Use of the modified Schirmer test to measure salivary gland hypofunction/hyposalivation: Systematic review and meta-analysis.

Although dry mouth is a relatively common condition, salivary flow is not routinely measured in dental clinical practice. Moreover, existing data regarding the use of the modified Schirmer test (MST) for the screening of dry mouth has not been summarized. This systematic review and meta-analysis, conducted in accordance with the PRISMA guidelines, aimed to determine whether the modified Schirmer test can be used to identify dry mouth. The databases of PubMed, Scopus, ScienceDirect, and CENTRAL (CRD42023393843) were systematically searched to retrieve articles published until 9th November 2023. Among the 343 original articles retrieved, six met the inclusion criteria. A total of 1150 patients, comprising 710 (61.7%) women and 440 (38.3%) men (mean age, 47.1 ± 7.3 years), were included. The meta-analysis revealed a weak correlation coefficient of r ¯ $\bar{r}$  = 0.42 (95% Cl: 0.29-0.55) between MST and the unstimulated salivary flow rate. Therefore, while the MST might offer a simple and accessible alternative for initial screening in the future, especially in non-specialized settings, its variability in sensitivity and specificity, along with an actual lack of standardization, necessitates cautious interpretation. Further studies are necessary before recommending the test in clinical routine.

A novel test for hyposalivation using a sugar cube.

BACKGROUND: Hyposalivation is a highly prevalent condition in old persons. OBJECTIVES: The aim of this study was to assess a novel tool for the diagnosis of hyposalivation using a sugar cube and to compare its reliability to other validated test methods. METHODS: Five tests were performed: unstimulated salivary flow test by draining method (USFT), oral moisture device Mucus® (MCS), sugar cube test (SCT), stimulated salivary flow test by chewing gum (CG) and Saxon test (SX). The sugar cube test consisted in measuring the time needed to disintegrate a standard-sized sugar cube N°4 (5.6 g) placed beneath the tongue. Bivariate correlation analyses were performed. ROC curve analysis and the Youden Index were used to determine the cut-off value. Sensitivity and specificity were calculated according to the determined cut-off point. RESULTS: A total of 121 participants were recruited, with an average age of 49.8 ± 18.2 years. The USFT was best correlated with the SCT. No correlation was found between SCT and the stimulated saliva tests (CG, SX) as well as the MCS test. According to the Youden index, 140 s is appropriate to diagnose hyposalivation. Sensitivity of .64 and specificity of .91 were found for SCT using USFT as gold standard. The mean subjective evaluation score of the SCT was 3.1 ± 1, significantly higher than USFT 2.6 ± 1.1 (p < .05). CONCLUSIONS: The sugar cube test proved to be a useful method for assessing unstimulated salivation, reducing test execution time and causing less participant discomfort than the gold standard unstimulated salivary flow test.

Impact of salivary flow inhibition on masticatory behaviours in healthy individuals.

BACKGROUND: It remains unclear how the salivary flow and the fat content of food affect bolus formation during mastication. OBJECTIVES: We aimed to clarify: (1) how hyposalivation affects jaw-closing and hyoid-elevating muscle activities in bolus formation, and (2) if the effect of hyposalivation on muscle activity depends on the fat content of food. METHODS: Eighteen healthy male volunteers were instructed to freely ingest four test foods: Plain, Fat without seasoning, Fat with seasoning, and Soft rice crackers. Masseter and suprahyoid electromyographic activities were recorded before and 30 min after the administration of atropine sulfate, a muscarinic receptor antagonist that induces hyposalivation. RESULTS: Hyposalivation extended the masticatory duration significantly in all the test foods except Fat with seasoning. Masticatory cycle time was significantly longer with vs without hyposalivation for the Soft (p = .011). Suprahyoid activity/cycle was significantly greater with vs without hyposalivation (p = .013). Masticatory cycle time was significantly longer at the late stage with vs without hyposalivation for the Soft (p < .001). Suprahyoid activity/cycle was significantly greater at the middle (p = .045) and late stages (p = .002) with vs without hyposalivation for the Soft and greater at the late stage with vs without hyposalivation for the Plain (p = .043). Changes in masticatory cycle time and suprahyoid activity/cycle for these foods had significantly positive relationship (p < .001). CONCLUSION: Hyposalivation-induced changes in masticatory behaviours resulted from the middle and late stage suprahyoid activity. Fat content and seasoning compensate for salivary flow inhibition.

In females, salivary secretion was significantly lower in patients with severe reflux esophagitis than in healthy controls.

BACKGROUND: The salivary secretion in patients with mild reflux esophagitis (RE) and non-erosive reflux disease is significantly lower in females, but not in males. However, sex differences in salivary secretion in patients with severe RE remain unknown. Therefore, the present study investigated sex differences in saliva secretion in patients with severe RE. METHODS: Subjects consisted of 23 male patients with severe RE, 24 male healthy controls (HCs), 26 female patients with severe RE, and 25 female HCs. Saliva secretion was assessed as follows: each patient chewed sugarless gum for 3 min prior to endoscopy, and the amount and pH of saliva secreted before and after acid loading as an index of the acid-buffering capacity were measured. RESULTS: In males, no significant differences were observed in the amount of saliva secretion, salivary pH, or the acid-buffering capacity between severe RE patients and HCs. In females, the amount of saliva secretion (severe RE: 2.4 [1.8-4.1], HCs: 5.3 [3.4-7.5], p = 0.0017), salivary pH (severe RE: 7.0 [6.7-7.3], HCs: 7.2 [7.1-7.3], p = 0.0455), and the acid-buffering capacity (severe RE: 5.9 [5.3-6.2], HCs: 6.2 [6.1-6.5], p = 0.0024) were significantly lower in severe RE patients than in HCs. CONCLUSION: Among females, the salivary secretion was significantly lower in severe RE patients than in HCs. This reduction in salivary secretion may contribute to the pathophysiology of severe RE in females.

LIMITED EVIDENCE SUGGESTS THAT END STAGE KIDNEY DISEASE AND HEMODIALYSIS MAY IMPACT SALIVARY FLOW RATE AND COMPOSITION.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Rodrigues RP, Vidigal MT, Vieira WA, Nascimento GG, Sabino-Silva R, Blumenberg C, Siqueira MF, Siqueira WL, Paranhos LR. Salivary changes in chronic kidney disease and in patients undergoing hemodialysis: a systematic review and meta-analysis. Journal of Nephrology. 2022 Mar 2:1-29. SOURCE OF FUNDING: The work has been partially funded by CAPES-Finance Code 001. The authors have also acknowledged The Brazilian National Council for Scientific and Technological Development (CNPq) and Minas Gerais State Agency for Research and Development, Brazil (FAPEMIG) for the support. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Disruption of tight junctions contributes to hyposalivation of salivary glands in a mouse model of type 2 diabetes.

Tight junction (TJ) plays an important role in regulating paracellular fluid transport in salivary glands; however, little is known about the involvement of TJs in diabetes salivary glands. This study aimed to investigate the alterations of TJs and their possible contribution in diabetes-induced hyposalivation. Here, we observed that the morphologies of submandibular glands (SMGs) were impaired, characterized by enlarged acini accumulation with giant secretory granules, which were significantly reduced in atrophic ducts in SMGs of db/db mice, a spontaneous model of type-2 diabetes. However, the secretory granules were increased and scattered in the acini of diabetes parotid glands (PGs). Other ultrastructural damages including swollen mitochondria, expansive endoplasmic reticulum, and autophagosomes were observed in the diabetes group. The levels of TJ proteins including claudin-1 (Cldn1) and claudin-3 (Cldn3) were increased, whereas those of claudin-4 (Cldn4), occludin (Ocln), and zonula occludens-1 (ZO-1) were decreased in SMGs of db/db mice. Higher Cldn1 and Cldn3 and lower claudin-10 (Cldn10) and Ocln levels were observed in PGs of diabetes mice. Taken together, the structures of SMGs and PGs were impaired in diabetes mice, and the disruption of TJ integrity in both SMGs and PGs may contribute to diabetes-induced hyposalivation.

If painters give you lemons, squeeze the knowledge out of them. A study on the visual perception of the translucent and juicy appearance of citrus fruits in paintings.

Citrus fruits are characterized by a juicy and translucent interior, important properties that drive material recognition and food acceptance. Yet, a thorough understanding of their visual perception is still missing. Using citrus fruits depicted in 17th-century paintings as stimuli, we ran three rating experiments. In Experiment 1, participants rated the perceived similarity in translucency or juiciness of the fruits. In Experiment 2, different groups of participants rated one image feature from a list obtained in a preliminary experiment. In Experiment 3, translucency and juiciness were rated. We constructed two-dimensional perceptual spaces for both material properties and fitted the ratings of the image features into the spaces to interpret them. "Highlights," "peeled side," "bumpiness," and "color saturation" fit the juiciness space best and were high for the highly juicy stimuli. "Peeled side," "intensity of light gradient," "highlights," and "color saturation" were the most salient features of the translucency space, being high for the highly translucent stimuli. The same image features were also indicated in a 17th-century painting manual for material depiction (Beurs, 1692; Beurs, in press). Altogether, we disclosed the expertise of painters with regard to material perception by identifying the image features that trigger a visual impression of juiciness and translucency in citrus fruits.

Evaluation of oral mechanical and gustatory sensitivities and salivary cotinine levels in adult smokers.

Objective: The aim was to examine oral mechanical and gustatory sensitivities in adult smokers and to estimate salivary levels of cotinine by tobacco consumption. A total of 54 adults (20-45 years old; 28 males/26 females) were divided into two sex-paired groups: smoker group (n = 27), tobacco consumers with no other chronic disease/use of chronic medication, and a control non-smoker non-exposed group with similar age (n = 27).Materials and Methods: 24 h-Recall was used to gather information about tobacco consumption, date of onset and duration of the habit. Oral mechanical evaluation comprised touch detection threshold (MDT) of upper and lower lips and tongue tip and two-point discrimination (TPD) assessments. Taste sensitivities for sweet, salty, sour and bitter were evaluated in four concentrations. Salivary cotinine was determined by high performance liquid chromatography. Statistical analysis comprised Mann-Whitney, Two-way ANOVA test and regression analysis.Results: The mean smoking time was 13.6 years (mean 8.4 mg/day; 13 cigarettes/day). A sex-effect was observed on MDT of tongue tip (higher sensitivity in females), while group-effect was observed on TPD of lower lip, showing a smaller sensitivity among smokers (p < .05; moderate effect: Eta partial2 = 0.076). Although the total score of gustatory sensitivity did not differ between groups, smokers exhibited an irregular pattern of correctly identified tastants among the different concentrations of salty, sour and bitter. The predictive model showed that salivary cotinine was dependent on "nicotine consumption on the day before" (R2 = 49%).Conclusion: A difference in tactile sensitivity of the lower lip and qualitative changes in taste sensitivity were observed in smokers.

Newly Distinguished Cell Punctures Associated with Transmission of the Semipersistent Phloem-Limited Beet Yellows Virus.

Here we report on plant penetration activities (probing) by the aphid Myzus persicae (Sulzer, 1776) in association with the transmission, acquisition, and inoculation of the semipersistent Beet yellows virus (BYV; Closterovirus) in sugar beet. During electrical penetration graph (EPG) recording of stylet pathways, standard intracellular stylet punctures occur which are called potential drop (pd) waveforms. In addition to the standard pd, there also appeared to be a unique type of intracellular stylet puncture that always preceded the phloem salivation phase (waveform E1). This type of pd, the phloem-pd, showed properties distinct from those of the standard pds and has never been described before. We manually ended EPG recordings during the acquisition and inoculation tests by removing aphids from the source or test plant after specific waveforms were recorded. Inoculation of BYV occurred at the highest rate when probing was interrupted just after a single or various phloem-pds. In contrast, BYV acquisition showed an intimate association with sustained phloem sap ingestion from phloem sieve elements (SEs) (E2 waveform). Our work shows for the first time that the inoculation of a phloem-limited virus occurs during specific intracellular stylet punctures and before phloem salivation (waveform E1). Further studies are needed to establish in what cells this novel phloem-pd occurs: phloem parenchyma, companion, or SE cells. The role of the different stylet activities in the acquisition and inoculation of BYV by M. persicae is discussed.IMPORTANCE We discovered the specific feeding activities of Myzus persicae (Sulzer, 1776) associated with the transmission of Beet yellows virus (BYV; Closterovirus). Our work strongly suggests that aphids can insert their stylets into the membranes of phloem cells-visualized as a unique type of waveform that is associated with the inoculation of BYV. This intracellular puncture (3 to 5 s) occurs just before the phloem salivation phase and can be distinguished from other nonvascular stylet cell punctures. This is the first time that the transmission of a phloem-limited semipersistent virus has been shown to be associated with a unique type of intracellular puncture. Our work offers novel information and strongly contributes to the existing literature on the transmission of plant viruses. Here we describe a new kind of aphid behavioral pattern that could be key in further works, such as studying the transmission of other phloem-limited viruses (e.g., luteoviruses).

Simultaneous monitoring of Ca2+ responses and salivary secretion in live animals reveals a threshold intracellular Ca2+ concentration for salivation.

NEW FINDINGS: What is the central question of this study? The effects of Ca2+ responses on salivary fluid secretion have been studied indirectly by monitoring ion channel activities and other indices. Therefore, Ca2+ responses during salivary secretion remain poorly understood. What is the main finding and its importance? Herein, we developed a simultaneous monitoring system for Ca2+ responses and salivary secretion in live animals using a YC-Nano50-expressing submandibular gland and a fibre-optic pressure sensor. This new approach revealed a clear time lag between the onset of Ca2+ responses and salivary secretion. We also estimated the [Ca2+ ]i and provided direct evidence for the regulation of salivary secretion by small increases in [Ca2+ ]i in submandibular gland acinar cells. ABSTRACT: We monitored changes in [Ca2+ ]i during salivary secretion in the rat submandibular gland in live animals using a combination of intravital Ca2+ imaging with the ultrasensitive Ca2+ indicator YC-Nano50 and a fibre-optic pressure sensor. Intravenous infusion of ACh (10-720 nmol min-1 ) increased [Ca2+ ]i and salivary flow rate in a dose-dependent manner. Repetitive stimulation with ACh induced equivalent Ca2+ responses and salivary secretion in the same individual animals. The accurate ACh stimulation experiments revealed a clear time lag between the onset of the increase in [Ca2+ ]i and salivary secretion. The time lag with the lowest dose of ACh (30 nmol min-1 ) was 106 s, which shortened to 19 s with the dose used for maximal salivary secretion (360 nmol min-1 ). This time lag might reflect the time required for [Ca2+ ]i to reach the level required to activate molecules for fluid secretion. The resting [Ca2+ ]i in submandibular gland was 37 nm, and [Ca2+ ]i at the onset of salivary secretion was 45-57 nm, irrespective of ACh dose. These results indicate that low [Ca2+ ]i is sufficient to trigger fluid secretion in the rat submandibular gland in vivo.

Impact of food odors signaling specific taste qualities and macronutrient content on saliva secretion and composition.

Olfactory food cues can induce appetite for similar food products in humans. Odors may thus signal essential information about a foods' composition such as taste or even macronutrient content and may stimulate specific physiological responses in anticipation of food intake. Several studies have shown that sensory food cues could stimulate saliva secretion. However, potential differences between food odors in their effect on saliva secretion, or the effects of olfactory stimulation on changes in saliva composition remain to be elucidated. To gain more insight, we conducted two studies to determine the influence of various odors, representing different taste qualities (study 1) and macronutrients (study 2), on salivary biomarkers. In study 1, 36 participants were randomly exposed to no-odor, non-food, and odors signaling sweet, savory, and sour taste. In study 2, 60 participants were randomly exposed to no-odor, non-food, and odors signaling carbohydrates, protein, fat, and low-calorie food. For each condition, whole-mouth saliva was collected and saliva secretion rate determined. Furthermore, we determined mouth-watering perception (subjective salivation), visco-elasticity (study 1 only), mucin concentration, α-amylase and lingual lipase activity (study 2 only). For both studies, linear mixed model analyses showed that saliva secretion rate significantly increased by food odor exposure compared to no-odor and non-food conditions. However, no changes in salivary composition were observed. These findings indicate that food odors play a crucial role in anticipatory saliva responses and can thereby affect subsequent eating behavior.

Repetitive Saliva Swallowing Test: Norms, Clinical Relevance and the Impact of Saliva Secretion.

Screening tests can be performed to identify stroke patients who require further assessment of swallowing function. The Repetitive Saliva Swallowing Test (RSST) is a screening test during which the patient is asked to swallow saliva as many times as possible for 30 s, while deglutition is counted through palpation of the larynx. This study aimed to establish normative values for three age groups of non-patients (total N = 120) on RSST. One patient group (N = 40) was also recruited from a geriatric stroke unit to assess whether RSST scores predicted outcomes on the Standardised Swallowing Assessment-Svenska (SSA-S), a clinical screening tool here used as a reference test. Since the RSST involves the swallowing of saliva, this study also measured the participants' saliva secretion in order to examine its effect on RSST performance. This study showed that RSST results vary with age (lower among older) and gender (higher for men than women), while the number of doctor-prescribed medications, objective saliva secretion and self-assessed dryness of mouth did not affect the performance significantly. In comparison to a more extensive clinical screening procedure (SSA-S), the RSST correctly predicted 93% of negative cases and 69% of positive cases. This suggests that patients who show signs of aspiration according to SSA-S have a lower probability of detection with RSST.

Influence of olfactory dysfunction on the perception of food.

PURPOSE: Eating-related problems are among the most frequent issues in olfactory impairment, causing a noticeable loss of quality of life for some of the affected persons. To what extent olfactory dysfunction impacts on the sensory perception of food is less explored. The aim of the present study was to examine the impact of olfactory dysfunction on the perception of food aromas, as well as the perception of the "basic tastes" salty, sour, sweet, and bitter. METHODS: Eighty-nine participants were recruited for the prospective study. Group 1 consisted of thoroughly examined patients with olfactory dysfunction (n = 48, mean age = 60.0 years), group 2 consisted of people with normal olfactory function (n = 41, mean age = 50.4 years). First, olfactory and gustatory functions were assessed for all participants with the help of the "Sniffin'Sticks" battery and the "taste strips" test. Second, food odors were rated for their pleasantness, intensity, familiarity and desirability. Last, real food items were tasted orally and the intensity for basic taste qualities (sweet, bitter, salty, and sour) and pleasantness was rated. In addition, salivation was measured following exposure to the food odors. RESULTS: In comparison to controls, patients rated orthonasal food odors as less pleasant, intense, familiar, and less appetizing. "Taste strip" scores were significantly lower in patients (M = 9.56, SD = 2.76) as compared to controls (M = 10.88, SD = 1.89). In addition, ratings of food liking for chocolate and peanut were lower in patients compared to controls (chocolate: patients-M = 6.85, SD = 2.09, controls-M = 7.90, SD = 1.53; peanut: patients-M = 4.88, SD = 2.20, controls-M = 6.80, SD = 2.33). No significant differences were found regarding the comparison of the salivary flow rate in controls (M = 0.52 g/min, SD = 0.19) and patients (M = 0.50 SD = 0.17). CONCLUSIONS: Changes in the perception of odors may change the perception of food with specific effects on food liking. Olfactory dysfunction affects gustatory function, indicating the central-nervous interaction between taste and smell. Still, olfactory dysfunction did not appear to affect patients' salivary flow.

The Acute Effects of Mat Pilates on Hemodynamic and Salivary Nitrite Responses After Exercise in Postmenopausal Women.

The aim of this study was to compare the hemodynamic and salivary responses after mat Pilates, aerobics, resistance exercises, and control. A total of 16 normotensive postmenopausal women performed: Pilates, 10 floor exercises; aerobics, 35 min on a treadmill (60-70% of heart rate reserve); resistance exercises, 60% of one-repetition maximum; and control, no physical exercise. Blood pressure and heart rate variability were evaluated at rest and 60 min after the intervention. Saliva samples were collected at rest, immediately after, and 30 and 60 min after exercise for analysis of nitrite concentration and total proteins. Systolic blood pressure, diastolic blood pressure, and mean blood pressure area under the curve were lower (p < .05) after both aerobic and resistance exercises sessions but not after the Pilates session when compared with the control session. Nitrite concentrations in saliva were higher 60 min after the end of all exercise sessions. Heart rate variability was higher after the resistance exercise. Aerobic and resistance exercises were capable of decreasing arterial blood pressure after acute exercise.

Assessment of dental caries and salivary nitric oxide levels in children with dyspepsia.

BACKGROUND: The increase in nitric oxide (NO) levels in the oral cavity and saliva have been associated with various oral diseases; however, the gastro-salivary interaction of NO remains controversial. Thus, the aim of this study was to determine and compare salivary NO levels of dyspeptic and non-dyspeptic healthy children and to conduct an evaluation of its association with dental caries. METHODS: Seventy children with dyspepsia (dyspeptic group) and 30 children without any gastrointestinal complaints (control group) were included in the study. Two biopsies from the gastric tissues were collected from dyspeptic children for histopathologic examination. Oral examination involved the assessment of dental caries, gingival index, plaque index, buffering capacity, salivary flow rate and pH. Salivary Streptococcus mutans (S. mutans) and Lactobacilli sp. counts were performed by commercial kits. For the comparison of the normal distribution between dyspeptic and control groups, Student t-test and for the comparison of the non-normal distribution, Kruskal-Wallis and Mann-Whitney-U tests were used. Chi-square test was used for comparison of qualitative data and the Pearson correlation test was used to evaluate the association between certain variables. Significance was assessed at p < 0.05 level. RESULTS: Helicobacter pylori (H.pylori) were found in gastric biopsies of 84.2% (59/70) of the dyspeptic children. While the mean salivary NO values did not differ significantly between gastric H.pylori positive, negative and control groups, the salivary NO level of the dyspeptic group (213.7 ± 51.68 µmol/dL) was found to be significantly higher than the control group (185.7 ± 16.66 µmol/dL). No significant relationship was found between the mean salivary NO values, DMFT/dmft numbers and other oral parameters. CONCLUSIONS: The association of dental caries and salivary NO levels could not be considered specific in the current study. Although there were no statistically significant differences between salivary NO levels of gastric H.pylori positive, gastric H.pylori negative and control groups, greater salivary NO levels among dyspeptic children compared with the control group demonstrated that the concentration of NO in the saliva could be used as a biological marker in dyspepsia, which could lead to the improvement of more specified, uncomplicated and susceptible methods for analysis.

New saliva secretion model based on the expression of Na+-K+ pump and K+ channels in the apical membrane of parotid acinar cells.

The plasma membrane of parotid acinar cells is functionally divided into apical and basolateral regions. According to the current model, fluid secretion is driven by transepithelial ion gradient, which facilitates water movement by osmosis into the acinar lumen from the interstitium. The osmotic gradient is created by the apical Cl- efflux and the subsequent paracellular Na+ transport. In this model, the Na+-K+ pump is located exclusively in the basolateral membrane and has essential role in salivary secretion, since the driving force for Cl- transport via basolateral Na+-K+-2Cl- cotransport is generated by the Na+-K+ pump. In addition, the continuous electrochemical gradient for Cl- flow during acinar cell stimulation is maintained by the basolateral K+ efflux. However, using a combination of single-cell electrophysiology and Ca2+-imaging, we demonstrate that photolysis of Ca2+ close to the apical membrane of parotid acinar cells triggered significant K+ current, indicating that a substantial amount of K+ is secreted into the lumen during stimulation. Nevertheless, the K+ content of the primary saliva is relatively low, suggesting that K+ might be reabsorbed through the apical membrane. Therefore, we investigated the localization of Na+-K+ pumps in acinar cells. We show that the pumps appear evenly distributed throughout the whole plasma membrane, including the apical pole of the cell. Based on these results, a new mathematical model of salivary fluid secretion is presented, where the pump reabsorbs K+ from and secretes Na+ to the lumen, which can partially supplement the paracellular Na+ pathway.

Sialendoscopy enhances salivary gland function in Sjögren's syndrome: a 6-month follow-up, randomised and controlled, single blind study.

OBJECTIVES: To assess the effect of sialendoscopy of the major salivary glands on salivary flow and xerostomia in patients with Sjögren's syndrome (SS). METHODS: Forty-nine patients with SS were randomly assigned to a control group (n=15) and two intervention groups: irrigation of the major glands with saline (n=16) or with saline followed by triamcinolone acetonide (TA) in saline (n=18). Unstimulated whole saliva flow (UWS), chewing-stimulated whole saliva flow (SWS), citric acid-stimulated parotid flow (SPF), Clinical Oral Dryness Score (CODS), Xerostomia Inventory (XI) score and the European League Against Rheumatism (EULAR) SS Patient-Reported Index (ESSPRI) were obtained 1 week (T0) before, and 1 (T1), 8 (T8), 16 (T16) and 24 (T24) weeks after sialendoscopy. RESULTS: Median baseline UWS, SWS and SPF scores were 0.14, 0.46 and 0.22 mL/min, respectively. After intervention, significant increases in UWS and SWS were observed in the saline group (at T8 (P=0.013) and T24 (P=0.004)) and the saline/TA group (at T24 (P=0.03) and T=16 (P=0.035)). SPF was increased significantly in the saline/TA group at T24 (P=0.03). XI scores declined after sialendoscopy in both intervention groups. Compared with the control group, CODS, XI and ESSPRI improved in the intervention groups. UWS, SWS and SPF were higher in the intervention groups compared with the control group, but these differences were not significant except for SPF in the saline/TA group at T24 (P=0.005). CONCLUSIONS: Irrigation of the major salivary glands in patients with SS enhances salivary flow and reduces xerostomia up to 6 months after sialendoscopy.

Preservation of Salivary Function Following Extracapsular Dissection for Tumors of the Parotid Gland.

PURPOSE: This study evaluated salivary function after extracapsular dissection (ECD) compared with partial superficial parotidectomy (PSP) and classic superficial parotidectomy (CSP) of benign parotid gland tumors. The authors hypothesized that ECD would be superior to PSP and CSP in preserving postoperative salivary function. MATERIALS AND METHODS: Retrospective analyses were performed for 43 consecutive patients who underwent parotidectomies of benign parotid tumors performed by a single experienced surgeon. Clinical data and pre- and postoperative whole salivary flow rates were compared among the operative procedures. Pearson χ2 and Fisher exact tests were used to compare categorical variables. Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed rank tests were used to compare means. A P value less than .05 was considered significant throughout the study. RESULTS: Tumor sizes did not differ among groups. Operative times, amounts of drainage, and hospital days for ECD were markedly decreased compared with CSP and tended to be decreased compared with PSP. Resection margins were exposed in 0, 12.5, and 6.7% of patients who underwent ECD, PSP, and CSP, respectively. Postoperative complications occurred less often (but not meaningfully) after ECD. Postoperative basal salivary flow rates in the ECD, PSP, and CSP groups were 0.39, 0.32, and 0.14 mL/minute, respectively (P = .05). Stimulated salivary flow rates remained stable for the ECD and PSP groups but decreased in the CSP group. CONCLUSION: ECD is a safe and time-efficient surgical approach, offering early recovery from parotid tumors and better preservation of salivary function. ECD should be considered a surgical approach for parotid tumors, especially those in the parotid tail region, such as Warthin tumors.

Saliva Production and Enjoyment of Real-Food Flavors in People with and Without Dysphagia and/or Xerostomia.

Non-food gustatory stimulation has multiple potential therapeutic benefits for people with dysphagia and xerostomia. This study examined palatability and saliva flow associated with dissolvable flavored films. Taste strips with real-food flavors dissolved on the tongues of 21 persons with dysphagia and/or xerostomia and 21 healthy age- and sex-matched adults while sublingual gauze pads absorbed saliva over randomized 3-min trials. Participants rated taste enjoyment for each trial on a hedonic general labeled magnitude scale. Flavored strips elicited more saliva than baseline for both groups, and production was higher for controls than patients (M = 2.386 and 1.091 g, respectively; p = 0.036). Main effects of flavor were observed for saliva production (p = 0.002) and hedonics (p < 0.001). Hedonic ratings and saliva production were weakly correlated (r = 0.293, p < 0.001). Results support dissolvable taste strips as a tool for providing low-risk taste stimulation in dysphagia and for eliciting an increase in saliva flow that may provide temporary relief from dry mouth symptoms. The preferred flavors were, on average, also the ones that elicited greater saliva production. Taste strips have the potential to be beneficial for swallowing-related neural activity, timing, and safety in dysphagia. Further, they may ameliorate complications of xerostomia.

Acute effects of snus in never-tobacco users: a pilot study.

BACKGROUND: Snus tobacco characteristics may attract non-tobacco users, including relatively low, but pharmacologically active, doses of nicotine. Lower nicotine doses may limit adverse drug effects while also producing a physiologically active response. OBJECTIVES: This pilot study is the first to profile the acute effects of snus on physiological and subjective assessments in a sample of never-tobacco users. METHODS: Eleven never-tobacco users (five women; <100 uses/lifetime) were recruited from the community via university-approved advertisements. Using a within-subject design, participants consumed six pouches in ascending dose order (0, 1.6, 3.2, 4.8, 6.4, and 8.0 mg nicotine) within one session. The start of each snus bout was separated by 45 minutes, and pre- and post-pouch assessments included ratings of drug effects and physiological response. RESULTS: The average heart rate and systolic blood pressure increased significantly from pre- to post-pouch use as a function of dose, though these increases were reliable for 8.0 mg nicotine only (p < .05). Collapsed across time, diastolic blood pressure was significantly higher for 8.0 mg nicotine than for all other doses (p < .05). Subjective ratings for "excessive salivation" and "satisfying" increased significantly from pre- to post-pouch use (p < .05), independent of dose. CONCLUSION: Significant increases in physiological response at some doses suggest that users were exposed to pharmacologically active doses of nicotine. The lack of reliable subjective effects may be the product of the dosing regimen or the relatively small sample size. Findings highlight the need for identification of doses of snus that may promote abuse among naïve users.