Xerostomia: An Update of Causes and Treatments

Xerostomia or dry mouth sensation is considered a complex condition that affects several stomatological functions that drives to the detriment of the quality of life of individuals who suffer from it. Often, xerostomia is accompanied by a decrease in salivary flow or hyposalivation, and this condition leads to oral health problems such as dental caries, candidiasis, and mucosal complications. Currently, the diagnosis and therapeutic methods for this condition are varied and it is difficult to achieve favorable results in all cases, since the etiology seems to be multifactorial where both local factors and systemic conditions would participate. This chapter presents, in a concise shape, the relevant data about etiology of xerostomia, such as age, autoimmune diseases, systemic diseases, infectious diseases, neuropathic complications, psychogenic factors and therapeutically consumption of drugs among others, and the current available treatments

Evaluation of saliva as a complementary technique to the diagnosis of COVID-19:a systematic review

Infectious disease coronavirus 2019 (COVID-19) is caused by the SARS-CoV-2 virus, and it mainly affects the upper respiratory tract. The gold standard for its diagnosis is real-time reverse transcription polymerase chain reaction (RT-qPCR) performed on a nasopharyngeal swab. In contrast, testing saliva has significant advantages as a diagnostic method. We searched for articles evaluating saliva as a diagnostic method for COVID-19 on the PUBMED/MEDLINE, WEB OF SCIENCE, COCHRANE, and SCIELO platforms. We initially found 233 articles and 20 were selected for inclusion following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol: 18 cross-sectional studies and 2 case reports, including 8 from America, 8 from Asia, and 4 from Europe. The studies evaluated the presence of viral RNA, IgG, IgM, and IgA in samples of unstimulated saliva from adults with confirmed or suspected COVID-19. The vast majority of the studies performed RT-qPCR on the saliva samples and compared the results with the gold standard (a nasopharyngeal swab of the same patient). Saliva samples analyzed by RT-qPCR, reverse transcription isothermal amplification (RT-LAMP), spectroscopy, and enzyme-linked immunosorbent assay (ELISA) offer high sensitivity to detect SARS-CoV-2 in the early stages of the disease and among asymptomatic patients as compared to nasopharyngeal swab RT-qPCR. In addition, the self-collection of saliva offers the possibility of receiving telemedicine instructions to carry out the test, reducing the risk of contagion. The diagnosis of COVID-19 through saliva is sensitive, non-invasive, and is of low risk for the healthcare professionals. However, further studies are recommended to validate its clinical use

Hypovitaminosis D, oral potentially malignant disorders, and oral squamous cell carcinoma:a systematic review

Oral squamous cell carcinoma (OSCC) and potentially malignant oral disorders (OPMDs) could be associated with low levels of vitamin D. This systematic review aimed to determine the relationship between serum levels of vitamin D with OPMDs and OSCC. This review was conducted according to Cochrane guidelines (PROSPERO CRD42020207382) on literature retrieved from the PubMed, Cochrane, and Web of Science databases. The antecedents extracted were study design, methodology, sample (country, number of patients, age, and sex), oral manifestations (type of lesion, location, prevalence, and follow-up), serum vitamin D levels or use of vitamin D supplements, results, and conclusions. Twelve articles were selected. Some of the most relevant findings were alterations in vitamin D could favor the progress of OPMDs to OSCC. Higher levels of vitamin D can increase levels of anti-inflammatory mediators, CD4+ T lymphocytes and CD8+ T lymphocytes and CD3+ T lymphocytes in intratumoral tissue. The normalization of vitamin D levels in patients with OSCC can increased cytotoxic activity of natural killer cells, favoring antitumor immune response. Vitamin D supplemented can lower adverse effects associated with chemotherapy like mucositis and pain. Tobacco can increase risk of developing OSCC altering vitamin D levels. Hypovitaminosis D could increase risk of developing OSCC from OPMDs, thus altering the immune response and it is associated with a lower survival rate in patients with OSCC, a greater recurrence of tumors in patients who underwent surgical treatment, and an increase in adverse reactions to chemotherapy. The use of vitamin D supplements can be a complement to primary therapy to prevent the recurrence of lesions and reduce adverse events associated with treatment

Successful conservative treatment of a mandibular unicystic ameloblastoma : 13-year follow-up

Ameloblastoma is an uncommon, locally aggressive benign odontogenic tumor and can reach considerable dimensions causing facial deformity and functional impairment. They are characterized by local aggressiveness. It is recommended that maxillary ameloblastomas be treated aggressively due to proximity of various vital structures. Conservative treatments such as marsupialization, enucleation and curettage while preserving bone integrity seem to be associated with a high rate of recurrence. Treatment evaluation of ameloblastomas is a complex issue, as ideally it should not be so destructive due to the benign nature of this lesion, but should be extensive enough to avoid recurrences. The present study is about a clinical case of a 16-year- old man with a unicystic ameloblastoma treated successfully with marsupialization. Patient was followed up every 12 months. About 13 years after diagnosis, the patient is clinically healthy and radiographically it is possible to observe evidence of bone repair

Increased nuclear β-catenin expression in oral potentially malignant lesions: a marker of epithelial dysplasia

Background: Deregulation of β-catenin is associated with malignant transformation; however, its relationship with potentially malignant and malignant oral processes is not fully understood. The aim of this study was to determine and compare the nuclear β-catenin expression in oral dysplasia and oral squamous cell carcinoma (OSCC). Material and Methods: Cross sectional study. Immunodetection of β-catenin was performed on 72 samples, with the following distribution: 21 mild dysplasia, 12 moderate dysplasia, severe dysplasia 3, 36 OSCC including 19 well differentiated, 15 moderately differentiated and 2 poorly differentiated. Through microscopic observation the number of positive cells per 1000 epithelial cells was counted. For the statistical analysis, the Kruskal Wallis test was used. Results: Nuclear expression of β-catenin was observed in all samples with severe and moderate dysplasia, with a median of 267.5, in comparison to mild dysplasia whose median was 103.75. Only 10 samples (27.7%) with OSCC showed nuclear expression, with statistically significant differences between groups ( p < 0.05). Conclusions: Our results are consistent with most of the reports which show increased presence of β-catenin in severe and moderate dysplasia compared to mild dysplasia; however the expression of nuclear β-catenin decreased after starting the invasive neoplastic process. This suggests a role for this protein in the progression of dysplasia and early malignant transformation to OSCC. Immunodetection of β-catenin could be a possible immune marker in the detection of oral dysplasi

Clinicopathologic and immunohistochemical characterization of 14 cases of angioleiomyomas in oral cavity

Angioleiomyoma (ALM) is a benign neoplasm that originates from vascular smooth muscle. It is extremely rare in oral cavity. The objective of this study was to evaluate the clinicopathological and immunohistochemical characteristics of all oral angioleiomyomas registered in a Center of Diagnosis of Oral Diseases from 1959 to 2017. Slides from 14 cases of ALM stained with hematoxylin and eosin (H&E) were analyzed to confirm the diagnosis. Moreover, an immunohistochemical panel with alpha-smooth muscle actin (alpha-SMA), desmin, AE1/AE3, CD68, S-100, and CD34 antibodies was performed to evaluate semi-quantitatively the positive cells. ALM correspond to 0.08% of all benign oral tumors analyzed during the 57-year period. The mean age of the patients was 45 years with a predilection to males (58%). The most frequently reported site was lips (50%). Microscopic analysis on H&E sections revealed similar pattern in all cases, showing well-circumscribed and encapsulated tumors, characterized by a proliferation of smooth muscle cells and wide vascular spaces of varying sizes. The predominant immuno profiles were: alpha-smooth muscle actin (alpha-SMA) positive (strong immunoreactivity); positive variable pattern for desmin, negative immunoprofile for AE1/AE3, CD68, and S-100. The endothelial cells of vascular spaces were CD34+. Based on the results, the alpha-SM actin can be elected as a good marker for angioleiomyomas and can help the confirmation of the morphologic diagnosis of this lesion

Salivary gland dysfunction markers in type 2 diabetes mellitus patients

Background: Diabetes mellitus (DM) is a chronic disease of the carbohydrate metabolism that, when not rigorously controlled, compromises systemic and organ integrity, thereby causing renal diseases, blindness, neuropathy, arteriosclerosis, infections, and glandular dysfunction, including the salivary glands. The aim of this study was to determine the relationship between the qualitative and quantitative parameters of salivary alteration, which are indicators of salivary gland dysfunction, and the level of metabolic control of type 2 diabetes patients. Material and Methods: A convenience sample of 74 voluntary patients with type 2 DM was selected, each of whom donated a sample of unstimulated saliva. Salivary parameters such as salivary flow rate, protein concentration, pH, and xerostomia were studied. Results: There is a positive relationship between the level of metabolic control measured with HbA1 and the protein concentration in saliva (Spearman rho = 0.329 and p = 0.004). The same assay showed an inverse correlation between HbA1 and pH (Spearman rho = -0.225 and p = 0.05). Conclusions: The protein concentration in saliva and, to a lesser extent, the pH may be useful as glandular dysfunction indicators in DM2 patients

Lesiones orales asociadas con VIH. Reporte de 3 casos clínicos

Acquired immunodeficiency syndrome (AIDS) is an advanced clinical manifestation resulting from infection with the human immunodeficiency virus (HIV). Some oral lesions may represent the first clinical signs of HIV infection or be the markers of the progression of immunodepression caused by the virus. The aim of this study was to present three clinical cases of patients in whom the suspicion of HIV infection was based on the presentation of intraoral manifestations. The three cases included were as follows: a woman with extensive red and pseudomembranous areas in the oral cavity, compatible with pseudomembranous candidiasis; a man presenting painless, erythematous gingival lesion, located in the lower molar area, compatible with necrotizing ulcerative periodontitis (PUN); and a man with vesiculoucerative lesions in hard palate, compatible with atypical presentation of recurrent intraoral herpes. It is important to emphasize the role of the dental surgeon in the recognition of such oral lesions, which may be the first manifestations in HIV-infected persons.El síndrome de inmunodeficiencia adquirida (SIDA) es una manifestación clínica avanzada resultante de la infección por el virus de la inmunodeficiencia humana (VIH). Algunas lesiones orales pueden representar los primeros signos clínicos de infección por VIH o ser los marcadores de la progresión de la inmunodepresión causada por el virus. El objetivo de este estudio es presentar tres casos clínicos de pacientes en los que la sospecha de infección por VIH se basó en la presentación de manifestaciones intraorales. Los tres casos incluidos fueron los siguientes: mujer con placas semiadheridas de color blanco amarillentas que se desprendían al raspado y áreas eritematosas compatibles con candidiasis pseudomembranosa; hombre con lesión gingival eritematosa indolora, localizada en la zona del molar inferior, compatible con periodontitis ulceronecrotizante (PUN); y un hombre con lesiones vesiculo-ucerativas en paladar duro, compatible con presentación atípica de herpes simple intraoral recurrente. Es importante destacar el papel del cirujano dentista en el reconocimiento de tales lesiones bucales, que pueden ser las primeras manifestaciones en personas infectadas por el VIH

Salivary characteristics may be associated with burning mouth syndrome?

Burning mouth syndrome (BMS) it is characterized by burning and uncomfortable sensations with no clinical alterations or laboratory findings. The evaluation of the salivary characteristics of people with BMS can help the understanding of the pathogenesi

Alfa-2 macroglobulina en saliva y su potencial como biomarcador del control metabólico en diabetes mellitus tipo 2

Tesis Magister en Ciencias Odontológicas con Mención en Patología y Medicina OralLa diabetes tipo 2 (DM2) es la enfermedad metabólica más frecuente del mundo. Si no es rigurosamente controlada por parte del sujeto afectado, puede comprometerse la integridad de sistemas y órganos y consecuentemente, derivar en el desarrollo de alteraciones renales, cardiovasculares, neurológicas, orales aumentar la predisposición a infecciones oportunistas. La medición continua de los niveles de hemoglobina glicosilada (HbA1c), es fundamental para prevenir las complicaciones derivadas de la progresión de la enfermedad ya que mide en sangre, el porcentaje de hemoglobina unida a la glucosa en un lapso de 90 días. Este valor en definitiva, representa el grado de control metabólico de la enfermedad. El objetivo de un adecuado control de la DM2, es mantener una HbA1c por debajo de 7% y de esta forma, evitar las complicaciones asociadas. Actualmente los biomarcadores en saliva, son utilizados como método de diagnóstico e indicativos del grado de progresión y control, de diferentes enfermedades tanto orales como sistémicas. Un estudio reciente demostró que los niveles de la proteína α-2-macroglobulina (A2MG) detectados en saliva presentan un incremento significativo en sujetos con DM2 en comparación con aquellos sujetos en estados pre diabético. El objetivo de este estudio fue evaluar la asociación que existe entre A2MG detectada en saliva en sujetos con DM2 y los valores de HbA1. Se reclutaron 120 sujetos con diagnóstico de DM2 a los cuales se les tomó una muestra de saliva para determinar la concentración de A2MG a través de la técnica de ELISA. Posteriormente se correlacionó esta variable con los valores de HbA1 obtenidos en sangre en cada individuo. Además, se asociaron los niveles de A2MG con otras variables, como la velocidad de flujo salival (VFS), pH y concentración de proteínas. El análisis de los resultados muestra una correlación positiva entre A2MG y HbA1. También observamos una correlación positiva entre las variables A2MG y concentración de proteínas en saliva y una correlación negativa entre A2MG y pH salival. Estos resultados sugieren que la determinación de A2MG en saliva es una alternativa de evaluación de control metabólico de la diabetes que eventualmente podría complementar o reemplazar a la HbA1, ya que es un procedimiento más sencillo, no invasivo y de bajo costo que podría favorecer una mayor adherencia a los mecanismos de control de la enfermedad por parte de los sujetos enfermos y mejorar su calidad de vida.Tesis adscrita a proyecto FIOUCH 13-00