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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 -
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 -
Stroke Jan 2018The use of oral anticoagulant therapy for stroke prevention in atrial fibrillation has been transformed by the availability of the nonvitamin K antagonist oral... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND PURPOSE
The use of oral anticoagulant therapy for stroke prevention in atrial fibrillation has been transformed by the availability of the nonvitamin K antagonist oral anticoagulants. Real-world studies on the use of nonvitamin K antagonist oral anticoagulants would help elucidate their effectiveness and safety in daily clinical practice. Apixaban was the third nonvitamin K antagonist oral anticoagulants introduced to clinical practice, and increasing real-world studies have been published. Our aim was to summarize current evidence about real-world studies on apixaban for stroke prevention in atrial fibrillation.
METHODS
We performed a systematic review and meta-analysis of all observational real-world studies comparing apixaban with other available oral anticoagulant drugs.
RESULTS
From the original 9680 results retrieved, 16 studies have been included in the final meta-analysis. Compared with warfarin, apixaban regular dose was more effective in reducing any thromboembolic event (odds ratio: 0.77; 95% confidence interval: 0.64-0.93), but no significant difference was found for stroke risk. Apixaban was as effective as dabigatran and rivaroxaban in reducing thromboembolic events and stroke. The risk of major bleeding was significantly lower for apixaban compared with warfarin, dabigatran, and rivaroxaban (relative risk reduction, 38%, 35%, and 46%, respectively). Similarly, the risk for intracranial hemorrhage was significantly lower for apixaban than warfarin and rivaroxaban (46% and 54%, respectively) but not dabigatran. The risk of gastrointestinal bleeding was lower with apixaban when compared with all oral anticoagulant agents (<0.00001 for all comparisons).
CONCLUSIONS
Use of apixaban in real-life is associated with an overall similar effectiveness in reducing stroke and any thromboembolic events when compared with warfarin. A better safety profile was found with apixaban compared with warfarin, dabigatran, and rivaroxaban.
Topics: Anticoagulants; Atrial Fibrillation; Clinical Trials as Topic; Female; Humans; Intracranial Hemorrhages; Male; Polymers; Pyrazoles; Pyridones; Risk Factors; Rivaroxaban; Saliva, Artificial; Stroke; Vitamin K; Warfarin
PubMed: 29167388
DOI: 10.1161/STROKEAHA.117.018395 -
International Journal of Molecular... Jun 2019The chronic sensation of a dry mouth is a disease condition called xerostomia and affects a large part of the population. Xerostomia is associated with decreased... (Review)
Review
The chronic sensation of a dry mouth is a disease condition called xerostomia and affects a large part of the population. Xerostomia is associated with decreased secretion, or more often, qualitative changes in saliva proteins and immunoglobulin concentrations that develop as a result of salivary gland dysfunction. Several reasons causing dry mouth were described, and usually, they include taking medications, diseases or radiotherapy. In some situations, when it is difficult to use salivary stimulants or salivary gland damage is irreversible, the only option might seem to be saliva substitutes. The paper presents the most important aspects considering saliva preparations. The rheological and lubricating properties and the reconstruction of the complex saliva structure has been the main purpose of research. The biological properties of saliva preparations were also widely discussed. As part of the work, the antimicrobial effect of three commercial saliva preparations was tested. Finally, inadequate antimicrobial properties against the strains isolated from the oral cavity were demonstrated. The development of salivary substitutes, in particular, the improvement of antimicrobial properties, can be achieved using nanotechnology, including drug delivery systems containing nanocarriers.
Topics: Animals; Anti-Infective Agents; Biomimetic Materials; Humans; Microfluidics; Saliva; Viscosity; Xerostomia
PubMed: 31261876
DOI: 10.3390/ijms20133199 -
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 -
Journal of Pharmacy & Bioallied Sciences Nov 2021In clinical practice, xerostomia or oral dryness is a chronic disease condition encountered by most dentists and dental hygienists, which often causes a negative impact... (Review)
Review
In clinical practice, xerostomia or oral dryness is a chronic disease condition encountered by most dentists and dental hygienists, which often causes a negative impact on the oral health-related quality of life of the affected individual. Xerostomia is caused due to salivary gland dysfunction. It is related to reduced salivary secretion or the absence of saliva flow, more frequently, exhibits qualitative changes in saliva proteins and immunoglobulin concentrations that arise due to salivary gland dysfunction. This condition causes discomfort and interferes with normal oral activities, and affected individuals are at high caries risk. There are several options for treatment and symptom management: salivary stimulants, topical agents, saliva substitutes, and systemic sialogogues. This review explores the current status of therapeutic management of patients affected by xerostomia and hyposalivation using artificial saliva.
PubMed: 35017895
DOI: 10.4103/jpbs.jpbs_236_21 -
The Chinese Journal of Dental Research 2014Xerostomia is becoming a major issue in dental and medical clinics with an increase of aged population. Medication is the most common etiology of xerostomia, while the... (Review)
Review
Xerostomia is becoming a major issue in dental and medical clinics with an increase of aged population. Medication is the most common etiology of xerostomia, while the most severe xerostomia generally occurs in patients with a history of head and neck radiotherapy. Xerostomic patients usually suffer from diminished quality of life due to various symptoms and complications. Decreased salivary output is a definite objective sign, but oral mucosal wetness is a more reliable factor for the evaluation of xerostomia. At present there are no effective therapeutic methods for the treatment of xerostomia. Sialogogues may have problematic side effects and their therapeutic effects last only brief duration. Artificial saliva typically does not produce satisfactory results in therapeutic efficacy. Therefore, further research and development of better therapeutic modalities are necessary. The basic concept for the development of ideal and functional artificial saliva is the mimicry of natural human saliva. We need proper candidate molecules and antimicrobial supplements to simulate the rheological and biological properties of human saliva. We also need better understanding of the interactions between the ingredients of artificial saliva themselves and between the ingredients and components of human saliva both in solution and on surface phases. In addition, we need accepted measures to evaluate the efficacy of artificial saliva. In conclusion, for the development of ideal artificial saliva, research based on the understanding of pathophysiology of xerostomia and knowledge about rheological and biological functions of human saliva are necessary.
Topics: Biology; Biomimetic Materials; Humans; Rheology; Saliva; Saliva, Artificial; Xerostomia
PubMed: 25531014
DOI: No ID Found -
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 -
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 -
International Journal of Molecular... Mar 2020Saliva plays a crucial role in oral cavity. In addition to its buffering and moisturizing properties, saliva fulfills many biofunctional requirements, including...
Saliva plays a crucial role in oral cavity. In addition to its buffering and moisturizing properties, saliva fulfills many biofunctional requirements, including antibacterial activity that is essential to assure proper oral microbiota growth. Due to numerous extra- and intra-systemic factors, there are many disorders of its secretion, leading to oral dryness. Saliva substitutes used in such situations must meet many demands. This study was design to evaluate the effect of core-shell magnetic nanoparticles (MNPs) adding (gold-coated and aminosilane-coated nanoparticles NPs) on antimicrobial (microorganism adhesion, biofilm formation), rheological (viscosity, viscoelasticity) and physicochemical (pH, surface tension, conductivity) properties of three commercially available saliva formulations. Upon the addition of NPs (20 µg/mL), antibacterial activity of artificial saliva was found to increase against tested microorganisms by 20% to 50%. NPs, especially gold-coated ones, decrease the adhesion of Gram-positive and fungal cells by 65% and Gram-negative bacteria cells by 45%. Moreover, the addition of NPs strengthened the antimicrobial properties of tested artificial saliva, without influencing their rheological and physicochemical properties, which stay within the range characterizing the natural saliva collected from healthy subjects.
Topics: Anti-Infective Agents; Bacterial Adhesion; Biofilms; Candida; Elasticity; Electric Conductivity; Gold; Magnetite Nanoparticles; Pseudomonas; Saliva, Artificial; Silanes; Streptococcus; Surface Tension; Viscosity
PubMed: 32183193
DOI: 10.3390/ijms21061979