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This work was funded by the Ministry of Higher Education and Scientific Research in Iraq, in partial fulfilment of the requirements for a PhD degree., Objectives: Patients with primary Sjogren's syndrome (pSS) often report smell and taste disturbances. However, the correlation between smell impairment and mucosal dryness is not well understood. The objectives of this study were to investigate the following: (1) the prevalence of smell hypofunction in patients with SS; (2) the impact of smell hypofunction on their quality of life (QoL); (3) whether the patients' smell is correlated with xerostomia; and (4) whether the patients' smell is affected by taste hypofunction, disease duration, age, smoking or self-reported neuropathy. Methodology: An ethically approved cross-sectional study was conducted on 65 female patients with SS and 62 sex-matched healthy controls. Their smell was assessed using the University of Pennsylvania Smell Identification Test. Their taste acuity was assessed using the Taste Strips Test. A visual analogue scale was used for the self-assessment of smell and taste functions. Xerostomia was assessed by the salivary flow rate, clinical oral dryness score and the Xerostomia Inventory. The patients' QoL and mental health well-being were assessed using validated questionnaires. Results: In the SS group, the patients' smell function was impaired in 27/65 patients compared with the controls (15/62, p < 0.05), and it did not correlate with the severity of xerostomia, taste acuity (r = 0.05, p = 0.6) or self-reported nasal dryness (r = -0.02, p = 0.7). In the patients' group, smell hypofunction was not correlated with disease duration (beta = 0.1, 95% CI = -0.07-0.1) or smoking (beta = -0.02, 95% CI = -8-7). Age was not correlated with the smell function in the patients' group (beta = 0.1, p = 0.5) but was correlated significantly with smell in the healthy participants' group (beta = -0.3, p = 0.02). Neuropathy affected 81.2% of the patients' group. Their QoL and mental health well-being were not affected by smell hypofunction. Conclusion: Smell hypofunction appears to be a clinical manifestation in patients with SS, but it does not seem to be associated with the severity of mucosal dryness or with taste disturbance., Ministry of Higher Education and Scientific Research in Iraq

Contexte et objectif: La préservation de la qualité de vie après un traitement anticancéreux est un défi majeur pour les survivantes du cancer du sein. Environ 42 à 70 % des patients qui reçoivent une thérapie systémique pour le cancer du sein, y compris une thérapie endocrinienne, développeront une atrophie vulvo-vaginale (AVV). Pour ces patientes, les traitements à base de gel couramment proposés pour les applications topiques sont restrictifs. Récemment, des approches thérapeutiques innovantes et non hormonales, telles que la thérapie laser, ont fait leur apparition. L'objectif de cette étude de faisabilité est d’étudier la sécurité et l'efficacité de la thérapie au laser CO2 chez les femmes ayant des antécédents de cancer du sein. Matériel et méthodes: Cette étude monocentrique prospective a porté sur 20 patientes atteintes d'AVV qui ont été traitées à l'hôpital universitaire Henri Mondor entre 2017 et 2018. Nous avons inclus des patientes ayant un indice de santé vaginale (IHV) < 15 et une contre-indication à l'administration d'hormones en raison d'antécédents de cancer du sein. Deux séances de laser au dioxyde de carbone ont été utilisées. Le traitement a été administré selon les paramètres suivants : programme « vaginal Tight », FinePulse (pulse largeur de 0,9 ms) et densité énergétique de 11,5 J/cm2 qui permet de couvrir 70 % de la zone vaginale ciblée à traiter. Toutes les patientes ont eu leur visite de suivi à un (M1), trois (M3) et six (M6) mois après le premier traitement pour évaluer l'efficacité du traitement sur l'atrophie vulvo-vaginale. Le score d'indice de santé vaginale et le score de détresse sexuelle féminine (FSD) ont été utilisés pour évaluer l'efficacité du traitement et son impact sur la qualité de vie sexuelle. Un score ≥ 11 a été associé à un dysfonctionnement sexuel. Les scores d'indice de santé vaginale et FSD ont été évalués avant traitement et mois1 M1, M3 et M6 du suivi. Résultats: L’âge moyen des patientes était de 56,1 ± 8,8 ans (min–max, 27–69 ans). Dix-sept des 20 patientes avaient déjà été ménopausées (âge moyen de la ménopause, 51,25 ± 1,5 ans). Au moment de l'inclusion, les scores moyens du score d'indice de santé vaginale et du FSD étaient respectivement de 10,58 ± 1,71 et 21,36 ± 15,10. Quatorze patientes sur 20 (70 %) avaient un score de détresse sexuelle féminine ≥ 11 au départ. À M1, le score d'indice de santé vaginale moyen a augmenté de manière significative pour atteindre 13,42 ± 2,3 (p = 0,03), ce qui représente une amélioration de 21 % par rapport au niveau de référence. Une amélioration persistante et significative du score d'indice de santé vaginale a été observée à M6, le score passant à 16,75 ± 4,23 après le traitement (p < 0,0001), ce qui représente une amélioration de 34 % par rapport au score moyen de départ. La moyenne su score FSD à M1 était de 19,83 ± 13,57, ce qui représente une diminution de 7 % par rapport aux scores de base (p < 0,01). À M3, le score de détresse sexuelle féminine a diminué de manière significative pour atteindre 13,88 ± 15,58, ce qui représente une amélioration de 35 % (p = 0,006). Il a augmenté à 10,35 ± 14,7 à M6, ce qui représente une amélioration de 52 % (p = 0,001). À M3, 35 % des patients avaient un score de détresse sexuelle féminine > 11, et à M6, seuls 15 % avaient un score de détresse sexuelle féminine > 11. Aucun effet secondaire n'a été signalé lors du suivi. Conclusion: Cette étude de faisabilité pilote a montré que le traitement par laser au dioxyde de carbone semble être une méthode efficace et sûre pour améliorer la trophicité et diminuer la sécheresse de la muqueuse vaginale chez les femmes atteintes d'atrophie vulvo-vaginale qui s'est développée après un traitement systémique du cancer du sein.

BACKGROUND The aim of this pilot study was the evaluation of primary, idiopathic mucosal dryness (xerostomia or dry mouth) in subjects without cancer. METHODS A group of non-diabetic subjects and a group of diabetics were managed with standard management (SM) or with SM+Pycnogenol® (150 mg/day) for 2 weeks. RESULTS In total, 48 subjects were included in the study; 24 diabetics and 24 non-diabetics. 12 diabetics and 12 non-diabetics took Pycnogenol® and 12 diabetics and 12 non-diabetics were followed up with standard management only and served as controls. No side effects and no tolerability problems were observed with Pycnogenol®. The registry groups were comparable for characteristics and symptoms at baseline. All otherwise healthy subjects had a BMI

WOS: 000391843800003, PubMed ID: 27991839, Objectives: The aim of this study was to reveal the frequency, presenting complaints, risk factors, complications, and ways for prevention of hypernatremic dehydration (HD) among term breastfed infants. Methods: The files of 159 breastfed term infants hospitalized because of HD between the years 2009 and 2014 were examined retrospectively in the Neonatal Intensive Care Unit of Sivas State Hospital, Turkey. The patients were classified according to serum sodium (Na) levels, group 1 (Na: 146-149 mEq/L, n = 68) and group 2 (Na >= 150 mEq/L, n = 91). Results: The most common complaint was fever (67.9%), and the most common physical finding was oral mucosal dryness (76%). There were positive correlations between serum Na levels and weight loss, hospital stay, admission age, admission to neonatal unit after discharge, serum urea levels, and body temperature (p < 0.05). The normalization period of Na levels was significantly longer (21.7 +/- 8.8 versus 29.3 +/- 17.8 hours, p = 0.03), and Na reduction rate was faster in group 2 (0.41 +/- 0.3 versus 0.50 +/- 0.3 mEq/L/hour, p = 0.02). Bradycardia was seen more commonly in group 2 (1.5% versus 16.5%, p = 0.002). Conclusions: HD is a significant condition that should be treated appropriately to avoid serious complications.

This article presents 2 cases of different neuropathic trigeminal pain conditions treated with intraoral botulinum toxin injections. There is a growing body of evidence to support the use of this substance when administered subcutaneously in the treatment of neuropathic pain, such as in extraoral injections for trigeminal neuralgia. However, reports of intraoral submucosal administration are still lacking. In the 2 cases presented here, neuropathic pain was refractory to treatment with an important intraoral peripheral component, so onabotulinum toxin A was introduced as an adjuvant therapy. The technique, doses, and dilution are discussed. The patients reported significant reductions in pain frequency and intensity, with minimal side effects of temporary mucosal dryness and smile droopiness. The analgesic benefits of botulinum toxin may be utilized to address intraoral neuropathic pain. Further studies are needed to confirm safety and effectiveness in larger samples.

Dry eye and dry mouth symptoms are each reported by up to 30% of persons more than 65 years of age, particularly in women. Medication side effects are the most common contributing factors. The evaluation of these symptoms requires measures of ocular and oral dryness. Sjogren syndrome is the prototypical disease associated with dryness of the eyes and mouth and predominantly affects women in their perimenopausal and postmenopausal years. In addition to topical treatment of the mucosal dryness, patients with Sjogren syndrome may require treatment with systemic immunomodulatory and immunosuppressive agents to manage a variety of extraglandular manifestations.

This study included 30 patients (17 males and 13 females; mean age, 73.7 ± 13.1 years) who were diagnosed with dehydration based on vital signs, skin symptoms, and blood test findings by emergency medicine physicians. First, the attending physician of our department measured oral mucosal dryness. Subsequently, the emergency medicine physician blindly divided the severity of dehydration into three stages according to clinical findings and blood test results. In this study, the oral moisture‐checking device (Mucus®; Life Co., Ltd., Saitama, Japan) was used to measure the oral mucosal dryness. We examined the oral moisture level for each dehydration severity level and the correlations of each severity level of dehydration with the measured values. Spearman's correlation coefficient (Medcalc version 11.3 for Windows) was used for statistical analysis. P

Vaginal Penetration Disorders (VPD) consist a major sexual disorder that has a significant impression on young ladies and couple’s relationships and also consist of a predisposing factor for anxiety disorders. All existing treatments of vaginismus are still a big challenge and often without success. Before performing PRP patients were referred to the gynaecologist, urologist or psychologist. Almost in every case after several attempts to be treated, they were disappointed with the results. Often, they have admitted to accept their problem and keep suffering because no physician could offer any effective help with significant results. We are reporting in this article a serie of ten cases where the Platelet Rich Plasma (PRP) treatment was tried based on their voluntary participation due to particular and relative sexual problems. Based on the results that are exposed here, we can say that PRP clearly has a positive effect not only on rejuvenation of the female genital structurebut also on improving VPD symptoms. It reduces pain, reduces mucosal dryness and chronic fissuration. The duration of the effect on the vaginal structure as well as clinical improvements requires more case studying and research. These patients will be evaluated for the coming 2 years to acquire more data to be analyzed in order to complete our observational study. It is nothing but the beginning of a new era in the sexual dysfunction therapy.

espanolEl sindrome de Sjogren (SS) es una enfermedad autoinmune, cronica e inflamatoria caracterizada por infiltracion de celulas plasmaticas y linfocitos en las glandulas exocrinas, particularmente en las salivales y oculares. La patogenesis del SS esta relacionada con factores inmunologicos, neurologicos, geneticos, virales y hormonales. La deficiente calidad y cantidad de saliva trae consecuencias devastadoras para la salud dental y bucal, alteraciones del esmalte, caries en las superficies dentarias expuestas, principalmente cervicales, fallas en la adhesion de los materiales obturadores, queratosis en las mucosas, sindrome de boca urente y disconfort en el uso de protesis dentarias, a pesar de un manejo exhaustivo del medio bucal. Un diagnostico tardio del SS conlleva a graves consecuencias fisicas, sicologicas y economicas en estos pacientes. Su diagnostico y tratamiento son de gran interes para el odontologo. La experiencia clinica senala que aquellas piezas dentarias restauradas con protesis fijas tienen mayor sobrevida y la rehabilitacion con protesis implantosoportadas brindaria un mayor confort para los pacientes. La clinica odontologica debe tener un enfoque integral del dano y la forma de tratamiento debe considerarlos como pacientes de muy alto riesgo de caries basados en CAMBRA (Caries management by risk assesement). El manejo eficaz de la salud oral en estos pacientes comprende la mejora de la produccion salival, preservacion de mucosas orales y la evaluacion periodica del estado bucal. Se propone un protocolo de atencion odontologica integral que consta de tres fases: 1) Fase inicial, paliativa y preventiva; 2) Fase restauradora y rehabilitadora, y 3) Fase de mantenimiento. EnglishSjogren´s syndrome (SS) is an autoimmune, chronic and inflammatory disease characterized by infiltration of plasma cells and lymphocytes in the exocrine glands. The pathogenesis of SS is related to immune, neurological, genetic, viral and hormonal factors. Complications are related to glandular destruction and mucosal dryness. The poor quality and quantity of saliva brings devastating consequences to dental and oral health. Alterations in the enamel structure, constant presence of caries in tooth surfaces exposed, mainly cervical, failures in the adhesion of filling materials, keratoses on the mucous membranes, burning mouth syndrome and discomfort in the use of dentures, despite the exhaustive management of the oral environment, are described. A late diagnosis of SS leads to serious physical, psychological and economic consequences in these patients. Its diagnosis and treatment are of great interest to the dentist. Clinical experience indicates that those teeth restored with fixed prostheses have an improved survival and rehabilitation with implant-supported prostheses would provide greater comfort for patients. The dental clinic must have a comprehensive approach to injury and the form of treatment should be considered as patients at high risk of caries based on CAMBRA (Caries management by risk assesement). Effective management of oral health in these patients includes improving the production of saliva, oral mucosal preservation and regular assessment of oral status. A comprehensive dental care protocol consisting of three phases, is proposed: 1) Initial, palliative and preventive phase, 2) Restorative and rehabilitation phase, and 3) Maintenance phase.

Primary Sjogren’s syndrome (pSS) is an autoimmune disease affecting the exocrine glands, resulting in diminished glandular secretion and mucosal dryness. In addition, various non-exocrine organs, i...

Sjögren's syndrome (SS) is a chronic, systemic autoimmune disease that affects typically the exocrine glands causing mucosal dryness. Dry eyes and mouth are considered by far the most common and early symptoms of the disease but systemic complications may also occur. In 1993, the preliminary European criteria were proposed and widely accepted, consisting of both subjective and objective criteria. Almost ten years later, these classification criteria were revised by introducing more stringent rules and precise diagnostic procedures leading to the currently used American-European Consensus Group (AECG) criteria. The AECG criteria have been largely employed to conduct epidemiologic and clinical studies of patients with SS and proved to be more specific compared to the preliminary European criteria. The recent American College of Rheumatology/Sjögren's International Collaborative Clinical Alliance (ACR/SICCA) criteria that are based exclusively on objective tests, the stringency of the AECG criteria and the potential therapeutic use of biologic agents in SS clearly set the need for new classification criteria. Whether the new diagnostic approach will further encompass subclinical and early forms of the disease remains to be addressed by the scientific community.

Dry eye and dry mouth symptoms are each reported by up to 30% of persons over the age of 65 years, particularly in women. Multiple factors contribute to these symptoms, but medication side effects are the most common. The evaluation of these symptoms requires measures of ocular and oral dryness, some of which can be done by the geriatrician in a clinic setting. Sjögren syndrome is the prototypic disease associated with dryness of the eyes and mouth and predominantly affects women in their peri- and postmenopausal years of life. The diagnosis requires substantive evidence of autoimmune-induced inflammation targeting the salivary or lacrimal glands. With current classification criteria, the diagnosis can only be established if the patient has antibodies to the SSA (Ro) and/or SSB (La) antigens or a labial gland biopsy showing a characteristic pattern and severity of inflammation, in concert with at least one measure of ocular or oral dryness. A diagnosis is important, since this disease is associated with a substantial increased risk of lymphoma and other forms of morbidity. In addition to topical treatment of the mucosal dryness, patients with Sjögren's syndrome may require treatment with systemic immunomodulatory and immunosuppressive agents to manage a variety of “extraglandular” manifestations.

An instrument based on friction measurement has been developed to evaluate oral mucosal dryness objectively. The purpose of this study was to compare the friction instrument with instruments measuring in vitro rheologic properties. Measurements were performed against steel and irreversible hydrocolloid after application of different concentrations of aqueous solutions of carboxymethylcellulose and chitosan lactate. The results of the measurements were logical, with inversely proportional values for the friction instrument as compared with values obtained using the instrument measuring rheologic properties; that is, increased viscosity led to decreased friction values.

Objective: Laryngopharyngeal reflux is a common disorder in otolaryngology patients. Some studies have shown that more than 50% of patients with hoarseness have evidence of laryngopharyngeal reflux. Because of mucosal dryness and mucus thickening in reflux laryngitis, we conducted a prospective study to evaluate the effects of N-acetyl cysteine.Method: Between 2009 and 2011, patients with a reflux symptom score of more than 10 were selected and underwent endoscopic examination. Patients were randomly allocated into 3 groups and received either omeprazole, N-acetyl cysteine, or both of them. Patients were followed for 3 months, and examination was repeated after 1 and 3 months.Results: Ninety patients entered the study (30 patients in each group). Forty-five of them were male, and 45 were females. Before treatment the reflux symptom scores were 18 ± 6, 16.3 ± 5, and 19.1 ± 3 for omeprazole, N-acetyl cysteine, and both drugs, respectively. These figures changed to 10.8 ± 4.6, 15.9 ± 5.3, and 7.6 ± 4.3 and s...

The aim of this study was to evaluate an infrared light absorption (ILA) method for registration of dryness of the oral mucosa. Measurements were performed in the buccal and in the lip mucosa immediately before and every 30 min after submucosal injection of 1.0 ml methylscopolamine nitrate in nine healthy subjects. For comparison, a dental mirror sliding friction test was used. About 1.5 h after injection the ILA method showed statistically significant (P less than 0.01) decreases of values in both the buccal and the lip mucosa. However, in the individual subjects the deviations from initial values showed only slight agreement when measured with the ILA method and the mirror friction test. Thus, the ILA method does not seem to be suitable for registration of individual variations in oral mucosal dryness.

The hallmark of Sjogren's syndrome is focal lymphocytic infiltration of exocrine glands leading to mucosal dryness, particularly of the eyes and mouth. In addition, approximately 70% of patients report fatigue as a particularly prominent and disabling feature associated with reduced health-related quality of life. Other key patient-reported extraglandular symptoms include arthralgia, myalgia, and Raynaud's phenomenon. This article reviews these patient-reported features, their relationships with objective assessment of the disease, potential therapies for these symptoms, and how measurements of these symptoms are relevant to outcome assessment in clinical therapeutic trials.

Sjorgen's syndrome (SS) is an autoimmune exocrinopathy characterized by lymphocyte infiltration of salivary and lacrimal glands that leads to progressive xerostomia and xerophtalmia. One-third of patients suffer of systemic manifestations including arthritis, fever, fatigue and mucosal dryness whereas those with major salivary involvement show an increased risk to develop low-grade non-Hodgkin lymphomas. We describe a case of a 45-year-old woman, previously misdiagnosed as arthritis. Patient exhibits various symptoms like xerostomia, xerophtalmia, fatigue, mucosal thinning. Accordingly changes in the treatment plan and change in medication were done. Diagnostically antibodies were present in cochlear sample suggesting auto immune disease. This case report outlines a case of diagnosis of Sjorgen's syndrome in the Endodontics department after careful examination and accordingly endodontic treatment plan was altered.

– For the objective measurement of oral mucosal dryness or moisture, a device registering oral mucosal surface slide friction has been developed. Two prototypes, Probe I and Probe II, have been tested. Probe I was constructed for initial testing of the method and was based on easily accessible electrical components. Probe I was computerized and developed for more accurate registration and also for easy handling. Reliability and validity tests were carried out on Probe I as well as on Probe II. In repeated in vitro measurements, the probes showed good reproducibility. Validity was assessed on healthy subjects injected with methylscopolamine nitrate submucosally in the labial sulcus. All subjects experienced a pronounced oral mucosal dryness within half an hour. Registration with the surface slide friction device showed maximum friction values 1-2 h after injection. These reliability and validity tests gave good results for both Probe I and Probe II, but Probe II had several practical advantages over Probe I. Both probes were considerably more sensitive to changes of the oral mucosal surface than the previously used simple friction test using the back of a mouth mirror.

– The aim of this study was to evaluate different electrical methods (resistance, capacitance and polarization resistance) for clinical and objective registration of dryness of the oral mucosa. Measurements were performed in the buccal and in the lip mucosa before and every 30 min after injection of 1.0 ml methylscopolamine nitrate submucosally in the labial sulcus in 10 healthy subjects. For comparison, a dental mirror sliding test was used. About 1 h after injection, all three methods showed statistically significant decreases, of values in the buccal as well as the lip mucosa except for polarization resistance, which showed such a difference only in the buccal mucosa. The deviations from initial values in the individual subject showed no agreement between measurements with the electrical instruments and oral mucosal dryness assessed with the mirror test. Neither was there any agreement between values registered with the three electrical methods. It seems that these electrical methods are not suitable for registration of individual variations in oral mucosal dryness.

Publisher Summary This chapter explains Sjogren's syndrome and the lung. Sjogren's syndrome, an autoimmune epithelitis, is a chronic, slowly progressive inflammatory autoimmune disease, characterized by lymphocytic infiltration of the exocrine glands and epithelia in multiple sites, leading to diminished or absent glandular secretions and to a more or less generalized, mucosal dryness. Sjogren's syndrome presents with a wide spectrum: from lacrimal and salivary exocrinopathy to systemic disease (lungs, liver, kidneys, and other organs or tissues), and, later in the illness and in a small number of patients (≈5%), an associated B-cell lymphoid malignancy. The chapter illustrates that Sjogren's syndrome can occur alone (primary Sjogren's syndrome) or in association with almost all of the other rheumatic autoimmune disorders (secondary Sjogren's syndrome). The co-existing rheumatic disease may be already present at the time of diagnosis of Sjogren's syndrome, or may later become apparent.

Patients with SS often suffer considerable distress due to sicca symptoms and the complications of mucosal dryness. Although there are many topical treatments available, the literature on their use is scant. This paper describes the treatments available and suggests a rationale for the choice of product.