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[Efficacy of oral balance gel for dry mouth in preoperative patients].

BACKGROUND: Following anticholinergic premedication and preoperative fasting, preoperative patients with a potential xerostomia have complaints associated with oral dryness. Xerostomia may lead to risk of mucosal burning and secondary infection. The purpose of this prospective study was to assess the effect of oral balance gel on dryness of the mouth in preoperative patients. METHODS: Thirty nine patients scheduled for elective surgery were randomly assigned to either of the group with or without using the oral balance gel. Severity of the dry mouth was assesed using a 4-point scale (0=none, 1=mild, 2=moderate, 3=severe) and diadochokinesis test was performed on the day before surgery and on arrival at the OR. RESULTS: Comparing results of the two stages, we found that patients with no treatment had significantly deteriorated state of dry mouth, but patients who had received the oral balance gel had no significantly worse dry mouth compared with the preoperative state. CONCLUSIONS: In this study, patients without the oral balance gel frequently reported oral symptons and oral dysfunction associated with xerostomia. We conclude that the use of oral balance gel in preoperative patients is effective for the prevention of dryness of the dry mouth.

Adult↗

[Inhibitory effect of xipayi mouth rinse on the secretion of IL-6 from human gingival fibroblast induced by lipopolysaccharide].

OBJECTIVE: To observe the effects of xipayi mouth rinse of different concentrations on the activities of interleukin-6 (IL-6) from human gingival fibroblast (HGF) induced by lipopolysaccharide (LPS). METHODS: HGF was stimulated with LPS at 25 g/mL, and the radioimmunoassay (RIA) was used to examine the effect of xipayi mouth rinse at 12.5 approximately 200 g/mL on the secretion of IL-6 in the supernatant of the cell culture. RESULTS: IL-6 secreted by human gingival fibroblast was significantly inhibited by xipayi mouth rinse in a dose dependent manner. CONCLUSION: Xipayi mouth rinse can inhibit the secretion of IL-6 from HGF induced by LPS, suggesting the anti-inflammatory effect of xipayi mouth rinse to treat and prevent periodontal diseases.

Anti-Inflammatory Agents↗

[Effects of xipayi mouth rinse on the DNA synthesis and change of cell cycles of human gingival fibroblast induced by lipopolysaccharide].

OBJECTIVE: To observe the effects of xipayi mouth rinse on the DNA synthesis and change of cell cycles of human gingival fibroblast (HGF) induced by lipopolysaccharide(LPS). METHODS: HGF was stimulated with LPS at 25 mg/L. Flow cytometry was used to examine the effect of xipayi mouth rinse at 25 mg/L on the DNA synthesis and change of HGF cell cycles. RESULTS: The percentage of HGF in G( 1) phase increased after the cells were induced by LPS, while the percentage of HGF in S phase decreased. Xipayi mouth rinse could ameliorate this phenomenon. CONCLUSION: Xipayi mouth rinse can significantly ameliorate the inhibitory effect of LPS on the proliferation of HGF, suggesting the anti-inflammatory effect of xipayi mouth rinse in the treatment and prevention of periodontal diseases.

Cell Cycle↗

Measuring mouth moisture: a case study in instrument development.

This paper describes the process through which an instrument for measuring mouth moisture was developed. The need to create a means of quantifying mouth moisture was realized while planning studies of oral care. Nursing texts assert that one indicator of successful oral care is "moist mucous membranes," and research on oral care typically names mouth moisture as an outcome variable. Yet the measures used in nursing research to assess mouth moisture have been characterized by imprecision, questionable reliability, and disregard for congruence between conceptual and operational definitions. The paper begins by critiquing the instruments commonly used in mouth care research to assess moisture. Next, the methodical process of building ideas to construct a new instrument is described. Finally, the trials that were conducted to arrive at the instrument's final design, estimates of reliability and validity, and a procedure for use that would preserve the integrity of the instrument are discussed.

Humans↗

Administration of metered-dose inhalers: comparison of open- and closed-mouth techniques in childhood asthmatics.

It has been suggested that the effectiveness of bronchodilators administered from metered-dose inhalers (MDI) may be improved by altering the inhalation technique with which they are taken. The efficacy of the traditional closed-mouth technique of MDI use was compared with one in which the mouth remained open throughout inhalation. Eighteen asthmatics, aged seven to 16 years whose peak expiratory flow rates (PEFR) were less than 70% predicted, were studied. PEFR was measured before and 5, 10 and 15 minutes after a single inhalation of isoetharine using the open-mouth and closed-mouth techniques on separate days. There was no significant difference in PEFR improvement at any time when the two techniques were compared. Routine re-training of pediatric patients already using the traditional closed-mouth method successfully is not warranted on the basis of these findings.

Adolescent↗

[Reproducibility of computer-assisted mouth occlusion pressure measurements].

BACKGROUND: The measurement of mouth occlusion pressure is an easy method to assess respiratory drive and muscle function. Lately there is a variety of computer assisted programmes, but their precision is discussed controversially. In this study we analysed the repeatability of measurements of mouth occlusion pressures performed by a computer assisted measurement unit. PATIENTS AND METHODS: We examined maximal inspiratory mouth occlusion pressure (PI(max)), mouth occlusion pressure 100 ms after onset of inspiration (PO.1) and PI(max) after 100 ms (PO.1(max)) of 32 patients with COPD. Subjects were divided into group A (normal blood gas pressures) and group B (hypercapnia due to alveolar hypoventilation). Controls (K) consisted of 22 healthy men. Criteria for repeatability were analysis of variance, intraindividual standard deviation of the mean and the variation coefficient of 5 consecutive measurements. RESULTS: Controls produced the highest values for PI(max) and the lowest ones for PO, 1. Intraindividual standard deviation was small as well as the variation coefficient; we found no statistically significant differences. Compared with controls in group A PI(max) values were markedly reduced with elevated PO.1 values. Intraindividual standard deviation and variation coefficient were low, differences not significant. We observed similar results for group B, variance analysis showed no significant differences, deviation around the mean was small. CONCLUSION: Our data suggest a high repeatability of measurements of mouth occlusion pressures. Especially patients with severe COPD and alveolar hyperventilation are able to produce valid and reliable test results.

Adult↗

[Reproducibility of inspiratory mouth occlusion pressure with a mobile computer-assisted measuring system].

BACKGROUND: The measurement of mouth occlusion pressure is an easy method to assess respiratory drive and muscle function. In addition to a variety of stationary systems, recently a mobile computer assisted system became available. In this study the repeatability of inspiratory mouth occlusion pressures with such a mobile system was examined. METHOD: Maximal inspiratory mouth occlusion pressure (PImax), mouth occlusion pressure 100 ms after onset of normal inspiration (P0,1), and PImax after 100 ms (P0,1max) were investigated 4 times in 12 healthy subjects. Measurements were performed with a mobile system (resPImax). Criteria of repeatability were analysis of variance, intraindividual standard deviation, variation coefficient and intraclass correlation coefficient. RESULTS: Of all analyzed parameters PImax was most reproducible with a 5.3% share of variance due to measurement methods of the total variance. P0,1 was least reproducible. There was no statistically significant difference between the results of each day. The variance due to measurement methods varied between 5.3% and 30%. CONCLUSION: The repeatability of mouth occlusion pressures with this mobile device was good and partly superior to stationary systems. The concept of a mobile measuring unit simplifies getting results of bed-bound and mechanically ventilated patients.

Adult↗

Estimates, from salivary analyses, of the turnover time of the oral mucosal epithelium in humans and the number of bacteria in an edentulous mouth.

The objectives were to obtain rough estimates of the number of bacteria in an edentulous mouth and the mean turnover time of the oral mucosa and the conditions under which the salivary phase in the mouth might act as a bacterial continuous culture system. The premise was that at steady state in vivo, the rates of loss of bacteria and epithelial cells in saliva must be equal to their rates of proliferation. Drooled saliva was collected from 17 subjects and the number of epithelial cells per millilitre was determined in a Coulter Counter. The numbers of adherent bacteria per epithelial cell were counted on cells stained with Toluidine Blue. For 10 subjects, salivary bacterial counts were obtained after saliva had been diluted in Reduced Transport Fluid and grown anaerobically on Blood Agar for 5 days. From the known surface areas of the oral mucosa and individual epithelial cells and the rate of loss of epithelial cells into saliva, the surface layer of epithelial cells was calculated to be replaced every 2.7h. From the calculated number of epithelial cells lining the oral mucosa, the number of bacteria per epithelial cell, and the rate of swallowing of the bacteria in saliva, the number of bacteria in an edentulous mouth was calculated to be about 1.58 x 10(9) and the mean time between bacterial cell divisions to be 1.38h. Given a residual volume of 0.8ml and a maximal bacterial division rate of 3h(-1), the salivary phase in the mouth could act as a continuous culture system for certain fast-growing bacteria only if the maximum flow rate were <0.04ml/min.

Adult↗

Carcinoma of the tongue and floor of the mouth. Preliminary results of a multidisciplinary approach.

UNLABELLED: Eighty-five patients (74 males, 11 females) with untreated squamous-cell carcinoma of the tongue (40 patients) and the floor of the mouth (45 patients) underwent a multidisciplinary treatment. FOLLOW-UP: 6-72 months (median 52 months). T1-4N0M0 lesions (tongue; 32 patients; floor of mouth, 32 patients) were treated with cryosurgery (T1-2: 1-2 sessions, T3-4: 2-4 sessions) and contemporaneously with CMF (cyclophosphamide, methotrexate, fluorouracil) (T1-2: 2 courses; T3-4: 3 courses). 15-20 days after the end of cryo-chemotherapy the patients underwent TCT (T1: 50 Gy to the tumour and lymph nodes; T2-3-4: same with an extra dose of 10-15 Gy to the primary lesion). T1-4N1-3M0 patients (tongue: 8, floor of mouth: 13) received the same cryotherapy and chemotherapy, followed by surgery (13 extended suprahyoid dissections, 8 conservative laterocervical dissections, 1 RND). The actuarial survival rate of patients with tongue tumours after 6 years was 81.4% (N0 87.1%; N+ 60.0%). Four months after treatment, 35 patients had reached complete remission (CR). The probability of remaining in CR for 6 years was 53.6% (N0 56.1%; N+ 50.0%). For tumours of the floor of the mouth the actuarial survival rate was 55.2% (N0 56.5%; N+ 48.6%). Four months after treatment, 38 patients had reached CR. The probability of remaining in CR for 6 years was 59.9% (N0 61.5%; N+ 59.3%). A controlled study is recommended in the light of these results and the conservative nature of the protocol.

Actuarial Analysis↗

High dose rate versus low dose rate interstitial radiotherapy for carcinoma of the floor of mouth.

PURPOSE: Patients with cancer of the floor of mouth are treated with radiation because of functional and cosmetic reasons. We evaluate the treatment results of high dose rate (HDR) and low dose rate (LDR) interstitial radiation for cancer of the floor of mouth. METHODS AND MATERIALS: From January 1980 through March 1996, 41 patients with cancer of the floor of mouth were treated with LDR interstitial radiation using 198Au grains, and from April 1992 through March 1996 16 patients with HDR interstitial radiation. There were 26 T1 tumors, 30 T2 tumors, and 1 T3 tumor. For 21 patients treated with interstitial radiation alone, a total radiation dose of interstitial therapy was 60 Gy/10 fractions/6-7 days in HDR and 85 Gy within 1 week in LDR. For 36 patients treated with a combination therapy, a total dose of 30 to 40 Gy of external radiation and a total dose of 48 Gy/8 fractions/5-6 days in HDR or 65 Gy within 1 week in LDR were delivered. RESULTS: Two- and 5-year local control rates of patients treated with HDR interstitial radiation were 94% and 94%, and those with LDR were 75% and 69%, respectively. Local control rate of patients treated with HDR brachytherapy was slightly higher than that with 198Au grains (p = 0.113). For late complication, bone exposure or ulcer occurred in 6 of 16 (38%) patients treated with HDR and 13 of 41 (32%) patients treated with LDR. CONCLUSION: HDR fractionated interstitial brachytherapy can be an alternative to LDR brachytherapy for cancer of the floor of mouth and eliminate radiation exposure for the medical staff.

Adult↗

Unilateral subcutaneous pedicled nasolabial island flap for anterior mouth floor reconstruction.

PURPOSE: This article describes the successful use of unilateral subcutaneous pedicled flaps in the reconstruction of defects of the anterior floor of the mouth by raising the flaps as skin islands, relying on a pedicle of subcutaneous tissue. PATIENTS AND METHODS: Nine flap procedures were performed on 9 patients for reconstruction of small defects of the anterior floor of the mouth. One patient underwent secondary reconstruction to release tongue that was functionally tethered anteriorly. RESULTS: All flaps healed without evidence of infection, dehiscence, or necrosis. This particular choice of unilateral flap seems to provide improved functional integrity of the anterior floor of the mouth. CONCLUSIONS: The unilateral inferiorly and subcutaneously based nasolabial island flap provides reliable coverage of small and intermediate-sized defects of the anterior floor of the mouth when used alone, improving the tongue mobility, articulation, and deglutition.

Aged↗

Articulatory function and tongue mobility after surgery followed by radiotherapy for tongue and floor of the mouth cancer patients.

The aim of this study was to determine which of the following factors--size of the post-excisional defect, site of the defect and type of reconstruction--influence tongue mobility and articulation disorders after treatment for cancer of the tongue and floor of the mouth. A total of 60 patients, who had been evaluated at least 6 months after surgery followed by radiotherapy (60 Gy in 30 fractions), were evaluated. According to the size of the post-excisional defect patients were divided into two groups: (1) defect less than 5 cm (35); (2) defect more than 5 cm (25). Based on the localisation of the defect patients were also divided into two groups: (1) anterior tongue and/or floor of the mouth (30); (2) lateral tongue and/or floor of the mouth (25) and tongue base (5). According to the type of reconstruction patients were divided into three groups: partly reconstructed (18); reconstructed with locally available tissue--local flaps (27); and with pectoralis major myocutaneous (PMMC) flaps (15). Articulation proficiency was assessed through Articulation Test and tongue mobility through Tongue Mobility Test. According to results of this study, type of reconstruction followed by size of post-excisional defect seemed to be the most influential factor in tongue mobility and articulation disorders after the tongue and floor of the mouth cancer treatment. Site of the defect has no influence.

Adult↗

[Diagnostic and therapeutic management of a big cyst at the floor of the mouth--a case report].

BACKGROUND: The growth of dysontogenetic cysts at the floor of the mouth is considered as a rare condition. Cysts of the floor of the mouth may be differentiated depending on location or on histopathologic-embryological criteria into dermoids, epidermoids and teratomas. PATIENTS AND METHODS: We report a case of a large cyst at the floor of the mouth and present the results of clinical examination, preoperative diagnostics and surgical approach. RESULTS: The tumour was resected by an enoral operation. Histological findings confirmed a large sublingual epidermoid cyst. There were no complication or relaps during postoperative course. The case is discussed within the framework of scientific literature. CONCLUSIONS: Dysontogenetic cysts should be considered in differential diagnosis of tumours of the floor of the mouth. Diagnostic and surgical management depends first of all on size and location of dysontogenetic cysts.

Adult↗

Mouth opening: a new angle.

BACKGROUND: The authors hypothesized that craniocervical extension occurs during normal mouth opening. METHODS: Twenty volunteers were studied. Interdental distance was measured at four different degrees of craniocervical extension. RESULTS: Interdental distance increased from 28 mm (95% confidence interval, 25-30) in slight flexion to 46 mm (95% confidence interval, 42-49) at full extension. Nearly maximal mouth opening was obtained with 26 degrees (95% confidence interval, 22-30) of craniocervical extension from neutral. CONCLUSION: Craniocervical extension is an integral part of complete mouth opening in conscious subjects. Fixation of the craniocervical junction by disease, an internal or external fixation device, or technique may restrict mouth opening, with consequences for airway management.

Adult↗

The effect of a one-stage full-mouth disinfection on different intra-oral niches. Clinical and microbiological observations.

A treatment for periodontal infections often consists of consecutive rootplanings (per quadrant, at a 1- to 2-week interval), without a proper disinfection of the remaining intra-oral niches (untreated pockets, tongue, saliva, mucosa and tonsils). Such an approach, could theoretically lead to a reinfection of previously-treated pockets. The present study aims to examine the effect of a full-mouth disinfection on the microbiota in the above-mentioned niches. Moreover, the clinical benefit of such an approach was investigated. 16 patients with severe periodontitis were randomly allocated to a test and a control group. The patients from the control group were scaled and rootplaned, per quadrant, at 2-week intervals and obtained oral hygiene instructions. The patients from the test group received a full-mouth disinfection consisting of: scaling and rootplaning of all pockets in 2 visits within 24 h, in combination with tongue brushing with 1% chlorhexidine gel for 1 min, mouth rinsing with a 0.2% chlorhexidine solution for 2 min and subgingival irrigation of all pockets (3x in 10 min) with 1% chlorhexidine gel. Besides oral hygiene, the test group rinsed 2x daily with 0.2% chlorhexidine and sprayed the tonsils with a 0.2% chlorhexidine for 2 months. Plaque samples (pockets, tongue, mucosa and saliva) were taken at baseline and after 2 and 4 months, and changes in probing depth, attachment level and bleeding on probing were reported. The full-mouth disinfection resulted in a statistically significant additional reduction/elimination of periodontopathogens, especially in the subgingival pockets, but also in the other niches. These microbiological improvements were reflected in a statistically-significant higher probing depth reduction and attachment gain in the test patients. These findings suggest that a disinfection of all intra-oral niches within a short time span leads to significant clinical and microbiological improvements for up to 4 months.

Adult↗

Perception of Nigerian athletes of the use of mouth guards to prevent the stresses of sports injury.

OBJECTIVE: The perception of Nigerian athletes of the use of mouth guards to prevent the stresses of sports injuries was examined using psychological, sociological, and physical stress variables. METHODS: The descriptive survey research design was used in this study. Participants (n = 333) were selected using the purposive random sampling technique and data were collected using the 4 point Likert type instrument. The coefficient alpha was used to determine the reliability of the instrument with r = 0.79 for psychological, r = 0.66 for physical, and r = 0.74 for sociological stress. RESULTS: The result reveals that female athletes perceived the use of mouth guards as being more important to prevent the stresses of sports injuries than male athletes, while athletes who had used mouth guards for longer periods also perceived them as being more important to prevent the stresses of sports injuries compared to those who had used them less. The result also revealed a significant difference (p<0.05) among the various sport groups as independent variables on the psychological and physical stress variables. Scheffe post hoc analysis was used to identify the group where significant difference was found. CONCLUSIONS: The study concluded that since the impact of injury is perceived to affect the cognitive function of athletes, athletes should be educated on the use of mouth guards in order to reduce the incidence of oral and dental injuries to the barest minimum.

Adolescent↗

Dermoid cyst of the floor of the mouth diagnosed by fine needle aspiration cytology: a case report.

BACKGROUND: Dermoid cyst of the floor of the mouth is a rare, benign lesion requiring surgical intervention. To our knowledge, the preoperative diagnosis of this entity by fine needle aspiration (FNA) cytology has not been previously reported in the cytologic literature. CASE: The patient presented with a massive swelling of the floor of the mouth that displaced the tongue superiorly. A computed tomographic (CT) scan demonstrated a cystic lesion thought to be consistent with a lymphangioma. FNA was performed without complications and demonstrated numerous anucleated and some nucleated squames consistent with a diagnosis of dermoid cyst. Establishment of the correct diagnosis by FNA enabled the surgeon to proceed with the appropriate operation; that outcome might not have been possible had the erroneous CT diagnosis of lymphangioma been trusted. CONCLUSION: A preoperative diagnosis of dermoid cyst of the floor of the mouth was established by FNA. In contrast to reports in the older literature, the FNA procedure caused no complications. In patients presenting with lesions of the floor of the mouth, FNA should be the diagnostic procedure of first choice.

Adult↗

Physiological factors affecting salivary flow rate, oral sugar clearance, and the sensation of dry mouth in man.

This paper discusses methods for collection of both whole saliva and individual gland secretions, the normal ranges of salivary flow rate, the effects of physiological variables which influence flow rate, and the role of saliva in oral sugar clearance. The physiological basis for the sensation of dry mouth is discussed, and a new concept is advanced which states that the sensation of dry mouth will occur when the salivary flow rate is less than the sum of the rates of water absorption and evaporation from the mouth. In a study of the effects of anticholinergic agents on salivary flow, the subjects experienced the sensation of dry mouth when the normal flow rate of unstimulated saliva was reduced by from 40 to 50%.

Absorption↗