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Statement of problem Xerostomia refers to the decrease in the quality and quantity of saliva. In denture wearers, xerostomia affects the retention of the denture because of lack of wettability of the denture base. However, which denture base resin materials are best wetted by artificial salivary substitutes is unclear. Purpose The purpose of this in vitro study was to determine the wetting properties of 3 different commercially available denture base resin materials with artificial salivary substitute by using contact angle measurements and to compare these properties before and after thermocycling. Material and methods A total 120 specimens were fabricated with 3 different denture base materials (n=40): heat-polymerized polymethylmethacrylate (DenTek), injection-molded nylon polyamide (Valplast), and microwave polymerized (VIPI WAVE). The advancing and receding contact angles were measured with a goniometer by using the WinDrop++ software program. The contact angle hysteresis was calculated from the advancing and receding contact angles values. The same specimens were subjected to thermocycling to measure the advancing and receding contact angles values. The comparative evaluation was carried out before and after thermocycling. Results The mean ±standard deviation contact angles of the microwave-polymerized material were (62.40 ±1.21 degrees) advancing contact angle, (32.12 ±0.66 degrees) receding contact angle, and (30.28 ±1.40 degrees) contact angle of hysteresis. It was followed by the injection-molded nylon polyamide material, whose mean ±standard deviation contact angle values were (68.57 ±1.72 degrees) advancing contact angle, (43.02 ±1.39 degrees) receding contact angle, (26.27 ±2.05 degrees) contact angle hysteresis and high impact strength heat-polymerized polymethylmethacrylate material, whose mean ±standard deviation contact angle values were (69.81 ±0.16 degrees) advancing contact angle, (41.90 ±1.02 degrees) receding contact angle, and (27.91 ±0.97 degrees) contact angle hysteresis. The statistical analysis showed significant differences among contact angle values of the microwave-polymerized material as compared with the heat-polymerized polymethylmethacrylate and injection-molded nylon polyamide materials (P Conclusions The microwave-polymerized material showed better wettability with artificial saliva substitute than heat-polymerized polymethylmethacrylate and injection-molded nylon polyamide.

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

Xersotomia is associated with food avoidance and low nutritional assessment. This review seeks to document whether products called "saliva substitutes" or "artificial saliva" can really replace saliva in food oral processing. Pubmed and Science Direct were searched for articles using the keywords "saliva substitutes" and "artificial saliva." An advanced search was applied using the terms "xerostomia" and/or "food oral processing" and/or "eating" and/or "mastication" and/or "chewing" and/or "swallowing." The analysis methods and the inclusion criteria were documented in a protocol published in the International prospective register of systematic reviews (PROSPERO with the registration number CRD42019124585). The search included 43 articles, published between 1979 and 2017. Among the included studies, 17 were observational studies, 5 were pilot studies, 21 were crossover studies, and 14 of these studies were blinded. The Strobe score for the included articles varied from 7.5 to 20. The possible effects of the use of saliva substitutes on the ingestion function were poorly investigated. No evidence was based on physiological studies. It is unknown whether using a saliva substitute has an effect on the composition and rheological properties of the food bolus, on the lubrication of the oral and laryngeal mucosa or on both phenomena. Moreover, saliva substitutes were not formulated to improve food oral processing and most of them are flavored. New saliva substitutes and artificial saliva should be designed and formulated to improve food oral processing.

Minkyung Kang,1 Hyounggeun Park,1 Joon-Ho Jun,1 Miwon Son,1 Myung Joo Kang2 1Pharmaceutical Product Research Laboratories, Dong-A ST Research Institute, Gyeonggi, 2Division of Pharmaceutical Sciences, College of Pharmacy, Dankook University, Cheonan, Chungnam, Korea Abstract: Saliva substitutes and/or lubricants are commonly employed to lessen dry mouth symptoms by stimulating and/or substituting for the secretion of saliva. In this study, a novel artificial saliva containing inorganic salts, including sodium chloride and potassium chloride, and bactericidal agents, including potassium thiocyanate and lactoperoxidase, was formulated in the form of a solution (DM-sol) or gel (DM-gel). Those in vivo therapeutic efficacies were assessed in terms of saliva secretion and anti-inflammatory activity in rats and mice, respectively. Salivary secretion was promoted by mucosal application of DM-formulations in normal rats. In particular, DM-gel resulted in 2.5- and 1.9-fold greater salivary flow rates compared to normal saline and DM-sol, respectively. In an in vivo efficacy evaluation in diabetic mice with salivary hypofunction, repeated application of DM-formulations alleviated histopathological changes in the buccal mucosa in terms of atrophy and thinning of the epithelium, compared to vehicle, after 4 weeks. Moreover, the DM-sol and DM-gel were comparably effective for relieving periodontal gingivitis, reducing infiltration of inflammatory cells, and normalizing the neutrophil level in the gingival gingiva, after 4 weeks. Therefore, the novel artificial saliva is expected to facilitate salivary secretion and restore physiological conditions in the mouth of patients with salivary hypofunction. Keywords: saliva substitute, carbopol gel, hypothiocyanite–hydrogen peroxide mixture, antimicrobial activity, diabetic rats

The fracture of zirconia abutments has been reported relative to different amounts of reduction. Data are not available to demonstrate whether the apical vertical reduction of a zirconia abutment at different levels can be achieved while maintaining an acceptable load-to-fracture value.The purpose of this study was to evaluate in vitro the effect of different levels of preparation of zirconia implant abutments on the fracture load.Twenty-seven zirconia abutments (NobelProcera Abutment Zirconia) and 27 implant analogs (NobelReplace Implant Replicas) were divided into 3 groups of 9 abutments and 9 implant analogs. The Zu group (n=9) without any modification and with a chamfer margin width of 0.8 mm served as the control. The Zp1 group (n=9) was prepared with a chamfer margin width of 0.8 mm and with a 1-mm step in the labial margin. The Zp2 group (n=9) was prepared with a chamfer margin width of 0.8 mm and with a 1.5-mm step in the labial margin. The zirconia abutment was attached to the implant analog and fixed in a customized steel mounting table. The abutment-implant complex was immersed in saliva substitute to simulate the clinical oral environment. A 250 000 cycle sinusoidal fatigue load that ranged between 10 N and 210 N was applied to the specimens by using a universal testing machine. Subsequently, the specimens were loaded to fracture. One-way ANOVA and the Tukey post hoc test were used to compare the groups statistically (α=.05).The mean (standard deviation) values of the abutment load to fracture were as follows: Zu group = 567.3 ± 35.4 N; Zp1 group = 445.4 ± 41.0 N; Zp2 group = 430.5 ± 39.4 N. The lowest abutment load-to-fracture value was in the Zp2 group (408.6 N), whereas the highest abutment load-to-fracture value was in the Zu group (591.4 N). A significant (P.05) difference was found between the Zu group and the other groups, but no significant difference was found between the Zp1 group and the Zp2 group. The primary mode of fracture (67%) was at the abutment-analog interface.Preparation of prefabricated zirconia abutments had a statistically significant negative effect on the abutment load-to-fracture values.

The sensation of dry mouth also referred to as xerostomia is becoming increasingly common worldwide. Current treatment strategies include topical agents, sialagogues and saliva substitutes. The latter have been reported to be ineffective as special physicochemical features of natural saliva have so far been ignored (e.g., buffer capacity, osmolality, etc.). The aim of this study was to comprehensively investigate the most relevant physicochemical properties of three products frequently used in the clinics and compare them to unstimulated whole saliva (UWS). Sialin-Sigma®, Glandomed® and Xylitol CVS HealthTM Dry Mouth Spray were characterized regarding their pH, osmolality, electrical conductivity, buffer capacity, rheological behaviour, microstructure, surface tension and wettability and compared to UWS. The influence of residual saliva was examined under consideration of the conditions of xerostomia to assess whether the quantity given in the instruction for use is appropriate. All three products showed significant differences to UWS regarding the values received. Only Xylitol CVS HealthTM Dry Mouth Spray showed a comparable wettability. It could be further determined that the recommended doses were too low. These data can not only be used for an improved understanding of saliva, but also for the development of a replacement fluid to successfully alleviate xerostomia.

Aim and Objectives: The aim of this study was to evaluate the influence of fluid environment mimicking intra-oral conditions on fatigue performance of standard diameter, 3.75-mm implants. Dental implants placed intra-orally are repeatedly submitted to mastication loads in the oral environment, which differ substantially from room-air standard laboratory conditions. Several studies that examined fracture surfaces of intra-orally fractured dental implants have identified corrosion fatigue as the main failure mechanism. Yet, fatigue performance of dental implants has been essentially studied in room air, based on the premise that the implant material is relatively resistant to corrosion in the intra-oral environment. Material and methods: Thirty-two 3.75-mm titanium alloy implants were tested under cyclic compressive loading. The tests were performed in artificial saliva substitute containing 250 ppm of fluoride. The loading machine stopped running when the implant structure collapsed or when it completed 5 9 10 6 cycles without apparent failure. The load vs. number of cycles was plotted as curve for biomechanical fatigue analysis (S–N curve). The S–N curve plotted for the artificial saliva test was compared to the curve obtained previously for the same implants tested in a room-air environment. Failure analysis was performed using scanning electron microscopy (SEM). Results: A comparison of the S–N curves obtained in artificial saliva and in room air showed a considerable difference. The S–N curve obtained in the artificial saliva environment showed a finite life region between 535N and 800N. The transition region was found below 465N, with a probability of survival of 50%, while in room air, the transition region was between 810N and 620N and an infinite life region below 620N was identified. Conclusions: The results of this study show that environmental conditions adversely affect implants’ fatigue performance. This fact should be taken into account when evaluating the mechanical properties of dental implants.

One of the major problems associated with xerostomic patients is the poor tolerance and retention of removable dental prostheses because of thin dry atrophic mucosa and lack of a saliva film. The use of salivary substitutes can improve lubrication, provide irrigation for dry mucosa, provide significant relief from symptoms, and also improve the retention of removable prostheses. These substitutes can be delivered over prolonged periods by using saliva reservoirs in the prosthesis itself. This report describes a novel technique for the fabrication of a functional palatal saliva reservoir in edentulous xerostomic patients. The technique uses a resilient liner in the floor of the reservoir. The tongue presses against the liner during swallowing, resulting in flow of saliva substitute through a hole in the anterior part of the floor of the reservoir.

Objective: Some saliva substitutes have been shown to demineralize dentine in vitro. This effect is counteracted by the application of various fluorides. In contrast, remineralizing saliva substitutes might be supported by these treatments, depending on the dynamics during remineralization. The aim of this in vitro study was to evaluate the effects of fluoride mouthrinses or gels in combination with de-/remineralizing saliva substitutes on dentinal subsurface lesions. Design: Demineralized bovine dentine specimens were stored either in mineral water [saturation with respect to octacalcium phosphate (SOCP): 0.7], Glandosane (G, SOCP: 0.3) or in a modified saliva substitute Saliva natura (SN, SOCP: 1.9) for five weeks (37 °C). Fluoride agents were applied twice daily for 10 min (n = 15/group): no treatment, Meridol mouthrinse, Elmex sensitive solution, ProSchmelz fluoride gel, Elmex gelee. After storage thin sections were prepared and mineral losses before and after storage were evaluated from microradiographs. Results: Specimens stored in G alone showed significantly higher mineral loss compared to those stored in water, SN or G in combination with any additional treatment (p

Objective The aim of this in vitro study was to investigate whether saliva substitute films influence the adhesion of Candida albicans to different dental substrata prior to and after artificial ageing. Design Specimens of a denture base resin (DB) and a veneering composite (VC) were polished and subjected to an artificial ageing protocol (thermal cycling, 2 × 3000 cycles 5/55 °C). Bovine enamel (BE) and glass were used as reference materials. After determination of surface free energy, specimens were rinsed with commercial saliva substitutes (Aldiamed, Saliva natura, Saliva Orthana, Salinum), a positive control (protein mixture), or a negative control (Phosphate Buffered Saline, PBS) for 2 h at 37 °C in a flow chamber. Specimens were then exposed to a C. albicans ATCC 10231 suspension for 4 h at 37 °C. Adherent, viable Candida cells were quantified using a luminometric ATP-based assay. Statistical analysis was performed using 1- and 2-way ANOVA, and post-hocs were analysed using the Tukey–Kramer test (α Results Our data indicated that VC (31.1 mJ/m2) and DB (33.9 mJ/m2) yielded the lowest surface free energy prior to artificial ageing, and BE (43.6 mJ/m2) yielded the highest surface free energy. For C. albicans adhesion, both the materials as well as the saliva substitutes influenced relative luminescence intensities, indicating significant differences in C. albicans adhesion between the various materials and after treatment with the saliva substitutes. Conclusions Saliva substitutes may have a decisive influence on C. albicans adhesion, but their impact appears to be dependent on the properties of the underlying substratum material.

Introduction Soft liners have been developed to offer comfort to denture wearers. However, this comfort is compromised when there is a change in the properties of the material, causing colour change, solubility, absorption and hardening. These characteristics can compromise the longevity of soft liners. Aim The aim of this in vitro study was to investigate the effect of ageing on both the hardness and colour change of two soft liners following accelerated ageing. Methods Two denture liners, one resin based (Trusoft, Bosworth, Illinois, USA) and one silicone based (Ufi Gel P, Voco GMBH, Cuxhaven, Germany), were tested in this study for both hardness (using the Shore A scale) and colour change (using the CIE L*a*b* colour scale), initially and after 1008 hours (6 weeks) of accelerated ageing. Statistical analysis was performed using the unpaired t-test with the Welch correction. Results These indicated that both materials increased in hardness and underwent colour change after accelerated ageing. The initial hardness of Trusoft was far lower than that of Ufi Gel P (18.2 Shore A units vs 34.8 Shore A units). However, for Trusoft the changes for both hardness (from 18.2 to 52.1 Shore A units) and colour change (16.85 on the CIE L*a*b* colour scale) were greater than those for Ufi Gel P, for which hardness changed from 34.8 to 36.5 Shore A units and the colour change was 5.19 on the CIE L*a*b* colour scale. Conclusions Ufi Gel P underwent less hardness and colour change after accelerated ageing than Trusoft. On the other hand, the use of Trusoft may be preferable in cases where initial softness is a major consideration, such as when relining an immediate denture after implant surgery.

The aim of this in vitro study was to evaluate whether saliva substitutes containing antimicrobial agents influence the initial adhesion of Streptococcus mutans to bovine enamel and various dental materials.Specimens of a denture base resin, a veneering composite and a dental ceramic were prepared according to the manufacturers instructions and polished. Standardized bovine enamel slabs were prepared for reference. Surface roughnesss and surface free energy were determined. Fifteen specimens of each substratum were rinsed with four saliva substitutes (Salinum, Aldiamed, Saliva natura and Saliva Orthana), a negative (PBS) and a positive control (protein mixture) for 2h at 37 degrees C in a flow chamber, and were subsequently exposed to S. mutans NCTC 10449 suspension for 4h at 37 degrees C. Adherent bacteria were quantified using a fluorometric assay. Statistical analysis was performed using one- and two-way ANOVA (p0.05), and post hocs were analyzed using the Tukey-Kramer multiple comparison test (p0.05).Substrata as well as saliva substitutes influenced fluorescence intensities decisively. No significant differences in fluorescence intensities indicating similar adhesion of S. mutans were found between substrata that had been exposed to the negative control, the positive control, Saliva Orthana and Aldiamed. On substrata with high surface free energy (ceramic and bovine enamel), significantly higher fluorescence intensities indicating higher adhesion of streptococci were found to specimens that had been exposed to Saliva natura and Salinum.The influence of saliva substitutes on initial S. mutans adhesion appears to be dependent on the substratum surface properties. Only little influence of antimicrobial agents was found.

Goals The commercially available saliva substitute Oralbalance (R) has been reported to alleviate symptoms of post-radiotherapy xerostomia in head and neck cancer patients. Oralbalance (R) may also be effective for xerostomia in patients undergoing hematopoietic cell transplantation (HCT) with high-dose chemotherapy and total-body irradiation. However, HCT patients are severely compromised, and saliva substitute must therefore not promote infection. This study was performed to determine the effects of Oralbalance (R) on microbial species identified during HCT. Patients and methods Microbial identification of oral mucosa was performed in 28 patients undergoing HCT. The antimicrobial effects of Oralbalance (R) against bacteria and fungi detected in the HCT period were examined in vitro. Briefly, bacteria and fungi were spread on agar plates, and 0.1g of Oralbalance (R) gel was applied (about phi 1cm). After incubation at 37 degrees C for 24h, the presence of a transparent zone of inhibition around Oralbalance (R) was observed. Main results Not only bacterial species constituting normal flora of the oral mucosa but also those not usually constituting normal flora, e.g., coagulase-negative Staphylococcus, were detected. A transparent zone was observed around Oralbalance (R) in all bacterial species examined. No transparent zone was observed for Candida albicans, but growth was inhibited in the area where Oralbalance (R) was applied. Conclusions Oralbalance (R) does not facilitate increases in microorganisms in the HCT period. Oral care with Oralbalance (R) does not promote infection in patients undergoing HCT.

Objectives This pilot study aimed to compare the in-mouth retention of an oil-based saliva substitute (emulsion, consisting of rice bran oil, soy lecithin and water) with water and a 1% w/v methylcellulose suspension (polymer) in healthy volunteers. Methods Each formulation was tagged with 1 mmol/L lithium and participants (n = 30) rinsed their mouth with one randomly assigned formulation (emulsion, polymer or water) for 30 s, before expectorating into a cup. Concentration of lithium expectorated was measured and amount of each formulation remaining in the mouth was estimated. Patient acceptability was investigated using questionnaires, and Fourier-Transform Infrared spectroscopy (FTIR) was used to determine the presence of oil in expectorated samples. Results Immediately after rinsing, taste was rated lower in the emulsion group compared to the polymer or water groups (p > 0.05), although variability was high. Mean retention was highest in the emulsion group, with a difference of 8.34 ± 2.71% (p = 0.003) and 4.57 ± 2.71% (p = 0.06) compared with the water and polymer groups, respectively. FTIR confirmed the presence of oil in all expectorated emulsion samples. Conclusion The emulsion was not inferior to the polymer in terms of retention immediately after rinsing. The next step is to conduct larger clinical studies over longer time periods in participants with salivary hypofunction.

The aim of the present study was to compare the efficiency of oral spray based on thermal spring water (Buccotherm®) versus commercial saliva substitute (Xeros®) and marshmallow root on the quality of life in patients with hyposalivation. A total of 60 patients with unstimulated salivary flow rate

The goals of this work were to investigate the effect of a mucin-containing spray on chronic xerostomia after radiotherapy in the head and neck region and to learn about the influence of age on the results of this treatment. A total of 73 patients with xerostomia following radiotherapy for various malignant disease in the head and neck region tested a bottle of the mucin spray (SALIVA-medac) and filled in a questionnaire about xerostomia. In all, 59 questionnaires were completed and returned. All patients had had some form of prior treatment for xerostomia, which was applied an average (mean) of 16 times per day (median 15 times per day). The mucin spray had to be used less frequently, i.e. 11 times daily (median 5 times per day) (P

Several studies have shown a reduction in enamel bond strengths when the bonding procedure is carried out immediately after vital bleaching with peroxides. This reduction in bond strengths has become a concern in cosmetic dentistry with the introduction of new "in-office" and "waiting-room" bleaching techniques. The aim of this in vitro study was to evaluate the effect of three bleaching regimens: 35% hydrogen peroxide (HP), 35% carbamide peroxide (CP), and 10% CP, on dentin bond strengths.One hundred and twenty fresh bovine incisors were used in this study. The labial surface of each tooth was ground flat to expose dentin and was subsequently polished with 600-grit wet silicon carbide paper. The remaining dentin thickness was monitored and kept at an average of 2 mm. The teeth were randomly assigned to four bleaching regimens (n = 30): (A) control, no bleaching treatment; (B) 35% HP for 30 minutes; (C) 35% CP for 30 minutes; and (D) 10% CP for 6 hours. For each group, half of the specimens (n = 15) were bonded with Single Bond/Z100 immediately after the bleaching treatment, whereas the other half was bonded after the specimens were stored for 1 week in artificial saliva at 37 degrees C. The specimens were fractured in shear using an Instron machine.For the groups bonded immediately after bleaching, one-way analysis of variance (ANOVA) followed by the Duncan's post hoc test revealed a statistically significant reduction in bond strengths in a range from 71% to 76%. For the groups bonded at 1 week, one-way ANOVA showed that group B (35% HP for 30 min) resulted in the highest bond strengths, whereas 10% CP resulted in the lowest bond strengths. Student's t-test showed that delayed bonding resulted in a significant increase in bond strengths for groups B (35% HP) and C (35% CP); whereas the group bleached with 10% CP (group D) remained in the same range obtained for immediate bonding. Storage in artificial saliva also affected the control group, reducing its bond strengths to 53% of the original.

The purpose of this study was to assess patient preference and product efficacy of three non-prescription products for the symptomatic relief of xerostomia. The study group consisted of 80 individuals with a complaint of chronic (six months) xerostomia and an unstimulated salivary flow rate of0.1 mL/min. The three products--a sorbitol/xylitol-sweetened chewing gum, a sorbitol-sweetened sour lemon lozenge, and a sorbitol/xylitol-sweetened artificial saliva substitute spray--were assigned in a permuted block randomization scheme. Each product was used for two weeks with an interval of one week between trials. The study did not identify any product to be statistically significant in terms of patient preference. Kruskal-Wallis testing revealed no statistical significance (P0.589) among the products. No product demonstrated marked efficacy in stimulating salivary output. ANOVA analysis followed by Tukey HSD testing revealed no significant difference between the baseline paraffin-stimulated mean flow rate and the gum- and lozenge-stimulated flow rates.

The effect of a linseed extract Salinum and a sodium carboxymethyl cellulose preparation called MAS-84 was compared with regard to its effect on the symptoms of dry mouth. Twenty patients with xerostomia, who had been treated for cancer in the head and neck by radiation were recruited from the clinic for maxillofacial surgery, Malmo University Hospital. Following radiation treatment the salivation was severely reduced. The symptoms of a general feeling of a dry mouth, difficulties in chewing and swallowing, taste disturbances, problems with speech and mouth burning were registered on a subjective verbal rating scale. In addition plaque index and gingival bleeding were determined. The study design was crossover and performed single blind. The experimental period was 7 weeks. The patients were randomly divided into 2 groups. One group used Salinum and the other MAS-84 for 3 weeks. The fourth week was a wash out period and for the next three weeks the patients shifted preparation. Each of the preparations was used ad libitum. Registrations of the various parameters were undertaken on days 0, 7 and 21 of the respective period. At the initial examination all patients reported considerable disturbances from mouth-dryness. These symptoms were reduced in 15 patients during the Salinum period and in 9 during the MAS-84 period. The relief was significantly more pronounced during the use of Salinum compared to that during the use of the methyl cellulose preparation. On day 21 plaque and gingival bleeding were significantly reduced during the Salinum period but not during the MAS-84 period. The results of the present study confirm those of a previous pilot study and indicate that the linseed mucilage significantly reduced the symptoms of dry mouth. This effect increased with increasing time of saliva substitute use. The linseed mucilage Salinum appeared to be a suitable saliva replacement in mouth dry patients.

The effect of a new saliva substitute, Salinum, was tested in 37 patients with severe symptoms of reduced salivation. The majority of the patients had suffered from hyposalivation and dry mouth for more than 8 years. The saliva substitute consisted of a water soluble extract of linseed. The physical properties of this extract are similar to those of the glycoproteins of the salivary secretions. The patients used the saliva substitute for a seven days period. Prior to the use of the extract the patients reported that the most severe symptoms of decreased salivation were a feeling of dryness in the mouth and burning sensations in the tongue, pharynx and oesophagus, The majority of the patients reported that the use of Salinum reduced the symptoms of hyposalivation. Great variation in effect occurred from patient to patient. Generally the patients with the most severe symptoms experienced the greatest relief of the symptoms when they used Salinum. Although of short duration the results of this pilot study indicate that an extract of linseeds may compensate for some aspects of the consequences of reduced salivation. Further studies are needed to elucidate the feasibility of the extract as saliva replacement.

Xerostomia, a clinical manifestation of salivary gland dysfunction, affects many people. These individuals frequently sip liquids to alleviate the discomforts associated with hyposalivation. Milk appears to have many of the chemical and physical properties of a good saliva substitute. Besides the obvious benefit of providing moisture and lubrication for the dehydrated mucosa, milk buffers oral acids, reduces enamel solubility, and contributes to enamel remineralization. These anticariogenic factors are generally attributed to the high calcium and phosphate content along with the milk phosphoproteins that strongly adsorb to enamel. Patients with xerostomia frequently have difficulty in obtaining proper nutrition due to problems associated with lubricating, masticating, tasting, and swallowing food. Milk is a food with high nutritional quality that would certainly benefit most patients with xerostomia. Because of the nutritional, anticariogenic, and moisturizing properties of milk, patients with xerostomia may find milk of value as a saliva substitute to help reduce the oral health problems associated with hyposalivation.

For patients with hyposalivation fluorides are supportive to prevent caries lesions. Remineralization of subsurface lesions might be improved by toothpastes containing 5000 μgF(-)/g compared with those having 1400 μgF(-)/g. This could be influenced by the degree of baseline mineralization. Therefore, this in vitro study evaluated the effects of fluoride toothpastes differing in fluoride concentration in combination with de- and remineralizing saliva substitutes using two lesion types.Specimens with shallow (SL; ΔZ (SD): 1915 (543) vol% × μm) or deep lesions (DL; 5804 (427) vol% × μm) were either stored in mineral water [saturation with respect to octacalcium phosphate (S(OCP)): 0.5], demineralizing experimental (Exp, S(OCP): 0.3), demineralizing commercial (Glandosane, S(OCP): 0.3), or remineralizing saliva substitute (modified Saliva natura; S(OCP): 1.9) for five weeks (37 °C). Either one of three brushing procedures was performed additionally three times daily: no brushing, Elmex anticaries toothpaste (E; 1400 μgF(-)/g), Duraphat toothpaste (D; 5000 μgF(-)/g). Mineral parameters before and after storage were evaluated using microradiographs.Storage in Exp as well as Glandosane induced a significant demineralization (p0.05; relatively more pronounced in SL than DL). Additional brushing in particular with D reduced these effects. Storage alone in modified Saliva natura remineralized specimens (p0.05).Under the in vitro conditions chosen shallow lesions seem to be more susceptible for demineralization compared with deeper ones when stored in an undersaturated (with respect to OCP) saliva substitute. The highly fluoridated toothpaste seemed to be more beneficial than a regular one.

Salivary research is at a critical crossroads regarding the clinical application of basic knowledge. Studies by numerous salivary researchers over the last 5 years using advanced technologies (e.g., protein chemistry, molecular biology, and biophysics) have demonstrated that the structural requirements for salivary function are quite complex. Nevertheless, several patterns or principles have evolved. First, the majority if not all salivary molecules are multifunctional. Second, the conformation of a molecule is an important factor in biological activity. Third, many molecules have overlapping functions (e.g., mucins and amylase interact with viridans streptococci; statherin and proline-rich proteins are involved in mineralization). Thus, saliva has "built-in" compensatory or redundant properties. Nevertheless, it must be determined which molecule is more potent or effective with respect to a particular function. Fourth, salivary molecules may be "amphifunctional". In other words, the different functions of a single molecule may be protective or potentially harmful depending on the intraoral site of action. Examples of amphifunctional molecules are amylase and statherin. Fifth, functional relationships may exist between different salivary components. The principles mentioned above can provide experimental strategies for the design and synthesis of a first generation of salivary substitutes that can be topically applied to oral surfaces. These molecules should be used to combat microbial mediated diseases and occlusal disharmony in subjects with normal salivary flow as well as those with xerostomia. In general, these substitutes should be long-lasting, biocompatible, biodegradable, and provide specific protective qualities that can be targeted to selected intraoral sites. Subsequent research endeavors will focus on the design and subsequent engineering of a second generation of artificial salivas comprised of molecules with enhanced as well as multiple functions. Examples of these strategies are provided.

To the editor, Previously, we published two articles in Supportive Care in Cancer on the in vitro and in vivo antibacterial effects of a commercial saliva substitute, Oralbalance® (Laclede, Inc., Rancho Dominguez, CA, USA; now GlaxoSmithKline, UK), which was a historic product for over 20 years and contributed to oral management for cancer patients with side effects such as xerostomia. The first report was entitled “An

Saliva substitutes are prescribed to patients suffering from radiation-induced hyposalivation to alleviate oral complaints; however, some available products have shown to demineralize dentin. The purpose of this in vitro study was to evaluate the effects of two saliva substitutes in combination or not with fluoridation on remineralization of bovine dentin subsurface lesions.Dentin specimens were demineralized, and stored in either mineral water (control; volvic, danone), Glandosane (cell pharm), or modified Saliva natura (SN, Medac) for 5 weeks (37° C). The following treatments were applied twice daily (n = 12/group): (1) no treatment; (2) immersion in pure Elmex sensitive mouthrinse (250 ppm F-; 10 min; Gaba); (3) brushing with Duraphat toothpaste (5,000 ppm F-; Colgate)/storage solution slurry (5 s; ratio 1:3); (4) combination of treatments 2 and 3. Differences in mineral parameters before and after storage/treatment were microradiographically evaluated.After 5 weeks, Glandosane-induced a significant demineralization of dentin specimens. The mineral loss of specimens stored in Glandosane was significantly higher compared to all other solutions (p 0.05), and this side effect was inhibited by the fluoride products (p 0.05; ANOVA, Tukey). Modified Saliva natura enabled considerable remineralization, and this was significantly increased by daily application of both fluoride products (p 0.05).Modified Saliva natura has remineralizing properties, while Glandosane is a demineralizing saliva substitute that should only be used with frequently applied fluorides in dentate patients.

This study deals with the determination of the retentive force between primary and secondary telescopic crowns under clinical conditions. Forty-three combined fixed-removable prostheses with a total of 140 double crowns were used for retention force measurement of the telescopic crowns prior to cementation. The crowns had a preparation of 1-2°. A specifically designed measuring device was used. The retentive forces were measured with and without lubrication by a saliva substitute. The measured values were analyzed according to the type of tooth (incisors, canines, premolars, and molars). Additionally, a comparison between lubricated and unlubricated telescopic crowns was done. As maximum retention force value 29.98 N was recorded with a telescopic crown on a molar, while the minimum of 0.08 N was found with a specimen on a canine. The median value of retention force of all telescopic crowns reached 1.93 N with an interquartile distance of 4.35 N. No statistically significant difference between lubricated and unlubricated specimens was found. The results indicate that retention force values of telescopic crowns, measured in clinical practice, are often much lower than those cited in the literature. The measurements also show a wide range. Whether this proves to be a problem for the patient's quality of life or not can however only be established by a comparison of the presented results with a follow-up study involving measurement of intraoral retention and determination by e.g. oral health impact profile.

This study aimed to evaluate the effect of different storage periods in artificial saliva and thermal cycling on Knoop hardness of 8 commercial brands of resin denture teeth.Eigth different brands of resin denture teeth were evaluated (Artplus group, Biolux group, Biotone IPN group, Myerson group, SR Orthosit group, Trilux group, Trubyte Biotone group, and Vipi Dent Plus group). Twenty-four teeth of each brand had their occlusal surfaces ground flat and were embedded in autopolymerized acrylic resin. After polishing, the teeth were submitted to different conditions: (1) immersion in distilled water at 37+/-2 degrees C for 48+/-2h (control); (2) storage in artificial saliva at 37+/-2 degrees C for 15, 30 and 60 days, and (3) thermal cycling between 5 and 55 degrees C with 30-s dwell times for 5000 cycles. Knoop hardness test was performed after each condition. Data were analyzed with two-way ANOVA and Tukey's test (alpha=.05).In general, SR Orthosit group presented the highest statistically significant Knoop hardness value while Myerson group exhibited the smallest statistically significant mean (P.05) in the control period, after thermal cycling, and after all storage periods. The Knoop hardness means obtained before thermal cycling procedure (20.34+/-4.45 KHN) were statistically higher than those reached after thermal cycling (19.77+/-4.13 KHN). All brands of resin denture teeth were significantly softened after storage period in artificial saliva.Storage in saliva and thermal cycling significantly reduced the Knoop hardness of the resin denture teeth. SR Orthosit denture teeth showed the highest Knoop hardness values regardless the condition tested.

The aim of this review is to summarize the in vitro and in vivo evidence on the performance of contemporary saliva substitutes in the treatment of xerostomia and hyposalivation caused by radiation therapy for head and neck malignancies. A literature search was conducted during July to September 2008 in PubMed, using the query terms “saliva substitute”, “saliva substitute and xerostomia”, “artificial saliva”, and “artificial saliva and xerostomia”; for clinical studies, only studies in patients suffering from radiation-induced xerostomia have been included in the review. Fifty-two studies met the inclusion criteria and were allotted either to the in vitro topics “viscosity”, “lubrication”, “wetting properties”, “antimicrobial effects”, and “enamel and dentin de- and remineralization”, or to the in vivo topics “clinical acceptance” or “influence on plaque formation and oral mucosa and microflora”. The findings suggest that there are significant differences in the performance of various saliva substitutes concerning the review parameters, yet indicate that further in vitro and in vivo studies on the properties of saliva substitutes are necessary.

The aim of the present study was to evaluate the effects of experimental saliva substitutes based on carboxymethyl cellulose (CMC) differing in degrees of saturation with respect to calcium phosphates on the mineral loss of enamel in vitro. Demineralized bovine specimens (subsurface lesions) were exposed to one of six experimental CMC-based solutions with theoretical degrees of saturation with respect to octacalcium phosphate (SOCP) of S0, S0.5, S1, S2, S4, and S8 for 10 weeks. A previously studied saliva substitute (Glandosane) and two aqueous solutions (C0 and C1) served as controls. Mineral losses and lesion depths before and after storage were evaluated from microradiographs. Free and bound calcium as well as phosphate and fluoride concentrations were determined. According to these measurements, SOCP of S2, S4, and S8 was 0.3, 1.1, and 3.4, respectively. Storage in Glandosane and both negative controls resulted in significant demineralization (p < 0.05). Only S2 significantly remineralized the specimens (p < 0.05). All other solutions showed neutral effects. No significant differences in mineralization between S0 and C0 as well as between S1 and C1 could be observed (p > 0.05). It can be concluded that a CMC-based solution actually unsaturated with respect to octacalcium phosphate (S2) shows most pronounced remineralization capability under the conditions chosen. This might be explained by a more favorable balance between calcium bound to CMC in an adsorbed layer at the enamel-liquid interface and heterogeneous nucleation of calcium phosphates within a solution compared to solutions either supersaturated or having lower levels of saturation.

This study investigated the effect of six lab-produced saliva substitutes based on carboxymethylcellulose (CMC) differing in octacalciumphosphate saturations (OCP-s) on mineralisation of bovine dentin in vitro.Dentin specimens were prepared (n=234); prior to and after demineralisation (37 degrees C; pH 5.0; 7 d), one-third of each specimen surface was covered with nail varnish (control of sound dentin). Subsequently, specimens (n=13) were exposed to either one of the six CMC-based solutions (OCP-s: 0, 0.5, 1, 2, 4, and 8) at pH 6.5 or to Glandosane for 5 and 10 weeks (37 degrees C). Two aqueous solutions (OCP-s: 0 and 1) served as controls. After storage, thin sections were prepared and mineral loss was calculated by transversal microradiography.After both storage periods specimens immersed in Glandosane revealed a significantly increased mineral loss compared to all other solutions (p0.05; Bonferroni post hoc test). Control solution with OCP-s=1 induced a significant remineralisation (p0.05; adjusted paired t-test). Only after 5 weeks exposure to the CMC-based solution with an OCP-s=2 a significant remineralisation compared to baseline (p0.05) as well as a significantly increased mineral gain of the surface area compared to higher saturated solutions (p0.05; Bonferroni post hoc test) could be observed.CMC seems to hamper dentin remineralisation, although after 5 weeks a mineral gain could be induced with slightly supersaturated CMC-solutions with respect to OCP.

Management of radiotherapy-related xerostomia is difficult. Saliva substitutes are helpful but the effects are short-lived. The purpose of the study was to develop a prototype intra-oral lubricating device for the management of radiotherapy-related xerostomia and to evaluate patient acceptance. An intra-oral lubricating device was fabricated that incorporated a reservoir in the palatal vault and permitted slow release of saliva substitute by the patient. Preliminary clinical testing was done in five patients with radiotherapy-related xerostomia. A measure incorporating seven questions was used to explore patient acceptance. The device was simple to fabricate using materials available in a technical laboratory. All patients were able to wear the device for at least 4 h per day throughout the test period. The device was considered easy to use and clean. Some impairment of speech and chewing was noted although this appeared to be related to the bulkiness of the reservoir. General oral comfort was improved due to the lubricating effect. The bulk of the reservoir was reduced as a consequence of patient feedback. The design addressed key problems associated with previous lubricating systems. Patient reports on oral functioning with the device in situ provided pivotal information on the device’s utility.

BACKGROUND AND AIM The feeling of a dry mouth may affect individual dietary habits, nutritional status, oral hygiene, speech, and gustatory sensitivity. The present study aimed to specifically investigate gustatory function before and after saliva replacement therapy. MATERIAL AND METHODS Whole-mouth gustatory function was assessed in 25 patients suffering from xerostomia (6 male, 19 female; age range 42-82 years) before and after 4 to 6 weeks of saliva replacement therapy using a preparation containing carboxymethylcellulose. The results were compared with those from healthy controls matched for age and sex (6 male, 19 female; age range 42-82 years). Using a whole-mouth test, gustatory function was assessed for sucrose, citric acid, sodium chloride, and caffeine. RESULTS All subjects detected the four taste qualities at the highest concentration. However, the patients with xerostomia had lower scores in the gustatory test compared with the healthy controls (p < .001). No correlation was found between gustatory scores and the duration or severity of the disorder. Therapy had no effect on measured gustatory function (p = .33); however, saliva replacement led to a significant improvement in other xerostomia-related symptoms (p < .001). CONCLUSIONS This study confirms previous work indicating that xerostomia is accompanied by decreased gustatory sensitivity. Lubricants based on carboxymethylcellulose may have a positive effect on some of the symptoms of xerostomia. However, these "simple" lubricants based on carboxymethylcellulose have little or no effect on whole-mouth gustatory function.

United Kingdom family physicians, General Practitioners (GPs), are allowed to prescribe from a Department of Health-approved list of non-medicines (the ‘ACES’ list) which includes a majority of proprietary saliva substitutes. Independent nurse prescribing, introduced in 2001, has improved patient access to effective remedies for a wide range of common medical problems. Further qualified ‘extended formulary nurse prescribers’ have access to a limited range of prescription medicines, and all non-prescription medicines that GPs may currently prescribe. Despite their specified role in the management of oral complications encountered in palliative care, a similar anomaly in NHS rules that prevents dental practitioners from prescribing ACBS listed saliva substitutes also prevents nurses from prescribing them. Sadly, patients are suffering poorer access to simple and effective remedies to conditions such as xerostomia – a condition that has recognised impact on their quality of life.

Changes in subjective sensations due to xerostomia before and after administration of Xialine®, a xanthan gum-based saliva substitute, were evaluated in 30 patients with radiation-induced xerostomia using the QLQ-H&N35. Xerostomia in general decreased with both Xialine® and placebo to almost the same degree. A trend was seen for Xialine® to improve problems with speech and senses.

OBJECTIVE: To provide extended intra-oral delivery of a saliva substitute. INTERVENTION: Three different types of prostheses containing saliva substitute were designed and assessed: a two-part device resembling a mandibular complete denture sealed by cobalt-samerium magnets, a one-part clear resin device for the edentate patients and a flexible mouth guard type of appliance containing a lubricant releasing bubble for the dentate patients. SETTING: A teaching hospital Oral Medicine and Rheumatology Clinic. SUBJECTS: 8 edentate and 3 dentate Sjogren Syndrome sufferers. OUTCOME MEASURES: Subjective dryness after a week of wearing the lubricating appliance. RESULTS: The majority of the subjects wore the appliances for 6-12 hours during each 24 hours. The initial dryness severity diminished after wearing the lubricating prosthesis. The patients preferred to wear the appliance at night. CONCLUSION: All criteria were fulfilled on designing a saliva substitute lubricating appliance and some of the subjects have worn this prosthesis successfully for up to 3 years. Particular benefit was obtained by night-time wear.

The purpose of this investigation was to evaluate whether the condition of the oral mucous membrane and the mouth comfort of the elderly could improve using a mucin-containing saliva substitute. In total, 52 patients were examined before and after a 60-day treatment period, with mucin-containing saliva substitute given three times a day before meals. The patients were examined with regard to weight, oral mucosa condition, the duration of meals, eating and swallowing. Before the treatment period the prevalence of stomatitis was 90.4% and oral candidosis was 80.8% compared to 15.4% and 5.8% respectively after the treatment period. The pH increased significantly. Artificial mucin-containing saliva substitute seems to be an adequate treatment of stomatitis and oral candidosis in elderly patients.

The lubrication regime displayed by human salivas (parotid and submandibular-sublingual), purified salivary molecules (the mucins MG1 and MG2 and alpha-amylases), and selected artificial salivas (Oracare D, Saliva Substitute, and Orthana) was assessed in vitro using a friction-testing device. Thin-film (boundary) lubrication was observed for all of the salivary samples and two of the artificial salivas examined. Oracare D, a glycerol-based artificial saliva, was the exception since it lubricated by a thick-film (hydrodynamic) regime. On a molar basis, the best lubricants of the purified salivary molecules were MG1 greater than MG2 approximately nonglycosylated alpha-amylases approximately glycosylated alpha-amylases.

Dentures that included a reservoir for saliva substitute in the palate of the maxillary denture were constructed for three xerostomic patients. Results were obtained through examinations and interviews. All patients found that the reservoir system helped control the xerostomia. Details of design and function were reviewed and general applications were discussed.

The objective of this study was to determine the magnitude of frictional force changes between several sizes of stainless steel orthodontic wires (0.018 inch round, 0.020 inch round, and 0.018 × 0.025 inch rectangular) and an edgewise bracket (0.022 × 0.028 inch slot) when an artificial saliva medium was introduced. The wires were secured in the bracket slots with a 0.010 inch polyurethane ligatures. The force values in the saliva substitute medium were compared with those produced in a dry control and in glycerin. Clinically significant differences among the environmental conditions and among the wire sizes were found. The introduction of saliva substitute provides a significant reduction in force values.

The efficacy of a mucin-coniaining saliva substitute was assessed in terms of changes in oral functioning and the psychic and social implications of these changes. Thirty-nine patients with xerostomia filled out a questionnaire before application of the artificial saliva and after six weeks of usage. The artificial saliva was applied with a spray. From this study it was concluded that: (1) the application of the mucin-containing saliva substitute reduced the sensation of a dry mouth and improved oral functions such as chewing, swallowing and speech (also less nocturnal oral discomfort was observed); (2) the subjects felt better about oral functioning using the saliva substitute; (3) patients using the mucin-containing saliva substitute felt less restricted in their social activities (e.g. communication).

Dry mouth is common in elderly patients. However, the use of saliva substitute has been limited due to its inedibility. This study investigated the efficacy of oral moisturizing jelly (OMJ), a novel edible saliva substitute. A pre-post design was conducted in 118 elderly patients diagnosed with hypertension and/or diabetes mellitus. After using OMJ, signs and symptoms of dry mouth were compared with baseline data. The properties of saliva were compared between the OMJ use and non-use periods. The use of OMJ for 2 weeks significantly reduced symptoms of dry mouth, while the use for 1 month reduced the signs of xerostomia, prevented the decline of salivary pH(s) and improved buffering capacities. OMJ was equally effective in patients taking 1 to 2 and 3 to 7 medications. Furthermore, 65% of patients preferred OMJ over a commercial product. OMJ could be new edible saliva substitute for elderly patients suffering from dry mouth.Clinicaltrials.gov ID: NCT02317172.

An isotachophoretic method is presented for the analysis of the glycoprotein mucin as raw material. The assay is also used for the mucin assay in the saliva substitute Saliva Orthana®.