Applicability of saliva as a diagnostic fluid in Sjögren's syndrome.
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Adult↗
Biomedical subjects
A Vissink
Publications and source records attributed to A Vissink.
Mucin-containing lozenges in the treatment of intraoral problems associated with Sjögren's syndrome. A double-blind crossover study in 42 patients.
Irreversible hyposalivation is a common sequela of Sjögren's syndrome and may lead to a decreased quality of the patient's life. The aim of this study was to evaluate the efficacy and therapeutic value of mucin-containing lozenges in reducing patients' complaints of hyposalivation. In a double-blind crossover trial in 42 patients with Sjögren's syndrome, the efficacy and therapeutic value of both a mucin-containing and placebo lozenge were assessed by means of self-administered questionnaires, which had to be completed before and after the use of each type of lozenge for a period of 2 weeks. Seventy-six percent of the patients preferred the mucin lozenge, 10% preferred the placebo, and 14% had no preference. In reducing patients' complaints, sucking the mucin lozenge resulted in a larger improvement of the total pattern of complaints and the sensation of oral dryness, and in a longer moistening of the oral cavity than the placebo. Oral functioning was improved after the use of the placebo, and the patients reported the taste of the placebo to be better than the mucin lozenge. From the responses it was concluded that the use of the mucin lozenges can be recommended in the treatment of oral symptoms of xerostomia.
Adult↗
Natural and induced radiation caries: A SEM study.
Radiation caries is a well-known indirect side effect of head and neck radiotherapy. The initiation and progression of radiation caries were studied using an in situ model. The morphology of induced carious lesions was compared with that of natural radiation caries. Both natural and induced radiation caries showed the same patterns of decay; widespread areas with porosity of enamel, crater formation with exposure of subsurface enamel, preferential dissolution of prisms with hollowing out of prism cores, loss of large parts of surface enamel and loss of full enamel coverage exposing the underlying dentin. In irradiated patients most enamel slabs were severely demineralized within 6 weeks whereas in control subject the slabs showed no significant demineralization after 12 weeks. The model may offer an excellent opportunity to study preventive fluoride regimens because of the rapid induction of radiation caries and its similarity with natural lesions.
Adult↗
Protocol for the prevention and treatment of oral sequelae resulting from head and neck radiation therapy.
In addition to the desired antitumor effects, head and neck radiation therapy induces damage in normal tissues that may result in oral sequelae such as mucositis, hyposalivation, radiation caries, taste loss, trismus, soft-tissue necrosis, and osteoradionecrosis. These sequelae may be dose-limiting and have a tremendous effect on the patient's quality of life. Current policies to prevent these sequelae primarily are based on clinical experience and show great diversity. A protocol for the prevention and treatment of oral sequelae resulting from head and neck radiation therapy, based on fundamental research and data derived from the literature, is presented. The protocol is particularly applicable in centers with a dental team. This team should be involved at the time of initial diagnosis so that a successful preventive regimen is an integral part of the overall cancer treatment regimen.
Clinical Protocols↗
Secondary retention of permanent molars: an assessment of ankylosis by scanning electron and light microscopy.
Secondary retention refers to the cessation of eruption of a tooth after emergence. This may be the result of pathological changes in the periodontal ligament. The aim of this study was to describe the morphological and histological aspects of the radicular surface of secondarily retained permanent molars. The roots of 12 secondarily retained molars and two control molars, were examined by means of scanning electron microscopy (SEM) and light microscopy (LM) in order to analyse the occurrence and localisation of ankylosis. With SEM it was observed that the root surface of retained molars showed local areas covered with bonelike tissue. LM of these areas showed that this tissue was bone in direct contact with the root surface (ankylosis). In 11 cases, the areas of ankylosis were observed in the bifurcation area and at the interradicular root surface. In the remaining case, ankylosis was located at the outer root surface. The results of this study endorse the assumption that focal ankylosis is an important factor in secondary retention. Treatment recommendations must be based on this fundamental principle, because orthodontic movement of ankylotic molars is not possible.
Adolescent↗
Secondary retention of permanent molars: a report of five families.
The aetiopathogenesis of secondary retention is not fully understood, but heredity is involved in at least some cases. In this study first-degree relatives of 52 patients with secondary retention of permanent molars were screened for the presence of the same phenomenon in their dentition. Familial occurrence could be shown in five families. The pedigrees are compatible with autosomal dominant inheritance. HLA phenotypes and blood groups ABO, rhesus and P1 were studied in two families. The lod scores for linkage with secondary retention were added to previously reported information. The lod score for linkage for blood group system P increased from +0.940 to +1.475 at a recombination fraction of 5 per cent. It is concluded that secondary retention of permanent molars is an aetiologically heterogeneous condition in which some cases are caused by the presence of an abnormal autosomal dominant gene.
Adult↗
A survey of prevention and treatment regimens for oral sequelae resulting from head and neck radiotherapy used in Dutch radiotherapy institutes.
Radiation treatment plays an important role in the management of head and neck cancer. Unfortunately several radiation-induced side effects may occur including mucositis, hyposalivation, radiation caries, trismus and osteoradionecrosis. It is generally accepted that most side effects can be prevented or reduced in severity. The purpose of this investigation was to make a survey of the prevention and treatment regimens for oral sequelae resulting from head and neck radiotherapy applied in all radiotherapy institutes in the Netherlands, and to evaluate the differences in these regimens. In all Dutch centers (n = 20) in which irradiation of head and neck cancer patients is performed, members of the staff responsible for prevention and treatment of oral side effects were interviewed. Questions referred to composition of the dental team, screening and care pre-irradiation, care during irradiation, and care post-irradiation. There appeared to be a great diversity in the preventive approach of the head and neck cancer patient in Dutch radiotherapy institutes. The most comprehensive counseling was performed by those centers in which a dental team was active, particularly when an oral hygienist was a member of such a team. The diversity is among others based on lack of well-defined guidelines in many centers, the spread of a relatively small patient group over a rather large number of centers, absence of a dental team in some centers, absence of an oral hygienist in some dental teams, and the observation that a rather large number of patients were not referred, or not timely referred to the dental team. There seems to be a need for the development of a general protocol for the prevention of oral complications applicable in all centers.
Dental Caries↗
Contrasting dose-rate effects of gamma-irradiation on rat salivary gland function.
The aim of this study was to investigate the effects of 60Co irradiation delivered at high (HDR) and low (LDR) dose-rates on rat salivary gland function. Total-body irradiation (TBI; total doses 7.5, 10 and 12.5 Gy) was applied from a 60Co source at dose-rates of 1 cGy/min (LDR) and 40 cGy/min (HDR) followed by syngeneic bone marrow rescue. Four days before and 1-30 days after TBI, submandibular and parotid saliva samples were collected in male albino Wistar rats using Lashley cups. Lag phase and flow rate were recorded, and [Na+] and [K+] were measured. The severity of salivary gland dysfunction for each dose-rate was dependent on total TBI dose in all parameters. LDR irradiation significantly enhanced the increase of lag phase, while it tended to further decrease flow rate during days 0-3. At later times the reverse effect was seen with significant LDR sparing in most cases. The changes in [Na+] and [K+] showed similar trends; LDR had an enhancing effect for early damage, while beyond day 3 it consistently produced less damage. From this dose-rate study it is concluded that the early postirradiation changes in salivary gland function are probably predominantly caused by irradiation damage to membrane structures and are less the result of reproductive failure. The later changes in salivary gland function are probably mainly dependent on repopulation of surviving stem cells.
Animals↗
[Dry mouth; possible cause--pharmaceuticals].
Many elderly complain about oral dryness. This complaint can be the result of the use of drugs, because many drugs, such as anti-depressives, anti-psychotics and anti-hypertensives, have an anti-cholinergic or anti-adrenergic action. Knowledge of this potential side-effect of drugs as well as adjustment of schedules of drug usage may result in (partly) relief of dryness-related complaints. In this paper first of all mechanisms that underly negative regulation of salivary secretion are discussed. An overview is given of drugs with an salivary secretion inhibitory action. In addition, suggestions are presented to manage drug-induced hyposalivation.
Aged↗
[Cause, effects and treatment of hyposalivation].
Adverse effects of drugs, radiotherapeutic treatment of head and neck tumors and Sjögren's syndrome are common causes of hyposalivation. The resulting sequelae include oral dryness, burning mouth, impeded oral functions, nocturnal oral discomfort and an increased incidence of rampant caries and oral infections. Causal therapy is only occasionally applicable. The main causes, consequences and management of hyposalivation are described.
Dental Caries↗
[Xerostomia-related dental caries].
The initiation and prevention of xerostomia-related dental caries were studied using an in situ model. The morphology of induced carious lesions was compared with that of natural xerostomia-related dental caries. Both natural and induced xerostomia-related dental caries showed the same patterns of decay. Using the in situ model three preventive procedures were tested: neutral F gel applied every second day or weekly, and a daily rinse with a fluoride mouthwash for a period of six weeks. Application of fluoride gel or the use of the fluoride mouthrinse resulted in significant inhibition of the demineralization process. Of the procedures evaluated fluoride gel applied every second day was the most effective in preventing the onset of xerostomia-related dental caries.
Administration, Topical↗
[Secondary retention of permanent molars. I. Clinical, radiologic and histologic characterization].
The clinical, radiographical and histological aspects of secondary retention in permanent molars were studied in a group of 53 patients with 81 secondarily retained permanent molars. First molars turned out to be affected most frequently. The mean infraocclusion at the patients' first visit was 4.3 mm. After six months, infraocclusion had increased in adolescents. It seemed to be stable in adults. Tilting of adjacent teeth was observed in 39 cases of secondary retention. A solid, clear percussion sound and a partial absence of the periodontal ligament space on radiographs was only noted in less than 20% of the affected molars, while histological examination of 38 removed molars revealed that local areas of ankylosis were present in all cases. During a follow-up period of four years, six new cases of secondary retention were observed in the same population.
Adolescent↗
[Secondary retention of permanent molars. II. Therapy].
The efficacy of 5 treatment modalities for secondary retention of permanent molars was evaluated in 62 patients with 92 affected molars. The results showed that a prosthetic build up is a proper treatment if secondary retention develops late in or after the growth spurt. In these cases the extent of infraocclusion is slight and relatively stable. If secondary retention starts before the growth spurt, immediate removal of the retained molar followed by orthodontic treatment to close the diastema gives maximal success. When secondary retention develops during the growth spurt, the tooth affected has to be observed at six monthly intervals. In such cases, no active treatment is indicated if the extent of infraocclusion is minor and stable. In all other cases the affected molar should be removed, followed by orthodontic closure of the diastema.
Adolescent↗
Management of the oral features of Sjögren's syndrome.
In this paper the basis of the oral features of Sjögren's syndrome is described and guidelines for proper management of these features are given. The most pronounced oral symptoms are a dry sensation in the mouth and difficulties with swallowing and speech. Furthermore, these patients do not sleep well and may complain about burning mucous membranes, rampant caries and candidosis. Rampant caries can be prevented by optimal oral hygiene and frequent applications of a fluoride gel. Prophylaxis of candidosis can be achieved by meticulous oral hygiene and removal of predisposing factors (e.g. poorly fitting dentures). It is only possible to treat the other oral signs of Sjögren's syndrome symptomatically, because damage of salivary-gland parenchyma is progressive and irreversible. In the early stages of Sjögren's syndrome, good results can be obtained by gustatory or pharmacological stimulation of the salivary secretion. In the more advanced stages, the patient has to resort to oral rinses and saliva substitutes, the majority of which are not satisfactory. Promising results have been obtained with mucin-containing lozenges.
Humans↗
Clinical, radiographic and histological characteristics of secondary retention of permanent molars.
Secondary retention refers to the cessation of eruption of a tooth after emergence neither due to a physical barrier in the path of eruption nor as a result of an abnormal position. In this study, the clinical and radiographic features of 81 secondary retained permanent molars in a group of 53 patients were evaluated. Retained molars removed for therapeutic reasons (n = 38) were examined histologically to detect any areas of ankylosis. The first molars in the mandible and maxilla were most frequently affected. The mean infraocclusion at the patients' first visit was 4.3 +/- 1.9 mm. After 6 months, infraocclusion increased in adolescents but was stable in adults. Tilting of the adjacent teeth was observed in 39 cases. A sharp, solid percussion sound and a partial absence of the periodontal ligament space on radiographs were noted in less than one-fifth of the affected molars, while histological evaluation revealed that local areas of ankylosis were present in all cases. From the data relating to the 38 molars removed for therapeutic reasons, the sensitivity of the percussion test and radiographic evaluation was found to be 29 and 21 per cent respectively. During a period of 4 years, six new cases of secondary retention were observed in the same population. From this study it is concluded that secondary retention of permanent molars seems to be associated with focal ankylosis and that percussion tests and radiographs are not sufficiently reliable to exclude the presence of ankylotic areas. The presence of ankylotic areas and tendency of infraocclusion to increase in adolescents but to be stable in adults have major implications for therapy.
Adolescent↗
Acute irradiation effects on morphology and function of rat submandibular glands.
In this study the morphologic and functional changes were compared after irradiation (single dose, 15 Gy) of rat submandibular salivary glands. Before and 1-10 days after local irradiation of the gland region, samples of submandibular saliva were collected after stimulation by pilocarpine. At the same time-points and also 3 h postirradiation submandibular glands were carefully extirpated and prepared for histocytologic examination (LM, TEM). Maximal increase of the lag phase and decrease of the flow rate were observed 3 days after irradiation, while [K+] and [Na+] increased and decreased, respectively, from days 1 and 3 after irradiation. Morphologic changes were observed from the third hour after irradiation, were maximal 3 days after irradiation and had partially recovered by day 10. Three hours and 1 day after irradiation degranulation of convoluted granulated tubes (CGT) was observed. Three days after irradiation the most striking morphologic changes in serous and mucous cells were distension of the cisternae of the RER, degeneration of mitochondria and vacuolization of the cytoplasm. Fibril-like condensations of electron dense material in the mucous granules were observed 3 h, 1 and 6 days after irradiation. Regranulation of CGT cells was observed from day 6. From this study it is concluded that changes in salivary gland function can be observed before major morphologic changes occur. Functional changes persist after the morphologic changes seem to have virtually returned to normal.
Animals↗
Eruption disturbances of permanent molars: a review.
Eruption disturbances of permanent molars may become clinically and radiographically manifest as impaction, primary retention or secondary retention. This may result in clinical problems such as malocclusion and loss of neighboring teeth due to caries and periodontal disease. Which of these disorders will develop, depends primarily on the eruptive stage. Factors that may interfere with the eruptive stages (i.e. follicular growth, pre-emergent eruptive spurt, postemergent eruptive spurt, juvenile occlusal equilibrium, circumpubertal occlusal eruptive spurt, adult occlusal equilibrium) and the clinical consequences of that interference are reviewed. Treatment recommendations are given.
Humans↗
Effects of split-dose X irradiation on rat salivary gland function.
The effect of a single local dose of 15 Gy on salivary gland function in male Albino Wistar rats was compared with the effect of two doses of 7.5 Gy. The intervals chosen were 0-24 h and 1 week. Before and 1-30 days after the last radiation dose, samples of parotid and submandibular saliva were collected simultaneously after stimulation of the glands with pilocarpine. Irradiation with the single dose resulted in an increased lag phase and potassium concentration, and a decreased flow rate and sodium concentration. The rate of secretion of amylase was decreased during Days 1-6, increased at Day 10, and was decreased again at Day 30. With two dose fractions, substantial dose-sparing effects on lag phase, flow rate, and secretion of amylase were observed for both the very early (0-6 days postirradiation) and later (6-30 days postirradiation) effects. These effects were maximal when the interval between the fractions was 6 h. A significant dose-sparing effect on electrolytes was observed for the later effects only, again with a maximum for the 6-h interval. The dose-sparing observed for the very early effects cannot be explained satisfactorily by repair of sublethal damage (SLD), redistribution of cells over the cell cycle, or repopulation of salivary gland tissue between the doses. In contrast to the earlier dose-sparing effects, the split-dose recovery seen for later damage may be attributed, in part, to SLD repair in providing for greater reproductive survival of intercalated ductal cells and enhanced tissue regeneration.
Amylases↗