Lubricating properties of chewing stimulated whole saliva from patients suffering from xerostomia.

OBJECTIVES: The study aimed to quantify the lubricating properties of chewing stimulated whole saliva from healthy controls (n = 22), from patients suffering from primary Sjögren's syndrome (n = 37) and from patients undergoing head-and-neck radiotherapy (n = 34). MATERIALS AND METHODS: All participants had to complete the Xerostomia Inventory questionnaire to score dry mouth sensation. Lubrication was measured using an ex vivo tongue-enamel friction system in terms of Relief and Relief period. MUC5b and total protein concentrations of the saliva samples were measured by an enzyme-linked immunosorbent assay and a bicinchoninic acid assay, respectively. RESULTS: Relief of Sjögren's patients' saliva and post-irradiation patients' saliva was similar compared with healthy controls, but saliva from post-irradiation patients lubricated significantly better than saliva from Sjögren's patients. The Relief period was similar between the three groups. The Relief and Relief period were higher for saliva samples post-irradiation compared to pre-irradiation. MUC5b and total protein concentrations were comparable in all groups. MUC5b and total protein output were significantly lower in patients subjected to radiotherapy compared to saliva from healthy controls and pre-irradiation patients. MUC5b concentrations positively correlated with lubricating properties of post-irradiation patient saliva. CONCLUSIONS: The lubricating properties of patient saliva were not any worse than healthy controls. Lower flow rate leads to lower availability of saliva in the oral cavity and decreases the overall output of protein and MUC5b, which might result in an insufficient replenishing of the mucosal salivary film. CLINICAL RELEVANCE: An insufficient replenishing might underlie the sensation of a dry mouth and loss of oral function.

Dry mouth: saliva substitutes which adsorb and modify existing salivary condition films improve oral lubrication.

OBJECTIVES: The aims of this study are to assess different saliva substitutes for their efficacy to lubricate the oral cavity, and to relate this oral lubrication to the ability of saliva substitutes to adsorb on and change the structure of the existing salivary conditioning film (SCF). MATERIALS AND METHODS: Quartz crystal microbalance with dissipation was used to study the capability of saliva substitutes to interact with natural SCF and the ability to change the secondary SCF (S-SCF). A tongue-enamel friction system mimicking xerostomic conditions was used to assess the relief and relief period expected from these substitutes under set circumstances. RESULTS: Saliva Orthana spray, Biotène spray and Gum Hydral gel had an immediate effect on a SCF, increasing its structural softness. BioXtra gel, Biotène gel, Gum Hydral gel and Glandosane spray changed the S-SCF by increasing salivary protein adsorption, while others showed no sign of interaction. With respect to relief, only 2 out of the 16 saliva substitutes tested (Saliva Orthana spray and Gum Hydral gel) performed better than water. Overall, relief period correlated positively to structural softness change, whereas a positive correlation was seen between relief and mass adsorption. CONCLUSIONS: The majority of saliva substitutes did not adsorb on the SCF, thus did not enhance lubrication. Only saliva substitutes containing carrageenan, carboxymethylcellulose, pig gastric mucin, xanthan gum and carbomer performed better in enhancing oral lubrication. CLINICAL RELEVANCE: This objective assessment will help clinicians and patients make better choice of saliva substitutes. This study provides a scientific basis for future improvement in saliva substitutes.

Effects of beverage carbonation on lubrication mechanisms and mouthfeel.

The perception of carbonation is an important factor in beverage consumption which must be understood in order to develop healthier products. Herein, we study the effects of carbonated water on oral lubrication mechanisms involved in beverage mouthfeel and hence taste perception. Friction was measured in a compliant PDMS-glass contact simulating the tongue-palate interface (under representative speeds and loads), while fluorescence microscopy was used to visualise both the flow of liquid and oral mucosal pellicle coverage. When carbonated water is entrained into the contact, CO2 cavities form at the inlet, which limit flow and thus reduce the hydrodynamic pressure. Under mixed lubrication conditions, when the fluid film thickness is comparable to the surface roughness, this pressure reduction results in significant increases in friction (>300% greater than under non-carbonated water conditions). Carbonated water is also shown to be more effective than non-carbonated water at debonding the highly lubricious, oral mucosal pellicle, which again results in a significant increase in friction. Both these transient mechanisms of starvation and salivary pellicle removal will modulate the flow of tastants to taste buds and are suggested to be important in the experience of taste and refreshment. For example this may be one reason why flat colas taste sweeter.