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 There may be a way to aid dry mouth condition.

A new battery-powered mouthguard was created to fix this problem. The mouthguard fits over the lower arch of the teeth and enables the production of saliva thanks to little electric shocks. This device is necessary because dry mouth impacts 20 percent of people older than 50.

This device could be extremely helpful because of the importance of saliva in digestion and fighting against bacteria. A healthy person can generate three pints of saliva per day but there are many people that don’t produce enough. The result is the condition of dry mouth, known as xerostomia. The condition usually stems from some kind of medication or cancer treatment.

This new mouthguard is custom designed for each person and triggers saliva production by way of electric shocks. Each patient controls the device and can be worn for up to 10 minutes every hour.

The device can be beneficial for people who developed dry mouth from Parkinson’s Disease and Sjogren’s Syndrome. More tests are on the way.

Scientists have also created mint disks with Xylitol in them, which are thought to aid dry mouth. The disks are applied at night. They melt while the person is asleep and studies from the University of Washington indicate a reduced impact of dry mouth symptoms with one week.

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dry mouth

 Dry mouth, also called xerostomia (ZEER-oh-STOH-mee-ah), is the condition of not having enough saliva, or spit, to keep the mouth wet.  Dry mouth can happen to anyone occasionally—for example, when nervous or stressed.  However, when dry mouth persists, it can make chewing, eating, swallowing and even talking difficult.  Dry mouth also increases the risk for tooth decay because saliva helps keep harmful germs that cause cavities and other oral infections in check.

Causes

Dry mouth occurs when the salivary glands that make saliva don't work properly.  Many over-the-counter and prescription medicines, as well as diseases such as diabetes, Parkinson's disease and Sjogren's syndrome, can affect the salivary glands.  Other causes of dry mouth include certain cancer treatments and damage to the glands' nerve system.  It's important to see your dentist or physician to find out why your mouth is dry.

Treatment

Depending on the cause of your dry mouth, your health care provider can recommend appropriate treatment. There are also self-care steps you can take to help ease dry mouth, such as drinking plenty of water, chewing sugarless gum, and avoiding tobacco and alcohol.  Good oral care at home and regular dental check-ups will help keep your mouth healthy.

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 Sjogren's syndrome is a disease that causes dryness in your mouth and eyes. It can also lead to dryness in other places that need moisture, such as your nose, throat and skin. Most people who get Sjogren's syndrome are older than 40. Nine of 10 are women. Sjogren's syndrome is sometimes linked to rheumatic problems such as rheumatoid arthritis.

Sjogren's syndrome is an autoimmune disease If you have an autoimmune disease, your immune system, which is supposed to fight disease, mistakenly attacks parts of your own body. In Sjogren's syndrome, your immune system attacks the glands that make tears and saliva. It may also affect your joints, lungs, kidneys, blood vessels, digestive organs and nerves. The main symptoms are:

  • Dry eyes
  • dry mouth
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What Causes Sjögren's Syndrome?

Sjögren's syndrome is an autoimmune disease. The immune system is supposed to fight disease by killing off harmful viruses and bacteria. But with autoimmune diseases, your immune system attacks parts of your own body by mistake.

In Sjögren's syndrome, your immune system attacks the glands that make tears and saliva (spit). The damage keeps these glands from working right and causes dry eyes and dry mouth.

Doctors don't know the exact cause of Sjögren's syndrome. They think it may be caused by a combination of two things:

  • Genes
  • Exposure to something like a virus or bacteria.
  • What Are the Symptoms of Sjögren's Syndrome?

The main symptoms are:

  • Dry eyes
  • Dry mouth.

Sjögren's syndrome also can affect other parts of the body, including the skin, joints, lungs, kidneys, blood vessels, digestive organs, and nerves. Symptoms can include:

  • Dry skin
  • Skin rashes
  • Chronic dry cough
  • Thyroid problems
  • Joint and muscle pain
  • Vaginal dryness
  • Numbness and tingling in the arms and legs.

Sjögren's can also make you very tired.

How Is Sjögren's Syndrome Diagnosed?

Doctors use a few ways to diagnose Sjögren's:

  • Medical history
  • Physical exam
  • Certain eye and mouth tests
  • Blood tests.

Doctors may also use:

  • A urine test
  • A chest x ray.
  • How Is Sjögren's Syndrome Treated?

Treatment differs for each person. It depends on what parts of the body are affected. Treatment will focus on getting rid of symptoms. Treatment may include:

  • Medicines for joint or muscle pain (such as aspirin and ibuprofen)
  • Medicines that help you make more saliva
  • Medicines that suppress inflammation (such as corticosteroids)
  • Medicines that suppress the immune system.

Treatment for dry eyes may include:

  • Artificial tears that come in different thicknesses. You may have to try a few to find the right one.
  • Eye ointments. These are thicker than artificial tears. They protect the eyes and keep them wet for several hours. They can blur your vision, so you may want to use them while you sleep.
  • Medicines to reduce inflammation in the eye.
  • A chemical that wets the surface of the eye and keeps the natural tears from drying out so fast. It comes in a small pellet that you put in your lower eyelid. When you add eye drops, the pellet melts. This forms a film over your own tears and traps the moisture.
  • Surgery to shut the tear ducts that drain tears from the eye.

Treatment for dry mouth may include:

  • Chewing gum or sucking on hard candy helps your glands make more saliva. However, gum and candymust be sugar-free.
  • Sipping water or a sugar-free drink often to wet your mouth.
  • Using oil or petroleum-based lip balm or lipstick to help dry, cracked lips feel better.
  • Using a saliva substitute prescribed by a doctor to make the mouth feel wet.
  • Using medicine to help your mouth make more saliva.

People with dry mouth can easily get mouth infections. Tell your doctor if you have white patches or red, burning areas in your mouth.

Medicines and Dryness

Some medicines can cause eye and mouth dryness. If you are taking one of the drugs listed below, ask your doctor whether you should stop.

Drugs that can cause dryness include:

  • Those used for allergies and colds (antihistamines and decongestants)
  • Those used to lower fluids (diuretics)
  • Some used to treat diarrhea
  • Some used to treat blood pressure
  • Some antipsychotic medicines
  • Tranquilizers
  • Antidepressants.
  • What Research Is Being Done on Sjögren's Syndrome?

Studies are being done on:

  • Genes and gene therapy
  • Bacteria and viruses
  • The immune system
  • Hormones
  • Predicting who may have lung problems
  • Treating other skin problems
  • Medicines that help the glands make moisture
  • Medicines to help the immune system and reduce swelling.
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Xerostomia (dry mouth) may be a side-effect of other medication. It is also caused by irradiation of the head and neck region or by damage to or disease of the salivary glands.

Patients with a persistently dry mouth may develop a burning or scalded sensation and have poor oral hygiene. They are prone to increased dental caries, periodontal disease, intolerance of dentures, and oral infections, particularly candidiasis. Where possible, treatment is directed at the underlying cause of dry mouth. If this is not possible, or is only partially successful, symptomatic treatment is used.

Treating the underlying cause
Drugs are a common cause of dry mouth. Reduce the dose or change the drug if possible. Morphine is a common, but often overlooked, cause of dry mouth. Other drugs that cause dry mouth include tricyclic antidepressants, antihistamines, antimuscarinic drugs, antiepileptic drugs, antipsychotics, betablockers, and diuretics.
Dehydration should be treated.
Simple measures will often relieve symptoms of dry mouth, even if rehydration is not undertaken.
Anxiety can also cause dry mouth.
Sjögren's syndrome - check anti-nuclear antibody titre.

General measures

Simple measures should be used by all patients. Dry mouth may be relieved in many patients by:

Frequent sips of cool drinks.
Sucking pieces of ice.
Sucking sugar-free fruit pastilles.
Eating partly frozen melon or pineapple chunks.
Sugar-free chewing gum stimulates salivation in patients with residual salivary function.
Petroleum jelly can be applied to the lips to prevent drying and cracking.

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Available treatments
Artificial saliva
This can provide useful relief of dry mouth. A properly balanced artificial saliva should be of a neutral pH and contain electrolytes (including fluoride) to correspond approximately to the composition of saliva.

Artificial saliva offers little advantage compared with simple measures for most patients. The few available studies are of poor quality, but suggest that many patients find no additional benefit with carmellose-based preparations compared with frequent tea, coffee, milk, or fruit juice.1 In addition, some patients find carmellose-based products feel sticky.
The duration of action of mucin products is only 10 to 15 minutes.
Long-term use of acidic products may demineralise tooth enamel. Glandosane® spray, Salivix® pastilles, and SST® tablets are acidic products.
Sugar-free chewing gum is as effective as artificial salivas.2
Consider using an artificial saliva containing mucin or lactoperoxidase when simple measures have been tried, but symptoms remain troublesome. The pH of some artificial saliva products may be inappropriate.

Luborant® is licensed for any condition giving rise to a dry mouth.
Biotene Oralbalance® BioXtra®, Glandosane®, Saliva Orthana®, and Saliveze®, have Advisory Committee on Borderline Substances (ACBS) approval for dry mouth associated only with radiotherapy or Sjögren's syndrome.
Salivix® pastilles, which act locally as salivary stimulants, are also available and have similar ACBS approval.
SST® tablets may be prescribed for dry mouth in patients with salivary gland impairment and patent salivary ducts.

Pilocarpine tablets
These are licensed for the treatment of xerostomia following:

Irradiation for head and neck cancer
Dry mouth and dry eyes (xerophthalmia) in Sjögren's syndrome
It can be considered for difficult cases.

Most patients with drug-induced dry mouth usually respond to treatment after the first dose.3
Only about 50% of patients with radiotherapy-induced dry mouth respond to treatment, and it may take up to 3 months before a response is seen.3
Pilocarpine 5 mg three times a day is more effective than artificial saliva, but also has more adverse effects, e.g. sweating, dizziness, rhinitis, urinary frequency, and blurred vision.
Acupuncture may be a useful alternative to pilocarpine in resistant cases.4
They are effective only in patients who have some residual salivary gland function. If there is no response they should be discontinued.
There is a risk of increased urethral smooth muscle tone and renal colic.
Adequate fluid intake should be maintained to avoid dehydration associated with excessive sweating.
Patients should be counselled that blurred vision or dizziness may affect performance of skilled tasks, e.g. driving, particularly at night or in reduced lighting.

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A comparison of artificial saliva and pilocarpine in the management of xerostomia in patients with advanced cancer

A comparison of artificial saliva and pilocarpine in the management of xerostomia in patients with advanced cancer.

This was a crossover study comparing a mucin-based artificial saliva (Saliva Orthana) and pilocarpine hydrochloride (Salagen) in the management of xerostomia in patients with advanced cancer. The pilocarpine was found to be more effective than the artificial saliva in terms of mean change in visual analogue scale scores for xerostomia (P = 0.003). Furthermore, more patients reported that it had helped their xerostomia, and more patients wanted to continue with it after the study. However, the pilocarpine was found to be associated with more side-effects than the artificial saliva (P < 0.001). These side-effects were usually reported as being mild. Of the patients who used both treatments, 50% preferred the artificial saliva, and 50% preferred the pilocarpine. The commonest reason for preferring the artificial saliva was the fact that it was a spray, rather than a tablet.

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Possible Solution to Dry Mouth Exists

There may be a way to aid dry mouth condition.

A new battery-powered mouthguard was created to fix this problem. The mouthguard fits over the lower arch of the teeth and enables the production of saliva thanks to little electric shocks. This device is necessary because dry mouth impacts 20 percent of people older than 50.

This device could be extremely helpful because of the importance of saliva in digestion and fighting against bacteria. A healthy person can generate three pints of saliva per day but there are many people that don’t produce enough. The result is the condition of dry mouth, known as xerostomia. The condition usually stems from some kind of medication or cancer treatment.

This new mouthguard is custom designed for each person and triggers saliva production by way of electric shocks. Each patient controls the device and can be worn for up to 10 minutes every hour.

The device can be beneficial for people who developed dry mouth from Parkinson’s Disease and Sjogren’s Syndrome. More tests are on the way.

Scientists have also created mint disks with Xylitol in them, which are thought to aid dry mouth. The disks are applied at night. They melt while the person is asleep and studies from the University of Washington indicate a reduced impact of dry mouth symptoms with one week.

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Sjögren's syndrome (SS) is a chronic inflammatory disorder characterized by diminished lacrimal and salivary gland function. SS occurs in a primary form not associated with other diseases and in a secondary form that complicates other rheumatic conditions. The most common disease associated with secondary SS is rheumatoid arthritis.

In primary or secondary SS, decreased exocrine gland function leads to the sicca complex, a combination of dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia) [1,2]. In addition, a variety of other disease manifestations can occur in SS. The clinical manifestations of SS are divided into the exocrine gland features and the extraglandular disease features [3].

An effective classification system for SS must accommodate the range of clinical manifestations of this disorder. The ends of the clinical spectrum of SS are diverse:

At the severe end are patients with florid salivary gland enlargement, adenopathy, antibodies to the Ro/SSA and La/SSB antigens, cryoglobulinemia, hypocomplementemia, a propensity to develop non-Hodgkin lymphoma, and other extraglandular disease manifestations.
At the mild end are patients with moderate symptoms of dry eyes, dry mouth, a low titer of antinuclear antibody, and vague symptoms of fatigue, myalgias, and cognitive dysfunction. In many patients with mild disease, distinguishing SS patients from individuals with fibromyalgia or depression who have ocular and/or oral dryness caused or exacerbated by medications with anticholinergic side effects is a major challenge.
Another group of patients with extraglandular manifestations may be found to have antinuclear antibody and Ro/SS-A antibody during evaluation, even though they lack dominant manifestations of dry eyes or dry mouth. These laboratory findings may be found during evaluation of neuropathies, nephropathies, hematologic abnormalities or lymphoproliferative involvement of other organs with a pattern suggestive of SS or systemic lupus erythematosus in the extraglandular organs

 

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 A salivary gland stone -- also called salivary duct stone, salivary calculus, or sialolith -- is a calcified structure that may form inside a salivary gland or duct and can block the flow of saliva into the mouth.

The majority of stones affect the submandibular glands located at the floor of the mouth. Less commonly, the stones affect the parotid glands, located on the sides of the face, or the sublingual glands, which are under the tongue. Many people with the condition have multiple stones.

Salivary Gland Stone Causes and Symptoms

Salivary stones form when chemicals in the saliva deposit. They mostly contain calcium. The exact cause is not known. But factors contributing to decreased saliva production and/or thickened saliva may be risk factors for salivary stones. These factors include: dehydration, poor eating, and use of certain medications, such as antihistamines, blood pressure drugs, psychiatric drugs, and bladder control drugs. Trauma to the salivary glands may also increase risk for salivary stones.

The stones cause no symptoms as they form, but if they reach a size that blocks the duct, saliva backs up into the gland causing pain and swelling. The pain, which is usually felt in a single gland, may be intermittent and get progressively worse. Inflammation and infection within the affected gland may follow.

Salivary Gland Stones Diagnosis and Treatments

If you experience symptoms of a salivary gland stone, your doctor will first check for stones with a physical exam. Sometimes tests may also be ordered, such as X-ray, CT scan, or ultrasound.

If a stone is detected, the goal of treatment is to remove it. For small stones, stimulating saliva production by sucking on a lemon or sour candies may cause the stone to pass spontaneously. In other cases where stones are small, the doctor or dentist may massage or manually push the stone out of the duct.

For larger, harder-to-remove stones, doctors usually make a small incision in the mouth to remove the stone.

Increasingly, doctors are using a newer and less invasive technique called sialendoscopy to remove salivary gland stones. Developed and used successfully in Europe for a decade, sialendoscopy uses tiny lighted scopes, inserted into the gland's opening in the mouth, to visualize the salivary duct system and locate the stone. Then, using specially designed micro instruments, the surgeon can remove the stone to relieve the blockage. The procedure is performed under local or light general anesthesia, which allows the patient to go home right after the procedure.

For people with recurrent stones or irreversible damage to the salivary gland, surgical removal of the gland is necessary.

In addition, antibiotics are prescribed if salivary stones have caused infection.

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A dry mouth is not a diagnosis in itself. It is a symptom and there are various causes which include:

Medication. Various drugs can cause a dry mouth as a side-effect. For example, tricyclic antidepressants, antihistamines, antimuscarinic drugs, some antiepileptic drugs, some antipsychotics, betablockers, and diuretics ('water tablets'). Many of these drugs cause a dry mouth by affecting the salivary glands which reduce the amount of saliva that these glands make.
Radiotherapy to the head or neck. The radiotherapy can damage the salivary glands.
Mouth breathing - which can be due to a blocked nose or other causes.
Anxiety.
Dehydration (low body fluid). This may occur for many reasons, but you will usually be quite ill with fever or other symptoms if you are dehydrated.
Sjögren's syndrome. This is a condition which can affect various parts of the body, including the joints (which can cause arthritis), the salivary glands (which can cause a dry mouth), and the tear glands (which can cause dry eyes).
What are the treatments for a dry mouth?
If possible, treat any underlying cause
In some cases, it may be possible to treat the underlying cause. For example:

If a drug is causing the dry mouth as a side-effect, it may be possible to change to a different drug, or to reduce the dose.
Dehydration, a blocked nose, and anxiety can often be treated.
Practical measures
Whatever the cause, the following will often help:

Take frequent sips or sprays of cold water. Always have a glass of water next to you when you go to bed.
Suck ice-cubes.
Sugar-free chewing gum is often helpful.
Eating pineapple chunks or partly frozen melon is often soothing and helpful.
Some people find that it helps to suck boiled sweets. (But, sugary or acid sweets may not be good for your teeth.)
Consider reducing or cutting out caffeine and alcohol which have a diuretic effect. (This means that they can make you pass out more urine, which can be dehydrating.) Caffeine occurs in tea, coffee, cola and other drinks. It is also part of some drugs.
You can apply petroleum jelly to your lips to prevent drying and cracking.
Artificial saliva
If the above measures are not adequate, then your doctor may prescribe a spray, gel or lozenge which acts as a substitute for saliva. Each dose only lasts a short time and so they need to be used frequently. Some people find artificial saliva products more helpful than others.

Saliva stimulants
In some cases of dry mouth, the saliva glands are only partially affected and can be stimulated to make more saliva:

Chewing sugar-free gum can help to increase the production and flow of saliva.
Pilocarpine is a drug which can stimulate salivary glands to make more saliva. It may be prescribed if other measures have not helped much.
Pilocarpine usually works well and quickly in most people with a dry mouth caused by a medication side-effect.
About half of people with radiotherapy-induced dry mouth respond to treatment with pilocarpine. In these people it may take several weeks, even up to three months, before the drug starts to work. So, it is worth persevering with treatment if it does not seem to be working at first.
Pilocarpine can cause side-effects in some people, such as sweating, dizziness, runny nose, blurred vision and frequent trips to pass urine. Side-effects tend to become less troublesome in time as your body becomes used to to this drug. So, a doctor may suggest a low dose at first and to take this for a while until any side-effects have eased. The dose may then be gradually increased with the aim of getting maximum benefit but with minimum side-effects.
Pilocarpine should not normally be used if you have asthma, chronic obstructive pulmonary disease (COPD), bradycardia (slow heart rate), bowel obstruction, or angle-closure glaucoma

 

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A little-known fluid produced in tiny amounts in the gums, those tough pink tissues that hold the teeth in place, has become a hot topic for scientists trying to develop an early, non-invasive test for gum disease, the No. 1 cause of tooth loss in adults. It's not saliva, a quart of which people produce each day, but gingival crevicular fluid (GCF), produced at the rate of millionths of a quart per tooth.
The study, the most comprehensive analysis of GCF to date, appears in ACS' monthly Journal of Proteome Research.
Eric Reynolds and colleagues note that GCF accumulates at sites of inflammation in the crevice between teeth and gums. Since dental workers can easily collect the fluid from patients, GCF has become a prime candidate for a simple inexpensive test to distinguish mild gum disease from the serious form that leads to tooth loss. But researchers have little information about the chemical composition of GCF.
The scientists collected GCF samples from 12 patients with a history of gum disease. Using high-tech instruments, they identified 66 proteins, 43 of which they found in the fluid for the first time. The fluid contained proteins from several sources, including bacteria and the breakdown products of gum tissue and bone, they note. They also identified antibacterial substances involved in fighting infection.
The findings advance efforts to develop an early test for gum disease, they suggest.

 

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Will oral health providers one day be able to scout for evidence of systemic disease in the time it takes to clean a patient's teeth? It's an ever-likely scenario, according to those at the forefront of salivary diagnostics research.
Clinical discoveries published in recent years have advanced the odds of salivary diagnostics becoming a chairside tool that could enhance the ability of dental practitioners to detect a spectrum of medical conditions.

Scientists working with saliva samples obtained from a group of Indian patients, for example, were able to validate the ability of portable electromechanical biosensor hardware technology to simultaneously analyze oral fluids for biomarkers thought to signal the pathogenesis of oral cancer (Clinical Cancer Research, July 1, 2009, Vol. 15:13, pp. 4446-4452).

A similar device developed by scientists and engineers in California sits at the cusp of commercialization (Annals of the New York Academy of Science, March 2007, Vol. 1098, pp. 401-410). The prototype Oral Fluid Nanosensor Test (OFNASET) awaits regulatory approval, with two contract manufacturing organizations waiting in the wings to begin commercialization.

And numerous studies funded by the National Institutes of Health (NIH) and others in 2009 and 2010 have pushed the salivary diagnostics envelope to its most advanced position yet, with molecular biomarkers being identified to monitor the systemic creep of breast, ovarian, pancreatic, and lung cancers.

And these advances represent just a portion of the salivary diagnostics portfolio. Combinations of analytes found in whole and ductal saliva are being characterized in ways that allow investigators to view them as molecular "proxies" for a host of systemic or systemic-related conditions, including periodontal infection, diabetes, human immunodeficiency virus (HIV), hepatitis, and cardiovascular disease.

In addition, investigators continue to refine ways to link the basic investigative tools of molecular biology -- such as mass spectrometry and microarray analysis -- with microfluidics and nanotechnology engineering, enabling them to develop portable salivary assay platforms for use in the dental operatory. If myriad challenges associated with regulatory approval, licensing, commercialization, and third-party reimbursement can be met, oral care providers may one day soon find themselves offering diagnostic health services that can identify life-threatening conditions.

Painless chairside option

The idea of an inexpensive and painless chairside option to blood or urine collection for disease diagnosis captivates the imagination of people like David Wong, DMD, DMSc, the associate dean of research at the University of California, Los Angles (UCLA) and director of the Dental Research Institute at the UCLA School of Dentistry.

"There's something very magical about salivary diagnostics," he said in an interview with DrBicuspid.com. "It has this resonance. It just echoes within the profession. Seemingly, there's this yearning for the profession to be able to move itself forward through a scientifically credible portfolio that, at least in the very beginning, they can claim is theirs."

Dr. Wong's name is attached to scores of papers on the subject. He and others have published prolifically on salivary diagnostics since 2002, when the National Institute of Dental and Craniofacial Research (NIDCR) awarded seven NIH grants to pursue development of a microelectromechanical systems approach to the nascent discipline. Funding was extended to a consortium of researchers that included Dr. Wong's group and scientists at the Scripps Research Institute, the University of Rochester, the University of Southern California, and the University of California, San Francisco.

The Wong Lab has since earned a special place in the research spotlight for its oncology studies, its collaborative work on the OFNASET portable device, and its sponsorship of the Salivaomics Knowledge Base (SKB). The latter is a collection of data "alphabets" describing the accumulated knowledge of saliva's molecular constituents, with primary emphasis on proteins and messenger RNA (mRNA) transcripts and secondary attention devoted to the metabolites, micro-RNAs, and microbes in oral fluids.

Dr. Wong acknowledged that the clinical utility of protein- and mRNA-specific alphabets in the SKB has so far eclipsed that of the other three analyte categories.

"Based on our own experience, what is important is to have the best capability to find the most discriminatory markers," he explained. "Using all five [alphabets] in any disease is ideal, but it's not practical."

The discovery of biomarkers via two-dimensional gel electrophoresis, for proteins, and reverse transcription polymerase chain reaction methodology, used to trace mRNA transcripts back to their complementary DNA, represents just two of the numerous methods being deployed to complete a portion of the salivary diagnostics puzzle. For their part, engineers are challenged to wed technologies that yield guidance at the proteome- and genome-wide level with compact nano- or micro-scaled platforms that can, at chairside, winnow the evidence down further to highly discriminatory panels of disease-specific biomarkers.

Microfluidics systems might be rendered in various combinations that merge components such as sensors or actuators with silicon substrates, allowing for the site-specific analysis of saliva samples and reagents. In the 2009 Clinical Cancer Research study of saliva from Indian patients, for example, a portable system was able to quantify interleukin biomarkers with a sensitivity and specificity nearly equal to that of traditional assay techniques. These claims are also made for the OFNASET device.

Oral cancer and Sjögren's syndrome

As new tools and assays emerge, investigators are expanding and refocusing the theoretic boundaries of oral fluid diagnostics while maintaining an investigative focus on those diseases that hold the greatest promise for application of the science in the near- to midterm.

"As I scan around, what I see that's in the pipeline is oral cancer and Sjögren's syndrome," Dr. Wong said. "That's what I'm seeing. There are other developments as well, but they're very, very early."

Oral squamous cell carcinoma (OSCC) and Sjögren's syndrome have indeed commanded a great deal of attention under NIDCR's proof-of-concept umbrella. A 2007 study in Arthritis & Rheumatism (November 2007, Vol. 56:11, pp. 3588-3600) found that 16 whole saliva proteins were down-regulated and 25 more were up-regulated in patients with primary Sjögren's syndrome, an autoimmune disorder characterized by dry mouth and eyes. These variations in expression were acknowledged as a reflection of glandular cell damage and an activated immune response.

Major findings specific to OSCC since 2004 have included explorations of mRNA transcriptome factors, the identification of three tumor markers at elevated levels in saliva (Cyfra 21-1, tissue polypetide antigen, and CA125), and the description of five salivary proteins (M2BP, MRP14, profilin, CD59, and catalese) that were shown to discriminate the presence of OSCC with 90% sensitivity and 83% specificity (Clinical Cancer Research, December 15, 2004, Vol. 10:24, pp. 8442-8450; July 1, 2006, Vol. 12:13, pp. 3979-3984; October 1, 2008, Vol. 14:19, pp. 6246-6252).

Elucidation of the biomarkers for these two diseases sets the stage for further studies to refine and validate them. Trial results also encouraged additional efforts aimed at ferreting out the salivary pointers to other malignancies. Evidence published in 2010 described protein and mRNA biomarkers for breast and pancreatic cancers (PLoS One, December 31, 2010, Vol. 5:12, e15573; Gastroenterology, March 2010, Vol. 138:3, pp. 949-957.e7). More recently, salivary biomarkers have been isolated for ovarian and lung cancers (Journal of Molecular Medicine, November 18, 2011; Molecular & Cellular Proteomics, November 17, 2011). These newest studies report biomarker sensitivities ranging between 83% and 96.4% and disease specificity measures ranging from 91.4% to 97%.

Early research critical

So why wasn't a fluid as ubiquitous as spit considered an effective diagnostic medium before? Saliva, after all, is a filtrate of the blood, and a liter or more of it issues each day from three major oral glands and a multitude of minor glands. Our mouths leverage the digestive function, facilitate our sense of taste, regulate pH balances, and bathe the oral cavity in a soup of minerals, antibacterials, enzymes, antibodies, hormones, electrolytes, and growth factors.

Dental practitioners, however, have regarded saliva more as a helpful nuisance than a harbinger of ill health, in large part because the telltale analytes associated with major categories of disease are much more concentrated in blood and urine than they are in oral fluids.

Efforts to get saliva off the bench and onto the diagnostic playing field got a major boost in 2003 and 2004 when various researchers collaborated under NIH-NIDCR sponsorship to document the salivary proteome. Eventually, 1,166 proteins were identified, 657 of which are also present in blood plasma. Researchers found that extracellular proteins excreted into the spaces between cells were more abundant in saliva than in plasma, while proteins located in or near lipid membranes were seen more frequently in plasma than in saliva.

Additional research published in 2004 found that saliva contains more than 3,000 chemically distinct mRNAs. A few of these were observed to comprise a core signature of mRNAs that typically are found in healthy individuals.

 

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findadentist's picture
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 Thanks for these tips. It will be helpful to us.

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 I encountered a female patient aged 24 years who came with a rather peculiar problem.She has no relevant medical history and her chief complaint was that every morning , till the time that she consumes her breakfast, she complains of her saliva gelating, that is her saliva turns into gelatin consistency.

 

A rather peculiar thing that i am absolutely not familiar with, kindly opine as to what should i advise her and what are the possible causes.

Currently i have asked her to use mouthwashes but i do not think that is going to make any difference

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 In context to this patient, are there any saliva thinning agents available in the market?

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 i think you should refer the patient to a specialist.

regards,

veerendra darakh

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From what I know you can make saliva thinner by drinking more water. Having thick saliva is a sign that you are dehydrated and need to drink more water
AvoidFoods and drinks that contain caffeine such as coffee, colas, and chocolate.
Alcoholic beverages including beer, wine, and mixed drinks.
Dry foods including tough meats, raw vegetables, breads, pretzels, rice, chips, muffins, and cakes.
Commercial mouthwashes. These contain alcohol which will dry the mouth further.

Saliva stimulators includeExamples of these products include saliva stimulators such as Salagen® (pilocarpine hydrochloride); saliva replacers such as Xero-Lube®, Salivart®, Mouth Kote®, Moi-Stir®, Orex®, Salix, Optimoist®, Sage Moist Plus® spray, and Gelclair®; and mouth moisturizers such as Oral Balance® and Sage Mouth Moisturizer®.

 

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A new study indicates that some bacteria may be capable of grow an appendage and swimming to a new area. This activity has recently been seen in marine sponges.

This information is applicable to dentistry because it may aid the way harmful bacteria in the mouth are understood. It’s possible that the bacteria in the plaque on teeth and in other areas of the body could be treated in a different, more advanced manner.

Bacteria have the ability to communicate with other bacteria. When a critical mass of bacteria is present in a certain area, an appendage known as a flagellum appears and finds a way to swim to a new area. A new biofilm can then develop.

All things considered, there are more bacteria on earth than all other forms of life combined. The more that is understood about bacteria, the more chance there is that the bacteria will be combatted in a more educated way.

This new study by scientists from the University of Maryland Center for Environmental Science’s Institute of Marine and Environmental Technology, Indiana University, and University of Colorado Denver’s School of Medicine, appears in the September issue of Molecular Microbiology.

 

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Will oral health providers one day be able to scout for evidence of systemic disease in the time it takes to clean a patient's teeth? It's an ever-likely scenario, according to those at the forefront of salivary diagnostics research.
Clinical discoveries published in recent years have advanced the odds of salivary diagnostics becoming a chairside tool that could enhance the ability of dental practitioners to detect a spectrum of medical conditions.

Scientists working with saliva samples obtained from a group of Indian patients, for example, were able to validate the ability of portable electromechanical biosensor hardware technology to simultaneously analyze oral fluids for biomarkers thought to signal the pathogenesis of oral cancer (Clinical Cancer Research, July 1, 2009, Vol. 15:13, pp. 4446-4452).

A similar device developed by scientists and engineers in California sits at the cusp of commercialization (Annals of the New York Academy of Science, March 2007, Vol. 1098, pp. 401-410). The prototype Oral Fluid Nanosensor Test (OFNASET) awaits regulatory approval, with two contract manufacturing organizations waiting in the wings to begin commercialization.

And numerous studies funded by the National Institutes of Health (NIH) and others in 2009 and 2010 have pushed the salivary diagnostics envelope to its most advanced position yet, with molecular biomarkers being identified to monitor the systemic creep of breast, ovarian, pancreatic, and lung cancers.

And these advances represent just a portion of the salivary diagnostics portfolio. Combinations of analytes found in whole and ductal saliva are being characterized in ways that allow investigators to view them as molecular "proxies" for a host of systemic or systemic-related conditions, including periodontal infection, diabetes, human immunodeficiency virus (HIV), hepatitis, and cardiovascular disease.

In addition, investigators continue to refine ways to link the basic investigative tools of molecular biology -- such as mass spectrometry and microarray analysis -- with microfluidics and nanotechnology engineering, enabling them to develop portable salivary assay platforms for use in the dental operatory. If myriad challenges associated with regulatory approval, licensing, commercialization, and third-party reimbursement can be met, oral care providers may one day soon find themselves offering diagnostic health services that can identify life-threatening conditions.

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Salivary diagnostics goes commercial

Saliva's potential as a keeper of secrets has unfolded slowly. In the 1970s and 1980s, researchers identified levels of serum albumin in saliva and cortisol concentrations in oral fluids (Helvetica Odontologica Acta, April 1970, Vol. 14:1, pp. 10-17; Annals of Clinical Biochemistry, November 1983, Vol. 20:Pt 6, pp. 329-335).

In the 1990s, researchers at the Naval Medical Center in Portsmouth, VA, and the University of Pennsylvania School of Dental Medicine described antibodies in saliva and an oral fluid test that can mark HIV with a specificity and sensitivity equal to that of blood serum (American Journal of Medicine, April 1, 1997, Vol. 102:4A, pp. 15-20; April 1997, Vol. 102:4A, pp. 9-14). Years later, the FDA-approved OraQuick Advance Rapid HIV-1/2 antibody test (OraSure Technologies) was introduced to the market.

Additional chairside products have been introduced to detect hormones in saliva (ZRT Laboratory) and identify the type of oral human papillomavirus for evaluating head and neck cancer risk (OralDNA Labs). OralDNA also offers bacterial and genomic biomarker tests for periodontal disease, while OraSure markets saliva-based screening tests for alcohol and substance abuse.

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Gene therapy may be safely used to study human salivary glands, according to a new study.

Scientists at the National Institute of Dental and Craniofacial Research, which is part of the National Institute of Health, stated that the phase 1 study of gene therapy in the human salivary gland displayed positive results. The information appeared in the Proceedings of the National Academy of Sciences.

Based on the study, the transferred gene, known as Aquaporin-1 could aid people who survived head and neck cancer who have problems with chronic dry mouth.

Aquaporin-1 encodes a protein that facilitates the flow of fluid in the cells. This process is similar to the way in which the salivary glands enable more studies to be conducted in this general vicinity. Salivary glands haven’t been studied closely in the past but the location, combined with the accessibility, makes these glands well-suited for gene therapy.

Bruce Baum was the lead author of the study. He’s been interested in information like this since he treated head and neck cancer survivors in the 1980s. His ideas for gene therapy began in 1991.

Many people have overcome cancer only to deal with chronic dry mouth problems. There aren’t many solutions. That’s why these studies in the salivary glands commenced in 2008.

There were 11 people studied to compile the data. Five of these people demonstrated an increase in saliva secretion and six people had no side effects.

More research is necessary to confirm these positive results.

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Spanish researchers have confirmed the effectiveness of a spray containing 1% malic acid, which improves xerostomia caused by antidepressant drugs, according to a study in Depression and Anxiety (February 2013, Vol. 30:2, pp. 137-142).
 
The product, combined with xylitol and fluorides in a spray format, stimulates saliva production in patients with xerostomia, improving their quality of life, according to the researchers from the University of Granada.
 
One of the main causes of xerostomia stems from taking medications. More than 500 drugs, belonging to 42 pharmacological groups, can cause xerostomia as a side effect, the researchers noted. Most of the drugs are antidepressants. Since the drugs have been prescribed more in recent years, it has resulted in more patients developing xerostomia, especially among 45- to 50-year-old people.
 
The researchers performed a double-blind randomized clinical trial on 70 patients diagnosed with antidepressant-induced xerostomia, split into two groups. The first group (n = 35) took a sialogogue mouth spray (1% malic acid), while the second group (n = 35) received a placebo. Both products were applied on demand over two weeks.
 
Dry mouth symptoms improved after 1% malic acid topical spray application (p < 0.05), the study authors reported. After two weeks of 1% malic acid application, unstimulated and stimulated salivary flows rates increased significantly (p < 0.05), they added.
 

Previous studies have described citric and malic acid as salivary stimulants, although for years their use was rejected due to the possible demineralizing effect on tooth enamel, the researchers noted. However, recent research has shown a reduction in the potential demineralizing effect of malic acid when used in the correct concentration and when combined with xylitol and fluorides. 

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Xerostomia (dry mouth) is a condition commonly encountered in clinical practice that can lead to multiple oral and systemic health problems. This condition has several potential etiologies, including medications, advancing age, head and neck radiation, and systemic diseases. Individuals with xerostomia are at increased risk for dental caries, infections of the oral cavity, generalized oral pain, poor nutrition intake, and significantly reduced quality of life. Topical sialogogues may be of limited benefit for patients with this condition, and systemic medications may be necessary to achieve improved clinical outcomes.

A pilot study by Brimhall and colleagues compared the efficacy of pilocarpine and cevimeline in the secretion of saliva and evaluated side effects of both medications. Pilocarpine is a cholinergic agonist that promotes generalized fluid secretion by acting on systemic muscarinic-cholinergic receptors. Cevimeline, another systemic agent that promotes fluid secretion, has higher affinity for muscarinic receptors located on lachrymal and salivary gland epithelium and is thought to produce fewer side effects than pilocarpine.

Twelve patients with moderate to severe xerostomia were included in the final analysis of this crossover, double-blind, randomized study. One half of the patients were randomly selected to receive cevimeline 30 mg 3 times daily for 4 weeks. This was followed by a 1-week washout period and initiation of therapy with pilocarpine 5 mg 3 times daily for 4 weeks. The other half of the patients were randomly selected to take pilocarpine first, followed by cevimeline in the same way as described previously.

Patients were evaluated by clinicians 3 times throughout the study: at baseline for informed consent, after the first 4 weeks of therapy, and then 5 weeks later (after the 1-week washout period and 4 weeks of the second medication course). Unstimulated and stimulated salivary flow measurements were obtained at each visit using standard techniques. Patients completed a weekly questionnaire about side effects of therapy, and the questionnaires were evaluated at each visit.

The results of the study were as follows:

Most cases of xerostomia (58%) in this cohort were caused by medications;

Although there was an overall increase in production of both unstimulated and stimulated saliva in patients taking either cevimeline and pilocarpine, the medications did not differ statistically in this regard; and

Patient-reported side effects of both medications included increased sweating, watering eyes, headache, nausea, stomach upset, diarrhea, and pain around the eyes; however, there was no statistical difference between the medications in the frequency or severity of side effects.

 

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