Tooth loss in Sjögren?s syndrome patients compared to age and gender matched controls

To analyze the prevalence and location of tooth loss in Sjögren?s syndrome (SS) patients and compare them with an age- and gender-matched control group. Dental charts and x-rays of 108 (SS) patients were retrieved from an academic dental center and special care dentistry department. For each SS patient, an age- and gender-matched non-SS patient was randomly selected. Medication, number of extractions and date and location of extractions were assessed. Differences between SS and non-SS patients were analyzed using Mann-Whitney U tests, Chi-square tests and Fisher?s exact tests. Significantly more SS patients were edentulous compared to the non-SS group (14.8% versus 1.9%, p = 0.001). SS patients had a 61% higher risk to have experienced one or more extractions than control patients. In the SS group, there was a non-significant tendency for more maxillary teeth to have been extracted than mandibular teeth (42:34). In the control group, the number of extractions in the maxilla and mandible were comparable (21:20). When divided into sextants, the number of SS patients with one or more extractions was significantly higher than for non-SS patients for each sextant (p = 0.001 to p = 0.032). The largest difference in the proportion of patients with one or more extractions between the SS and non-SS patients occurred in the upper anterior sextant (3.4 times more frequent). SS patients are more prone to experience dental extractions compared to patients without SS. It could be speculated that this is related to a decreased salivary secretion

Sialendoscopy increases saliva secretion and reduces xerostomia up to 60 weeks in Sjogren's syndrome patients:a randomized controlled study

OBJECTIVE: To assess the effect of sialendoscopy of the major salivary glands on salivary flow and xerostomia in patients with Sjögren's syndrome (SS). METHODS: Forty-five patients with SS were randomly assigned to a control group (no irrigation, control, n = 15), to irrigation of the major salivary glands with saline (saline, n = 15) or to irrigation with saline followed by corticosteroid application (triamcinolone acetonide in saline, saline/TA, n = 15). Unstimulated whole saliva flow (UWSF), chewing-stimulated whole saliva flow (SWSF), citric acid-stimulated parotid flow, Clinical Oral Dryness Score (CODS), Xerostomia Inventory (XI) and EULAR SS Patient Reported Index (ESSPRI) scores were obtained 1 week before (T0), and 1, 8, 16, 24, 36, 48 and 60 weeks after sialendoscopy. Data were analysed using linear mixed models. RESULTS: Irrespective of the irrigation protocol used, sialendoscopy resulted in an increased salivary flow during follow-up up to 60 weeks. Significant between-group differences in the longitudinal course of outcomes were found for UWSF, SWSF, XI and ESSPRI scores (P = 0.028, P = 0.001, P = 0.03, P = 0.021, respectively). UWSF at 60 weeks was higher compared with T0 in the saline group (median: 0.14 vs median: 0.10, P = 0.02) and in the saline/TA group (median: 0.20, vs 0.13, P = 0.035). In the saline/TA group SWSF at 48 weeks was higher compared with T0 (median: 0.74 vs 0.38, P = 0.004). Increase in unstimulated salivary flow was also reflected in improved CODS, XI and ESSPRI scores compared with baseline. CONCLUSION: Irrigation of the major salivary glands in patients with SS increases salivary flow and reduces xerostomia

Intraoperative visualisation and treatment of salivary glands in Sjögren's syndrome by contrast-enhanced ultrasound sialendoscopy (CEUSS):protocol for a phase I single-centre, single-arm, exploratory study

INTRODUCTION: We established a promising sialendoscopic treatment for in vivo enhancement of salivation in salivary glands affected by Sjögren's syndrome (SS). In this technique, the ducts of the salivary glands are irrigated with saline and steroids. This allows for dilatation of ductal strictures and removal of debris. Unfortunately, it is not possible to assess the delivery and penetration of saline or medications in the ductal system and parenchyma. To address this problem, we will conduct contrast-enhanced ultrasound sialendoscopy (CEUSS) using sulphur hexafluoride microbubbles. To the best of our knowledge, microbubbles have never been used for the treatment of salivary glands in SS. It is, therefore, imperative to test this application for its safety and feasibility. METHODS AND ANALYSIS: A single-arm phase I study will be performed in 10 SS patients. Under local anaesthesia, ultrasound (US) guided infusion of the parotid and submandibular glands with microbubbles will be performed. Continuous US imaging will be used to visualise the glands, including the location of strictures and occlusions. Main outcomes will be the evaluation of safety and technical feasibility of the experimental treatment. Secondary outcomes will consist of determinations of unstimulated whole mouth saliva flow, stimulated whole mouth saliva flow, stimulated parotid saliva flow, clinical oral dryness, reported pain, xerostomia, disease activity, salivary cytokine profiles and clinical SS symptoms. Finally, salivary gland topographical alterations will be evaluated by US. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the Medical Ethics Committee of the Amsterdam University Medical Centre, Amsterdam, The Netherlands (NL68283.029.19). data will be presented at national and international conferences and published in a peer-reviewed journal. The study will be implemented and reported in line with the Standard Protocol Items: Recommendations for Interventional Trials' statement. TRIAL REGISTRATION NUMBERS: The Netherlands Trial Register: NL7731, MREC Trial Register: NL68283.029.19; Pre-results

Dental implants in dentate primary and secondary Sjögren's syndrome patients:A multicenter prospective cohort study

Objectives: To prospectively assess the clinical performance and patient-reported outcomes of dental implants in dentate patients with primary and secondary Sjögren's syndrome (pSS and sSS, respectively) compared to patients without SS. Materials and Methods: Thirty-seven implants were placed in 17 patients with pSS/sSS and 26 implants in 17 non-SS patients to replace missing (pre)molars. Clinical performance, marginal bone-level changes, patient satisfaction, and oral health-related quality of life (OHRQoL) were assessed at 1 (T1), 6 (T6), 12 (T12), and 18 (T18) months after placement of the superstructure. Marginal bone-level changes were measured on standardized dental radiographs. Clinical parameters included implant and crown survival, plaque, bleeding and gingival indices, and probing depth. Patient satisfaction and OHRQoL were assessed with validated questionnaires. Results: Implant survival at T18 was 100% in the patients with pSS/sSS and 96.2% in the non-SS group. Mean marginal bone loss at T18 did not differ between patients with pSS/sSS and non-SS patients, 1.10 ± 1.04 and 1.04 ± 0.75 mm, respectively (p =.87). Clinical performance was good with no differences between the groups for all outcome measures (p >.05). OHRQoL in patients with pSS/sSS had improved significantly after placement of implant supported crowns at all measuring moments compared to baseline (p <.05). Nevertheless, patient satisfaction and OHRQoL remained significantly higher for patients without SS at all measuring moments (p <.05). Conclusion: Dental implants can be successfully applied in dentate patients with pSS/sSS and have a positive effect on OHRQoL

Dental erosion : the role of acidic beverages, saliva and toothpastes in the development and reduction of dental erosion

Tanderosie, het oplossen van glazuur en dentine onder invloed van zuren die niet door bacteriën zijn geproduceerd, lijkt een grote rol te spelen in het ontstaan van gebitsslijtage op jonge leeftijd. Het is nog niet volledig bekend hoe tanderosie ontstaat. Daarom was het doel van dit promotieonderzoek het verkrijgen van inzicht in de rol van (fris)dranken, speeksel en tandpasta’s op het ontstaan van tanderosie. Verschillende laboratoriumstudies en in vivo onderzoeken met vrijwilligers zijn uitgevoerd om dit te bestuderen. Uit de studies waarbij de rol van de frisdranken werd onderzocht, kwam naar voren dat vooral de pH en de verzadigingsgraad van de frisdrank een belangrijke rol spelen in de mate van schadelijkheid van een bepaalde frisdrank. Vervolgens is de rol die speeksel speelt in het ontstaan van tanderosie onderzocht. Dat niet iedereen even vatbaar is voor tanderosie kan mede verklaard worden door verschillen in de speekselsamenstelling tussen personen. Tenslotte werd onderzocht of toevoeging van melkeiwitten of tinfluoride aan tandpasta’s de bescherming van een tandpasta tegen tanderosie verhogen. Uit deze studies kwam naar voren dat tinfluoride en mogelijk ook melkeiwitten de vatbaarheid van een individu voor tanderosie kunnen verminderen. Concluderend kan worden gezegd worden zowel factoren aan de aanvalskant (frisdranken) als factoren die bescherming zouden kunnen bieden (speeksel, tandpasta’s) mede bepalen in welke mate tanderosie optreedt. Dental erosion, the progressive loss of tooth substance by chemical processes that does not involve bacterial action, seems to play a major role in the development of dental wear. The development of dental erosion is still not fully understood. Therefore, the general aim of this PhD research was to obtain insight in the role of beverage parameters, saliva, salivary film/pellicle and toothpaste in the development of dental erosion. Several studies in a laboratory setting and in vivo studies with volunteers were used to investigate this. In the first part of this PhD research the role of acidic beverages in the development of dental erosion was investigated. It was found that the pH and the degree of saturation are important parameters that determine the erosive potential of acidic beverages. In the second part, the role of saliva in the development of erosion was investigated. There is a difference in susceptibility to dental erosion among individuals. This can partly be explained by differences in saliva composition. In the third part of this PhD research we studied whether it whether adding of proteins and stannous fluoride to a toothpaste had an effect on the susceptibility of enamel to erosion. It was found that both protein-containing toothpaste and stannous fluoride toothpaste could give some reduction in susceptibility to dental erosion. Overall, it can be suggested that factors on the “attack side” (acidic beverages) and on the “defense side” (saliva and toothpaste components) are important factors whether and to which extent erosive wear occurs.

Relationship among perceived stress, xerostomia, and salivary flow rate in patients visiting a saliva clinic

Objective: This aimed to assess the potential role of chronic stress in saliva secretion, xerostomia, and oral health in a population attending a saliva clinic. Materials and methods: Data of 114 patients who met the inclusion criteria and completed all questionnaires were analyzed in this study. Participants completed several validated questionnaires, including the Perceived Stress Scale, the Oral Health Impact Profile (OHIP-14), Xerostomia Inventory (XI), and Bother xerostomia Index (BI). Subsequently, the unstimulated, chewing-stimulated, and citric acid-stimulated saliva secretion rates were determined gravimetrically. Data were evaluated using Spearman’s correlation analysis and the Mann–Whitney U test. Results: A significant correlation was observed between perceived stress and XI score (r = 0.312, p = 0.001), as well as between perceived stress and BI score (r = 0.334, p = 0.001). Stress levels also were significantly associated with OHIP-14 scores (r = 0.420, p < 0.001), but an association between experienced stress and salivary flow rate could not be established. Conclusion: In this population, perceived chronic stress seems to be related to several aspects of dry mouth, including the perception of dry mouth, suffering from dry mouth, and the impact on quality of life. These effects were independent of the use of psychotropic medication. No actual reduction in salivary flow was found. Further studies to explore the causal linkage of stress with xerostomia seem warranted. Clinical relevance: Perceived chronic stress seems to be related with several aspects of dry mouth. This finding might be relevant in future prevention and treatment of xerostomia