substitutes in patients with xerostomia--viscoelastic properties.

The purpose of the present study was to investigate lecithin-rice bran oil rheological properties with the view to consider these as potential saliva substitutes in patients with severe xerostomia and salivary hypofunction. Pseudo-ternary phase diagrams of rice bran oil, lecithin and water mixtures were constructed and characterised using polarising light microscopy. Viscoelastic properties, which we hypothesise are important determinants in product performance, were analysed using both flow and oscillatory rheology. Rheological properties were influenced by composition, frequency and shear stress. Frequency-dependent viscoelasticity was observed in some formulations where viscosity dominated (tanδ>1) at frequencies under 5 Hz and elasticity dominated (tanδ<1) at higher frequencies. Threshold frequencies were determined for each formulation, where a peak in loss tangent was observed, coinciding with a reduction in the storage modulus and increase in loss modulus. The frequency-dependent behaviour of emulsions are of interest because these combinations exhibit viscous behaviour at low frequencies, which may improve lubrication of the oral cavity at rest, whereas increased elasticity at higher frequencies may improve retention during higher-shear tasks such as swallowing and speaking.

Oral health promotion interventions on oral yeast in hospitalised and medically compromised patients: a systematic review.

Yeast are major aetiological agents of localised oral mucosal lesions, and are also leading causes of nosocomial bloodstream infections. The purpose of this systematic review was to examine the effectiveness of oral health promotion interventions on the prevalence and incidence of these opportunistic oral pathogens in hospitalised and medically compromised patients. The PubMed, ISI Web of Science and Cochrane Library databases were searched for clinical trials assessing the effect of oral health promotion interventions on oral yeast. Chlorhexidine delivered in a variety of oral hygiene products appeared to have some effect on oral yeast, although some studies found equivocal effects. Although a wide array of other compounds have also been investigated, their clinical effectiveness remains to be substantiated. Likewise, the utility of mechanical oral hygiene interventions and other oral health promotion measures such as topical application of salivary substitute, remains unsettled. Although many chemical agents contained in oral hygiene products have proven in vitro activity against oral yeast, their clinical effectiveness and potential role as adjuncts or alternative therapies to conventional treatment remains to be confirmed by further high-quality randomised controlled trials. This is pertinent, given the recent emergence of yeast resistance to conventional antifungal agents.

Interventions for the management of dry mouth: topical therapies.

BACKGROUND: Xerostomia (the feeling of dry mouth) is a common symptom especially in older adults. Causes of dry mouth include medications, autoimmune disease (Sjögren's Syndrome), radiotherapy or chemotherapy for cancer, hormone disorders and infections. OBJECTIVES: To determine which topical treatments for dry mouth are effective in reducing this symptom. SEARCH METHODS: We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (28 October 2011), The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4 2011), MEDLINE via OVID (1950 to 28 October 2011), EMBASE via OVID (1980 to 28 October 2011), CINAHL via EBSCO (1980 to 28 October 2011), AMED via OVID (1985 to 28 October 2011), CANCERLIT via PubMed (1950 to 28 October 2011). SELECTION CRITERIA: We included randomised controlled trials of topical interventions such as lozenges, sprays, mouthrinses, gels, oils, chewing gum or toothpastes for the treatment of dry mouth symptom. We classified interventions into two broad categories, saliva stimulants and saliva substitutes, and these were compared with either placebo or another intervention. We included both parallel group and crossover trials. DATA COLLECTION AND ANALYSIS: Two or more review authors independently carried out data extraction and assessed risk of bias. Trial authors were contacted for additional information as required. MAIN RESULTS: Thirty-six randomised controlled trials involving 1597 participants met the inclusion criteria. Two trials compared saliva stimulants to placebo, nine trials compared saliva substitutes to placebo, five trials compared saliva stimulants directly with saliva substitutes, 18 trials directly compared two or more saliva substitutes, and two trials directly compared two or more saliva stimulants. Only one trial was at low risk of bias and 17 were at high risk of bias. Due to the range of interventions, comparisons and outcome measures in the trials, meta-analysis was possible for only a few comparisons. Oxygenated glycerol triester (OGT) saliva substitute spray shows evidence of effectiveness compared to an electrolyte spray (standardised mean difference (SMD) 0.77, 95% confidence interval (CI) 0.38 to 1.15) which corresponds to approximately a mean difference of 2 points on a 10-point visual analogue scale (VAS) for mouth dryness. Both integrated mouthcare systems (toothpaste + gel + mouthwash) and oral reservoir devices show promising results but there is insufficient evidence at present to recommend their use. Although chewing gum is associated with increased saliva production in the majority of those with residual capacity, there is no evidence that gum is more or less effective than saliva substitutes. AUTHORS' CONCLUSIONS: There is no strong evidence from this review that any topical therapy is effective for relieving the symptom of dry mouth. OGT spray is more effective than an aqueous electrolyte spray (SMD 0.77, 95% CI 0.38 to 1.15) which is approximately equivalent to a mean difference of 2 points on a 10-point VAS scale for mouth dryness. Chewing gums appear to increase saliva production in those with residual secretory capacity and may be preferred by patients, but there is no evidence that gum is better or worse than saliva substitutes. Integrated mouthcare systems and oral reservoir devices may be helpful but further research is required to confirm this. Well designed, adequately powered randomised controlled trials of topical interventions for dry mouth, which are designed and reported according to CONSORT guidelines, are required to provide evidence to guide clinical care. For many people the symptom of dry mouth is a chronic problem and trials should evaluate whether treatments are palatable, effective in reducing xerostomia, as well as the long-term effects of treatments on quality of life of those with chronic dry mouth symptoms.

Effect of supplementation of soft drinks with green tea extract on their erosive potential against dentine.

BACKGROUND: Matrix metalloproteinase (MMP) inhibitors reduce dentine erosion. This in vitro study evaluated the effect of the supplementation of soft drinks with green tea extract, a natural inhibitor of MMPs, on their erosive potential against dentine. METHODS: For each drink tested (Coca-Cola, Kuat guarana, Sprite and light Coca-Cola), 40 dentine specimens were divided into two subgroups differing with respect to supplementation with green tea extract at 1.2% (OM24, 100%Camellia sinensis leaf extract, containing 30 ± 3% of catechin; Omnimedica, Switzerland) or not (control). Specimens were subjected to four pH cycles, alternating de- and remineralization in one day. For each cycle, samples were immersed in pure or supplemented drink (10 minutes, 30 mL per block) and in artificial saliva (60 minutes, 30 mL per block) at 37 °C, under agitation. Dentine alterations were determined by profilometry (µm). Data were analysed by two-way ANOVA and Bonferroni's test (p < 0.05). RESULTS: A significant difference was observed among the drinks tested with Sprite leading to the highest surface loss and light Coca-Cola to the lowest. Supplementation with green tea extract reduced the surface loss by 15% to 40% but the difference was significant for Coca-Cola only. CONCLUSIONS: Supplementation of soft drinks with green tea extract might be a viable alternative to reduce their erosive potential against dentine.

[Xerostomia. Improved care using a spray with herbal polysaccharides]. / Xerostomie. Verbesserte Linderung durch ein Spray mit pflanzlichen Polysacchariden.

BACKGROUND: In a prospective clinical study the topical use of a polysaccharide-containing spray for the treatment of xerostomia after radiotherapy in the head and neck area was tested. PATIENTS AND METHODS: A total of 83 patients (evaluable return: n=55) with xerostomia after radiotherapy in the head and neck area received a pump spray with 50 ml Saliva natura (medac, Wedel, Germany) to test for 1 week. The patients were asked to fill in a questionnaire about their xerostomia with and without use of the spray. Individual items included: xerostomia in the state of rest, difficulties speaking, eating and sleeping, frequency of the use of treatment against xerostomia, changes in taste, and saliva viscosity. Additionally, they assessed the spray in general and for taste. RESULTS: Patients reported an improvement in all areas included in the questionnaire. The greatest effect of the spray was seen in sleeping difficulties, which improved by almost a whole point from 3.65 to 2.67, as well as in the frequency of use of xerostomia treatment (averagely 15x/day without and 10x/day with the spray). On average the spray was graded as "satisfactory" (3.09), while its taste was graded as "good" (2.17). CONCLUSION: The tested spray may help improve the situation of patients with xerostomia following radiotherapy in the head and neck area. These patients should be given the opportunity to test a spray of this kind.

Effect of various calcium/phosphates ratios of carboxymethylcellulose-based saliva substitutes on mineral loss of bovine enamel in vitro.

OBJECTIVES: The present study evaluated the effects of various calcium and phosphate concentrations and ratios of carboxymethylcellulose (CMC)-based solutions on the mineral loss of predemineralised bovine enamel in vitro. METHODS: Bovine enamel specimens were prepared, polished and partly covered with nail varnish, thus serving as control of sound enamel. After demineralisation (37 degrees C; pH 5.0; 14 days) the specimens were exposed to CMC-based solutions (20g/l) with various saturations with respect to apatites containing 0.1mM NaF, CaCl2 (0-32 mM) and KH2PO4 (0-52 mM) at two different pH values (5.5 or 6.5). A fluoride-free solution served as control, and four commercially available products were tested as well. The differences in mineral loss (DeltaDeltaZ) between the values prior to (DeltaZ Demin) and after storage (DeltaZ Effect) in the various solutions were evaluated from microradiographs of thin sections (100microm). RESULTS: The general linear model revealed a significant dependency for DeltaDeltaZ on 'calcium' (p<0.001), 'phosphate' (p=0.023), 'fluoride' (p=0.002) and 'pH' (p<0.001). With increasing calcium and phosphate concentrations an increase in DeltaDeltaZ could be observed up to the solution containing the third highest saturation with respect to octacalciumphosphate (3.2), showing a significant remineralisation (p<0.05; t-test). The commercially available products as well as the control groups revealed significantly reduced DeltaDeltaZ values compared to this group (p<0.01; Bonferroni). CONCLUSIONS: A saturation with respect to octacalciumphosphate of 3.2 and a pH of 6.5 enables CMC-based solutions to remineralise bovine enamel in vitro.

Surface microhardness of enamel after different home bleaching procedures.

OBJECTIVES: The purpose of this study was to evaluate the influence of different home bleaching procedures on surface microhardness of human enamel. METHODS: Among eight groups 192 incisors were distributed. The facial surface of each incisor was polished and baseline hardness of enamel (m0; Knoop) was assessed with a load of 1N for 30s. Subsequently, the enamel was treated for 14 days with the bleaching agent: groups 1, 2 and 4 Viva Style Paint on, 8% carbamide peroxide (CP) 1x20min, 2x20min and 2x5min; group 3 Colgate Simply White, 5.9% hydrogen peroxide (HP), 2x30min; group 5 Viva Style 10% CP 1x1h; group 6 Blend-a-med White Strips, 5.9% HP 2x30min; group 7 Odol-med3 Beauty-Kur, sodium chlorite 2x10min; group 8 control, running water 1x1h. Hardness was reassessed after the last bleaching treatment (m1) and after 6 weeks storage in artificial saliva (m2). RESULTS: Changes in microhardness were as follows (m0-m1): (1) -2.3 (+/-20.3); (2) -8.9 (+/-27.2); (3) 63.4 (+/-56.3); (4) 9.6 (+/-30.1); (5) 12.8 (+/-62.6); (6) 92.2 (+/-50.2); (7) 158.4 (+/-59.7); (8) 10.6 (+/-38.5). Statistical analysis showed that hardness values were significantly (p< or =0.0005; Wilcoxon test) reduced in groups 3, 6, and 7 (m1) and in group 7 (m2). SIGNIFICANCE: Both type of bleaching agent and concentration have a significant influence on the microhardness of enamel. The most critical bleaching agent seems to be the one containing sodium chlorite in combination with citric acid.

Randomized-controlled trial: effect of a reservoir biteguard on quality of life in xerostomia.

BACKGROUND: To assess the effect of a reservoir biteguard for artificial saliva on the oral health-related quality of life of patients with xerostomia. METHODS: Double-blind randomized placebo-controlled trial among 86 adults with xerostomia. Study group received the trial biteguard. Control group received a conventional biteguard. Outcomes were number of impacts and total scores as recorded by oral impacts on daily performances (OIDP). RESULTS: At 1-month follow up 84 people remained in the trial. The median number of impacts in the study and control groups was 3 and 4 respectively. The median total score was 6 and 12 respectively. In ANCOVA receipt of the reservoir biteguard reduced the number of impacts recorded by OIDP but there was no difference in the total score. CONCLUSIONS: Reservoir biteguards improved the quality of life of people with xerostomia by reducing the number of impacts on daily life.

The efficacy of casein phosphoprotein-calcium phosphate complex (DC-CP) [Dentacal] as a mouth moistener in patients with severe xerostomia.

OBJECTIVES: The purpose of this study was to evaluate casein derivatives coupled with calcium phosphate (CD-CP) (Dentacal, NSI Pty Ltd, Hornsby, Australia) as a mouth moistener in a group of dentate patients with severe xerostomia. DESIGN: The study was a subjective, patient self-evaluation questionnaire on the use of Dentacal compared with the moistening strategies that they usually used. SETTING: The study was hospital and community based. SUBJECTS/MATERIALS, AND METHODS: Thirty eight patients with severe xerostomia were recruited from the larger group of 124 who had taken part in a clinical trial of the anti-caries efficacy of casein derivatives complexed with calcium phosphate (Hay and Thomson, 2002). Each patient used Dentacal for 14 days and the responses to it were compared with the responses to their other mouth moistening strategies. RESULTS: The outcome indicated that Dentacal, when used as an atomised spray in the mouth, provided good moistening and lubrication. CONCLUSIONS: The material could provide benefits in both oral moistening and dental caries prevention in dentate people with xerostomia.

Comparison of the effect of the linseed extract Salinum and a methyl cellulose preparation on the symptoms of dry mouth.

The effect of a linseed extract Salinum and a sodium carboxymethyl cellulose preparation called MAS-84 was compared with regard to its effect on the symptoms of dry mouth. Twenty patients with xerostomia, who had been treated for cancer in the head and neck by radiation were recruited from the clinic for maxillofacial surgery, Malmo University Hospital. Following radiation treatment the salivation was severely reduced. The symptoms of a general feeling of a dry mouth, difficulties in chewing and swallowing, taste disturbances, problems with speech and mouth burning were registered on a subjective verbal rating scale. In addition plaque index and gingival bleeding were determined. The study design was crossover and performed single blind. The experimental period was 7 weeks. The patients were randomly divided into 2 groups. One group used Salinum and the other MAS-84 for 3 weeks. The fourth week was a wash out period and for the next three weeks the patients shifted preparation. Each of the preparations was used ad libitum. Registrations of the various parameters were undertaken on days 0, 7 and 21 of the respective period. At the initial examination all patients reported considerable disturbances from mouth-dryness. These symptoms were reduced in 15 patients during the Salinum period and in 9 during the MAS-84 period. The relief was significantly more pronounced during the use of Salinum compared to that during the use of the methyl cellulose preparation. On day 21 plaque and gingival bleeding were significantly reduced during the Salinum period but not during the MAS-84 period. The results of the present study confirm those of a previous pilot study and indicate that the linseed mucilage significantly reduced the symptoms of dry mouth. This effect increased with increasing time of saliva substitute use. The linseed mucilage Salinum appeared to be a suitable saliva replacement in mouth dry patients.