Efficacy of gel-based artificial saliva on Candida colonization and saliva properties in xerostomic post-radiotherapy head and neck cancer patients: a randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of an edible artificial saliva gel, oral moisturizing jelly (OMJ), and a topical commercial gel (GC dry mouth gel) on Candida colonization and saliva properties. MATERIALS AND METHODS: This study was a secondary analysis of a single-blinded randomized controlled trial conducted in xerostomic post-radiotherapy head and neck cancer patients. Candida colonization, stimulated salivary flow rate (SSFR), saliva pH, and buffering capacity (BC) were measured at 0, 1, and 2 months after each intervention. Candida colonization was quantified by colony counts and species identified by Candida Chromagar, polymerase chain reaction, and API 20C AUX system. Statistical significance level was 0.05. RESULTS: A total of 56 participants in OMJ (N = 30) and GC (N = 26) groups completed the study. OMJ significantly increased saliva pH (p = 0.042) and BC (p = 0.013) after 1-month use, while GC only improved saliva pH (p = 0.027). Both interventions tended to increase SSFR but only GC had a significant increase at 2 months (p = 0.015). GC and OMJ significantly decreased the number of Candida species at 1 and 2 months, respectively. Both groups tended to reduce Candida counts but not significant. CONCLUSIONS: Both OMJ and GC saliva gels could improve saliva pH and decrease the number of Candida species. OMJ is superior to GC in its buffering capacity, while GC may better improve salivary flow rate. Long-term and large-scale study is warranted to test the efficacy of artificial saliva in oral health improvement. CLINICAL RELEVANCE: OMJ and GC gel could decrease the number of Candida species and improve saliva properties in post-radiation xerostomic patients. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov NCT03035825. Date of registration: 25th January 2017.

Riceberry rice puddings: rice-based low glycemic dysphagia diets.

BACKGROUND AND OBJECTIVES: Swallowing difficulty and diabetes mellitus are common in the elderly. However, texture-modified foods suitable for blood sugar control are scarce. This study was aimed to identify texture, glycemic indices (GIs) and postprandial responses of original and high-fiber Riceberry rice puddings. METHODS AND STUDY DESIGN: International Dysphagia Diet Standard Initiative (IDDSI)'s methods were used to determine texture. In vitro digestion was performed for estimating glycemic indices. A randomized cross-over controlled trial was conducted in twelve healthy volunteers. Original pudding, high-fiber pudding and white bread containing 40 g carbohydrate each were assigned in random sequence with twelve-day wash-out intervals. Plasma glucose concentrations were measured at 0, 15, 30, 60, 90, 120, 150, and 180 min after food intake. Individual GIs of puddings were calculated. RESULTS: Original and high-fiber puddings were classified as IDDSI level 3 (liquidized) and 4 (pureed), respectively. The in vitro estimated GIs were 51 for original and 48 for high-fiber puddings. Clinical trial showed rapid kinetics (peaked at 30 min) but lower postprandial responses of both puddings, compared to white bread (peaked at 60 min). The adjusted GIs for original and high-fiber puddings were not significantly different (at 41±7.60 and 36±6.40, respectively). CONCLUSIONS: Addition of fiber to the original pudding changed physical properties but not significantly reduced the GI. Original and high-fiber Riceberry rice puddings could be low-GI dysphagia diets, which may be useful for step-wise swallowing practice from IDDSI level 3 to 4 for those who also required blood sugar control.

Oral Candida colonization in xerostomic postradiotherapy head and neck cancer patients.

OBJECTIVES: To evaluate (a) oral colonization of Candida species, especially for non-albicans Candida species (NACS), in xerostomic postradiotherapy head and neck cancer patients and (b) risk factors affecting their colonization. MATERIALS AND METHODS: Subjective and objective dry mouth scores, stimulated salivary flow rates, pH and buffering capacity were measured in 72 xerostomic postradiotherapy head and neck cancer patients. Candida counts and species identification were performed using oral rinse samples cultured in Candida Chromagar, followed by polymerase chain reaction and API 20C AUX system. RESULTS: Candida colonization was observed in 87.5% of subjects, with 80.6% and 48.6% of study population colonized by C. albicans and NACS, respectively. NACS was associated with high objective dry mouth scores, denture use, and females (p = .006, .009, and .036, respectively). In addition, Candida glabrata was detected more in females (p = .018) and denture wearers (p = .026), while Candida tropicalis was associated with high objective dry mouth scores (p = .022) and females (p = .027). Quantity of Candida colonization correlated positively with objective dry mouth scores (r = 0.599, p < .001) and negatively with salivary flow rates (r = -0.258, p = .041) and pH (r = -0.290, p = .022). CONCLUSION: NACS colonization was common in xerostomic head and neck cancer patients. Increased signs of dry mouth, female and dental prostheses may promote NACS colonization.

Sensory acceptable equivalent doses of ß-phenylethyl isothiocyanate (PEITC) induce cell cycle arrest and retard the growth of p53 mutated oral cancer in vitro and in vivo.

High doses of ß-phenylethyl isothiocyanate (PEITC), a phytochemical in cruciferous vegetables, are not feasible for consumption due to a strong mouth-tingling effect. This study investigated the anti-cancer effect of PEITC at sensory acceptable doses. In vitro, PEITC was selectively toxic to oral cancer cells (CAL-27, FaDu, SCC4, SCC 9, SCC15, SCC25 and TU138), compared to oral keratinocytes (OKF6/TERT2 and NOK/Si). In vivo, 5 and 10 mg kg-1 PEITC, equivalent to human organoleptically acceptable doses, retarded tumor growth and prolonged the survival of mice bearing p53-mutated oral cancer cells - TU138 xenograft. Mechanistically, PEITC induced ROS accumulation, nuclear translocation of p53 and p21 and G1/S cell cycle arrest in vitro; increased p53 and 8-oxo-dG levels; and decreased Ki-67 intense/mild staining ratios without TUNEL changes in vivo. These findings suggested that the sensory acceptable doses of PEITC selectively induced ROS-mediated cell cycle arrest leading to delayed tumor progression and extended survival. PEITC could be a functional ingredient for oral cancer prevention.