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Purpose Symptoms of oral chronic graft-versus-host-disease (cGVHD) may significantly affect the oral health–related quality of life (OHRQoL). This study aimed to assess the OHRQoL in patients with oral cGVHD and to examine whether oral cGVHD symptoms, mucosal cGVHD, and salivary gland function correlated with OHRQoL. Methods Patients referred to the oral cGVHD outpatient clinic were included. Severity of oral mucosal cGVHD, oral cGVHD symptoms, and OHRQoL was assessed by the NIH OMS, NIH OSS, and OHIP-14, respectively. Unstimulated and stimulated whole salivary flow rates were determined and categorized into “hyposalivation,” “normal salivary flow,” and “hypersalivation.” Results Of 56 included patients, 80% had mild, moderate, or severe oral mucosal cGVHD. Mean total score of OHRQoL was 16.5 (±11.7), negatively affected by functional problems. Patients reported highest scores regarding oral sensitivity and xerostomia. Significant correlations were found between severity of oral pain and OHRQoL and between oral sensitivity and OHRQoL. No correlation was found between oral mucosal cGVHD and OHRQoL. Patients with hyposalivation, normal salivary flow, and hypersalivation reported equal levels of OHRQoL. Conclusion Results demonstrate that the OHRQoL was mostly negatively affected by complaints of oral pain and oral sensitivity and less by the severity of oral mucosal cGVHD assessed by the NIH OMS score. Special attention of (oral) health care professionals for patients with oral cGVHD is mandatory to alleviate their symptoms and improve OHRQoL.

Background: Dental caries may cause discomfort and pain when chewing food, which in turn leads to insufficient absorption of nutrients, including iron, by the body. Lack of iron intake can cause iron-deficiency anaemia. Iron deficiency may also decrease salivary secretion and buffer capacity due to reduced salivary gland function, which may lead to dental caries. Purpose: This study aims to analyse the correlation between dental caries and serum iron (Fe) levels in the students of Mamba’ul Khoiriyati Islamiyah (MHI) Madrasa Aliyah in Bangsalsari Jember. Methods: Out of 71 students aged 15-18 years, 24 students were examined for caries with the DMF-T index and blood samples were also collected using the phlebotomy technique to assess the serum iron (Fe) level in µg/dL. The data were analysed using the Spearman’s correlation test ( α = 0.05). Results: The average DMF-T score was high (7 ± 3.4) and the average serum iron (Fe) level was below normal (38 ± 11.5 µg/dL). The Spearman’s correlation test for dental caries and serum iron (Fe) levels showed significant results (p

Radiotherapy remains a mainstay of cancer treatment, being used in roughly 50% of patients. The precision with which the radiation dose can be delivered is rapidly improving. This precision allows the more accurate targeting of radiation dose to the tumor and reduces the amount of surrounding normal tissue exposed. Although this often reduces the unwanted side effects of radiotherapy, we still need to further improve patients’ quality of life and to escalate radiation doses to tumors when necessary. High‐precision radiotherapy forces one to choose which organ or functional organ substructures should be spared. To be able to make such choices, we urgently need to better understand the molecular and physiological mechanisms of normal tissue responses to radiotherapy. Currently, oversimplified approaches using constraints on mean doses, and irradiated volumes of normal tissues are used to plan treatments with minimized risk of radiation side effects. In this review, we discuss the responses of three different normal tissues to radiotherapy: the salivary glands, cardiopulmonary system, and brain. We show that although they may share very similar local cellular processes, they respond very differently through organ‐specific, nonlocal mechanisms. We also discuss how a better knowledge of these mechanisms can be used to treat or to prevent the effects of radiotherapy on normal tissue and to optimize radiotherapy delivery., Here, we discuss the complexity of radiotherapy‐induced side effects and approaches for prevention or treatment. Radiation damage develops at a cellular level, progresses to intercellular interactions resulting in intra‐ and interorgan functional responses. These need different approaches for prevention or treatment, for instance intracellular signaling modification, sparing of specific stem cell‐containing areas or contributing organs, and stem cell therapies.

A considerable number of patients arriving in dental offices are being treated with ongoing medication for a variety of chronic diseases. As a result, dentists must be familiar with the potential side effects these therapeutic agents may have on the tissues of the oral cavity, and in particular on the salivary gland. Salivary gland function may be altered by a wide range of medications, leading to effects such as xerostomia, hyposalivation, hypersalivation or even swelling of the glands. These disorders can cause a variety of other health complications. This review will focus on the most common groups of drugs responsible for salivary gland dysfunction, including psychoactive drugs, antidepressants, antipsychotics, antihypertensives, and antihistamines.

Radioiodine (131 I, RAI) has traditionally been used in thyroid cancer treatment but its benefit should be balanced against possible risks. Among them, salivary gland dysfunction has often been discussed, although the reported data have been inconsistent. The aim of our prospective study was to evaluate salivary gland function in 31 thyroidectomised patients (6 men, 25 women; median age 52 yr) before and 4-6 months after RAI remnant ablation (RRA), using activity of 3.7 GBq 131 I-NaI. Salivary gland uptake and excretion fractions were quantitatively assessed with 99m Tc - pertechnetate salivary gland scintigraphy. Pre- and post-treatment values were compared using Wilcoxon signed rank test. No statistically significant difference in the pre- and post-treatment values was observed in parotid or submandibular glands uptake, or in the parotid or submandibular excretion fractions. The calculated power for minimum relevant difference of 25% with the sample size of 31 ranged between 86% and 96% for the individual variables, making our negative results reasonably reliable. The results suggest that RRA with the most commonly used activity of 3.7 GBq has no important impact on salivary gland function. Therefore, the concerns about putative salivary gland functional deterioration following RRA are probably unjustified.

Primary Sjögren's syndrome (pSS) is a chronic, systemic autoimmune disease. It is the second most common rheumatic autoimmune disorder, affecting 0.7% of European Americans and up to 1% of people globally. pSS is characterized by the impaired secretory function of exocrine glands, including salivary and lachrymal glands. A lymphocytic infiltration of these organs leads to the common and debilitating symptoms of oral and ocular dryness, majorly affecting the quality of life of these patients. Currently, no disease-modifying drug has been approved for the treatment of pSS, with therapies largely aimed at relieving symptoms of dry mouth and dry eyes. In particular, management of oral dryness still represents a major unmet clinical need in pSS and a significant burden for patients with this condition. Recently, several randomized clinical trials in pSS with biological therapies targeting specific mechanistic pathways implicated in the disease pathogenesis, including B-cell hyperactivity, T-cell co-stimulation and the aberrant role of cytokines, have been completed with mixed results. In this review, we summarize evidence from recent clinical trials investigating biological therapy in pSS, specifically highlighting efficacy, or lack thereof, in modulating local inflammation and improving salivary gland function.

Salivary diagnosis is an increasingly important field in dentistry, physiology, internal medicine, endocrinology, pediatrics, immunology, clinical pathology, forensic medicine, psychology, and sports medicine. A growing number of drugs, hormones, and antibodies can be reliably monitored in saliva, which is an easily obtainable, non-invasive diagnostic medium It has become apparent that many systemic diseases affect salivary gland function and salivary composition. Studies of the effects of systemic diseases on salivary variables have been valuable in understanding the pathogenesis of the diseases, but their use as diagnostic markers has been limited. This article aims to review the point in the literature role of salivary biomarkers in systemic diseases.

Dry mouth, caused by decreased salivary gland function and/or weak salivary stimulation, can severely affect oral health in older individuals. Therefore, the aim of this study is to evaluate whether a lip trainer device and sonic toothbrush can improve salivary flow and oral wetness in older patients complaining of dry mouth. Overall, 39 subjects aged ≥60 years who had at least 20 natural teeth were randomly assigned to use a lip trainer device (group P, n = 13) or a sonic toothbrush (group S, n = 13). The subjects who did not experience oral dryness were included as controls (group C; n = 13). The unstimulated and stimulated salivary flow rates and oral wetness were measured at baseline, 1 and 6 months. The unstimulated salivary flow significantly increased in both groups at 1 and 6 months (P < 0.05). The stimulated salivary flow was also significantly increased in group P (P < 0.01) compared with the level at baseline. However, no significant difference was observed over time in group S. Oral wetness of the tongue and buccal mucosa in group P had significantly improved at 1 and 6 months (P < 0.05). Dry mouth in older individuals may be improved by using a lip trainer device or a sonic toothbrush.

Saliva plays an important role in supporting upper gastrointestinal tract function and oral well-being. Salivary dysfunction mainly manifests with a decrease in salivary flow. Among varieties of quantitative methods, salivary scintigraphy is a relatively noninvasive, well-tolerated, reproducible, and objective approach for functional evaluation of salivary disorders, yet the lack of precise quantitative reference values and no standardized protocol limit its generalized utilization. In this article, we review the scintigraphic performance between the visual analysis and quantitative methods in predicting Sjögren’s syndrome and verify the potential aspects of the application in interpreting different disease entities and phases of functional salivary disorders.

Background. Previous studies have shown that environmental cadmium exposure could disrupt salivary gland function and is associated with dental caries and reduced bone density. Therefore, this cross-sectional study attempted to determine whether tooth decay with tooth loss following cadmium exposure is associated with some dental or skeletal traits such as malocclusions, sagittal skeletal pattern, and tooth decay. Methods. Between August 2019 and June 2020, 60 orthodontic patients with no history of previous orthodontics, functional appliances, or surgical treatment were examined. The patients were stratified into two groups according to their urine cadmium concentrations: high (&gt, 1.06 µg/g creatinine, n = 28) or low (&lt, 1.06 µg/g creatinine, n = 32). Results. The patients were 25.07 ± 4.33 years old, and most were female (female/male: 51/9 or 85%). The skeletal relationship was mainly Class I (48.3%), followed by Class II (35.0%) and Class III (16.7%). Class I molar relationships were found in 46.7% of these patients, Class II molar relationships were found in 15%, and Class III molar relationships were found in 38.3%. The mean decayed, missing, and filled surface (DMFS) score was 8.05 ± 5.54, including 2.03 ± 3.11 for the decayed index, 0.58 ± 1.17 for the missing index, and 5.52 ± 3.92 for the filled index. The mean index of complexity outcome and need (ICON) score was 53.35 ± 9.01. The facial patterns of these patients were within the average low margin (26.65 ± 5.53 for Frankfort–mandibular plane angle (FMA)). There were no significant differences in the above-mentioned dental indices between patients with high urine cadmium concentrations and those with low urine cadmium concentrations. Patients were further stratified into low (&lt, 27, n = 34), average (27–34, n = 23), and high (&gt, 34, n = 3) FMA groups. There were no statistically significant differences in the urine cadmium concentration among the three groups. Nevertheless, a marginally significant p-value of 0.05 for urine cadmium concentration was noted between patients with low FMA and patients with high FMA. Conclusion. This analysis found no association between environmental cadmium exposure and dental indices in our orthodontic patients.

Background: Alcohol consumption not only affects the general health yet in addition the dental and gingivalhealth of a person. Heavy drinkers are at high danger of creating dental caries, gingival health alterationand tooth disintegration. This condition brings about change in the salivary gland function. Alcohol abusewith smoking have diverse effects on oral health. This study presented to evaluate the effect of alcoholconsumption severity on oral health in relation to salivary parameters, smoking and tooth wear in Baghdad,Iraq.Materials and Method: One hundred and twenty 35-40 years old men with alcohol consumption selectedrandomly. Alcohol consumption individuals classified into three groups according to frequency of alcoholconsumption: regular drinker (GA), frequent drinker (GB) and occasion drinker (GC). Each group consistsof 40 individuals. Gingival (GI), calculus (CI) and dental caries (DMFT) indices were utilized to assessdental and gingival health for all individuals. Parameters of saliva including flow rate and pH assessedimmediately. Tooth wear (TW) was estimated according to the presence or absence of dentine. Smokingwas recorded directly from individual. The results of present study was dissected utilizing SPSS version 23.Results: The median is higher in GA than GB and GC with highly significant difference between groups.For PII, median is higher in GC than other groups, but the mean rank is higher in GA than other groups(no significant difference). For both GI and CI, median and mean rank are higher in GA than others withsignificant difference between them. Salivary flow rate and pH means are higher in GC than other groups withhighly significant differences regarding pH. The high percentage of drinker with tooth wear was recorded inGA compared to other groups with significant difference. The median and mean rank are higher in smokingdrinker than non-smoking drinkers with highly significant difference.Conclusion: Dental caries, periodontal diseases, tooth wear and lower salivary pH were more presented inindividuals with more frequent alcohol consumption. Alcohol drinking with smoking increase the occurrenceof dental caries.

Background Excessive inflammatory reactions participate in primary Sjögren’s syndrome (pSS) progression. In addition, biological clock genes have been detected in the salivary glands, which indicates that clock genes regulate the growth and development of the salivary glands as well as the quality and quantity of saliva secretion. Melatonin is an amine hormone secreted by the pineal gland that has many physiological functions, such as regulating immunity and correcting disorder in the biological clock rhythm. The purpose of this study was to clarify the correlation between pSS and the biological clock rhythm and explore the possibility of applying melatonin to treat pSS. Methods Melatonin (10 mg/kg/d or 15 mg/kg/d) or vehicle was administered to NOD/Ltj mice by intraperitoneal injection for 4 weeks. Clock gene expression levels in labial gland biopsy specimens from pSS patients and submandibular gland specimens from mice were measured by Western blotting (WB) and RT-PCR. The salivary flow rate of mice was measured at 12, 14, and 16 weeks. The severity of lymphocyte infiltration in the salivary glands was analysed by haematoxylin and eosin (H&E) staining. Enzyme-linked immunosorbent assay (ELISA) and immunohistochemical staining were used to detect the expression levels of related inflammatory factors in mice. The percentages of Th17, Th2, and Treg cells were analysed by flow cytometry. Results There was a distinct expression profile for clock genes in pSS patients compared with controls. Continuous melatonin administration improved salivary gland function in NOD/Ltj mice, with decreased lymphocyte infiltration in the submandibular glands and reduced related inflammatory factor expression in the serum and salivary glands. Melatonin treatment skewed T cells towards the Treg and Th2 subsets while suppressing Th17 responses. Additionally, melatonin administration regulated clock gene expression in NOD/Ltj mice. Conclusion pSS pathogenesis and progression are correlated with abnormal circadian gene expression. Melatonin improves the hypofunction of the salivary glands and inhibits the inflammatory development of pSS in NOD/Ltj mice. This study provides a theoretical basis and potential approach for the clinical prevention and treatment of pSS.

Permanent damage to the salivary glands and resulting hyposalivation and xerostomia has a substantial impact on patient health, quality of life and healthcare costs. At present patients rely on lifelong treatments that alleviate the symptoms but currently, no long-term restorative solutions exist. Recent advances in adult stem cell enrichment and transplantation, bioengineering and gene transfer have proved successful in rescuing salivary gland function in a number of animal models that reflect human diseases and that result in hyposalivation and xerostomia. By overcoming the limitations of stem cell transplants and better understanding the mechanisms of cellular plasticity in the adult salivary gland, such studies provide encouraging evidence that a regenerative strategy for patients will be available in the near future.

This randomized placebo-controlled trial evaluates the impact of photobiomodulation (PBMT) on the salivary flow and biochemistry of patients with chronic kidney disease (CKD) on hemodialysis. Forty-four patients on hemodialysis self-responded two questionnaires for oral health and salivary gland function perception. The subjects were evaluated for function of salivary glands and randomly allocated to two groups: PBMT group (three irradiations at 808 nm, 100 mW, 142 J/cm2, and 4 J per site); and placebo group. Patients were submitted to non-stimulated and stimulated sialometry and after the treatment at baseline and 14 days. Salivary volume and biochemical of the saliva were analyzed. At baseline, most subjects had self-perception of poor oral health (52.6%) and salivary dysfunction (63.1%). Clinical exam revealed that 47.3% of subjects presented dry mucosa. PBMT promoted increase of the non-stimulated (p = 0.027) and stimulated saliva (p = 0.014) and decrease of urea levels in both non-stimulated (p = 0.0001) and stimulated saliva (p = 0.0001). No alteration was detected in total proteins and calcium analysis. Patients with kidney disease can present alteration in flow, concentrations, and composition of saliva, affecting oral health, but our findings suggest that PBMT is effective to improve hyposalivation and urea levels in saliva of patients with CKD.

The oral cavity is a unique environment; it includes a range of different tissue types that rely on maintenance of a constant environment or homeostasis. The health of the mucosa and teeth relies on maintenance of good salivary function and also integrity of the mucosa. Toxicities associated with cancer treatments presenting in the mouth do not occur in isolation from each other or other systemic toxicities. Oral toxicities broadly include mucosal damage (mucositis), changes in salivary gland function (most notably by causing reduced salivary flow), and also can affect the integrity of bone (osteonecrosis of the jaws). These effects can have additional outcomes which affect quality of life including loss of taste, difficulty swallowing, compromised nutrition, increased dental caries, and oral infections. For most patients, the most debilitating acute toxicity is oral mucositis, and this is the main focus of this chapter. Important chronic toxicities include long-term salivary hypofunction and osteonecrosis of the jaws.

Objective: Salivary flow rate exerts an essential impact on the development and progression of dental erosion. In this work, the experimental dental erosion in non-obese diabetic (NOD) mice with reduced salivary flow rate was induced, and the erosive effect of acidic drinks on their dentition was studied. Material and methods: Three acidic drinks (sports drink, cola light drink and sugar containing cola drink) were given to adult NOD mice (groups: N = 11) as the only drink for 6 weeks. Two control groups were included; wild type and NOD control (groups: N = 9). Experimental and control (water) teeth were dissected out and observed by scanning electron microscopy (SEM). Mandibular first molars were subsequently embedded in Epon, ground transversely, observed again by SEM, and the enamel thickness and tooth height were measured. Results: Mandibular molars were considerably more eroded than maxillary molars. The erosive process started at the top of the cusps and subsequently extended in the cervical, mesio-distal, and pulpal direction. Erosive lesions were evident in increased succession from sports drink, cola light to cola drink exposed mandibular molars, with the lingual tooth height being approximately 23%, 26%, and 37% lower, respectively, compared to the control. The lingual enamel was approximately 48% thinner in sports drink molars and 62% thinner in cola light molars. In cola drink molars, the lingual enamel was totally eroded, and significant erosion of dentine was evident. Conclusion: Reduced salivary flow, together with a high consumption of acidic drinks, results in severe erosion of NOD mice molars.

Objectives Salivary gland hypofunction, known as xerostomia, caused by radiation therapy for head & neck cancer and Sjӧgren's syndrome, causes various problems in oral health, and profoundly reduces quality of life. This review describes our database in the area of oral biology to establish new therapies for patients suffering from xerostomia. Highlight Here we review the recent approaches that have enabled us to better understand the mechanisms of salivary gland development. Furthermore, we highlight proposed approaches intended to recover salivary gland function using both gene and cell-based therapy. Conclusions A thorough understanding of the mechanisms involved in salivary gland is necessary in order to design effective therapies for regeneration of damaged salivary glands.

Background Xerostomia caused by radiation-induced salivary glands injury has a considerable impact on patients’ quality of life. Nowadays, the existed different methods of evaluating xerostomia in clinical practice there are still some disadvantages and limitations. This study used diffusion-weighted magnetic resonance imaging (DW-MRI) with gustatory stimulation to assess salivary glands function after intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC). Methods DW-MRI was performed in 30 NPC patients and swab method was used to calculate rest and stimulated salivary flow rates (SFR). DW sequence at rest and then repeated ten times during stimulation were obtained. Apparent diffusion coefficients (ADCs) maps of three glands were calculated. Patients before and after RT were recorded as xerostomia and non-xerostomia groups separately. Rest and stimulated ADCs, ADCs increase rates (IRs), time to maximum ADCs (Tmax), ADCs change rates (CRs), rest and stimulated SFR, SFR increase rates (IRs) and SFR change rates (CRs) before and after RT were assessed. Results The rest and stimulated ADCs of three glands after RT were higher than those before RT (p p p = 0.019, p = 0.009), stimulated ADCs and stimulated SFR in parotid glands before RT (p = 0.047). The rest ADCs of parotid glands after RT correlated to XQ scores (p = 0.037). Conclusions The salivary glands’ ADCs increased after RT both in rest and stimulated state due to the radiation injury and the ADCs correlated with SFR and XQ scores of evaluating the xerostomia in clinical practice.

Objectives This study aimed to demonstrate the prevalence and risk factors of laryngopharyngeal reflux (LPR) in patients with xerostomia and to investigate the association between salivary function and LPR. Study Design The prevalence of LPR among patients with xerostomia was analyzed and the clinical and salivary gland function were compared between 2 groups; the non-LPR and the LPR groups. Results The prevalence of LPR was 82.2% in patients with xerostomia. The presence of LPR was correlated with the unstimulated or stimulated salivary flow rate (SFR). LPR did not correlate with scintigraphy findings except time to the minimum count of the parotid gland. Low stimulated SFR and unstimulated SFR were recognized as independent risk factors of LPR. A significant correlation was observed between the Reflux Symptom Index and the xerostomia symptoms score. Furthermore, RFS also correlated with unstimulated and stimulated SFR. Conclusions This finding supports that salivary secretory function has an impact on LPR.

Aim: Radioiodine (RAI) improves survival in patients with locally advanced or metastatic differentiated thyroid carcinoma (DTC). Although there has been an ongoing debate on RAI-induced salivary gland damage, published data have been inconsistent. Therefore, the purpose of our study was to compare salivary gland function in intermediate and high risk DTC patients after single or repeated RAI treatment with their age- and sex-matched RAI-naive counterparts. Methods: Uptake and excretion of parotid and submandibular glands were quantitatively evaluated using 99mTc-pertechnetate salivary gland scintigraphy in 23 patients previously treated with RAI. Patients (median 9.25 GBq 131I-NaI; Q1-Q3: 5.55-16.65; range: 5.55-27.5) were divided into subgroups according to previously administered 131I-NaI activity using cut-off values 5.55 GBq and 9.25 GBq. Their salivary gland scintigraphy results were compared with RAI-naive patients using Mann-Whitney test. Results: Compared to RAI-naive patients, parotid glands pertechnetate uptake was significantly lower in those treated with > 9.25 GBq (P=0.034) and parotid glands excretion fraction was already decreased with RAI activities > 5.55 GBq (P=0.031). In submandibular glands, no statistically significant difference in either function was observed even with RAI activity > 9.25 GBq. Conclusion: Our data suggest that RAI therapy using activities ≤ 5.55 GBq does not substantially decrease saliva production. Activities > 5.55 GBq may lead to significant decrease in parotid excretion, and activities > 9.25 GBq also diminish parotid uptake. Surprisingly, submandibular glands, providing majority of seromucinous saliva under basal condition, seem to be unaffected even by RAI activities above 9.25 GBq.

Purpose of the Study: Radioiodine (I-131) is used as an effective noninvasive treatment for thyroid malignancies. Salivary gland is one of the most affected nontarget organs. The present study aims to perform early quantification of salivary gland function after I-131 therapy (RIT) for thyroid cancer considering I-131 down-scatter in the Tc-99m window. Materials and Methods: A total of 20 patients (6 males and 14 females) with differentiated thyroid carcinoma were enrolled in the study. Baseline dynamic salivary scintigraphy was performed in all patients using 185–370 MBq (5–10 mCi) Tc-99m pertechnetate. Posttherapy, salivary scintigraphy was performed 10–25 days after RIT in the range of 1.85–7.4 GBq (50–200 mCi). Time–activity curves obtained from the pre- and posttherapy dynamic salivary scintigraphy were used for semi-quantitative analysis. Uptake ratio (UR), ejection fraction (EF%), and maximum accumulation (MA%) were calculated by drawing regions of interest of individual parotid and submandibular glands over a composite image, after correcting for down-scatter from I-131 in the Tc-99m window. A paired t-test was used for comparison of the parameters obtained. Results: Significant changes were observed in UR and EF% of both parotid and submandibular glands (P < 0.05). No significant changes were found in the value of MA% of left parotid gland and both submandibular glands in the posttherapy scans in comparison to pretherapy scans (P > 0.05). However, significant difference was observed in the MA% of the right parotid gland (P = 0.025). Conclusion: Salivary gland function was found to deteriorate after RIT, with the parotid glands affected more than the submandibular glands.

Sjogren's syndrome is a chronic autoimmune disorder characterized by lymphocytic infiltration, and consequently hypofunction of lacrimal and salivary glands. The loss of salivary function induces oral dryness (xerostomia). This review focuses on methods for determining salivary gland function including clinical signs, salivary flow rate measurements (sialometry), analysis of salivary composition (sialochemistry), histopathological and radiologic examinations, and other recent advanced techniques.

Salivary gland hypofunction, also termed as xerostomia, is caused by radiation therapy for head and neck cancer or Sjogren's syndrome, leading to a detrimental impact on oral health and quality of life. This review describes current studies on salivary gland development and the translational approaches of basic science to treating patients with dysfunction and hypofunction of the salivary gland. Here, we review the most recent studies that have offered better insight into the mechanisms of salivary gland development and regeneration. Furthermore, we highlight proposed approaches with the aim of recovering salivary gland function using both gene- and cell-based therapy. A thorough understanding of the mechanisms involved in salivary gland development is necessary in order to design effective therapies for regeneration and repair of damaged salivary glands.

Background: To investigate the effect of low-level laser therapy to salivary gland function in diabetic patients with hyposalivation. Methods: Twelve diabetic patients were recruited. A 940-nm indium-gallium-arsenide-phosphide low-power semiconductor diode laser was used to stimulate the major salivary glands with an irradiation time of 40 s; this was done three times a week for 2 consecutive weeks. Patients were given questionnaires related to dry mouth symptoms. Salivary flow rates, questionnaire responses as well as MUC7, MUC5B and histatin 5 protein salivary concentrations were assessed at the first and sixth visits after laser therapy as well at the 6-week follow-up visit. Results: The unstimulated salivary flow rate and MUC5B concentration at the follow-up visit significantly increased (p < 0.01). Histatin 5 concentration significantly decreased at the follow-up visit compared with that at the first visit (p < 0.05). The mean dry mouth score revealed a significant decrease in dry mouth symptoms at the sixth visit and follow-up visit compared with those at the first visit (p < 0.001). The positive correlation between dry mouth score and flow rate was the strongest at the sixth visit (rs = 0.549). Conclusions: Low-level laser therapy increased the salivary flow rate and decreased dry mouth symptoms in diabetic patients.

Objective The aim of this study was to bring attention to a rather unnoted side effect of salivary gland surgery-reduced salivary flow. Methods A systematic PubMed, Cochrane Library, LIVIVO, and Embase databases search was performed to identify relevant articles. Results Eight studies matched the inclusion criteria. All studies described an association between salivary gland surgery and reduced salivary flow. In five of the eight studies, patients reported on xerostomia after salivary gland surgery. Conclusions Head and neck surgeons should inform their patients more accurately about reduced salivary flow and possible xerostomia after salivary gland surgery, and focus more on conservative strategies and minimally invasive techniques. Laryngoscope, 129:2053-2058, 2019.

Background The purpose of this study was to determine whether sialendoscopy could ameliorate radioactive iodine-induced obstructive sialadenitis and restore the salivary gland dysfunction in recalcitrant radioactive iodine sialadenitis. Methods Ten patients with 15 parotid glands of chronic radioactive iodine sialadenitis who did not respond to medical treatment were enrolled in this prospective study. We assessed subjective symptom scores and evaluated the objective salivary gland functions before and 3 months after sialendoscopy. Results The post-sialendoscopic obstructive symptoms were significantly improved relative to pre-sialendoscopy (p = .009). Xerostomia-related symptom scores post-sialendoscopy did not differ significantly from the pre-sialendoscopy scores. Stimulated salivary flow rate post-sialendoscopy tended to increase relative to pre-sialendoscopy. No pre-sialendoscopic parameters associated with salivary uptake and secretion by salivary gland scintigraphy were significantly improved post-sialendoscopy. Conclusion These results show that sialendoscopy can improve obstructive symptoms; however, it seems to have some limitations for relief of xerostomia and improvement of salivary gland dysfunctions in recalcitrant chronic radioactive iodine sialadenitis. © 2015 Wiley Periodicals, Inc. Head Neck 38: 51–58, 2016

Objective To investigate the value of diffusion-weighted magnetic resonance imaging (DW-MRI) as a noninvasive tool to assess salivary gland function for follow-up of patients with radiation-induced xerostomia. Materials and Methods This study included 23 patients with nasopharyngeal carcinoma who had been treated with parotid-sparing radiotherapy (RT). Salivary function was assessed by DW-MRI pre-treatment and one week and one year post-RT, respectively. The maximum apparent diffusion coefficient (ADC) of parotid glands (pADCmax) and the time to peak ADC of parotid glands (pTmax) during stimulation were obtained. Multivariate analysis was used to analyze factors correlated with the severity of radiation-induced xerostomia. Results The ADCs of parotid and submandibular glands (1.26 ± 0.10 × 10-3 mm2/s and 1.32 ± 0.07 × 10-3 mm2/s pre-RT, respectively) both showed an increase in all patients at one week post-RT (1.75 ± 0.16 × 10-3 mm2/s, p < 0.001 and 1.70 ± 0.16 × 10-3 mm2/s, p < 0.001, respectively), followed by a decrease in parotid glands at one year post-RT(1.57 ± 0.15 × 10-3 mm2/s, p < 0.001) but not in submandibular glands (1.69 ± 0.18 × 10-3 mm2/s, p = 0.581). An improvement in xerostomia was found in 13 patients at one year post-RT. Multivariate analysis revealed 4 significant predictors for the improvement of xerostomia, including dose to parotid glands (p = 0.009, odds ratio [OR] = 0.639), the ADC of submandibular glands (p = 0.013, OR = 3.295), pADCmax (p = 0.024, OR = 0.474), and pTmax (p = 0.017, OR = 0.729) at one week post-RT. Conclusion The ADC value is a sensitive indicator for salivary gland dysfunction. DW-MRI is potentially useful for noninvasively predicting the severity of radiation-induced xerostomia.

In order to evaluate autoantibody to SP-1 as an early biomarker in pSS, we investigated autoantibody to SP-1 in Chinese patients with primary Sjogren's syndrome (pSS). Autoantibodies to SP-1 are significantly increased in pSS patients compared to RA patients, SLE patients, and healthy people without secondary SS. The presence of anti SP-1 antibodies was negatively correlated with the focus score (FS), RF, and salivary gland function. It was positively correlated with FS=0, RF≤20, and normal salivary gland function. In further studies, the autoantigen SP-1 was identified in ductal epithelia of salivary glands in il14α TG mice by IIF. SP-1 mRNAs expression increased with growing age in il14α TG mice. SP-1 mRNA was also identified in labial biopsies of patients with pSS. In conclusion, autoantibody to SP-1 is an early marker in pSS. It is useful to diagnose pSS patients who lack RF or antibodies to Ro/La.

Objective This study examined the application of a simple screening test for salivary gland function by measuring resting and stimulated submandibular and sublingual secretions. Study Design An assay system was designed to use filter paper incorporating the chromophore of melanoidin or stimuli such as capsaicin and citric acid. We investigated the relationship between resting and stimulated secretions and melanoidin migration at 2 minutes for healthy and dry mouth groups. Results The healthy group showed a significant increase in the migration of melanoidin in the paper after citric acid or capsaicin stimulation. In contrast, patients with Sjogren syndrome showed no significant migration in spite of the stimulation. However, some participants with Sjogren syndrome or dry mouth showed a significant increase in the migration of melanoidin after stimulation. Conclusions These results show that the newly developed method should be useful for evaluation of residual salivary gland function and screening for hyposalivation with dry mouth.

Salivary gland scintigraphy (SGS) is a noninvasive, simple and reproducible technique for the functional evaluation of salivary gland involvement in patients with Sjögren’s syndrome. Using Labview environment (National Instruments, Austin, Texas) we have developed a software tool for the automatic calculation of most commonly investigated salivary and oral indices derived from salivary time-activity curves. We have shown examples that illustrate the application of the software. Our software enables the comparison of findings among several research centers with the aim of standardizing a processing protocol, defining the reference values of quantitative indices and introducing new salivary indices.