Annica Almståhl

Electrolytes in stimulated whole saliva in individuals with hyposalivation of different origins

There are reasons to believe that changes in the secretion rate of saliva as well as changes in its protein and electrolyte composition promote the growth of micro-organisms associated with oral disorders. Knowledge of the electrolytes in the saliva of those with hyposalivation might therefore be of value in designing oral health-promoting measures. In this study, electrolytes in stimulated whole saliva were analysed in individuals with hyposalivation due to radiation therapy in the head and neck region (RT group), primary Sjögrens syndrome (pSS group), neuroleptic treatment (Neuro group), and to medication or of unknown origin (Unknown group). The bicarbonate concentration was significantly lower in all four hyposalivation groups compared with controls. The bicarbonate concentration, which in normal conditions is positively correlated with the salivary secretion rate, was lower in the Neuro group than in the RT and Sjögrens groups despite a stimulated secretion rate about twice as high. Furthermore, the Neuro group had the highest phosphate concentration. The RT and Sjögrens groups tended to have increased sodium concentrations. For potassium and calcium, the RT group had significantly higher concentrations than the other hyposalivation groups and the controls. The substantial increase in calcium and decrease in bicarbonate suggest that the function of the parotid glands is more affected than that of the other salivary glands. The results also indicate a contribution of plasma to the electrolyte concentrations determined in whole saliva in the RT and Sjögrens groups. In conclusion, in individuals with hyposalivation the concentrations of electrolytes in stimulated whole saliva seem to be more related to the reason for the hyposalivation than to the salivary secretion rate.

Microflora in oral ecosystems in subjects with radiation-induced hyposalivation

AIM To analyse the microbial flora in specific oral sites in 13 dentate subjects, 6-8 months after completed radiation therapy (RT group) and in 13 matched controls. MATERIAL AND METHODS The microflora on the tongue, buccal mucosa, vestibulum, supragingival plaque and subgingival region was analysed using duplicate sampling and cultivation technique. A clinical examination was also performed. RESULTS Candida albicans was found in one or more sites in 54% of the RT subjects and in 15% of the controls. In three RT subjects, C. albicans was found at all four sites analysed. An unexpected finding was that enterococci were found in all RT subjects and in high number in 38%. None of the controls harboured enterococci. In supragingival plaque, Lactobacillus spp. were detected in 92% of the RT subjects and the number and proportion of Lactobacillus spp. were extremely high compared with the controls. Mutans streptococci were detected in high numbers in 31% of the RT subjects, while they were not detected in 23%. CONCLUSION The microbial results explain why some RT subjects have an increased susceptibility to oral diseases and stress that site-specific microbial analysis is an important diagnostic tool when planning oral health preventive care for RT subjects.

Dental Plaque pH and Micro-organisms during Hyposalivation

We have previously reported that minor gland and whole saliva flow rates and salivary proteins showed differences in individuals with primary Sjögren’s syndrome or head and neck radiation therapy, compared with controls (Eliasson et al., 2005). We now hypothesize that pH and number of acidogenic micro-organisms in dental plaque as well as saliva buffering capacity also differ in these individuals. Plaque pH was measured by the microtouch method up to 60 min after a sucrose rinse. Plaque collected from the same sites was analyzed for counts of total and acidic micro-organisms. Compared with their controls, the irradiated group but not the Sjögren’s syndrome group displayed significantly lower plaque pH, increased numbers of lactobacilli and Candida species, as well as reduced buffering capacity. Stepwise regression tests suggested that the buccal minor-salivary-gland secretion rate in the test groups and counts of mutans streptococci in the controls were of significant importance for dental plaque pH.

Virulence factors and antibiotic susceptibility in enterococci isolated from oral mucosal and deep infections

Abstract Objective This study evaluates the presence of virulence factors and antibiotic susceptibility among enterococcal isolates from oral mucosal and deep infections. Methods Forty-three enterococcal strains from oral mucosal lesions and 18 from deep infections were isolated from 830 samples that were sent during 2 years to Oral Microbiology, University of Gothenburg, for analysis. The 61 strains were identified by 16S rDNA, and characterized by the presence of the virulence genes efa A (endocarditis gene), gel E (gelatinase gene), ace (collagen binding antigen gene), asa (aggregation substance gene), cyl A (cytolysin activator gene) and esp (surface adhesin gene), tested for the production of bacteriocins and presence of plasmids. MIC determination was performed using the E-test method against the most commonly used antibiotics in dentistry, for example, penicillin V, amoxicillin and clindamycin. Vancomycin was included in order to detect vancomycin-resistant enterococci (VRE) strains. Results Sixty strains were identified as Enterococcus faecalis and one as Enterococcus faecium. All the virulence genes were detected in more than 93.3% (efa A and esp) of the E. faecalis strains, while the presence of phenotypic characteristics was much lower (gelatinase 10% and hemolysin 16.7%). Forty-six strains produced bacteriocins and one to six plasmids were detected in half of the isolates. Conclusions Enterococcal strains from oral infections had a high virulence capacity, showed bacteriocin production and had numerous plasmids. They were generally susceptible to ampicillins but were resistant to clindamycin, commonly used in dentistry, and no VRE-strain was found.

Lactobacillus species in supragingival plaque in subjects with hyposalivation

UNLABELLED The aim of the study was to analyse the frequency of different Lactobacillus species in relation to the pH-lowering potential of the plaque. METHODS Ten subjects with radiation-induced hyposalivation (RT group) and 10 subjects with primary Sjögrens syndrome (pSS group) and matched controls with normal salivary secretion were included. Lactobacillus species were selected from their growth on Rogosa agar and identified by PCR and restriction fragment length polymorphism using HaeIII and HpaII restriction enzymes. RESULTS Lactobacilli were isolated from 14 subjects (6 RT, 3 pSS, 5 controls). The most prevalent species were Lactobacillus fermentum (7 subjects), Lactobacillus casei (7 subjects) and Lactobacillus rhamnosus (6 subjects). L. fermentum and L. casei were the most prevalent species in anterior sites and L. rhamnosus and L. fermentum in posterior sites. In anterior sites, hyposalivated subjects with high Lactobacillus counts had an increased plaque acidogenicity compared to those with low counts. In posterior sites, subjects with high Lactobacillus counts had a lower final pH compared with those with low counts. CONCLUSION There were large intra- and inter-individual variations in frequencies of Lactobacillus species and Lactobacillus counts, but no specific species could be related to plaque acidogenicity.

Oral Care and Mortality in Older Adults with Pneumonia in Hospitals or Nursing Homes: Systematic Review and Meta‐Analysis

The objectives of the study were to compare the effect of intensified oral care interventions given by dental or nursing personnel on mortality from healthcare‐associated pneumonia (HAP) in elderly adults in hospitals or nursing homes with the effect of usual oral care. Systematic literature searches were conducted in PubMed, the Cochrane Library, and the Health Technology Assessment database of the National Health Service Centre for Reviews and Dissemination (August 2015). Randomized controlled trials (RCTs) were considered for inclusion. Data were extracted and risk of bias was assessed independently and agreed on in consensus meetings. Five RCTs, with some or major study limitations, fulfilled the inclusion criteria. Based on meta‐analyses, oral care interventions given by dental personnel reduced mortality from HAP (risk ratio (RR) = 0.43, 95% confidence interval (CI) = 0.25–0.76, P = .003), whereas oral care interventions given by nursing personnel did not result in a statistically significant difference in mortality from HAP (RR = 1.20, 95% CI = 0.97–1.48, P = .09), in elderly adults in hospitals or nursing homes from usual oral care. Oral care interventions given by dental personnel may reduce mortality from HAP (low certainty of evidence, Grading of Recommendations Assessment, Development and Evaluation (GRADE) ⊕⊕○○), whereas oral care interventions given by nursing personnel probably result in little or no difference from usual care (moderate certainty of evidence, GRADE ⊕⊕⊕○) in elderly adults in hospitals or nursing homes.

Microflora in oral ecosystems and salivary secretion rates – A 3-year follow-up after radiation therapy to the head and neck region

OBJECTIVE Results indicate that late improvements of radiation therapy (RT) in the head and neck region may diminish the long-term effects on salivary glands and oral microflora. The aim was therefore to analyze salivary secretion rates and oral microflora over time in RT subjects. DESIGN Twelve dentate subjects (28±2 teeth) and 12 controls were included. A clinical examination was performed and the salivary secretion rates were determined. Microbial samples, analyzed using cultivation technique, were collected from the soft tissues, supragingival plaque and gingival crevice region. RESULTS Compared with the controls, the RT group (n=11) had 3 years post RT higher numbers and proportions of lactobacilli (p<0.001 and p<0.01) and Candida albicans (p<0.01 and p<0.05) in the supragingival plaque, higher numbers of enterococci in the vestibulum in the molar region and on the tongue (p<0.05 for both), a lower total count (p<0.001) and lower numbers of streptococci, Streptococcus salivarius and Fusobacterium nucleatum (p<0.01) on the tongue. Although both stimulated and unstimulated salivary secretion rates were increased over time, the proportion of microorganisms associated with oral health decreased, and microorganisms associated with oral disorders increased. Despite a comparable oral hygiene, it was only the 27% who had a stimulated salivary secretion rate ≥1.0ml/min and a buffering capacity ≥6.0, where a recovery of the flora could be seen. CONCLUSION The results indicate that regaining a normal, stimulated salivary secretion rate and buffering capacity are prerequisites to regaining an oral flora associated with good oral health.

A prospective study on oral microbial flora and related variables in dentate dependent elderly residents.

OBJECTIVE Oral microorganisms and related variables were followed over a 1-year period in dentate dependent elderly. BACKGROUND For nursing personnel, oral hygiene for the dependent elderly is demanding. It requires good knowledge of how to carry out preventive oral health measures and to judge when help is needed. Previous studies indicate low levels of knowledge, which might be reflected in the oral health of dentate residents. MATERIAL AND METHODS Twenty-one subjects participated at baseline and 14 one year later. Microbial samples were analysed using cultivation technique. The labial minor gland secretion rate was measured using the Periotron(®) method, and oral clinical data were registered. RESULTS Low labial mucosal flow rates were seen for 95% of the participants. At baseline, visibly thick plaque was seen in 48% and 1 year later in 57%. Both frequency and number of bacteria associated with caries and frequency of microorganisms associated with oral soft tissue infections were high. One year later, a decrease in bacteria associated with good oral health and a tendency to an increase in aciduric microorganisms were seen. CONCLUSION Poor oral health, tending to further deteriorate over time, advocates regular professional supplementary support when elderly dentate dependent residents need assistance with their oral care.

Explorative study on quality of life in relation to salivary secretion rate in patients with head and neck cancer treated with radiotherapy

Radiotherapy (RT) to the head and neck region often results in oral complications. In this explorative study, the pretreatment and posttreatment (6 months and 12 months) quality of life (QOL) was analyzed for patients with head and neck cancer. The associations between QOL and salivary secretion rates were analyzed.

Acid-producing capacity from sugars and sugar alcohols among Lactobacillus isolates collected in connection with radiation therapy

OBJECTIVE To investigate the acid-producing capacity from sugars and sugar alcohols of oral Lactobacillus collected in connection with radiation therapy (RT) to the head and neck region. DESIGN Lactobacillus were collected from the tongue, buccal mucosa and supragingival plaque in 24 patients before, during, and after RT. The acid-producing capacity of Lactobacillus isolates (n=211) was analyzed using a colorimetric fermentation test in microtiter plates. Solutions containing 2% sugars (sucrose, glucose, fructose, lactose) or sugar-alcohols (sorbitol and xylitol) were used. After 24h of incubation, bacterial acid-producing capacity was determined as strong (pH<5), weak (pH  ≥5-≤ 6) or low/absent (pH>6). Data regarding intake frequency of sugar-rich products and products with sugar-alcohols was collected. RESULTS The highest acid-producing capacity using the sugars was seen for isolates collected during RT. Sorbitol was fermented to a higher extent during and post RT, especially among isolates from plaque. Lactobacillus fermenting xylitol showed the highest acid-producing capacity during RT (p<0.05). No statistically significant correlations between stimulated whole salivary secretion rate and acid-producing capacity, or between the intake frequency of sugar-rich products or sugar-alcohol containing products and Lactobacillus acid-producing capacity, were found. CONCLUSION The results suggest that Lactobacillus isolates, collected from the tongue, buccal mucosa and supragingival plaque, have a higher acid-producing capacity using sugars and sugar-alcohols during RT than one year post RT.