Smell and taste disorders, a study of 750 patients from the University of Pennsylvania Smell and Taste Center.

Smell and taste disorders are common in the general population, yet little is known about their nature or cause. This article describes a study of 750 patients with complaints of abnormal smell or taste perception from the University of Pennsylvania Smell and Taste Center, Philadelphia. Major findings suggest that: chemosensory dysfunction influences quality of life; complaints of taste loss usually reflect loss of smell function; upper respiratory infection, head trauma, and chronic nasal and paranasal sinus disease are the most common causes of the diminution of the sense of smell, with head trauma having the greatest loss; depression frequently accompanies chemosensory distortion; low body weight accompanies burning mouth syndrome; estrogens protect against loss of the sense of smell in postmenopausal women; zinc therapy may provide no benefit to patients with chemosensory dysfunction; and thyroid hormone function is associated with oral sensory distortion. The findings are discussed in relation to management of patients with chemosensory disturbances.

Effects of pharmacologic reductions in salivary flow on taste thresholds in man.

The effects of short-term salivary flow reductions on human taste thresholds were measured. Recognition and detection thresholds were obtained from 65 subjects during periods of both normal and reduced salivary flow. Decreased salivary flow was achieved by oral administration of either Elavil, Benadryl or atropine. Thresholds were measured for NaCl, citric acid, quinine sulphate and sucrose with a traditional series of aqueous solutions as well as with a series of dry taste stimuli using a filter-paper base. Whole mouth resting flow and stimulated salivary flow were measured before and after taste testing. The pharmacologic agents produced depressions in salivary flow ranging between 30 and 75 per cent of normal levels. The large decreases in flow produced no measurable changes in taste thresholds with the exception that an increased sensitivity to aqueous and dry citric acid stimuli consistently was observed following atropine administration. Changes in salivary bicarbonate levels, produced by atropine, may have mediated the observed shifts in oral sensitivity to citric acid.

Relationship of medical status, medications, and salivary flow rates in adults of different ages.

Multiple systemic disorders and medications have been reported to cause xerostomia or salivary gland hypofunction. The purpose of this study was to evaluate the relationship among systemic disorders, medications, and salivary flow rates. Sixty-three ambulatory dental patients aged 23 to 82 years were randomly selected. The nature, duration, and number of systemic disorders and medications were documented. Repeated measurements of unstimulated whole, chewing-stimulated whole, acid-stimulated parotid, and candy-stimulated parotid salivary flow rates were obtained. Data were analyzed with the Wilcoxon rank-sum test, nonparametric multivariate analysis of variance, and Fisher's exact test. For persons with systemic disorders who were taking medication, all salivary flow rates were significantly (p = 0.03 - 0.001) lower than the flow rates in healthy persons. Among persons with at least one systemic disorder who were taking medication, those who had been taking medication for longer than 2 years had significantly lower unstimulated whole saliva (p = 0.002), chewing-stimulated whole saliva (p = 0.0004), and candy-stimulated parotid saliva (p = 0.02) flow rates than those who had been taking medication for 1 to 2 years. The number of systemic disorders significantly (p = 0.02) and negatively affected the acid-stimulated parotid salivary rates. The prevalence of salivary hypofunction determined on the basis of unstimulated whole saliva and acid-stimulated parotid saliva was significantly higher (p = < 0.001, p = 0.007) in the those persons with systemic disorders and taking medications. The results suggest that salivary secretion is affected by the number of systemic disorders and duration of the potentially xerogenic medications.

Relationship between salivary flow rates and Candida albicans counts.

Seventy-one persons (48 women, 23 men; mean age, 51.76 years) were evaluated for salivary flow rates and Candida albicans counts. Each person was seen on three different occasions. Samples of unstimulated whole, chewing-stimulated whole, acid-stimulated parotid, and candy-stimulated parotid saliva were collected under standardized conditions. An oral rinse was also obtained and evaluated for Candida albicans counts. Unstimulated and chewing-stimulated whole flow rates were negatively and significantly (p < 0.001) related to the Candida counts. Unstimulated whole saliva significantly (p < 0.05) differed in persons with Candida counts of 0 versus <500 versus < or = 500. Chewing-stimulated saliva was significantly (p < 0.05) different in persons with 0 counts compared with those with a > or = 500 count. Differences in stimulated parotid flow rates were not significant among different levels of Candida counts. The results of this study reveal that whole saliva is a better predictor than parotid saliva in identification of persons with high Candida albicans counts.

Clinical study of a C31G containing mouthrinse: effect on salivary microorganisms.

In vitro studies have demonstrated the antiplaque properties of C31G, a potent broad spectrum antimicrobial agent consisting of an equimolar mixture of alkyl dimethyl glycine and alkyl dimethyl amine oxide, buffered with citric acid. In this initial clinical study, C31G at concentrations of 0.05%, 0.1%, 0.2% and 0.5%. Listerine, and placebo were tested in a complete crossover design. Twelve subjects were evaluated, with a minimum of 2 days between treatments. Parameters monitored were salivary bacterial counts and saliva glycolysis. The 0.5% and 0.2% C31G mouthrinses significantly reduced total bacterial counts in saliva samples obtained up to and including three hours after rinsing, compared with counts obtained prerinsing or after placebo rinsing. Both 0.5%, and 0.2% C31G significantly inhibited glycolysis of salivary bacteria for up to 6 hours postrinsing, compared with pH values obtained prerinsing. 0.1% and 0.05% C31G exhibited little or no effect in either assay. Listerine showed a significant reduction in bacterial counts for up to 1 hour postrinsing, compared with prerinse counts, but the effect was less sustained. Listerine showed no significant inhibition of glycolysis at any time point. No tooth staining or altered taste sensation was noted with either product.

Incidence of recurrent herpes labialis and upper respiratory infection: a prospective study of the influence of biologic, social and psychologic predictors.

In a 3-year prospective study of recurrent herpes labialis (RHL) in a population of 149 student nurses, 40 to 50 per cent of the variance in incidence could be explained by a small group of variables. Measures of previous experience with RHL accounted for the largest fraction of the explained variance, followed by upper respiratory infection (URI) rate, socioeconomic status, and mood trait, in order of declining influence. Timing of RHL episodes was not related to phase of the menstrual cycle.

Early application of topical 15% idoxuridine in dimethyl sulfoxide shortens the course of herpes simplex labialis: a multicenter placebo-controlled trial.

In a double-blind, randomized, patient-initiated treatment study at five medical centers, 301 immunocompetent patients experiencing a recurrence of herpes labialis were treated with topical 15% idoxuridine (IDU) in dimethyl sulfoxide (DMSO), 80% DMSO control solution, or 2% DMSO control solution. IDU did not prevent the development of lesions but significantly accelerated lesion resolution in comparison with the combined control groups. For the total population, the mean duration of pain was reduced by 1.3 days (35%, P = .01) and the mean healing time to loss of crust by 1.7 days (21%, P = .004). Analysis of subpopulations revealed that the beneficial activity of the treatment was concentrated among the patients who began treatment in the prodrome or erythema lesion stage. For these patients, the mean duration of pain was reduced by 1.8 days (42%, P = .08) and the mean healing time to loss of crust by 3.3 days (38%, P less than .001). If only patients with classic herpes lesions (vesicle, ulcer, or crust formation) were considered, there was a greater drug effect on the duration of pain (reduction by 2.6 days, 49%; P = .03) and the mean healing time to normal skin was significantly shortened (reduction by 2.3 days, 23%; P = .004). Adverse reactions to the medication were minimal.