Pilocarpine-Hydrocloride Has a Short-Time Effect on Reducing Xerostomia

Kserostomija, tj. suhoća usta jest stanje uglavnom uzrokovano uzimanjem lijekova, imunološkim bolestima (Sy. Sjoegren) ili radioterapijom tumora usta i glave. Postoje mnogi ali ne dovoljno učinkoviti terapijski postupci, uključujući i uporabu agonista muskarinskih receptora pilokarpin- hidroklorida. U Hrvatskoj liječenje salivarne hipofunkcije polikarpin-hidrokloridom još nije uvedeno. U ovome istraživanju cilj je bio ocijeniti učinak peroralne uporabe pilokarpina na male žlijezde slinovnice i ukupnu salivaciju te nadzirati moguće neželjene pojave i subjektivni odgovor bolesnika na terapiju. Bio je to jednostruko slijepi placebo pokus. Deset bolesnika s kserostomijom sudjelovalo je u pokusu. Isključeni su bolesnici sa srčanim i plućnim bolestima te oni kojima se tijekom uključenog ispitivanja 7 dana prije pokusa kemijskom stimulacijom C-vitaminom nije povećao salivarni tok. Pokus je obuhvaćao 7 uzastopnih mjerenja količine sline u vremenskim razmacima od 15 do 30 min, od vremena neposredno prije i nakon jedinstvene doze 5 mg pilokarpin- hidroklorida (5 kapi otopine, Pilokarpin 2%, Pliva, hrvatska). Sekrecija malih slinovnica mjerena je na donjoj usni i nepcu s pomoću Periotrona (Oraflow, Plainview, SAD), a ukupna salivacija mjerna je s piomoću graduiranih epruveta. Svaki je ispitanik ispunio jednostavan upitnik o subjektivnoj percepciji liječenja i o možebitnim nuspojavama. Sljedeći je tjedan procedura ponovljena, ali tada je umjesto pilokarpina upotrebljena dekspantenolna otopina (D-panthenol, Ljekarne Zagreb, Hrvatska) kao placebo. Pilokarpin je povećao slivaciju i poboljšao simptome u svakog bolesnika. Razlike u sekreciji sline bile su statistički znatne i u usporedbi sa stanjem prije ordiniranja pilokarpina i u usporedbi s placebom (p = 0,01). Nije bilo zabilježenih nepoželjnih pojava ni nakon ordiniranja pilokarpina ni nakon placeba. Nakon poboljšanja salivacije učinak pilokarpina se vremenom smanjuje, što je zabilježeno tijekom promatranja bolesnika. Uzimajući u obzir kontraindikacije i neželjene učinke, rezultati našeg ispitivanja upućuju da bi se pilokarpin trebao redovito upotrebljavati u liječenju kserostomije.Xerostomia, i.e. oral dryness, is mainly caused by side effects of medications, immunologic diseases, e.g. Sy. Sjoegren, and radiation treatment for oral and neck cancer. There are variable, although far from satisfactory, treatment options, including that of muscarinic receptor agonist pilocarpine-hydrochloride. Pilocarpine treatment of salivary hypofunction is not yet an established method in croatia. The aim of this preliminary study was to assess the autcome of oral administration of pilocarpin on minor salivary glands and whole saliva production, as well as to monitor possible side effects and patients subjective responses to treatment. Is was a single blind-placebo controlled trial. Ten patients suffering from xerostomia underwent this trial. Patients with cardiac or pulmonary diseases were excludet, as well as those that did not show any increase in salivary flow rate after administration of ascorbic acid solution (chemical stimulant) at inclusion testing one week prior to the experiment. The experiment comprised 7 repeated measurements in time intervals of 15-30 min., from the baseline up to 2 h after single oral administration of 5 mg of pilocarpine hydrochloride ( 5 drops of slution, Pilokarpin 2%, pliva, Croatia). The flow rate of minor salivary glands was measured on the lower lip and palate by means of Periotron (Oraflow Inc., Plainview, USA) and whole saliva was collected in calibrated test tubes . A simple questionnaire was filled in to record patients subjective perception of treatment. The same procedure was repeated one week later, when dexpanthenol drops (DPanthenol, Ljekarne Zagreb, Croatia) were used as placebo instead of pilocarpine. Pilocarpine increased salivary output and gave symptomatic relief in every patient. The differences in salivary output were significant both compared to baseline and to placebo controls (p = 0,01). There were no side effects during the trial, either after administration of pilocarpine; or placebo. After increasing salivary flow rate the action of pilocarpine decrease in time, which was recordable during the observation session. Respecting possible contraindications and side effects, according to our finding pilocarpine should be regulary used in treatment of xerostomia

ADHERENCE TO »AMERICAN EUROPEAN CONSENSUS GROUP« CLASSIFICATION CRITERIA FOR SJÖGREN’S SYNDROME IN DIFFERENTIAL DIAGNOSIS OF XEROSTOMIA

Svrhe rada su dobiti epidemiološke i etiološke podatke o problemu kserostomije u dijelu hrvatske populacije i utvrditi dosljednost pridržavanja klasifikacijskih kriterija American European Consensus Group (AECG) za Sjögrenov sindrom (SSj), s ciljem identificiranja moguće potrebe za poboljšanjem dijagnostičkog postupka u diferencijalnoj dijagnostici kserostomije. Retrospektivno istraživanje provedeno je u Zavodu za oralnu medicinu među bolesnicima primljenima zbog osjećaja suhih usta. Uključne kriterije zadovoljilo je 395 bolesnika. Napravljena je baza epidemioloških, kliničkih i sijalometrijskih podataka, nalaza seroloških, scintigrafskih, ultrazvučnih i patohistoloških pretraga žlijezda slinovnica te podataka o farmakoterapiji. Rabili su se deskriptivni statistički postupci. Salivarna hipofunkcija dokazana je u 74% bolesnika. Najčešći vjerojatni uzrok kserostomije bila je farmakoterapija. SSj je dokazan u 6,7% ispitanika sa kserostomijom, dok u 8% postoji visoka sumnja, ali biopsija labijalnih slinovnica nije učinjena, što upućuje na nepridržavanje kriterija AECG za dijagnostiku SSj-a. Nužno je provoditi kriterije AECG u obradi bolesnika sa suhim ustima i provesti edukaciju liječnika opće prakse, stomatologa i bolesnika o kserogenim nuspojavama farmakoterapije.The aims were to obtain epidemiological and etiological data on xerostomia in cross section of Croatian population, and to evaluate adherence to »American European Consensus Group« (AECG) classification criteria for Sjögren’s syndrome (SSj), in order to identify possible need for improvements in differential diagnosis of xerostomia. A retrospective study among patients seen at the Department of oral medicine for complaints of dry mouth was performed. Three hundred and ninety-five patients met inclusion criteria. A data base was formed, comprising epidemiological, clinical and sialometric data, immunological, scintigraphic, ultrasonographic and histopathological findings of salivary glands, coupled with drug intake listings. Descriptive statistics were used for data analysis. Objective salivary hypofunction was found in 74% of our patients. The most common probable cause of xerostomia was side effect of pharmacotherapy. SSj was diagnosed in 6.7% of patients with xerostomia, whereas in another 8% of patients Sjögren’s syndrome was strongly suspected, but labial gland biopsy wasn’t performed, indicating a lack of adherence to AECG criteria for SSj diagnosis. Application of AECG criteria in differential diagnosis of patients with dry mouth is mandatory, as well as educating general practitioners, dentists and patients on xerogenic side effects of pharmacotherapy

Izolacija, karakterizacija i diferencijacijski potencijal matičnih stanica oralne sluznice

Human oral mucosal stem cells (hOMSC) originate from the neural crest and possess multipotency, especially differentiation potential towards neuroectodermal lineage. They are easy to collect, as sampling does not result in irreversible destruction of oral tissues. Potential clinical use of hOMSC is also in the other medical fields; hOMSCs have been successfully transplanted to the cornea in patients with limbal defect, and similar cells can be differentiated into cardiomyocytes after myocardial infarction. hOMSC research in animal models of neurological diseases and injuries has shown their potential role in diseases which modern medicine has failed to treat. In this regard, we started the research of hOMSC and the possibility of their application in the model of ischemic brain stroke. After successfully isolating hOMSC and following their differentiation in the neuroectodermal and mesodermal directions, it was proved that it is possible to produce co-cultures of hOMSC mouse neural stem cells, which we see as an indicator that those cells will be able to coexist and communicate in the mouse model.Ljudske matične stanice iz oralne sluznice (hOMSC) potječu od neuralnog grebena, posjeduju multipotentnost, naročito potencijal diferencijacije prema neuroektodermalnoj liniji. Jednostavno ih je prikupiti, jer uzorkovanje ne rezultira nepovratnim uništenjem oralnih tkiva. Potencijalna klinička upotreba hOMSC također se može naći u drugim medicinskim područjima; hOMSC se uspješno transplantira u rožnicu pacijenata s limbalnim defektom, a slične stanice mogu se diferencirati u kardiomiocite nakon infarkta miokarda. Istraživanje hOMSC-a na životinjskim modelima neuroloških bolesti i ozljeda pokazalo je njihovu moguću ulogu u bolestima koje suvremena medicina ne može adekvatno liječiti. U tom smislu, započeli smo istraživanje hOMSC-a i mogućnosti njihove primjene u modelu ishemijskog moždanog udara. Nakon uspješnog izoliranja hOMSC-a i praćenja njihove diferencijacije u neuroektodermalnim i mezodermalnim pravcima, dokazano je da je moguće proizvesti ko-kulture hOMSC mišjih neuralnih matičnih stanica, što vidimo kao pokazatelj da će te stanice moći koegzistirati i komunicirati u mišjem modelu

The Mouth and Sexually Transmitted Diseases

Ovaj pregledni rad opisuje oralne aspekte spolno prenosivih bolesti (SPB). SPB se mogu vidjeti na oralnoj sluznici, bilo kao uzrok lokalne bolesti ili kao mjesto ulaska opće infekcije. K tomu, bez obzira na oralni ili genitalni put prijenosa, neke SPB mogu izazvati karakterističan oralni nalaz, koji često dovodi do postavljanja točne dijagnoze. U pregledu se nalaze osvrti na bakterijske (gonoreja, sifilis, klamidijska infekcija), virusne (HSV-1 i 2, HPV, HIV) i kandidalne infekcije, odnosno na njihove oralne poveznice. Posebna pozornost pridana je kontroverznim stajalištima, kao što su postojanje gonokoknog stomatitisa i uloga oralnog seksa u nastanku karcinoma usne šupljine. Uloga pružatelja oralne skrbi bit će od velike važnosti u multidisciplinarnom pristupu prevenciji i dijagnozi SPB.This review discusses oral aspects of sexually transmissible diseases (STDs). STDs can affect oral mucosa, either due to a local infection or a systemic infection. Furthermore, whether they are transmitted orally or genitally, some STDs may produce characteristic oral findings, which often lead to a correct diagnosis. The review addresses oral aspects of bacterial (gonorrhoea, syphilis, chlamydial infection), viral (HSV-1&2, HPV, HIV), and candidal infections. Special attention is given to controversial standpoints, such as the existence of gonococcal stomatitis and the role of oral sex in oral cancer development. The role of oral care professionals will be essential in a multidisciplinary approach to the prevention and diagnosis of STDs

ADHERENCE TO »AMERICAN EUROPEAN CONSENSUS GROUP« CLASSIFICATION CRITERIA FOR SJÖGREN’S SYNDROME IN DIFFERENTIAL DIAGNOSIS OF XEROSTOMIA

Svrhe rada su dobiti epidemiološke i etiološke podatke o problemu kserostomije u dijelu hrvatske populacije i utvrditi dosljednost pridržavanja klasifikacijskih kriterija American European Consensus Group (AECG) za Sjögrenov sindrom (SSj), s ciljem identificiranja moguće potrebe za poboljšanjem dijagnostičkog postupka u diferencijalnoj dijagnostici kserostomije. Retrospektivno istraživanje provedeno je u Zavodu za oralnu medicinu među bolesnicima primljenima zbog osjećaja suhih usta. Uključne kriterije zadovoljilo je 395 bolesnika. Napravljena je baza epidemioloških, kliničkih i sijalometrijskih podataka, nalaza seroloških, scintigrafskih, ultrazvučnih i patohistoloških pretraga žlijezda slinovnica te podataka o farmakoterapiji. Rabili su se deskriptivni statistički postupci. Salivarna hipofunkcija dokazana je u 74% bolesnika. Najčešći vjerojatni uzrok kserostomije bila je farmakoterapija. SSj je dokazan u 6,7% ispitanika sa kserostomijom, dok u 8% postoji visoka sumnja, ali biopsija labijalnih slinovnica nije učinjena, što upućuje na nepridržavanje kriterija AECG za dijagnostiku SSj-a. Nužno je provoditi kriterije AECG u obradi bolesnika sa suhim ustima i provesti edukaciju liječnika opće prakse, stomatologa i bolesnika o kserogenim nuspojavama farmakoterapije.The aims were to obtain epidemiological and etiological data on xerostomia in cross section of Croatian population, and to evaluate adherence to »American European Consensus Group« (AECG) classification criteria for Sjögren’s syndrome (SSj), in order to identify possible need for improvements in differential diagnosis of xerostomia. A retrospective study among patients seen at the Department of oral medicine for complaints of dry mouth was performed. Three hundred and ninety-five patients met inclusion criteria. A data base was formed, comprising epidemiological, clinical and sialometric data, immunological, scintigraphic, ultrasonographic and histopathological findings of salivary glands, coupled with drug intake listings. Descriptive statistics were used for data analysis. Objective salivary hypofunction was found in 74% of our patients. The most common probable cause of xerostomia was side effect of pharmacotherapy. SSj was diagnosed in 6.7% of patients with xerostomia, whereas in another 8% of patients Sjögren’s syndrome was strongly suspected, but labial gland biopsy wasn’t performed, indicating a lack of adherence to AECG criteria for SSj diagnosis. Application of AECG criteria in differential diagnosis of patients with dry mouth is mandatory, as well as educating general practitioners, dentists and patients on xerogenic side effects of pharmacotherapy

Electromyographic Evaluation of Masticatory Muscle Activity in Patients with Temporomandibular Dysfunction

Pojam temporomandibularna disfunkcija (TMD) obuhvaća mnoge poremećaje u vezi sa žvačnim mišićima i temporomandibularnim zglobovima. U vezu s nastankom TMD-a najčešće se dovode okluzalni, traumatski, psihosocijalni i sustavski čimbenici. Svrha ovoga istraživanja bila je ustanoviti postoji li promijenjena aktivnost žvačnih mišića u ispitanika s poremećajem te utvrditi mogućnosti dijagnostike temporomandibularnih poremećaja metodom elektromiografije. U ispitivanju je sudjelovalo 40 ispitanika: 13 ispitanika sa simptomima temporomandibularne disfunkcije i 27 asimptomatskih ispitanika, usporedivih po spolu i dobi. Elektromiografska mjerenja provedena su na šest mišića (desni i lijevi prednji temporalis, maseter i digastrikus) u osam referentnih položaja. Ispitivanje odnosa vrijednosti mioelektričkih signala pojedinog mišića desne i lijeve strane u skupini zdravih ispitanika u lateralnim okluzijskim položajima i u maksimalnim lateralnim položajima pokazalo je znatno veću aktivnost temporalnoga mišića radne strane (p0,05). Razlika u vrijednosti mioelektričkih signala između asimptomatske i simptomatske skupine pronađena je za desni i lijevi maseter u maksimalnoj interkuspidaciji s 50% MVC (p<0,05), kod kojih su veće vrijednosti nađene u simptomatskoj skupini. Rezultati ovoga istraživanja pokazali su postojanje promjena aktivnosti žvačnih mišića u ispitanika s TMD-om te potvrdili mogućnost uporabe elektromiografije u dijagnostici temporomandibularnih poremećaja.The term temporomandibular dysfunction (TMD) encompasses a group of disorders of the masticatory muscles and temporomandibular joints. Major precipitating factors are occlusal, traumatic, psychosocial and systemic factors. The aim of this investigation was to determine possible altered muscular function in patients with TMD, as well as to determine the need for EMG application in TMD diagnosis. Forty young adults participated in this study: 13 subjects with signs and symptoms of TMD and 27 asymptomatic subjects, sex and age matched. Surface EMG recordings were obtained from left and right anterior temporal muscle, left and right masseter muscle and from left and right digastric muscle in eight mandibular positions. Right side to left side ratio of examined muscles myoelectrical signals in lateral occlusal and maximal lateral positions for the asymptomatic group showed significantly higher activity of the working side anterior temporal muscle (p0.05). Comparison of myoelectrical signals in the position of maximal intercuspation of teeth between the patients and the controls, showed significantly higher activity in right and left masseter muscle at 50% MVC (p<0.05) in the symptomatic group. Results of this investigation showed the presence of altered masticatory muscle activity in TMD patients and confirmed the use of electromyography in TMD diagnosis