Dov Laufer

Oral health and salivary composition in diabetic patients

The salivary composition and flow rate were examined in 20 patients with insulin-dependent diabetes mellitus (IDDM) and in 19 patients with non-insulin-dependent diabetes mellitus (NIDDM) and compared with 20 healthy controls. Resting and stimulated whole and submandibular saliva was analyzed. Significantly lower resting salivary flow rates were found in the IDDM patients as compared to the NIDDM group. In the IDDM patients potassium concentration in resting saliva was significantly higher compared with healthy controls and in stimulated whole saliva compared with NIDDM patients. No difference in salivary total protein, amylase, lactoferrin, or lysozyme was found among the three groups examined. The IgA concentration of the IDDM patients was significantly higher in whole resting saliva compared with controls and in the submandibular saliva compared with both NIDDM patients and controls. No difference was found between controls and the diabetic patients examined in prevalence of complaint of dry mouth. The salivary flow rates, however, were significantly lower in the three subgroups with dry mouth compared with the subgroups without this complaint. Caries were detected in 100% of the diabetic patients and controls. No correlation was observed between the incidence of caries and any of the salivary parameters examined. A higher prevalence and severity of periodontal disease was detected in the diabetic patients as compared to the controls. A significant positive correlation was found between the gingival index and the concentrations of total protein, albumin, lysozyme, and lactoferrin in whole resting saliva in the three groups examined.

Salivary composition in diabetic patients

Abstract Salivary composition and flow rate were examined in 35 patients with insulin-dependent diabetes mellitus (IDDM) and compared to 31 healthy controls. Significantly lower whole-saliva flow rate was observed in the IDDM patients, but was not correlated with the subjective complaint of xerostomy. Glucose concentration was significantly higher in the parotid saliva of the IDDM patients. Potassium concentration was significantly higher in whole and parotid, resting and stimulated saliva, as was total protein concentration in resting whole and in stimulated parotid saliva of the diabetics. No significant difference between diabetics and healthy controls was found in sodium and lgA concentration or in amylase activity. The significantly higher glucose, lower flow rate, and higher potassium and protein concentrations indicate that salivary glands are affected in IDDM. The subjective complaint of dry mouth, often present in diabetics, while not correlated with salivary flow rate, might reflect qualitative changes in salivary composition and/or altered mucosal perception. Salivary glucose concentration, although significantly higher in the diabetics, was not significantly correlated with serum glucose, preventing the use of saliva for monitoring blood sugar.

The salivary flow rate and composition of whole and parotid resting and stimulated saliva in young and old healthy subjects

Resting and stimulated whole and parotid salivary composition and flow rate were examined in 63 healthy volunteers. No significant differences were found between the young and old in secretion rates and salivary concentrations of sodium, potassium, calcium, magnesium, and total protein. The activity of amylase in the resting and stimulated parotid saliva was significantly lower in the old.

Patient motivation and response to surgical correction of prognathism.

Twenty-five patients operated upon between 1969 and 1973 for correction of mandibular prognathism were recalled in 1975 and asked to evaluate their attitudes toward the procedure and the postoperative results. All but one were satisfied with the results. Postoperative numbness of the lip and chin lasting more than 6 months was commonly noted following the intraoral sagittal split method. This did not influence the patients satisfaction with the operation. The minimal postoperative scar following the extraoral oblique osteotomy was not a negative factor. Most patients underwent the surgical procedure for esthetic reasons. A large number (68 per cent) noted a change in personality postoperatively. A rationale for selective preoperative psychologic counseling is suggested.

Composition of whole unstimulated saliva of healthy children: Changes with age

Whole unstimulated saliva was collected from 136 healthy subjects divided into 5 groups according to age: (1) 25 infants, 7-11 months old; (2) 28 toddlers, 2-3 yr old; (3) 28 children, 6-8 yr old; (4) 28 adolescents, 12-14 yr old; (5) 27 adults, 25-63 yr old. The concentrations of Na, K, total protein, IgA and amylase activity were measured. A significant ascending linear correlation with age was found for concentrations of Na, total protein, IgA and amylase activity. There were significant differences between age groups in K and IgA concentrations. Salivary amylase activity was very variable, and a significant difference was found between infants and toddlers only. Salivary composition thus changes significantly during childhood, implying a process of development and maturation of the salivary glands and indicating the need of age-matched controls for the clinical use of saliva.

Midface advancement in sheep by gradual distraction: a 1-year follow-up study.

PURPOSE The purpose of this study was to find a solution to the unsatisfactory postoperative maxillary relapse after major maxillary advancement or inferior repositioning of the maxilla. MATERIALS AND METHODS Major midface advancement by gradual distraction was performed on three young adult sheep over 21 days. Using an external device, the midface was advanced 36 mm in the nasofrontal area and 43 mm in the lateral aspect of the maxilla. The apparatus remained as an external fixation device for 6 weeks after the distraction to allow better ossification. After removal of the device, a 1-year clinical and radiographic follow-up was conducted. RESULTS Direct measurements between the markers showed 2- to 3-mm relapse after 1 year. Radiologic measurements demonstrated that the relapse occurred during the first 3 months after removal of the distraction apparatus. CONCLUSION It was concluded that midface advancement by gradual distraction may obviate the need for bone grafting and offer a greater movement of bone segments with good skeletal stability.

Effects of irradiation on saliva in cancer patients

Whole unstimulated saliva was analyzed in 15 healthy individuals and 15 patients with malignant tumors in the head and neck region before and during irradiation therapy. Flow rate, pH, electrolytes (Na, K, Ca, Mg), protein and phosphate were measured. There was a decrease in rate of flow, and pH changed towards acidity. The most significant finding was the increased sodium content. We believe that irradiation reduces the reabsorption ability of the tubuli, causing the sodium content of the saliva to increase.

Early diagnosis and treatment monitoring roles of tumor markers Cyfra 21-1 and TPS in oral squamous cell carcinoma

Mucosal oral squamous cell carcinoma (SCC) accounts for 3–5% of all reported cancers, with a 5‐year survival rate of approximately 50%. Unfortunately, current detection means are of no value in diagnosing lesions early enough for cure, especially when they recur after resection. Postoperative radiotherapy and/or covering the resection site with reconstructive flaps (regional or free vascularized) often makes early diagnosis an impossible task.

Clinical and radiographic features of eosinophilic granuloma in the jaws: review of 41 lesions treated by surgery and low-dose radiotherapy.

Eosinophilic granuloma within the jaws may radiographically mimic other benign odontogenic cysts and tumors, and different protocols have been suggested in the literature for treating eosinophilic granuloma of the jaws. Forty-one lesions of eosinophilic granuloma, diagnosed in 25 patients, were reviewed retrospectively, and data were collected regarding age, gender, ethnic origin, location, symptoms, clinical appearance, radiographic features, treatment, and recurrence. The lesions were found in youngsters (18.1 +/- 4.7 years of age), mostly in the posterior parts of the mandible, and the most common presenting symptom was pain (92%), often accompanied by swelling. Approximately one half of the lesions were radiographically well defined without ossification. All patients were treated by enucleation (with or without peripheral ostectomy) and radiotherapy; 7.3% lesions recurred during follow-up (9.3 +/- 4.6 years). In addition, the different treatments suggested in the literature for eosinophilic granuloma of the jaws were reviewed.

Squamous cell carcinoma of the tongue: the prevalence and prognostic roles of p53, Bcl-2, c-erbB-2 and apoptotic rate as related to clinical and pathological characteristics in a retrospective study.

In the current study, we examined the clinical characteristics and survival probability rates of 116 patients treated for squamous cell carcinoma (SCC) of the tongue. In 55 randomly selected patients these data were correlated with the immunohistological analysis of the tumor and apoptosis-related markers, p53, Bcl-2, c-erbB-2 (Her-2/neu), and to the apoptosis rate assessment by the terminal dUTP nick-end-labeling (TUNEL) method. The overall 5-year survival probability was 55%, which might be the result of the low incidence of smoking and/or alcohol consumption among the patients (21%), the early diagnosis (65% at Stages I-II) and the low histological grades (91% good-moderate). Radiotherapeutic or surgical treatment of the neck did not alter the survival probability achieved by local surgery for Stage I patients, but significantly improved survival for Stage II patients. Independent tumor-related variables which significantly worsened the probability of survival were found. Concomitant non-oral cancer was found to be a poor variable for prognosis prediction. Positive staining of p53, TUNEL (apoptosis rate), c-erbB-2 and Bcl-2 was found in 60, 48, 18 and 15% of the lesions, respectively (P<0.0001). The possible biological significance of these markers in tongue SCC is discussed in relation to the current literature, and an independent role for TUNEL and p53 is suggested.