Oral epithelial MUC1 and oral health.

OBJECTIVES: To provide information about MUC1, epithelial membrane-bound mucin, in terms of its role in oral health. DESIGN: The expression and functional roles of MUC1 in the oral mucosa and salivary glands were reviewed. Information on the modulation of oral mucosal epithelial MUC1 expression compared with that of endometrial epithelial MUC1 expression was also reviewed. In addition, the possible associations between oral mucosal epithelial MUC1 and oral diseases were explored. RESULTS: MUC1 is expressed in the oral mucosa and major and minor salivary glands. Protection of oral mucosal surfaces is believed to be the main function of oral mucosal epithelial MUC1. Its role in the salivary glands is thought to facilitate salivary flow through the ductal system. Information on the role of MUC1 in signal transduction and modulation of immune function in the oral cavity is sparse. However, the possible roles of MUC1 in dry mouth conditions, burning mouth syndrome, dental caries, and oral candidiasis have been suggested. CONCLUSIONS: Despite limited information, it is clear that oral epithelial MUC1 plays an important role in oral health. Further research evaluating the physiological and pathological roles of MUC1 in the oral cavity is warranted.

Geriatric oral and maxillofacial dysfunctions in the context of geriatric syndrome.

OBJECTIVES: To propose the application of the concept of geriatric syndrome for common geriatric oral and maxillofacial dysfunctions and to suggest the necessity of developing effective evaluation methods for oral and maxillofacial frailty. DESIGN: The concepts of frailty and geriatric syndrome based on multi-morbidity and polypharmacy were applied to five common geriatric oral medicinal dysfunctional problems: salivary gland hypofunction (dry mouth), chronic oral mucosal pain disorders (burning mouth symptoms), taste disorders (taste disturbances), swallowing disorders (dysphagia), and oral and maxillofacial movement disorders (oromandibular dyskinesia and dystonia). RESULTS: Each of the dysfunctions is caused by various kinds of diseases and/or conditions and medications, thus the concept of geriatric syndrome could be applied. These dysfunctions, suggested as components of oral and maxillofacial geriatric syndrome, are associated and interacted with each other in a complexity of vicious cycle. The resulting functional impairments caused by this syndrome can cause oral and maxillofacial frailty. CONCLUSIONS: Geriatric oral and maxillofacial dysfunctions could be better appreciated in the context of geriatric syndrome. The development of effective methods for evaluating the severity of these dysfunctions and the resulting frailty is essential.

Differential diagnosis of jaw pain using informatics technology.

This study aimed to deduce evidence-based clinical clues that differentiate temporomandibular disorders (TMD)-mimicking conditions from genuine TMD by text mining using natural language processing (NLP) and recursive partitioning. We compared the medical records of 29 patients diagnosed with TMD-mimicking conditions and 290 patients diagnosed with genuine TMD. Chief complaints and medical histories were preprocessed via NLP to compare the frequency of word usage. In addition, recursive partitioning was used to deduce the optimal size of mouth opening, which could differentiate TMD-mimicking from genuine TMD groups. The prevalence of TMD-mimicking conditions was more evenly distributed across all age groups and showed a nearly equal gender ratio, which was significantly different from genuine TMD. TMD-mimicking conditions were caused by inflammation, infection, hereditary disease and neoplasm. Patients with TMD-mimicking conditions frequently used "mouth opening limitation" (P < .001), but less commonly used words such as "noise" (P < .001) and "temporomandibular joint" (P < .001) than patients with genuine TMD. A diagnostic classification tree on the basis of recursive partitioning suggested that 12.0 mm of comfortable mouth opening and 26.5 mm of maximum mouth opening were deduced as the most optimal mouth-opening cutoff sizes. When the combined analyses were performed based on both the text mining and clinical examination data, the predictive performance of the model was 96.6% with 69.0% sensitivity and 99.3% specificity in predicting TMD-mimicking conditions. In conclusion, this study showed that AI technology-based methods could be applied in the field of differential diagnosis of orofacial pain disorders.

Changes in oral mucosal MUC1 expression and salivary hormones throughout the menstrual cycle.

OBJECTIVE: To investigate relationships among oral mucosal epithelial MUC1 expression, salivary stress markers, and female gonadal hormones throughout the menstrual cycle. SUBJECTS AND METHODS: Thirty healthy women (25.9 ± 2.1 years) with regular menstrual cycle were included. Unstimulated (UWS) and stimulated whole saliva (SWS) were collected during the menstrual cycle. The expression level of oral mucosal MUC1 was analyzed. 17ß-Estradiol, progesterone, dehydroepiandrosterone (DHEA), cortisol, chromogranin A (CgA), and blood contamination levels were measured from UWS and SWS. RESULTS: Significant positive correlations were observed between 17ß-estradiol and DHEA in UWS, cortisol and CgA in UWS, MUC1 expression and DHEA in SWS, and among cortisol, progesterone, and DHEA in UWS and SWS. Significant negative correlations were observed between MUC1 and cortisol/DHEA ratio in UWS and SWS. When each phase was analyzed individually, MUC1 expression showed significant negative correlations with cortisol, progesterone, and cortisol/DHEA ratio in UWS and with progesterone and cortisol/DHEA ratio in SWS during the mid-luteal phase. A significant negative correlation was also observed between MUC1 and cortisol/DHEA ratio in UWS during the late luteal phase. CONCLUSIONS: Stress-related psychoendocrinological interactions throughout the menstrual cycle resulted in a decrease in oral mucosal epithelial MUC1 expression and a weakening of oral mucosal defense.

Oral lesions associated with imatinib mesylate therapy: five new cases and a literature review.

This study aimed to report the collective clinical characteristics of oral side effects associated with imatinib therapy according to age, sex, and clinical condition. A bibliographic review was performed using the PubMed, Web of Science, Scopus, Cochrane Library, and Embase databases. Forty-five cases of oral side effects due to imatinib therapy were identified in the literature. With the addition of five new cases seen at the authors' institution, a total of 50 cases were analysed. Of the five new cases, four with gastrointestinal stromal tumours developed oral lichenoid lesions (OLLs), and one with chronic myeloid leukaemia (CML) developed oral hyperpigmentation (OHP). Of the total 50 patients, 26 were male and 24 were female, and age ranged from 29 to 86 years. Most patients were ≥50 years old (80%); only three patients were jaw was the least common, with just five cases (10%). Among the patients with OHP, the predominant clinical condition was CML (22 cases, 91.7%). In conclusion, the possibility of oral side effects needs to be considered during the examination of patients receiving imatinib therapy.

Salivary cortisol, 17ß-estradiol, progesterone, dehydroepiandrosterone, and α-amylase in patients with burning mouth syndrome.

OBJECTIVE: The aim of this study was to investigate salivary markers related with burning mouth syndrome (BMS). MATERIALS AND METHODS: Thirty female patients with BMS and twenty female control subjects were included. Unstimulated (UWS) and stimulated whole saliva samples (SWS) were collected, and their flow rates were determined. Salivary levels of cortisol, 17ß-estradiol, progesterone, dehydroepiandrosterone (DHEA), and enzymatic activity of α-amylase were determined. Salivary transferrin level was measured to determine the level of blood contamination in saliva samples. RESULTS: The levels of all analytes in UWS were significantly correlated with those of SWS. The levels of 17ß-estradiol, progesterone, and DHEA in UWS were significantly correlated with age. Age-matched comparisons revealed that the patient group had significantly higher levels of cortisol in UWS and of 17ß-estradiol in SWS. When the patients were divided into older (≥60years) and younger (<60years) groups, the older group showed a significantly lower level of progesterone in UWS. There were no significant relationships between treatment efficacy and levels of salivary analytes. CONCLUSIONS: In conclusion, patients with BMS showed significantly higher levels of cortisol in UWS and of 17ß-estradiol in SWS compared with controls.

Comparison between the SCL-90-R and MMPI in TMD patients with psychological problems.

OBJECTIVE: The aim of the study was to investigate the relationships between the Symptom Checklist-90-Revision (SCL-90-R) and the Minnesota Multiphasic Personality Inventory (MMPI) in temporomandibular disorders (TMD) patients with psychological problems. MATERIALS AND METHODS: Subjective symptoms, objective signs, and psychological characteristics of 36 TMD patients with psychological problems were analyzed. The symptom severity index (SSI) and craniomandibular index (CMI) were used to assess subjective symptoms and objective signs of patients with TMD, respectively. The SCL-90-R and MMPI were used for psychological evaluation. RESULTS: The SSI was not significantly correlated with the CMI in TMD patients with psychological problems, and these indices displayed significant correlations with the SCL-90-R and MMPI in several selected subscales. The results of SCL-90-R had a limited relationship with those of MMPI in these patients. Based on the MMPI diagnosis, the SCL-90-R somatization subscale showed moderate to high sensitivity and specificity, but the SCL-90-R depression subscale showed moderate to low sensitivity and specificity. CONCLUSIONS: Considering the limited relationship between the SCL-90-R and MMPI in TMD patients with psychological problems, more comprehensive psychological tests are recommended when clinicians suspect patients with TMD of having accompanying psychological problems.

Autoantibodies in Sjögren's syndrome patients acutely inhibit muscarinic receptor function.

OBJECTIVES: Autoantibodies from the sera of Sjögren's syndrome patients (SS IgG) have been suggested to inhibit muscarinic receptor function. However, the acute nature of such an inhibitory effect remains controversial. In this study, we investigated the acute effects of SS IgG on muscarinic receptor function in human submandibular gland (HSG) cells. METHODS: The effects of autoantibodies on muscarinic receptor function were studied using microspectrofluorimetry, whole-cell patch clamp, immunofluorescence confocal microscopy, and a co-immunoprecipitation assay. RESULTS: Carbachol (CCh) was found to consistently increase intracellular calcium concentration ([Ca(2+) ](i) ) and activate K(+) current in HSG cells. However, pretreatment of the cells with SS IgG for 5 or 30 min significantly attenuated these responses, with a substantially more prominent effect after 30 min of treatment. Like CCh, adenosine 5'-triphosphate (ATP) also increased [Ca(2+) ](i) and activated K(+) currents in HSG cells, although pretreatment with SS IgG did not affect the cellular response to ATP. CCh was found to reorganize α-fodrin in HSG cells in a Ca(2+) -dependent manner. However, pretreatment with SS IgG prevented the cytoskeletal reorganization of α-fodrin induced by CCh. CONCLUSIONS: SS IgG acutely and reversibly inhibited muscarinic receptor function, thereby inhibiting the Ca(2+) mobilization necessary for the activation of K(+) currents and α-fodrin reorganization in HSG cells.

Long-term prognosis of burning mouth syndrome following treatment.

The purpose of this study was to evaluate the long-term prognosis of patients with burning mouth syndrome (BMS) after the termination or discontinuation of treatment and to identify the clinical characteristics that might affect that prognosis. Of 769 patients with an oral burning sensation, 202 with primary BMS who had been treated for at least 3 months were included. Among them, 28 patients who responded to the treatment and 25 patients who did not were assigned to responder and non-responder groups, respectively. Based on telephone interviews, the responders were classified into relapse and non-relapse subgroups, and the non-responder group into persistence and remission subgroups. The majority of responders reported no oral discomfort since their last visit. Compared with the non-relapse subgroup, the relapse subgroup had significantly higher levels of xerostomia at the first visit (P = 0.026) and taste disturbance at the last visit (P = 0.015). The majority of non-responders reported persistent oral discomfort since their last visit. No significant differences were found in the characteristics of oral symptoms between the persistence and remission subgroups. In conclusion, the treatment outcomes in the majority of responders and non-responders were maintained following treatment. Xerostomia and taste disturbance were associated with relapse of oral discomfort in the responders.

Plasma and saliva levels of nerve growth factor and neuropeptides in chronic migraine patients.

OBJECTIVES: To investigate the level and interrelationship of nerve growth factor (NGF) and sensory neuropeptides [substance P (SP), calcitonin gene-related peptide (CGRP)] in plasma and saliva of chronic migraine patients, and to analyze the association between pain intensity and their concentration. MATERIALS AND METHODS: Plasma and resting whole saliva were collected from 33 chronic migraine patients and 36 control subjects. NGF, SP, and CGRP concentrations were measured by enzyme immunoassay and pain intensity of each subject was measured using the Graded Chronic Pain Scale. RESULTS: Chronic migraine patients showed higher NGF and neuropeptide levels in both plasma and saliva compared to the control subjects. Plasma NGF, and plasma and saliva levels of SP and CGRP were highly associated with pain intensity. There was a significant positive correlation between NGF and both neuropeptide levels in plasma, and between the neuropeptide levels in both plasma and saliva. Plasma levels of SP and CGRP were significantly correlated with their saliva level. CONCLUSIONS: The increased production of NGF and sensory neuropeptides may play an important role in the maintenance of pain in chronic migraine and analysis results of human saliva could act as an index of disease state and therapeutic outcome.

Influences of hyaluronic acid on the anticandidal activities of lysozyme and the peroxidase system.

OBJECTIVE: To investigate the fungistatic and fungicidal activity of hyaluronic acid (HA) and the influences of HA on the anticandidal activities of lysozyme and the peroxidase system. MATERIALS AND METHODS: HA, hen egg-white lysozyme, and the bovine lactoperoxidase system were used. Candida albicans ATCC 10231, 18804, and 11006 strains were used in the experiments. The fungistatic activity of HA was determined by measuring the optical densities of the cultures. The candidacidal activity of HA and the influences of HA on the candidacidal activities of lysozyme and the peroxidase system were determined by comparing the numbers of colony-forming units. RESULTS: Hyaluronic acid displayed inhibitory effects on the growth of C. albicans, and the inhibitory effects were proportional to HA concentration. HA did not have any measurable candidacidal activity. HA showed inhibitory effects on the candidacidal activities of lysozyme, and the peroxidase system that was proportional to HA concentration. HA at 1.0-2.0 mg ml(-1) almost completely inhibited the candidacidal activities of lysozyme and the peroxidase system. CONCLUSIONS: Hyaluronic acid possesses fungistatic activity but no candidacidal activity. HA showed inhibitory effects on the candidacidal activities of lysozyme and the peroxidase system.

Relationships between subjective taste sensations and electrogustometry findings in patients with taste disorders.

This study aimed to examine the relationships between subjective taste sensations and electrogustometry (EGM) findings in patients with taste disturbances according to the presence of burning mouth (BM) symptoms. Forty-six patients were included and asked to complete a questionnaire that contained questions on subjective taste sensations for the four basic taste qualities and the pattern of taste disorders such as ageusia, hypogeusia and dysgeusia. EGM was performed to measure detection thresholds. To examine the influence of BM symptoms, patients were divided into two groups: patients with and without BM symptoms. The patients consisted of 11 men and 35 women. The group without BM symptoms (n=26) had significantly lower degrees of subjective taste sensations for all taste qualities and higher correlation levels between subjective taste sensations and EGM thresholds than the group with BM symptoms (n=20). The patterns of taste disorders also showed more significant associations with the levels of subjective taste sensations in the patients without BM symptoms compared with those with BM symptoms. In conclusion, patients with taste disorders without BM symptoms had more severe taste disturbances than those with BM symptoms. The pathophysiology of taste disturbances differs according to the presence or absence of BM symptoms.

Effects of smoking on trace metal levels in saliva.

OBJECTIVES: To compare the salivary levels of trace metals between non-smokers and smokers using inductively coupled plasma mass spectroscopy (ICP-MS). The effect of pretreatment methods on the accuracy of ICP-MS analysis and daily variations in trace metal levels in saliva were also investigated. SUBJECTS AND METHODS: The participants were 10 male non-smokers (mean age: 27.4 ± 3.4 years) and 30 male smokers (mean age: 26.5 ± 4.1 years). Unstimulated whole saliva was collected. Salivary flow rate, the number of metal restorations in the oral cavity, the level of blood contamination in the saliva and the levels of cotinine and trace metals in the saliva of each participant were determined. RESULTS: Direct dilution of saliva samples with nitric acid showed the most accurate ICP-MS results. Trace metal levels in saliva showed wide daily variations. They were not affected by the number of metal restorations. Trace metal concentrations of saliva samples without blood contamination were much lower than the previously reported values. Salivary levels of cotinine and aluminum were significantly increased in smokers. CONCLUSIONS: Saliva can be a medium for trace metal analysis. Salivary levels of cotinine and aluminum can be useful markers to evaluate smoking status.

Clinical and psychological characteristics of TMD patients with trauma history.

OBJECTIVE: The purpose of this study was to investigate clinical and psychological characteristics of temporomandibular disorders (TMD) patients with trauma history. MATERIALS AND METHODS: The clinical and psychological characteristics of 34 TMD patients with trauma history were compared with those of 340 TMD patients without trauma history. Craniomandibular index (CMI) was used for clinical characteristics of TMD patients. Symptom severity index (SSI) was used to assess the multiple dimensions of pain. Symptom checklist-90-revision (SCL-90-R) was used for psychological evaluation. RESULTS: Temporomandibular disorders patients with trauma history displayed significantly higher CMI and palpation index. TMD patients with trauma history also exhibited higher values in duration, sensory intensity, affective intensity, tolerability, scope of symptom, and total SSI score. In addition, these patients showed significantly higher values in symptom dimensions of somatization, depression, anxiety, phobic anxiety, and paranoid ideation. Among the symptom dimensions of SCL-90-R, somatization showed the most significant correlations with CMI and SSI. CONCLUSIONS: Temporomandibular disorders patients with trauma history displayed more severe subjective, objective, and psychological dysfunction than those without trauma history. Pain of myogenous origin, history of physical trauma, and psychosocial dysfunction were all closely related.

Rheological properties of hyaluronic acid and its effects on salivary enzymes and candida.

OBJECTIVE: To investigate the viscosity and wettability of hyaluronic acid (HA), its effects on lysozyme and peroxidase activities, and its candidacidal activity. MATERIALS AND METHODS: Human whole saliva, HA, hen egg-white lysozyme (HEWL), and bovine lactoperoxidase (bLPO) were used. Viscosity was measured with a cone-and-plate digital viscometer, while wettability was determined by measuring the contact angle. Lysozyme activity was determined by the turbidimetric method. Peroxidase activity was determined with NbsSCN assay. Candidacidal activity was determined by comparing colony forming units. RESULTS: The viscosity of HA solutions was proportional to its concentration, with 0.05 mg ml(-1) of HA in distilled water or 0.5 mg ml(-1) in simulated salivary buffer displaying similar viscosity values to stimulated whole saliva. The contact angle of HA solutions showed no significant differences according to the tested materials and tested HA concentrations. Contact angles of HA solutions on acrylic resin were higher than those of human saliva. HA did not affect lysozyme or peroxidase activities of whole saliva as well as HEWL or bLPO activities. HA also showed no candidacidal activity. CONCLUSIONS: The viscoelastic properties of HA compared with human saliva were objectively confirmed, indicating a vital role for HA in the development of effective salivary substitutes.

Salivary flow rate and clinical characteristics of patients with xerostomia according to its aetiology.

The purpose of the present study was to investigate the differences in salivary flow rates and dry mouth-related subjective symptoms and behaviours in patients with xerostomia according to its aetiology. One hundred and forty patients (24 men and 116 women, mean age, 58.1 +/- 13.3 years) with a chief complaint of xerostomia were included. The patients were divided into five groups; Sjögren's syndrome (n = 34), post-radiation therapy in the head and neck region (n = 16), antipsychotic medications (n = 30), systemic diseases or medications affecting salivary flow (n = 35), and unknown aetiology (n = 25). The patients were asked a standardized series of questions concerning dry mouth, and their whole salivary flow rates were measured. Patients with a history of radiation therapy displayed the most decreased values of salivary flow rates and the most severe associated symptoms and behaviours while patients with unknown aetiology displayed the least decreased values of salivary flow rates and relatively favourable symptoms and behaviours. A burning sensation in the mouth was the most prevalent in patients with systemic diseases or those who were taking medications while altered taste perception was the most prevalent in patients taking antipsychotics. In conclusion, patients with xerostomia displayed various degrees of discomfort related to the quality of life according to the aetiology of their conditions.

Comparison of clinical characteristics between burning mouth syndrome patients with bilateral and unilateral symptoms.

The purpose of the present study was to investigate and compare the clinical characteristics of burning mouth syndrome (BMS) patients with bilateral and unilateral symptoms. Of 769 patients with oral burning sensation, 421 patients with primary BMS were included. Among them, 324 patients who complained of oral symptoms on both sides of the oral cavity were assigned to the bilateral group and 97 patients who complained of symptoms only on one side of the oral cavity were assigned to the unilateral group. Clinical characteristics, psychological status, and salivary secretion were compared between the two groups. There were no significant differences in the mean age, sex ratio, unstimulated and stimulated salivary flow rates, or duration of symptoms between the two groups. The bilateral group had higher levels of psychological distresses compared with the unilateral group. The bilateral group had higher prevalence rates in burning, taste alteration, and xerostomia than the unilateral group. The proportion of patients who considered dental procedures as an initiating factor of BMS symptoms was higher in the unilateral group than in the bilateral group. Conclusively, BMS patients with bilateral and unilateral symptoms had different clinical characteristics, suggesting that the neuropathic mechanisms in these two groups are different.

Effects of carboxymethylcellulose (CMC)-based artificial saliva in patients with xerostomia.

The purpose of this study was to investigate the effects of carboxymethylcellulose (CMC)-based artificial saliva according to residual secretory potency, assessed by the salivary flow rate in patients with dry mouth. Fifty patients (6 men and 44 women, 57.8+/-13.2 year of age) with a chief complaint of dry mouth were asked a standardized series of questions regarding dry mouth-related symptoms and behaviors. Whole salivary flow rates were measured under unstimulated and stimulated conditions. After using CMC-based artificial saliva for 2 weeks, each patient completed the same questionnaire. Use of the artificial saliva decreased the severity of 'oral dryness at night or on awakening', 'oral dryness at other times of the day', and 'the effect of oral dryness on daily life' (P<0.05). Patients with an undetectable flow rate of stimulated whole saliva responded better on 'oral dryness during eating' compared with the other patients (P<0.05). The use of CMC-based artificial saliva also improved dry mouth-related behaviors, especially 'awakening from sleep at night because of oral dryness'. In conclusion, CMC-based artificial saliva demonstrated moderate effects in reducing dry mouth-related symptoms and behaviors with more significant effects appearing in patients whose residual secretory potency was severely compromised.

Comparison between burning mouth syndrome patients with and without psychological problems.

The purpose of this study was to compare clinical and socio-demographic characteristics between burning mouth syndrome (BMS) patients with and without psychological problems. Of 644 patients with symptoms of oral burning, 224 with primary BMS were selected on the basis of laboratory testing, medical history, and psychometric tests: 39 with psychological problems (age 62.5±11.5years) and 185 without psychological problems (age 58.4±11.4years). Comprehensive clinical and socio-demographic characteristics, including psychological profiles and salivary flow rates, were compared between the two groups. No significant difference in sex ratio, duration and diurnal pattern of symptoms, unstimulated whole saliva flow rate, or marital status was found between the groups. The patients with psychological problems had a significantly higher mean age, reduced stimulated whole saliva flow rate, and lower level of education than those without psychological problems. The patients with psychological problems also displayed higher rates and greater severity of various types of BMS-related symptom in most parts of the oral mucosa, higher rates of stress-related symptoms, and greater difficulties in daily activities. The severity of taste disturbance was the factor most significantly correlated with the level of psychometry. In conclusion, psychological problems in BMS patients are associated with an aggravation of BMS symptoms.