This study surveyed salivary flow rate, salivary viscosity, and salivary buffering capacity in order to intensively analyze salivary factors among factors of occurrence in dental caries for finding mutually different factors that function in occurrence of dental caries depending on each individual. Even the acid body within dental plaque has great influence upon dental caries. Thus, the comparative analysis was carried out by surveying the hydrogen ion concentration in dental plaque. The following results were obtained in this study. 1. The average decayed teeth in the survey subjects stood at 1.67 piece. The extracted teeth caused by dental caries stood at 0.47 piece. The filled teeth were indicated to be 6.31 pieces. Accordingly, the average permanent dental caries experience teeth were surveyed to be 8.44 pieces. 2. The results according to dental caries activity test method were indicated to be $12.56{\pm}4.15ml$ for the average stimulated salivary flow rate, $3.89{\pm}1.83ml$ for non-stimulated salivary flow rate, $1.49{\pm}0.69$ for salivary viscosity, and $8.51{\pm}2.44$ for salivary buffering capacity. The hydrogen ion concentration test in dental plaque was indicated to be $5.62{\pm}0.50$ for before brushing teeth, $5.23{\pm}0.58$ for 5 minutes after brushing teeth, $5.25{\pm}0.56$ for 10 minutes after brushing teeth, $5.29{\pm}0.62$ for 15 minutes after brushing teeth, $5.34{\pm}0.58$ for 20 minutes after brushing teeth, $5.40{\pm}0.53$ for 25 minutes after brushing teeth, and $5.61{\pm}0.59$ for 30 minutes after brushing teeth. 3. Stimulated salivary and non-stimulated salivary flow rate, salivary viscosity, and salivary buffering capacity were indicated to be higher in group with non-caries than group with caries. However, it was statistically insignificant. The hydrogen ion concentration in dental plaque showed wholly statistical significant in the relationship with people with dental caries under progression. However, people without dental caries were indicated to be higher than people with dental caries. 4. As for correlation between caries activity test methods, the stimulated salivary flow rate had significantly positive correlation with non-stimulated salivary flow rate(p<0.001). Non-stimulated salivary flow rate showed negative correlation with salivary buffering capacity(p<0.01). The hydrogen ion concentration test in dental plaque showed positive correlation according to the passage of time after brushing teeth. However, there was no significant correlation with salivary viscosity and salivary buffering capacity(p>0.05).
The purpose of this study is to evaluate salivary flow rate, salivary pH, and cariogenic activity using unstimulated saliva of the head and neck cancer patients. Twenty three cancer patients (19 males, 4 females) who had undergone chemotherapy and radiation therapy and twenty four healthy volunteers (14 males, 10 females) as a control were included. Salivary flow rate, salivary pH, and cariogenic activity using unstimulated saliva were examined. Compared to saliva of the control group, salivary flow rate (p<0.001) and salivary pH (p<0.001) were significantly lower in head and neck cancer patients. The colony counts of Lactobacilli was higher in head and neck cancer patients (p<0.05) than in control group. These salivary factors and cariogenic activity can increase the prevalence of dental caries in head and neck cancer patients.
To investigate whether the cervical sympathetics contains specific secretory fibers for the salivary glands, reflex salivation was evoked and the role of the sympathetics or the reflex was examined in ketamine-anesthetized cat. Stimulation of the central end of the glossopharyngeal nerve produced a copious secretion from the submaxillary gland and the response was not affected by the section of the cervical sympathetics or by the administration of phenoxybenzamine, whereas the response was abolished by severing the chorda tympani or by the administration of atropine. The salivary response was always associated with an increase in glandular blood flow. Both salivary and blood flow responses were decreased markedly by the superimposed stimulation of the cervical sympathetics or by the administration of norepinephrine. The decreased submaxillary blood flow always preceded the decrease in salivary flow on stimulation of the cervical sympathetics and the decreased blood flow recovered prior to the salivary flow upon cessation of the sympathetic stimulation. The inhibitory effects of the sympathetics and norepinephrine were completely abolished by the pretreatment with phenoxybenzamine. These results indicate that the glossopharyngeal nerve is one of the afferent limbs of the submaxillary salivary reflex and the chorda tympani is the only efferent limb of the reflex pathway. Thus, it is suggested that the cervical sympathetics does not contain the specific secretory fibers for the gland, but plays a role in inhibiting the reflex secretion by decreasing the blood flow to the gland.
Saliva have many important functions in the maintenance of oral health. Saliva contains protective components, antibacterial enzymes, and other rubricating glycoprotein elements. When the salivary flow decreases of the salivary composition changes, a normally healthy mouth can become susceptible to caries, periodontal disease, and mucositis, and other diseases. Salivary peroxidase system acts as an antimicrobial factor in the oral cavity, having a role in the prevention of dental plaque accumulation, dental caries and gingivitis. Recently, this enzyme system has been introduced by many researchers in the form of toothpaste, mouthwash or moisturizing gel for use in patients with various disease states . The author prescribed the peroxidase system containing gel (Oralbalance) to the 18 Burning Mouth Syndrome (BMS) patients for 1 week and investigated the changes of the subjective symptoms, $HOSCN/OSCN^-$ levels of unstimulated whole saliva, and the salivary flow rates. The obtained results were as follows : 1. The patients reported decrease in all symptoms of BMS after the use of peroxidase system containing gel, particulary, a significantly higher decreases of dry mouth and burning symptoms. 2. Decreased $HOSCN/OSCN^-$ levels of unstimulated whole saliva were detected in the patients with BMS after the use of perosidase system containing gel for 1 week. 3. There was no difference between the flow rates of unstimulated whole saliva before and after uses of peroxidase system containing gel for 1 week.
Park, Jo-Eun;Song, Chan-Woo;Kim, Ki-Suk;Kim, Mee-Eun
Journal of Oral Medicine and Pain
/
v.40
no.1
/
pp.10-16
/
2015
Purpose: Pilocarpine has the effects on improvement of salivary flow and subjective symptoms for xerostomic patients. Because of unwanted side effects following its systemic administration, topical pilocarpine has been paid attention as an alternative. This study aimed to investigate effects of pilocarpine solution as mouthwash on salivary flow and adverse effects compared to systemic administration of 5 mg pilocarpine tablet in healthy subjects. Methods: The study was a double blind, placebo-controlled, crossover clinical trial. Five milligrams pilocarpine tablets, 4 mL of 2% pilocarpine solution and placebo solution were given to 12 healthy volunteers (6 males and 6 females) in a predetermined order with wash-out period of at least two days and unstimulated whole saliva was collected before and after administration of each drug. Blood pressure and pulse rate was also measured and subjective effect and potential side effects were evaluated by a self-administrated questionnaire. Results: Systemic (5 mg tablet) and topical (2% solution) use of pilocarpine significantly increased salivary flow rate in healthy subjects compared to placebo (p<0.001). In both the pilocarpine solution and tablet groups, salivary flow rates at 120 minutes after administration remained increased. Subjective effect on salivation was the largest in the pilocarpine tablet group, followed by the pilocarpine solution group (p<0.05). There was no significant difference in blood pressure and pulse rate after administration of all three drugs. Fewer side effects reported in the pilocarpine solution group than in the tablet group. Conclusions: Two percents pilocarpine solution as mouthwash increases salivary flow rate, definitely superior to placebo solution and comparable to pilocarpine tablet, with fewer side effects in healthy subjects. It indicates a possibility of pilocarpine solution as a useful alternative of pilocarpine tablets for the xerostomic patients with systemic diseases.
Objectives : The purpose of the study is to investigate the xerostomia in the chronic severe psychiatric patients in Korea because there were few reports on xerostomia in the psychiatric patients. Methods : The subjects were 61 psychiatric patients in the mental hospital by convenience cluster sampling. A self-reported symptom questionnaire was filled out by the three researchers on the basis of medical records by the informed consent. The stimulated salivary flow rate of the patients was measured by saliva sampling. Results : The subjects consisted of 45.9% of male and 54.1% of female. High school graduation accounted for 40.0% and 20.0% did not attend the school. The majority of the patients were medicaid recipients. Schizophrenia accounted for 86.9% and most patients were long term care recipients. A total of 68.9% of the patients suffered from salivary dysfunction. The medication in schizophrenia seemed to decrease the stimulated salivary flow rate and made the patients difficult in chewing and swallowing due to xerostomia and low saliva secretion(p<0.05). Conclusions : Medication in schizophrenic patients caused the salivary dysfunction. So the collaboration between the psychiatry doctors and dental hygienists is very important to improve the salivary secretion in the schizophrenic patients. The continuous and long term care of the xerostomia will help the patients maintain the good oral hygiene.
In Nembutal anesthetized cats, the sobmaxillary duct was cannulated with polyethylene tube, and effects of stimulation of the chorda tympani and cervical sympathetics on, the submaxillary secretion and intraluminal pressure of the submaxillary duct were observed. The stimulation of tile chorda tympani elicited a profuse salivary secretion. The stimulation of the cervical sympathetics evoked only a scanty flow, and on repeated stimulation of the nerve salivary flow response gradually diminished and finally the flow ceased. In this state the salivary flow by the sympathetic stimulation was resumed after the stimulation of the chorda tympani. Atropine abolished these responses to nerve stimulation. Intraluminal pressure of the submaxillary duct was abruptly increased and remained on a plateau during the stimulation of the chorda tympani, whereas sympathetic stimulation elicited moderate increase of the intraluminal pressure which did not remain in spite of continued stimulation. These results suggest that scanty salivary flow induced by cervical sympathetic stimulation is not real secretion but simple elimination of the saliva already present in the duct due to contraction of the contractile elements known to exist in the duct wall.
The author performed Snyder test, estimation of salivary flow rate, salivary viscosity test, salivary buffering capacity test, M-R test, oral hygiene ability test, estimation of oral glucose clearance time and plaque reformation test in the 107 male Koreans aged form the age of 20 to 29, in order to detect and control the active cariogenic factors contributing to caries development on the individual basis. Thereafter, the data from 8 kinds of caries activity test were analysed and evaluated. The obtained results were as follows: 1. Snyder test was positive in 86.0% of total tested persons, and among those showing positive Snyder test reaction, slight caries activity was appeared in 39.1%, moderate caries activity in 23.9%, and marked caries activity in 37.0%. 2. Salivary flow rate was under the average flow amount in 53.3%. 3. Salivary buffering capacity was low in 22.4%. 5. Buffering capacity of dental plaque was high in 12.5%. 6. Oral hygiene ability was insufficient in all persons tested. 7. Oral glucose clearance time was long in 42.1%. 8. Plaque reformation rate was high in 8.4% of the 107 persons tested.
Xerostomia is caused by organic or functional changes affecting the salivary system at different levels. Patients suffering from xerostomia may also complain of an oral burning sensation, ulceration or soreness, difficulty in swallowing, and poor denture retention. And pilocarpine is administered orally to induce salivary secretion. In Seoul National University Hospital(SNUH) pharmacy, the pilocarpine chewing tablets are prepared and supplied to patients of xerostomia in request of the dental hospital in SNUH. And we tested the salivary flow induction and the dissolution patterns of these products in saliva by a double-blind, sequential cross-over trials to eight healthy human volunteers with placebo. The pilocarpine chewing tablet contained 5 mg of pilocarpine, and placebo consisted of same materials as test drug, but didn't contain pilocarpine. In vivo experiment, all subjects were instructed to chew as 60-80 times/min. Mixed saliva was collected in the ranges of intervals such as 0-2, 2-5, 5-10, 10-15, 15-20, 20-30, 30-45 and 45-60 min after pilocarpine chewing tablet or placebo administration. Saliva volume was measured in each collecting time interval, and saliva pilocarpine concentrations were determined by reversed phase HPLC. The 82.5 percent $(4.13{\pm}0.69\;mg)$ of pilocarpine was extracted from chewing tablets during mastication of 60-80 times per minute for 60 minutes. Among these dissolved amounts, 90 percent was extracted within 20 minutes. The salivary flow rates were more increased in a group who administered pilocarpine chewing tablet at the interval of 5-10, 10-15, 20-30 and 45-60 min rather than a placebo-group, but only extracted amount of pilocarpine at 45-60 min interval is significanly different between two groups (p<0.05). But total amounts of saliva secreted for 1 hour in two group-pilocarpine and placebo treated- were $46.36{\pm}9.72\;ml\;and\;39.09{\pm}7.81\;ml$, respectively, and were not significantly different between two groups.
The purposes of this study were to investigate the effect of pilocarpine-containing chewing gum for the treatment of xerostomia and to compare the effect of pilocarpine-containing chewing gum with that of pilocarpine oral administration. The 20 subjective and objective xerostomic patients were included in this study and divided into 3 groups. Five subjects were included in gum base chewing group, 10 in pilocarpine-containing gum chewing, and 5 in pilocarpine oral administration. The author measured unstimulated whole salivary flow rate, stimulated parotid salivary flow rate, pH of resting whole saliva, viscosity of stimulated whole saliva, and subjective symptoms and discomforts using VAS(visual analogue scale) at the beginning of the experiment. And the author investigated the changes of these factors at 1, 2, 3, and 4 week after. The obtained results were as follows : 1. There were significant increases in the unstimulated whole salivary flow rate in pilocarpine-containing gum chewing and pilocarpine oral administration groups. But there was no significant difference between pilocarpine-containing gum chewing and pilocarpine oral administration groups. 2. There was a significant increase in the stimulated parotid salivary flow rate in pilocarpine- containing gum chewing group. But there was no significant difference between pilocarpine- containing gum chewing and pilocarpine oral administration groups. 3. The change of salivary pH showed the increasing pattern in all groups. But there was no significant difference among groups. 4. There were no significant changes in the values of salivary viscosity in all groups through the experimental period. 5. There were significant decreases of VAS(visual analogue scale) in the degree of subjective symptoms and discomforts in pilocarpine-containing gum chewing and pilocarpine oral administration groups. But there was no significant difference between pilocarpine- containing gum chewing and pilocarpine oral administration groups.
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