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Annals of the Rheumatic Diseases Jan 2020The therapeutic management of Sjögren syndrome (SjS) has not changed substantially in recent decades: treatment decisions remain challenging in clinical practice,...
The therapeutic management of Sjögren syndrome (SjS) has not changed substantially in recent decades: treatment decisions remain challenging in clinical practice, without a specific therapeutic target beyond the relief of symptoms as the most important goal. In view of this scenario, the European League Against Rheumatism (EULAR) promoted and supported an international collaborative study (EULAR SS Task Force) aimed at developing the first EULAR evidence and consensus-based recommendations for the management of patients with SjS with topical and systemic medications. The aim was to develop a rational therapeutic approach to SjS patients useful for healthcare professionals, physicians undergoing specialist training, medical students, the pharmaceutical industry and drug regulatory organisations following the 2014 EULAR standardised operating procedures. The Task Force (TF) included specialists in rheumatology, internal medicine, oral health, ophthalmology, gynaecology, dermatology and epidemiology, statisticians, general practitioners, nurses and patient representatives from 30 countries of the 5 continents. Evidence was collected from studies including primary SjS patients fulfilling the 2002/2016 criteria; when no evidence was available, evidence from studies including associated SjS or patients fulfilling previous sets of criteria was considered and extrapolated. The TF endorsed the presentation of general principles for the management of patients with SjS as three overarching, general consensus-based recommendations and 12 specific recommendations that form a logical sequence, starting with the management of the central triplet of symptoms (dryness, fatigue and pain) followed by the management of systemic disease. The recommendations address the use of topical oral (saliva substitutes) and ocular (artificial tear drops, topical non-steroidal anti-inflammatory drugs, topical corticosteroids, topical CyA, serum tear drops) therapies, oral muscarinic agonists (pilocarpine, cevimeline), hydroxychloroquine, oral glucocorticoids, synthetic immunosuppressive agents (cyclophosphamide, azathioprine, methotrexate, leflunomide and mycophenolate), and biological therapies (rituximab, abatacept and belimumab). For each recommendation, levels of evidence (mostly modest) and TF agreement (mostly very high) are provided. The 2019 EULAR recommendations are based on the evidence collected in the last 16 years in the management of primary 2002 SjS patients and on discussions between a large and broadly international TF. The recommendations synthesise current thinking on SjS treatment in a set of overarching principles and recommendations. We hope that the current recommendations will be broadly applied in clinical practice and/or serve as a template for national societies to develop local recommendations.
Topics: Administration, Ophthalmic; Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Antirheumatic Agents; Cyclosporine; Glucocorticoids; Humans; Hydroxychloroquine; Immunosuppressive Agents; Lubricant Eye Drops; Muscarinic Agonists; Saliva, Artificial; Sjogren's Syndrome
PubMed: 31672775
DOI: 10.1136/annrheumdis-2019-216114 -
Supportive Care in Cancer : Official... Jun 2020The aim of this study is to investigate the effect of an edible saliva substitute, oral moisturizing jelly (OMJ), and a topical saliva gel (GC) on dry mouth, swallowing... (Randomized Controlled Trial)
Randomized Controlled Trial
Alleviation of dry mouth by saliva substitutes improved swallowing ability and clinical nutritional status of post-radiotherapy head and neck cancer patients: a randomized controlled trial.
PURPOSE
The aim of this study is to investigate the effect of an edible saliva substitute, oral moisturizing jelly (OMJ), and a topical saliva gel (GC) on dry mouth, swallowing ability, and nutritional status in post-radiotherapy head and neck cancer patients.
METHODS
Sixty-two post-radiation head and neck cancer patients with xerostomia completed a blinded randomized controlled trial. They were advised to swallow OMJ (n = 31) or apply GC orally (n = 31) for 2 months. Outcome measures were assessed at baseline, 1, and 2 months, including subjective and objective dry mouth (Challcombe) scores, subjective swallowing problem scores (EAT-10), water swallowing time, clinical nutritional status (PG-SGA), body weight, and dietary intake.
RESULTS
After 1 and 2 months of interventions, subjective and objective dry mouth scores, subjective swallowing problem scores, swallowing times, and clinical nutritional status in both groups were significantly improved (p < 0.0001). Compared to GC, OMJ group had higher percent improvement in all outcome measures (p < 0.001) except swallowing time and clinical nutritional status. Interestingly, subjective dry mouth scores were significantly correlated with subjective swallowing problem scores (r = 0.5321, p < 0.0001).
CONCLUSIONS
Continuous uses of saliva substitutes (OMJ or GC) for at least a month improved signs and symptoms of dry mouth and enhanced swallowing ability. An edible saliva substitute was superior to a topical saliva gel for alleviating dry mouth and swallow problems. These lead to improved clinical nutritional status. Thus, palliation of dry mouth may be critical to support nutrition of post-radiotherapy head and neck cancer patients.
CLINICAL TRIAL REGISTRY
Clinicaltrials.gov NCT03035825.
Topics: Deglutition; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Nutritional Status; Saliva; Saliva, Artificial; Single-Blind Method; Treatment Outcome; Xerostomia
PubMed: 31732852
DOI: 10.1007/s00520-019-05132-1 -
BMJ Clinical Evidence Sep 2014Halitosis can be caused by oral disease or by respiratory tract conditions such as sinusitis, tonsillitis, and bronchiectasis, but an estimated 40% of affected...
INTRODUCTION
Halitosis can be caused by oral disease or by respiratory tract conditions such as sinusitis, tonsillitis, and bronchiectasis, but an estimated 40% of affected individuals have no underlying organic disease.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments in people with physiological halitosis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2013 (Clinical evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 11 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: artificial saliva; cleaning, brushing, or scraping the tongue; regular use of mouthwash; sugar-free chewing gums; and zinc toothpastes.
Topics: Chewing Gum; Halitosis; Humans; Mouthwashes; Saliva, Artificial; Tongue; Toothpastes
PubMed: 25234037
DOI: No ID Found -
Journal of Physiology and Pharmacology... Dec 2017Examination of dental materials and their properties at the initial stage of the digestive process requires the development of conditions that mimic the environment of... (Review)
Review
Examination of dental materials and their properties at the initial stage of the digestive process requires the development of conditions that mimic the environment of the oral cavity. One of the main components of this area is saliva, where many reactions occur under natural conditions. Human saliva is an important physiological fluid that is essential for the maintenance of good oral health and of the entire human body; it is the place where digestion begins and thus contributes to the supply of those nutrients and health-promoting substances that are essential to the body but may also cause release of potential toxins. Thereby, the main aim of the study was to review the use of artificial saliva models in the context of stomatological and biological research. Biological studies have shown that the amount of biologically active substances in biological material is not the same as their quantity released under the conditions of the human digestive system and thus bioavailable to it. These results show that tables of active ingredients in drugs and food stuffs do not present their actual usefulness and availability to the human body.
Topics: Humans; Saliva; Saliva, Artificial
PubMed: 29550792
DOI: No ID Found -
Biorheology 2020Numerous functions of saliva depend on its biophysical properties. Mouth rinses react with saliva and change both their own properties and properties of saliva.
BACKGROUND
Numerous functions of saliva depend on its biophysical properties. Mouth rinses react with saliva and change both their own properties and properties of saliva.
OBJECTIVE
The aim of this study was to define the level of mixing of artificial saliva and mouth rinses, and define their viscosity and its changes at room and body temperature.
METHODS
Artificial saliva, fluoride solutions, chlorhexidine, zinc-hydroxyapatite solution and casein phosphopeptide amorphous calcium phosphate were used. To simulate their mixing, Y-channel PVC chips were used, in two different microfluidics systems. The experiments were recorded with a microscope, then the proportion of mixing was calculated using Matlab. For viscosity measurements rotational viscometer was used.
RESULTS
The results show partial mixing of all solutions with artificial saliva. Measurements with a viscometer indicate different viscosities of all used solutions. Viscosity of a mixture of solution and artificial saliva is always in the range of viscosity of the artificial saliva and the solution separately. Moreover, viscosity of all solutions, as well as mixture with artificial saliva, significantly decreases at higher temperature.
CONCLUSION
Intraoral administration of mouth rinses results in change of biophysical properties of both saliva and mouth rinses. Those changes can affect preventive and therapeutic effect, and therefore oral health.
Topics: Chlorhexidine; Mouthwashes; Saliva; Saliva, Artificial; Viscosity
PubMed: 33459691
DOI: 10.3233/BIR-201008 -
Journal of Investigative and Clinical... Feb 2016Saliva plays a key role in maintaining oral homeostasis, function, and health. The prevalence of xerostomia and its consequences are rising due to the increasing aging... (Review)
Review
Saliva plays a key role in maintaining oral homeostasis, function, and health. The prevalence of xerostomia and its consequences are rising due to the increasing aging population, the effects of some systemic diseases, medical management, and commonly-prescribed medications that reduce saliva production. When salivary function is diminished, patients are at a greater risk of developing caries, discomfort in wearing dentures, and opportunistic diseases, such as candidiasis. The psychosocial aspects of xerostomia can range from a mild effect on self-rated oral health to frustration, embarrassment, unhappiness, or substantial disruptions in quality of life. This article reviews the clinical features, diagnosis, and prevalence of dry mouth, as well as its treatment strategies.
Topics: Aged; Aged, 80 and over; Dental Caries; Humans; Quality of Life; Saliva; Saliva, Artificial; Xerostomia
PubMed: 25175324
DOI: 10.1111/jicd.12120 -
Journal of Texture Studies Apr 2021The aim of this review is to assess the objective and subjective diagnosis, as well as symptomatic topical treatment of dry mouth conditions with a clear focus on... (Review)
Review
The aim of this review is to assess the objective and subjective diagnosis, as well as symptomatic topical treatment of dry mouth conditions with a clear focus on textural perspective. We critically examine both the current practices as well as outline emerging possibilities in dry mouth diagnosis and treatment, including a patent scan for saliva substitutes. For diagnosis, salivary flow rates and patient-completed questionnaires have proven to be useful tools in clinical practice. To date, objective measurements of changes in mechanical properties of saliva via rheological, adsorption, and tribological measurements and biochemical properties of saliva such as assessing protein, mucins (MUC5B) are seldom incorporated into clinical diagnostics; these robust diagnostic tools have been largely restricted to application in non-clinical settings. As for symptomatic treatments of dry mouth, four key agents including lubricating, thickening, adhesive, and moisturizing agents have been identified covering the overall landscape of commercial saliva substitutes. Although thickening agents such as modified celluloses, polysaccharide gum, polyethylene glycol, and so forth are most commonly employed saliva substitutes, they offer short-lived relief from dry mouth and generally do not provide boundary lubrication properties of real human saliva. Innovative technologies such as self-assembly, emulsion, liposomes, and microgels are emerging as novel saliva substitutes hold promise for alternative approaches for efficient moistening and lubrication of the oral mucosa. Their adoption into clinical practice will depend on their efficacies, duration of relief, and ease of application by the practitioners and patient compliance.
Topics: Humans; Lubrication; Mucins; Saliva; Saliva, Artificial; Xerostomia
PubMed: 33274753
DOI: 10.1111/jtxs.12575 -
Compendium of Continuing Education in... Jun 2018The patient with xerostomia (sensation of dry mouth) or inadequate saliva (salivary gland hypofunction) may present with a wide range of clinical signs and symptoms... (Review)
Review
The patient with xerostomia (sensation of dry mouth) or inadequate saliva (salivary gland hypofunction) may present with a wide range of clinical signs and symptoms affecting the oral cavity and systemic health. Recognition of these clinical presentations allows the dental healthcare professional to perform objective tests to identify the status of salivary gland function. Based on these results, recommendations for treatment using over-the-counter and prescription medications can be made. This article discusses clinical indications related to salivary gland hypofunction, testing methodologies, and treatment approaches.
Topics: Drinking; Humans; Muscarinic Agonists; Saliva, Artificial; Salivary Glands; Salivation; Secretagogues; Xerostomia
PubMed: 29847962
DOI: No ID Found -
European Review For Medical and... Nov 2022We aimed at evaluating some chemical-physical properties of artificial saliva substitutes easily available on the E.U. market, such as viscosity, pH, buffering capacity,...
OBJECTIVE
We aimed at evaluating some chemical-physical properties of artificial saliva substitutes easily available on the E.U. market, such as viscosity, pH, buffering capacity, superficial tension, density and spinnbarkeit and to compare the results with human natural saliva bibliographic data.
MATERIALS AND METHODS
Based on the easy availability on the market, twelve artificial saliva solutions in liquid formulation were analyzed. Kinematic viscosity (cSt) was determined using a micro-Ubbelohde model capillary viscosimeter (ViscoClock, SCHOOT-GERATE Mainz, Germany). Dynamic viscosity (mPas) was determined, through a simple multiplication between density (g/cm3) and kinematic viscosity of each solution. pH analyses were carried out at room temperature using a pH-meter (Mettler Toledo®- Five Easy, Columbus, OH, USA). Spinnbarkeit analysis was performed by a self-owned instrument built for the purpose.
RESULTS
The median density value, obtained from the cohort of artificial saliva substitutes, was 1.036 g/cm3. The median value of the kinematic viscosity was 8.984 cSt. The median spinnbarkeit value was 3.2 mm and the median pH value was 6.29. In this study we found an almost linear correlation between the kinematic viscosity and spinnbarkeit values of the artificial saliva substitutes evaluated.
CONCLUSIONS
Saliva substitutes should be as faithful as possible to the characteristics of human saliva, in order to completely replace its functions in the oral cavity. Nevertheless, despite several R&D efforts, it is difficult to reproduce all the different features that belongs to natural saliva in one device. Therefore, it would be desirable to create more products reproducing saliva with various rheological characteristics in respect of the main salivary functions such as: chewing, speaking and tissue coating.
Topics: Humans; Saliva, Artificial; Viscosity; Rheology; Saliva; Physical Examination
PubMed: 36394731
DOI: 10.26355/eurrev_202211_30132 -
Supportive Care in Cancer : Official... Mar 2015Dry mouth (xerostomia) is one of the commonest symptoms in cancer patients and can adversely affect quality of life. The aim of this review was to determine the... (Review)
Review
PURPOSE
Dry mouth (xerostomia) is one of the commonest symptoms in cancer patients and can adversely affect quality of life. The aim of this review was to determine the effectiveness of pharmacological and non-pharmacological interventions in treating xerostomia in adult advanced cancer patients.
METHODS
The literature search was performed in February 2014 using databases including EMBASE, MEDLINE, CINAHL, BNI and Cochrane library. The search was carried out using standard MeSH terms and was limited to adult population and English language. Studies investigating xerostomia secondary to head and neck cancer treatment and autoimmune disease were excluded. Titles and abstracts were screened and reviewed for eligibility. Only studies involving primary research were included in the analysis.
RESULTS
Six studies met the eligibility criteria for review: three randomized controlled trials and three prospective studies. The quality assessment and reporting was performed using PRISMA, Jadad and STROBE. These studies compared acupuncture, pilocarpine, Saliva Orthana and chewing gum with each other or with placebo. All interventions were considered effective in treating xerostomia. However, effectiveness versus placebo could not be demonstrated for Saliva Orthana. Meta-analysis could not be performed due to heterogeneity of the study type and intervention.
CONCLUSION
Limited published data exists reporting the effectiveness of measures in the treatment of xerostomia in cancer patients. Based on primary research of low quality, firm conclusions cannot be drawn. However, pilocarpine, artificial saliva, chewing gum and acupuncture can be tried based on the available data. This highlights the explicit need to improve our evidence base. Properly constructed randomized controlled trials demonstrating effectiveness of pharmacological and non-pharmacological interventions for dry mouth are required.
Topics: Acupuncture Therapy; Adult; Chewing Gum; Disease Progression; Humans; Neoplasms; Pilocarpine; Prospective Studies; Quality of Life; Saliva, Artificial; Xerostomia
PubMed: 25322971
DOI: 10.1007/s00520-014-2477-8