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Xerostomia, commonly referred to as dry mouth, is a medical condition where the flow of saliva in the mouth is reduced or completely absent. Xerostomia is not categorized as a particular disease entity but is a symptom associated with decreased or lack of salivary secretion. Its effects on oral health and overall well-being can be significant and it can be caused by various factors such as medication use, radiation therapy, surgery, salivary gland problems, and other underlying medical conditions. A health-care professional typically diagnoses xerostomia by evaluating a patient's symptoms and conducting a physical clinical exam. The patient's medical and medication history may also be reviewed to identify any potential underlying causes. Decreased salivary secretion can make chewing, breaking up the food and the formation of a food bolus difficult, which increases the risk of incorrect swallowing as well as altered taste and can contribute to the experience of dysphagia. It is crucial for individuals experiencing xerostomia to seek medical attention from a health-care professional to determine the underlying cause and develop a suitable management plan. Xerostomia represents a serious problem with medical and dental implications. The search for related articles was conducted through databases including PubMed, Science Direct, and Google Scholar. This comprehensive review article offers the latest insights into the origins, diagnosis, and treatment of xerostomia, with a particular focus on prevention. In addition, it recognizes the significant impact of innovative approaches in addressing xerostomia and highlights their valuable contribution to its management.

Xerostomia, commonly referred to as dry mouth, is a medical condition where the flow of saliva in the mouth is reduced or completely absent. Xerostomia is not categorized as a particular disease entity but is a symptom associated with decreased or lack of salivary secretion. Its effects on oral health and overall well-being can be significant and it can be caused by various factors such as medication use, radiation therapy, surgery, salivary gland problems, and other underlying medical conditions. A health-care professional typically diagnoses xerostomia by evaluating a patient's symptoms and conducting a physical clinical exam. The patient's medical and medication history may also be reviewed to identify any potential underlying causes. Decreased salivary secretion can make chewing, breaking up the food and the formation of a food bolus difficult, which increases the risk of incorrect swallowing as well as altered taste and can contribute to the experience of dysphagia. It is crucial for individuals experiencing xerostomia to seek medical attention from a health-care professional to determine the underlying cause and develop a suitable management plan. Xerostomia represents a serious problem with medical and dental implications. The search for related articles was conducted through databases including PubMed, Science Direct, and Google Scholar. This comprehensive review article offers the latest insights into the origins, diagnosis, and treatment of xerostomia, with a particular focus on prevention. In addition, it recognizes the significant impact of innovative approaches in addressing xerostomia and highlights their valuable contribution to its management. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the efficacy of a new oral rinse containing sodium hyaluronate and other functional ingredients in reducing xerostomia‐associated symptoms. Materials and Methods: In this 8‐week, double‐blind crossover study, xerostomia subjects used all three of GUM®HYDRAL™ Oral Rinse, placebo rinse, and Biotene® Oral Rinse as active control. Visual Analog Scale, a dry mouth questionnaire, Oral Health Impact Profile‐14, unstimulated saliva flow rate (USFR), and Revised Oral Assessment Guide (ROAG) were assessed before and after 2 weeks of treatments. Results: Thirty‐seven patients completed all three treatment modalities. Subjective measurements were significantly decreased by test product and active control; however, no significant difference was observed between the treatments. Test product and active control demonstrated a significant increase in USFR over 0.2 ml/min, a normal threshold of hyposalivation. Both test product and active control improved a total score of ROAG, whereas the effectiveness of the test product was significantly better than that of other two treatments. Conclusions: The new oral rinse may be beneficial to improve the quality of life of xerostomia patients as dry mouth symptoms were reduced for both subjective and objective measurements. Test oral rinse was found to be more effective than placebo or active control for some of the objective measurements. [ABSTRACT FROM AUTHOR]

Introduction: Salivary substitutes are gaining popularity these days because of the increase in patients with dry mouth. These substitutes must satisfy certain criteria to fulfill the patient's needs. One of these is wettability. Materials and Methods: One hundred fifty rectangular specimens of heat-cured denture base acrylic resin were prepared. A drop of test liquids (human saliva, distilled water, aqwet, saleva, and wet mouth) was placed over the test specimen and right and left contact angles were measured using optical contact angle machine. Results: All test liquids performed better than distilled water. Human saliva has the least contact angle followed by aqwet. Conclusion: Carboxymethyl cellulose base aqwet saliva substitute was found to be best having similar contact angle values to human saliva. [ABSTRACT FROM AUTHOR]

Introduction: Salivary substitutes are gaining popularity these days because of the increase in patients with dry mouth. These substitutes must satisfy certain criteria to fulfill the patient's needs. One of these is wettability. Materials and Methods: One hundred fifty rectangular specimens of heat-cured denture base acrylic resin were prepared. A drop of test liquids (human saliva, distilled water, aqwet, saleva, and wet mouth) was placed over the test specimen and right and left contact angles were measured using optical contact angle machine. Results: All test liquids performed better than distilled water. Human saliva has the least contact angle followed by aqwet. Conclusion: Carboxymethyl cellulose base aqwet saliva substitute was found to be best having similar contact angle values to human saliva.

Purpose: To create and investigate artificial mucin-based saliva substitutes with properties similar to natural saliva.Materials and Methods: Natural saliva and six saliva preparations were tested. Saliva substitutes were made using phosphate buffered saline (PBS) prepared in deionised water or plasma-treated water (PBSPT) with addition of porcine gastric mucin and guar gum or poloxamer 407. A wide range of properties were characterised: physicochemical (changes of pH, conductivity and surface tension over time: 1, 24, 96, 168 h after mixing ingredients), rheological (viscosity and viscoelasticity), tribological (coefficient of friction for titanium alloy Ti-6Al-7Nb kinematic couple) and corrosive (open circuit potential, corrosion potential, polarisation resistance).Results: Saliva preparations based only on mucin had pH, viscosity, coefficient of friction and corrosion parameters similar to those of natural saliva. Guar gum increased the values of viscosity, viscoelasticity and the coefficient of friction. Similar results were obtained for poloxamer 407, whereas it decreased the surface tension of tested preparations. Plasma-treated PBS enhanced the corrosion resistance of saliva substitutes with guar gum and poloxamer 407.Conclusion: Among the tested compositions, saliva substitutes based only on mucin were found to have parameters similar to human whole saliva. Mucin saliva preparations may have wide applicability for patients with e.g. xerostomia or patients using a metal prosthesis. [ABSTRACT FROM AUTHOR]

Objectives: Xerostomia is a prevalent sequelae among nasopharyngeal cancer (NPC) survivors; yet, effective treatment protocols have been elusive. This study was a prospective randomized clinical trial to compare the effects of saliva substitute mouthwash in nasopharyngeal cancer survivors with xerostomia, between two treatment arms, conducted in a tertiary center. Materials and methods: This study measured the effects within 4 weeks in relation to summated xerostomia inventory (SXI) and unstimulated whole saliva (UWS). Patients randomized into the interventional arm were prescribed an immunologically active saliva substitute (IASS), while patients in the control arm were prescribed a non-immunologically active mouthwash as placebo. Results: The study population consisted of 94 patients. There was a significant difference in SXI difference (p < 0.0001) and UWS difference (p < 0.0001) between control and interventional arms. No harmful side effects associated with the use of either mouthwash encountered throughout the study duration. Conclusion: IASS mouthwash significantly reduces subjective xerostomia scores measured using SXI and improves objective measurement of salivary flow using UWS among nasopharyngeal cancer survivors with xerostomia. Clinical relevance: IASS is significantly more effective in improving subjective and objective xerostomia measurements compared to non-immunologically active mouthwash. Additionally, this treatment is very safe, with superior side effect profiles. Trial registration: ClinicalTrials.gov Identifier: NCT04491435 [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to compare the wettability of saliva, a saliva substitute, and distilled water to three denture base materials. Materials and Methods: Thirty specimens of each denture base material: Heat cure polymethylmethacrylate (DPI heat cure), high-impact polymethylmethacrylate (Trevalon HI), and nylon (Valplast) were fabricated. The specimens of each denture base material were divided into three groups of ten specimens. The advancing and receding contact angles of three media: a commercially available carboxymethylcellulose-based saliva substitute (WET MOUTH), human whole saliva, and distilled water, with each denture base material were determined using a goniometer. The contact angle hysteresis was calculated as the difference between the advancing and receding contact angles. The data were statistically analyzed using univariate analysis of variance and Duncan post hoc test. Results: Low-advancing and receding contact angles were demonstrated on high-impact heat-polymerized polymethylmethacrylate denture base material. Highest hysteresis values were calculated for nylon denture base material. Conclusion: Best wettability was demonstrated on high-impact heat-polymerized polymethylmethacrylate denture base material. Based on the high hysteresis values calculated with nylon denture base material, it would possibly provide better denture retention.

Context: An aesthetic restorative material that would be suitable to be used in patients who are prescribed saliva substitute (SS) for symptomatic relief from xerostomia. Aims: This study aimed to evaluate and compare the effect of SS on the color stability of three different direct tooth-colored restorative materials. Settings and Design: This is an in vitro spectrophotometric study where standard uniform disc-shaped specimens were immersed in a SS for 30 days. Materials and Methods: The materials investigated were resin-modified-glass ionomer cement (RM-GIC), light-cured (LC) resin composite restorative material (Filtek™ Z350 XT), and LC fluoride-releasing restorative material (Ketac™ N100). Sixteen disc-shaped samples of each test material were prepared using a polytetrafluoroethylene mold, making up a total of 48 samples and were assigned to three groups: Group I (RM-GIC), Group II (Filtek™ Z350 XT), and Group III (Ketac™ N100). They were further divided into two subgroups A and B with eight samples each based on the immersion solutions namely distilled water (DW) and SS, respectively. The samples were immersed for 30 days. Baseline and postimmersion color analysis was done with a spectrophotometer. The CIE L*a*b* values were measured and CIE ΔE values obtained were tabulated. Statistical Analysis Used: The data obtained were statistically analyzed using ANOVA and independent t-test, and the pair-wise significance between groups was obtained using least significant difference test. P < 0.05 was considered statistically significant. Results: All the samples immersed in SS showed greater discoloration (ΔE >3.3) than the samples immersed in DW and was found to be statistically significant (P < 0.05). Ketac™ N100 displayed relatively lesser discoloration when compared to RM-GIC and Filtek™ Z350 XT when immersed in a SS. Conclusions: Among the materials tested, Ketac™ N100 was found to be more color stable.

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. [ABSTRACT FROM AUTHOR]

Dysphagia is a significant late morbidity following treatment with radiotherapy (RT) for head and neck squamous cell carcinomas (HNSCC). The purpose of this feasibility study was to test a gel-based saliva substitute to reduce the subjective assessment of dysphagia while eating food items varying in size and texture. Eligible study subjects treated with curative intended RT and suffering from dysphagia and xerostomia were recruited from the outpatient clinic during a two-month period. Nineteen subjects consented to participation and completed the EORTC QLQ-H&N35 questionnaire and three test meals. A Numeric Rating Scale (NRS) was used for subjective assessment of dysphagia during all test meals. All data on patient, tumor, and treatment characteristics were obtained from the Danish Head and Neck Cancer (DAHANCA) database. NRS data suggested reduction of dysphagia after application of the oral gel. The swallowing dysfunctions, discomfort while swallowing (p = 0.008), stuck food items (p = 0.02), and multiple attempts of clearing the throat (p = 0.05), improved significantly for soft and regular items. Both small- and large-sized food items were tested. EORTC QLQ-H&N35 showed improvement regarding eating problems (p = 0.03) and social eating (p = 0.02). No episodes of food aspiration were recorded during the test meals. Late dysphagia reduces QOL and is an important morbidity following RT. In this feasibility study, the oral gel was able to reduce dysphagia while eating soft and selected regular food items. Eating-related EORTC QLQ-H&N35 items also improved, indicating a beneficial reduction in dysphagia after application of the oral gel. [ABSTRACT FROM AUTHOR]

Objectives: Remineralization of dentin by mucin-containing saliva substitutes might be inhibited by sialic acids bound to mucin, which are known to complex calcium. Thus, the aim of this investigation was to evaluate the effects of various mucin-containing solutions, differing in calcium phosphate concentrations, to be used as saliva substitutes on demineralized bovine dentin in vitro. Method and Materials: Bovine specimens (153) were embedded in epoxy resin, polished (4,000 grit), and partly covered with nail varnish (control of sound dentin). After demineralization for 14 days (pH 5.5), the specimens (n = 9) were exposed to 14 mucin-based solutions (30 g/L) at 2 different pH values (5.5 or 6.5) and differing in saturation with respect to apatites. Two fluoride-free solutions and the commercially available saliva substitute Saliva Orthana(Orthana, Kastrup) served as controls. Differences in mineral loss (ΔΔZ) and lesion depth (ΔLD) between the values prior to and after storage in the various solutions were evaluated from microradiographs of thin sections (100 μm). Results: The general linear model revealed an almost significant dependency on calcium for ΔΔZ (P = .050) and a significant dependency on calcium for ΔLD (P = .037). pH influenced ΔΔZ significantly (P < .001), whereas ΔLD was not influenced significantly (P = .169). Neither ΔΔZ (P = .475) nor ΔLD (P = .703) were influenced significantly by phosphate. Conclusion: Even with low concentrations of calcium and phosphates, mucin-based saliva substitutes are capable of inhibiting demineralization of bovine dentin, whereas with solutions supersaturated with respect to apatites, a remineralizing effect could be observed. [ABSTRACT FROM AUTHOR]

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

Objectives: The aim of this study was to investigate the attitude, observations, and knowledge of German dentists regarding the management of dry mouth. Materials and methods: A questionnaire including queries about attitudes, observations, and treatment options in patients with dry mouth was developed and sent to all 1251 dentist members of a regional German dental association. Results: An overall total of 284 returned questionnaires were included in the analyses, which relates to a response rate of 22.7%. Dentists infrequently encountered dry mouth in their clinical routine, yet were well aware that patients suffer from the symptoms of dry mouth; for affected patients, the majority of participating dentists provided specific dental prophylaxis measures. Drug side effects, neoplasia, and psychological disorders were regarded as the primary etiological factors for dry mouth, and caries, increased plaque formation, and rhagades as the most frequently observed clinical symptoms. While the majority of participating dentists was of the opinion that saliva substitutes are useful treatment options in patients with dry mouth, only few frequently recommended their use. Mechanical and gustatory stimulation of salivary flow as well as the advice to rinse with water were the most frequently pursued treatment options. Conclusions: Despite the high prevalence of dry mouth identified in epidemiological studies, it appears to be an infrequent observation in clinical routine. Clinical relevance: Pre- and postgraduate education should sensitize dentists for dry mouth and its treatment options. [ABSTRACT FROM AUTHOR]

Objective: A saliva substitute based on polyglycerylmethacrylate, lactoperoxidase, and glucose oxidase (Oral Balance) has been developed. The aim of this study was to evaluate the effect of Oral Balance on the dryness-related oral complaints in patients suffering from irradiation-induced xerostomia. Method and materials: The efficacy of Oral Balance on the dryness-related complaints of 28 patients was assessed by means of self-administered questionnaires. Each patient completed an initial questionnaire about dryness-related symptoms and then was given the moistening gel. The patients were instructed to apply the gel as often as desired. After 2 weeks and 3 months, the patients were asked to complete a progress questionnaire. The severity of xerostomia was measured with a saliva absorption method. Results: All patients suffered from moderate-to-severe xerostomia, the severity of which did not change during the experimental period. Three patients did not complete the study. In the other 25 patients, the application of Oral Balance tended to diminish the sensation of oral dryness and improve oral functioning. Statistically significant reduction of the dryness-related complaints was observed only in the patients suffering from severe xerostomia. Conclusion: Use of Oral Balance is of potential benefit in patients suffering from severe xerostomia. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to compare the wettability of saliva, a saliva substitute, and distilled water to three denture base materials. Materials and Methods: Thirty specimens of each denture base material: Heat cure polymethylmethacrylate (DPI heat cure), high-impact polymethylmethacrylate (Trevalon HI), and nylon (Valplast) were fabricated. The specimens of each denture base material were divided into three groups of ten specimens. The advancing and receding contact angles of three media: a commercially available carboxymethylcellulose-based saliva substitute (WET MOUTH), human whole saliva, and distilled water, with each denture base material were determined using a goniometer. The contact angle hysteresis was calculated as the difference between the advancing and receding contact angles. The data were statistically analyzed using univariate analysis of variance and Duncan post hoc test. Results: Low-advancing and receding contact angles were demonstrated on high-impact heat-polymerized polymethylmethacrylate denture base material. Highest hysteresis values were calculated for nylon denture base material. Conclusion: Best wettability was demonstrated on high-impact heat-polymerized polymethylmethacrylate denture base material. Based on the high hysteresis values calculated with nylon denture base material, it would possibly provide better denture retention. [ABSTRACT FROM AUTHOR]

Context: An aesthetic restorative material that would be suitable to be used in patients who are prescribed saliva substitute (SS) for symptomatic relief from xerostomia. Aims: This study aimed to evaluate and compare the effect of SS on the color stability of three different direct tooth-colored restorative materials. Settings and Design: This is an in vitro spectrophotometric study where standard uniform disc-shaped specimens were immersed in a SS for 30 days. Materials and Methods: The materials investigated were resin-modified-glass ionomer cement (RM-GIC), light-cured (LC) resin composite restorative material (Filtek™ Z350 XT), and LC fluoride-releasing restorative material (Ketac™ N100). Sixteen disc-shaped samples of each test material were prepared using a polytetrafluoroethylene mold, making up a total of 48 samples and were assigned to three groups: Group I (RM-GIC), Group II (Filtek™ Z350 XT), and Group III (Ketac™ N100). They were further divided into two subgroups A and B with eight samples each based on the immersion solutions namely distilled water (DW) and SS, respectively. The samples were immersed for 30 days. Baseline and postimmersion color analysis was done with a spectrophotometer. The CIE L*a*b* values were measured and CIE ΔE values obtained were tabulated. Statistical Analysis Used: The data obtained were statistically analyzed using ANOVA and independent t-test, and the pair-wise significance between groups was obtained using least significant difference test. P < 0.05 was considered statistically significant. Results: All the samples immersed in SS showed greater discoloration (ΔE >3.3) than the samples immersed in DW and was found to be statistically significant (P < 0.05). Ketac™ N100 displayed relatively lesser discoloration when compared to RM-GIC and Filtek™ Z350 XT when immersed in a SS. Conclusions: Among the materials tested, Ketac™ N100 was found to be more color stable. [ABSTRACT FROM AUTHOR]

Xerostomia, or perceived mouth dryness, increases with advancing age, but its influence on swallowing effort is unknown. This study: (1) quantified relationships among age, perceived sense of swallowing effort, and ratings of perceived mouth dryness, and (2) examined changes in swallowing effort following application of a gel-based saliva substitute in healthy participants. This was a cross-sectional observational study and data were collected from attendees of a community healthy aging fair. Forty-two healthy participants (mean age = 65 years; 20 female) were enrolled. Each participant rated perceived effort with swallowing and perceived mouth dryness on a 10-cm horizontal, undifferentiated line. After participants applied a gel-based saliva substitute (Biotene® Oral Balance) to their tongue and oral mucosa, they rated perceived effort with swallowing again. Age was associated with greater perceived mouth dryness (r = 0.37, p < 0.03) but not with perceived swallowing effort (r = 0.16, p = 0.32). Perceived mouth dryness was associated with greater perceived swallowing effort (r = 0.62, p < 0.001). Perceived swallowing effort declined following application of the salivary substitute (mean difference = 9.39 mm, p < 0.002). Age was found to be a significant predictor of perceived mouth dryness (p < .02); and perceived mouth dryness was found to significantly predict perceived swallow effort (p < .001). Perceived mouth dryness increased with advancing age, but perceived swallowing effort did not. Regardless of age, participants with higher levels of perceived mouth dryness also reported more perceived effort with swallowing suggesting a role for adequate oral lubrication in this perception. Even in healthy participants, use of a gel-based saliva substitute lowered perceived swallowing effort. [ABSTRACT FROM AUTHOR]

Researchers have recently developed a novel oily formulation for potential use as a saliva substitute for the treatment of dry mouth. The aim of this randomised, crossover study was to compare this new formulation to a currently available saliva substitute and a control of water on measures of mastication, subjective feeling of oral dryness and product acceptability. Forty participants treated with radiotherapy to the head and neck and experiencing xerostomia were invited to participate in the trial. Each participant trialled all three products in a randomised order. The effect of each product was measured using the Test of Masticating and Swallowing Solids ( TOMASS), the Shortened Xerostomia Inventory ( SXI) and a questionnaire designed to test patient acceptability of each product. Outcome data were gathered in a single session after the first administration of each product to evaluate immediate effects and after 7 days of use to evaluate longer-term effects. Statistical analyses consisted of repeated-measures analysis of variance and mixed models. There was no evidence that application of the three formulations had an effect on any of the TOMASS measures, either immediately or after one week of use ( P > 0·05). There was a significant main effect of formulation on the SXI score ( P = 0·02). Application of the novel emulsion resulted in a clinically small but significant improvement in SXI score ( P < 0·01); however, application of methylcellulose ( P = 0·21) and water ( P = 0·81) resulted in no significant difference. There was no difference in participant acceptability between the three products ( P = 0·32). The novel oily emulsion showed no clinically significant benefit over two existing products for relief of xerostomia. Indeed, none of the three products demonstrated significant change in patient outcomes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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Objective: This study aimed to determine whether the application of a high-fluoride gel could increase the remineralization of subsurface dentin lesions stored in saliva substitutes. Materials and methods: Demineralized bovine dentin specimens were stored in mineral water (W), Glandosane (G), or modified Saliva natura (SN). Different treatments were applied twice daily: no treatment, Elmex sensitive mouth rinse (E), ProSchmelz gel (P), Duraphat toothpaste (D), ED, PD, and EPD. Differences in mineral loss were evaluated by transversal microradiography after 2 and 5 weeks. Results: The treatments with E, D, and ED inhibited the mineral loss induced by G and enabled some mineral gain. ProSchmelz was not able to inhibit the demineralizing effect of G. This high-fluoride gel induced an erosive mineral loss in combination with G. The use of ProSchmelz in combination or not with other fluoride products did not increase remineralization of specimens stored in SN or W ( p > 0.05). ProSchmelz resulted in an erosion of the specimens stored in W and revealed a lower mineralized surface layer of specimens stored in SN. Conclusion: Topical application of high-fluoride gel reduced the mineral loss induced by G but resulted in an erosion of specimens' surface. In addition, ProSchmelz did not demonstrate beneficial effects in combination with SN on subsurface dentin lesion remineralization. Clinical relevance: Within the limitations of an in vitro study, it was concluded that the application of a high-fluoride gel did not promote additional effects on remineralization of subsurface dentin lesions in combination with saliva substitutes when compared to products with lower fluoride concentration. [ABSTRACT FROM AUTHOR]

Objective To investigate the viscosity of yam tuber mucilage ( YTM) and its effects on lysozyme and peroxidase activities in solution phase and on surface phase. Methods Two kinds of YTM were extracted, one containing both protein and carbohydrate and the other containing mainly carbohydrate. Hen egg-white lysozyme and bovine lactoperoxidase were used as lysozyme and peroxidase sources, respectively. Viscosity was measured with a cone-and-plate digital viscometer. Lysozyme activity was determined using the turbidimetric method, and peroxidase activity was determined using the Nbs SCN assay. Hydroxyapatite beads were used as a solid phase. Results The viscosity values of YTM followed a pattern of a non- Newtonian fluid. The carbohydrate concentration affected the viscosity values at all shear rates, while the protein concentration affected the viscosity values at low shear rates. It could be suggested that YTM composed of 1.0 mg/ml protein and 1.0 mg/ml carbohydrate has viscosity values similar to those of unstimulated whole saliva at shear rates present at routine oral functions. Hydroxyapatite-adsorbed YTM significantly increased the adsorption and subsequent enzymatic activities of lysozyme, but not those of peroxidase. Conclusions Yam tuber mucilage has viscoelastic properties similar to those of human saliva and enhances the enzymatic activity of lysozyme on hydroxyapatite surfaces. [ABSTRACT FROM AUTHOR]

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 × 106 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. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of the present study was to investigate lecithin-rice bran oil rheological properties with the view to consider these as potential saliva substitutes in patients with severe xerostomia and salivary hypofunction. Pseudo-ternary phase diagrams of rice bran oil, lecithin and water mixtures were constructed and characterised using polarising light microscopy. Viscoelastic properties, which we hypothesise are important determinants in product performance, were analysed using both flow and oscillatory rheology. Rheological properties were influenced by composition, frequency and shear stress. Frequency-dependent viscoelasticity was observed in some formulations where viscosity dominated (tan δ >1) at frequencies under 5Hz and elasticity dominated (tan δ <1) at higher frequencies. Threshold frequencies were determined for each formulation, where a peak in loss tangent was observed, coinciding with a reduction in the storage modulus and increase in loss modulus. The frequency-dependent behaviour of emulsions are of interest because these combinations exhibit viscous behaviour at low frequencies, which may improve lubrication of the oral cavity at rest, whereas increased elasticity at higher frequencies may improve retention during higher-shear tasks such as swallowing and speaking. [Copyright &y& Elsevier]

In recent years, there has been a particular interest in bioadhesive formulations for oromucosal drug delivery as this may promote prolonged local therapy and enhanced systemic effect. Saliva plays a vital role in oromucosal drug absorption by dissolving the drug and presenting it to the mucosal surface. However, the rheological, chemical, and interfacial properties of this complex biological fluid may strongly affect the adhesion of bioadhesive formulations. There is a need for well characterized in vitro models to assess the bioadhesive properties of oral dosage forms for administration in the oral cavity. Thus we aimed at developing an advanced ex vivo buccal retention model, with focus on choosing a physiologically relevant irrigation media closely resembling human saliva. Spray dried chitosan microparticles containing metformin hydrochloride as an example of a small hydrophilic drug, were employed as bioadhesive formulations. Chewing-stimulated human whole saliva was collected and characterized for use in retention studies in comparison with four artificial irrigation media; phosphate buffer, Saliva Orthana®, porcine gastric mucin base media (PGM3), and xanthan gum based media (XG2). Retention of metformin, applied as spray dried microparticles on porcine buccal mucosa, greatly depended on the characteristics of the irrigation media. When rheology of the irrigation media was examined, changes in retention profiles could be interpreted, as irrigation media containing mucin and xanthan gum possessed a higher viscosity than phosphate buffer, which led to longer retention of the drug due to better hydration of the mucosa and the spray dried microparticles. Metformin retention profiles were comparable when human saliva, Saliva Orthana®, or PGM3 were used as irrigation media. Moreover, PGM3 displayed physico-chemical properties closest to those of human saliva with regard to pH, protein content and surface tension. Saliva Orthana® and PGM3 are therefore considered as suitable irrigation media for further retention studies. [ABSTRACT FROM AUTHOR]

The present paper describes the results of tests on the influence of human saliva and its substitutes on tribological characteristics of implant materials on the example of the Ti-6Al-4V (a-Ti) titanium alloy. The saliva substitutes were prepared on the basis of pyrophosphates and mucins dissolved in saline buffer. The results of the presented tribological tests show that the values of the parameters under research varied from each other, while much similarity was observed between the evaluated level of wear characteristics after the friction process in the human saliva environment and that in the environment of one of the mucins tested. The microscopic observations of surfaces of the a-Ti samples after friction revealed varied forms of tribological wear. Infrared microspectroscopy studies of surfaces of the a-Ti samples after friction revealed the presence of secondary lubricating films based on mucin found in the artificial saliva solutions. [ABSTRACT FROM AUTHOR]

The objective of the present study was to evaluate the efficacy of Oral Balance saliva substitute in alleviating dry mouth symptoms in a sample of patients with secondary Sjögren's syndrome. Twenty-one consecutive secondary Sjögren's syndrome patients with dry mouth complaints and hyposalivation were included in this study. Patients used a lactoperoxidase-system-containing gel (Biotène Oral Balance) for 4 weeks. The effects on subjective oral symptoms were recorded by means of a 7-items questionnaire which contained questions regarding dry mouth sensation and its effect on chewing, swallowing, taste, speech, burning sensation and denture retention. The severity of symptoms was assessed using a visual analogical scale. Oral symptom scores and unstimulated whole salivary flow were recorded at baseline and after 4 weeks' use of the product. Two patients withdrew from the study, because of nausea and unpleasant taste caused by the product. Nineteen patients (all women, mean age 52.7 years) participated throughout the entire study. Wilcoxon signed-ranked tests indicated significant improvements in visual analogical scale scores posttreatment for 5 of the 7 items on the oral dryness questionnaire, although no increase in salivary flow was found. However, the improvement in certain variables did not take a positive course in all cases. Patients with lower salivary flow at baseline tended to have greater improvement in oral symptoms. The study suggests that the use of Oral Balance gel is effective in alleviating the dry mouth symptoms in secondary Sjögren's syndrome patients, but a randomized controlled trial is needed to assess the placebo effect. [ABSTRACT FROM AUTHOR]