Stress and Salivary Glands.

Salivary glands produce a bicarbonate-rich fluid containing digestive and protective proteins and other components to be delivered into the gastrointestinal tract. Its function is under strict control of the autonomic nervous system. Salivary electrolyte and fluid secretion are primarily controlled by parasympathetic activity, while protein secretion is primaily triggered by sympathetic stimulation. Stress activates the hypothalamic - pituitary - adrenal axis. The peripheral limb of this axis is the efferent sympathetic/adrenomedullary system. Stress reaction, even if it is sustained for long, does not cause obvious damage to salivary glands. However, stress induces dramatic changes in the constituents of secreted saliva. Since salivary protein secretion is strongly dependent on sympathetic control, changes in saliva can be utilized as sensitive stress indicators. Some of the secreted compounds are known for their protective effect in the mouth and the gut, while others may just pass through the glands from blood plasma because of their chemical nature and the presence of transcellular salivary transporting systems. Indeed, most compounds that appear in blood circulation can also be identified in saliva, although at different concentrations. This work overviews the presently recognized salivary stress biosensors, such as amylase, cortisol, heat shock proteins and other compounds. It also demonstrates that saliva is widely recognised as a diagnostic tool for early and sensitive discovery of salivary and systemic conditions and disorders. At present it may be too early to introduce most of these biomarkers in daily routine diagnostic applications, but advances in salivary biomarker standardisation should permit their wide-range utilization in the future including safe, reliable and non-invasive estimation of acute and chronic stress levels in patients.

Alteration of consciousness via diverse photo-acoustic stimulatory patterns. Phenomenology and effect on salivary flow rate, alpha-amylase and total protein levels.

Long-term photo-acoustic stimulation is used for the induction of altered states of consciousness for both therapeutic and experimental purposes. Long-term photo-acoustic stimulation also leads to changes in the composition of saliva which have a key contribution to the efficiency of this technique in easing mucosal symptoms of oral psychosomatic patients. The aim of this study is to find out whether there is any cumulative effect of repeated stimulation and whether there are any detectable differences between diverse stimulatory patterns of long lasting photo-acoustic stimulation on the phenomenology of the appearing trance state and on salivary secretion. There was significant cumulative effect in relation with the appearance of day dreaming as phenomenological parameter, and in relation with protein output and amylase/protein ratio as salivary parameter. Pattern specific effect was detectable in relation with salivary flow rate only. Although our results clearly indicate the existence of certain cumulative and stimulation-pattern specific effects of repeated photo-acoustic stimulation, the absolute values of all these effects were relatively small in this study. Therefore, in spite of their theoretical importance there are no direct clinical consequences of these findings. However, our data do not exclude at all the possibility that repeated stimulation with other stimulatory parameters may lead to more pronounced effects. Further studies are needed to make clear conclusion in this respect.

Molecular mechanisms of taste recognition: considerations about the role of saliva.

The gustatory system plays a critical role in determining food preferences and food intake, in addition to nutritive, energy and electrolyte balance. Fine tuning of the gustatory system is also crucial in this respect. The exact mechanisms that fine tune taste sensitivity are as of yet poorly defined, but it is clear that various effects of saliva on taste recognition are also involved. Specifically those metabolic polypeptides present in the saliva that were classically considered to be gut and appetite hormones (i.e., leptin, ghrelin, insulin, neuropeptide Y, peptide YY) were considered to play a pivotal role. Besides these, data clearly indicate the major role of several other salivary proteins, such as salivary carbonic anhydrase (gustin), proline-rich proteins, cystatins, alpha-amylases, histatins, salivary albumin and mucins. Other proteins like glucagon-like peptide-1, salivary immunoglobulin-A, zinc-α-2-glycoprotein, salivary lactoperoxidase, salivary prolactin-inducible protein and salivary molecular chaperone HSP70/HSPAs were also expected to play an important role. Furthermore, factors including salivary flow rate, buffer capacity and ionic composition of saliva should also be considered. In this paper, the current state of research related to the above and the overall emerging field of taste-related salivary research alongside basic principles of taste perception is reviewed.

Salivary defense proteins: their network and role in innate and acquired oral immunity.

There are numerous defense proteins present in the saliva. Although some of these molecules are present in rather low concentrations, their effects are additive and/or synergistic, resulting in an efficient molecular defense network of the oral cavity. Moreover, local concentrations of these proteins near the mucosal surfaces (mucosal transudate), periodontal sulcus (gingival crevicular fluid) and oral wounds and ulcers (transudate) may be much greater, and in many cases reinforced by immune and/or inflammatory reactions of the oral mucosa. Some defense proteins, like salivary immunoglobulins and salivary chaperokine HSP70/HSPAs (70 kDa heat shock proteins), are involved in both innate and acquired immunity. Cationic peptides and other defense proteins like lysozyme, bactericidal/permeability increasing protein (BPI), BPI-like proteins, PLUNC (palate lung and nasal epithelial clone) proteins, salivary amylase, cystatins, prolin-rich proteins, mucins, peroxidases, statherin and others are primarily responsible for innate immunity. In this paper, this complex system and function of the salivary defense proteins will be reviewed.

[Dental fear and anxiety scores of a Hungarian population living in the Hungarian-Slovakian border region. A pilot study]. / Adatok a magyar-szlovák határ mentén élo magyar populáció fogászati félelem- és szorongás-értékeirol. Tájékozódó vizsgálat.

The aim of the authors was to investigate whether living as a minority has an influence on the dental fear and anxiety values. In this study 201 volunteers (n = 201, inside border Hungarians 144, outside border Hungarians 57, male 90, female 111; age 8 to 83 years, mean 44 +/- 16 yrs.) were investigated. Our methods included collection of demographic data (gender, age, marital status, profession), and administration of the Hungarian versions of dental fear and anxiety related scales namely: DAS, DAQ, DASQ, DFS, DBS, STAI-S, STAI-T and Expectation Scale. Mean values of the scales were: DAS: 10,34 +/- 3,54; DAQ: 2,3 +/- 1,15; DASQ: 12,58 +/- 4,55; DFS: 40,37 +/- 15,67; DBS: 32,89 +/- 12,94; Expectation Scale: 2,87 +/- 3,56, STAI-S: 39,51 +/- 10,68; STAI-T 41,65 +/- 9,08. The mean scores of all the scales were higher in the case of Hungarians living inside the borders of Hungary. The differences were significant in the case of DAS, DAQ, DASQ and DFS scales (p < 0,05). Data of our study indicate that living as a minority not necessarily leads to the increase of dental fear and anxiety.

[Restoration of profound tooth damage caused by intrinsic erosion, with porcelain crowns. A case report]. / Intrinsic erosio okozta foganyagveszteség helyreállítása porcelánborító koronákkal. Esetismertetés.

In the presented case extensive tooth damage has been caused by an eating disorder (bulimia nervosa coupled with frequent vomiting). Although the patient's premised disorder has been treated successfully, palatal and occlusal surfaces of the upper teeth were profoundly damaged due to previous acidic erosion. There was also a significant hypersensitivity of upper teeth, and the patient was dissatisfied with the aesthetics of the upper teeth as well. In order to treat pain symptom, replace lost hard dental tissues, and restore aesthetics, porcelain covered zirconium dioxide crowns of upper teeth were prepared. Tooth hypersensitivity disappeared as a result of the insertion of crowns following a careful minimal-invasive preparation. Patient's high aesthetic needs were also fulfilled by using high quality materials. At the 6-months-follow-up examination disappearance of tooth sensitivity and satisfaction with the aesthetics were reported by the patient. Long run gingival and mucosal health as well as proper condition of dental hard tissues and dentures were determined by the intraoral control examination. The patient also presented high level of oral hygiene.

[Effect of being disabled, dental fear and anxiety on drawings]. / Adatok fogyatékkal elok fogászati félelem es szorongás ertékeirol, valamint embert, szájat illetve fogat abrázoló rajzairól.

AIM: To investigate if there is an influence of being a disabled people (with disturbed body-image), dental fear and anxiety on several form/shape parameters of drawings. SUBJECTS: Disabled (46) and healthy (33) volunteers (n = 79; male 39, female 40; age: 18.16 +/- 3.01 yrs.) were investigated. METHODS: Collection of demographic data (gender, age, marital status, profession), and administration of the Hungarian versions of dental fear and anxiety related scales namely: DAS, DAQ, DASQ, DFS, DBS, STAI-S, STAI-T and Expectation scale. Free drawing test portraying a person, a mouth, and a tooth were also administered, and form/shape parameters were analyzed. RESULTS: Mean values of the scales were: DAS: 10.22 +/- 3.1; DAQ: 2.21 +/- 0.9; DASQ: 12.44 +/- 3.9; DFS: 40.98 +/- 14,0; Expectation Scale: 2.32 +/- 0.7, DBS: 34.50 +/- 9.0; STAI-S: 37.56 +/-10.7; STAI-T 42.41 +/-10.2. Disables subjects scored higher in all of the scales but there was a significant difference (t-probe, p < 0.05) in the case of DBS scale only. Being a disabled influenced 2 of person-, 5 of tooth-, and 3 of mouth-drawing parameters significantly (chi2 probe, p < 0.05). Dental fear related scales influenced 5 of person-, 5 of tooth-, and 1 of mouth-drawing parameters significantly (one-way ANOVA, p < 0.05). Anxiety influenced 2 of person-, 1 of tooth-, and none of mouth-drawing parameters significantly (one-way ANOVA, p < 0.05). CONCLUSION: Interestingly, the influence of being a disabled people was the strongest in case of tooth-drawings, and the influence of dental fear on drawing parameters was stronger than that of anxiety.

Spondyloarthropathies and bone resorption: a possible role of heat shock protein (Hsp70).

Spondyloarthropathies consist of chronic inflammatory disorders genetically linked with each other through HLA-B27 molecules, and are connected with the destruction of periarticular bone and also with systemic bone loss in many cases. Expected molecular mechanisms behind these conditions overlap the functions of Hsp70s, a group of major molecular chaperones and cytokines. Hsp70s may control disease progression via inhibition of unfolded HLA-B27 protein accumulation and alteration of ER stress signaling. Further, Hsp70s may improve disease related malfunction of antigen presentation, and may induce nitric oxide (NO) release from macrophages which probably protective against spondyloarthropathies as well. Considering premised possible influence of Hsp70s on core mechanisms of spondyloarthropathies it may be expected that, increased expression of Hsp70s advantageously retards disease progress, or may lead to remission. On the other hand Hsp70s as danger signals induce the secretion of proinflammatory cytokines playing major role in the progression of spondyloarthropathy induced bone loss. Consequently, the effect of Hsp70s on the progression of spondyloarthropathic bone loss is "Janus-faced" in some respect: increase of Hsp70s' level is likely advantageous regarding to the core of disorder; but it may facilitate existing bone resorption processes.

Attitude toward death: does it influence dental fear?

The possible influence of fear of death and attitude toward death were studied related to dental anxiety in Hungarian elementary and secondary school subjects (n = 277; 114 males, 163 females; age between 8 and 18 years). Dental fear and anxiety scores were DAS: 10.8 +/- 3.6; DFS: 40.6 +/- 15.6; STAI-S: 38.0 +/- 11.0; STAI-T: 40.3 +/- 10.0. Lester's Attitude Toward Death Scale scores were 6.3 +/- 1.3. Girls scored higher on DAS, STAI-S, and STAI-T scales (P < or = 0.05). Age influenced STAI-S, STAI-T, and Lester's Scale scores (P < or = 0.05). Lester's Scale scores influenced the expectations of the subjects about the dental fear of their surrounding people (parents, brother, sister, friends) (P < or = 0.05). A percentage of 7.22 of the subjects indicated a rather strong connection between dental fear and fear of death. These subjects had significantly higher dental fear and anxiety scores as compared to others (P < or = 0.01). Death-related content was found in 4.3% of drawings and in 10.5% of free associations (couplings) related to teeth (in 12.6% either in drawings or in couplings). The appearance of death-related content was higher with higher age, and higher expected dental fear of surrounding people (P < or = 0.01). Our data indicate a detectable influence of fear of death on dental fear, especially in subjects with higher dental fear scores.

Potential immunological functions of salivary Hsp70 in mucosal and periodontal defense mechanisms.

Molecular chaperones were considered to be intracellular, but there is increasing evidence demonstrating their cytoprotective and immune modulator properties outside the cell. The major extracellular chaperone (Hsp70) was also found in saliva, indicating a possible effect of Hsp70 on mucosal surfaces. Here we summarize the immune-modulatory role of the 70-kDa stress protein family, with special attention on the potential impact of salivary Hsp70 on oral defense mechanisms. There are three major facets of Hsp70-induced immune activation: 1) the appearance of Hsp70 on the surface of certain tumor cells or virally infected cells, leading to their phagocytosis and subsequent lysis; 2) the role of extracellular uncomplexed Hsp70 as a danger signal, leading to the secretion of proinflammatory cytokines from antigen-presenting cells and T lymphocytes and of nitric oxide from macrophages as well as to complement activation; 3) receptor-mediated uptake of peptide-loaded Hsp70 to antigen-presenting cells and cross-presentation of the Hsp70-peptide complex as an antigen to cytotoxic T cells and natural killer lymphocytes. The immune-activating effect of salivary Hsp70 may also be highly important in oral defense, especially in areas where molecular and cellular participants of the immune response appear on the surface of the oral cavity (i.e. several lesions of the mucosa and the periodontal tissues).

[Initial analysis of tooth drawings of 8-18 years old schoolchildren from normal population]. / Fogat ábrázoló rajzok alapparamétereinek vizsgálata normal populáción, 8-18 éves korcsoportban.

The connection between unconscious subjects and psycho-somatic manifestation is well known in the literature. Although more and more data is known about this connection related to the oro-facial region as well, investigation of this interesting problem is still has theoretical and clinical relevance. To collect more data about this field, 257 of tooth drawings of 8-18 years old schoolchildren from normal population were studied as a pilot to establish further investigations related to drawing-projections in connection with the oro-facial region. This first analysis of the data indicated that, gender correlates significantly with the size of the drawings (p< or =0.05), and localisation of the drawings (p< or =0.05). Differences between elementary schoolchildren and the more mature middle school children were detected as well related to subject (p< or =0.05) and localisation (p< or =0.05) of the drawings.

[Relaxation techniques in dentistry]. / Relaxációs módszerek alkalmazásának lehetoségei a gyakorló fogorvos szemszögébol lrodalmi osszefoglaló.

In the field of dentistry the increasing number of psychosomatic patients justify the introduction of psychological treatment methods into the dental care system. In this review authors try to collect the main points of the theoretical background and clinical principles of relaxation techniques. Some aspects of the concept of mental hygiene is also discussed to help dental professionals working in the field of general and psychosomatic dentistry in the orientation in this interesting and important field.

[Dental fear scores of 12-19-year-old school children of the Hungarian minority in Transylvania]. / Adatok a határon túli magyarság fogászati félelem értékeiro1 12-19 éves korcsoportban.

In this study 549 school children of the Hungarian minority in Transylvania were investigated (n=549, 342 female, 207 male, age between: 12-19 years). Mean dental fear scores were high: DAS: 12.6 +/- 3.3, DFS: 50.6 +/- 25.1. Girls scored significantly higher (p< or =0.01) in both scales. Scores increased between age of 12 and 16 confluently in both scales (DAS, DFS; p< or =0.05). There was a strong Pearson's correlation between DAS and DFS scales: (r= 0.70; p< or =0.01), and a somewhat lower correlation between these scales and the general anxiety scores. Mean DBS score (n = 203 only) was: 44.9 +/- 10.2.

[Psychology and psychosomatics of the orthodontic treatment]. / Pszichológia és pszichoszomatika a fogszabályozásban irodalmi áttekintés.

Psychosomatic problems related to orthodontic treatment are a special group of oral psychosomatic disorders. The most frequent complaints are related to aesthetics and occlusion. Most of the patients are children, adolescence or young adults, with special emotional problems. Authors reviewed the most important knowledge related to this specific field, but some general aspects of oral psychosomatics are also discussed.

[Background data about the dental fear scores of Hungarian secondary school students]. / Adatok budapesti középiskolások fogászati kezeléssel kapcsolatos félelmeinek hátterérol.

Free association (coupling) of 139 Hungarian secondary school students (90 females, 49 males, age between 14-18 yr.) about their teeth was collected. Dental fear (DAS, DFS) and general anxiety scores were measured. Typical dental events (i.e.: simple and traumatising dental treatments, etc.) were coupled by the participants in 36,7% of the cases. Functions and importance of the teeth and oral hygiene were described in 7,2% of the cases. Simple, grotesque, or magical stories and tales about teeth were found in 16,5% of the cases. No answer was found in 39,6% of the cases. Highest dental fear and general anxiety scores were found in the group coupled traumatising dental treatment. Age had no influence on the sense of the association (coupling).

[Pastoral psychology, spiritual counseling in dentistry. Review of the literature]. / A pasztorálpszichológia, lelkigondozás fogászati vonatkozásai Irodalmi összefoglaló.

Although there were drastic changes in the XX-th century, still 70% of the Hungarian population believe in God, and 10-15% can be counted as active believer. A percentage of 44% of the hospitalised patients indicated a need of pastoral counseling during the treatment time. In the field of psychiatry and psychotherapy the percentage of the need of religious care (pastoral psychology, pastoral counseling) may be even higher. In the field of dentistry the increasing number of psychosomatic patients justify the introduction of such religious treatment methods into the dental care system as well. In this review authors try to collect the main points of this special, religious type of therapy to help dental professionals working in the field of psychosomatic dentistry in the orientation in this interesting and important field.

[Lexicologic parameters of free association (coupling) about teeth of Hungarian primary school children. An initial study]. / Fogakkal kapcsolatos történetek szótani alapparamétereinek vizsgálata általános iskolás (8-15 éves) korcsoportban.

Free association (coupling) of 97 Hungarian primary school children (age: 8-15 yrs, 44 male, 53 female) about their teeth was collected and analysed related to lexicologic parameters, as a pilot to establish further investigations. In some cases significant (p < or = 0.05) differences within the groups related to several topics were detected in the case of the length of the text and in the case of the distribution of etymons (root of word). Gender significantly influenced the length of the text as well. Some effect of dental fear and anxiety on the length of the text, and on the etymon's distribution may also be possible. The analysis of the most frequently used words indicated some coupling of pain and fear, and the importance of the mother in how the children see dental life events.

[Effectiveness of psychotherapy in the treatment of denture intolerance. Evaluation of 25 cases]. / Fogpótlás intoleranciás betegek pszichoterápiájában szerzett tapasztalatok értékelése 25 eset alapján.

25 "problem-patients" of the Clinic of Prosthetic Dentistry participated in this study (21 female, 4 male, aged between 32-81 yr.; mean age: 56.92+/-12.09). All included therapies were provided by dentists specialised in psychotherapy, and the efficacy of our model to treat denture intolerance patients was analysed based on the time need, and other parameters. Psychiatric diagnostic (ICD-10) categories were: F20-29: 12%; F30-39: 40%, F40-48: 36%; F60-69: 12%. The efficacy of the provided psychotherapy was: recovery in 44% (patient accepted the denture); improvement in 32% (patient compromised to accept the denture); no effect in 24% (the patient did not accept the denture). Number of psychotherapeutic sittings ranged: 1-10 in 24%; 10-20 in 28%, 20-30 in 16%, 30-40 in 8%; 40-50 in 8%; 50-60 in 12%; and 80-90 in 4% of the cases. Our results indicate that, the efficacy of dentists specialised in psychotherapy is appropriate to treat denture intolerance patients. However, treatments are rather time consuming, and 24% of the cases are unsuccessful. Because of this, the prevention and early diagnosis of this problems are crucial.

[Background data about the high dental fear scores of Hungarian 8-15-year-old primary school children]. / Adatok általános iskolás (8-15 éves) gyermekek fogászati kezeléssel kapcsolatos félelmeinek hátterérol.

Free associations (coupling) of 139 Hungarian primary school children about their teeth was collected. Dental fear (DAS, DFS) and general anxiety scores were measured. Typical dental events (i.e.: loss of deciduous teeth, simple and traumatising dental treatments, tooth fractures) were coupled by the participants in 41.0% of the cases. Functions and importance of the teeth and oral hygiene were described in 20.1% of the cases. Simple, grotesque, or magical stories and tales about teeth were found in 8.6% of the cases. No answer was given in 30.2% of the cases. Highest dental fear and general anxiety scores were found in the group coupled traumatising dental treatment. Traumatising loss of deciduous teeth was caused by the dentist or by the father of the child, and was associated with higher dental fear and general anxiety comparing to simple loss of deciduous teeth. Higher dental fear and general anxiety scores were found in the group coupled functions and importance of the teeth comparing to the group coupled simple, grotesque, or magical stories and tales, or the group giving no answer.

[Some background data about the high dental anxiety of the Hungarian population]. / Adatok a hazai populáció fokozott fogászati szorongásának hátteréról.

100 dental patients waiting for hypnotic dental treatment (n = 100, 58 female, 42 male, mean age: 36.4 +/- 10.6 yr.) was investigated about their perceived origins of dental anxiety. Dental anxiety levels (DAS, DFS) and general anxiety were measured as well. Mean dental anxiety scores were high (DAS: 12.5 +/- 3.3; DFS: 47.9 +/- 17.3). The most frequent reason of high dental anxiety was previous painful dental treatment (20.0%), dislike of dentist's behaviour (15.0%), treatment error (5.0%), and "other reasons" (4.0%). A large amount of the patients (48.0%) did not know what to expect, and 8.0% indicate no fear related to dentistry. Previous painful dental treatment induced the highest dental anxiety (DAS: 15.1 +/- 3.1; DFS: 58.1 +/- 20.3), followed by the "other reasons" (DAS: 14.0 +/- 0.8; DFS: 50.5 +/- 13.5), treatment error (DAS: 13.0 +/- 3.7; DFS: 49.0 +/- 16.1), and dislike of dentist's behaviour (DAS: 11.4 +/- 2.8; DFS: 45.0 +/- 12.5). Increased general anxiety was found in the groups indicated previous painful dental treatment, "other reasons", and no expectation.