Ibtisam Al-Hashimi

Xerostomia secondary to Sjögren's syndrome in the elderly: recognition and management.

Xerostomia is a common symptom in the elderly population. Studies have suggested that the underlying cause of approximately 40% of xerostomia in the elderly is Sjögren’s syndrome. Although it is highly prevalent among middle-aged individuals, elderly patients account for up to 20% of Sjögren’s syndrome cases. Sjögren’s syndrome is a multisystem exocrinopathy characterised by dry mouth and dry eyes with wide-ranging extraglandular involvement. The exocrine manifestations of Sjögren’s syndrome affect the mouth, eyes, nose, ears, skin, vagina and the entire respiratory and gastrointestinal systems. The nonexocrine involvement may include the joints, thyroid gland, liver, kidneys and the musculoskeletal, vascular and central nervous systems. Currently, the mechanism(s) of development and progression of Sjögren’s syndrome is/are not clear. Inflammation and lymphocytic infiltration of the exocrine glands is a classical feature of Sjögren’s syndrome. During the progression of the disease, the acinar cells of the exocrine glands are replaced by fibrosis, rendering the glands nonfunctional. Sjögren’s syndrome remains one of the most underdiagnosed conditions, particularly in the elderly population, because the cardinal sicca symptoms, which are the hallmark of the disease, are frequently attributed to aging and/or medications, which consequently delays the diagnosis. This delay in diagnosis imposes significant physical, psychological and economic burdens on elderly patients. The diagnosis of Sjögren’s syndrome requires evaluation of both the exocrine and nonexocrine components of the disease. Management of Sjögren’s syndrome requires collaboration by the primary-care physician, rheumatologist, ophthalmologist and dentist. This article reviews current understanding of the clinical manifestations, diagnosis and treatment of Sjögren’s syndrome with special emphasis on the oral component of the disease.

Evaluation of the levels of oral Candida in patients with Sjögren's syndrome

OBJECTIVE The purpose of this study was to investigate the levels of oral Candida in patients with Sjögrens syndrome METHODS The Candida count and salivary flow rate of patients with Sjögrens syndrome were compared with those of healthy control subjects. Candida cultures were obtained from oral rinses. The numbers of colony-forming units were determined through use of the Spiral System. RESULTS The mean Candida count of patients with Sjögrens syndrome was 1672 +/- 1455 colony-forming units per mL; the count of healthy control subjects was 0.00 colony-forming units per mL. The mean salivary flow rate of patients with Sjögrens syndrome was significantly lower than that of healthy control subjects (0.16 +/- 0.13 mL/min/gland vs 0.55 +/- 0.24 mL/min/gland, respectively; p = 0.0001). However, Spearman rank correlation analyses did not reveal a significant correlation between salivary flow rate and Candida count (in colony-forming units per mL) among patients with Sjögrens syndrome. CONCLUSIONS Alteration in the oral microbial flora in patients with Sjögrens syndrome may be enhanced by the reduction in salivary output.

Cytokine concentrations in stimulated whole saliva among patients with primary Sjögren's syndrome, secondary Sjögren's syndrome, and patients with primary Sjögren's syndrome receiving varying doses of interferon for symptomatic treatment of the condition: a preliminary study

Abstract. Sjögren’s syndrome is an autoimmune disorder which causes diminished salivary flow due to autoimmune sialoadenitis. This decrease in saliva flow is the result of inflammation and atrophy of the salivary glands. Most treatment regimens are palliative in nature, but treatment with interferon (IFN) holds promise for Sjögren’s syndrome sufferers. Several studies have investigated cytokine concentrations in the salivary glandular tissues from Sjögren’s syndrome patients; however, there is little information concerning cytokine expression in saliva. This is especially true with respect to treatment modalities and their effects on local cytokines. A clinical study was conducted to determine salivary interleukin (IL)-6, IFN , and IL-2, concentrations among subjects diagnosed with primary and secondary Sjögren’s syndrome and a healthy control group. The primary Sjögren’s syndrome showed significantly higher salivary IL-2 and salivary IL-6 than the control and secondary Sjögren’s groups. There were no between group differences for salivary IFN concentrations. In addition, the study assessed salivary IL-6, IFN, and IL-2 concentrations among 18 Sjögren’s syndrome patients before and after administration of IFN via the oral mucosal route. The results of the study showed that the mean values for the pre- and post-treatment groups for stimulated whole saliva flow rates were 3.15 and 3.74 ml/5 min, respectively. The post-treatment group exhibited a 16.8% increase in stimulated whole saliva flow rates. The salivary IL-6 concentration was 53.3% lower for the post-treatment group (17.79) as compared to the baseline value (33.35). The values for salivary IFN and salivary total protein were virtually unchanged from their baseline values. Salivary IL-2 values, however, were 50% lower in the post-treatment group (3.07) when compared to their respective baseline values(6.10). The results of this study suggest that healthy individuals exhibit lower salivary IL-2 and IL-6 as compared to individuals suffering from primary and secondary Sjögren’s syndrome. The results also suggest that administration of IFN via the oral mucosal route may increase salivary flow rates and depress certain cytokines (IL-2, IL-6) associated with inflammatory destruction of salivary glandular tissues in Sjögren’s syndrome patients.

Evaluation of major parotid glycoproteins in patients with burning mouth syndrome

OBJECTIVE This study was to investigate the potential role of salivary glycoproteins in burning mouth syndrome. STUDY DESIGN This study compared major parotid glycoproteins in a group of patients with burning mouth syndrome and age-, sex-, race-matched healthy controls. RESULTS By use of a glycoprotein detection kit, saliva from both patients and controls exhibited three major parotid glycoprotein banding patterns consisting of either one or two bands, molecular weights 58 kDa and 77 kDa. The strong lectin reactivity of major parotid glycoproteins with Ricinus communis agglutinin suggests that galactose is the most prevalent terminal sugar. In addition, major parotid glycoproteins were shown to express blood group antigen H. On the basis of metachromatic characteristics and immunologic reactivity, major parotid glycoproteins appear to be members of the proline rich protein multigene family, proline rich glycoprotein, genetic polymorphism G1. No qualitative difference was observed in major parotid glycoprotein banding patterns between patients and controls. CONCLUSION These findings do not support a role for major parotid glycoproteins in burning mouth syndrome.

Salivary electrophoresis in the diagnosis of Sjögren's syndrome

OBJECTIVE The purpose of this study was to investigate the potential use of salivary electrophoresis for the diagnosis of Sjögrens syndrome. METHODS Salivary protein profiles of 43 patients and 39 healthy control subjects were compared on three different gel electrophoresis systems: sodium dodecylsulfate-polyacrylamide gel electrophoresis, anionic polyacrylamide gel electrophoresis, and immobilized pH gradient gel electrophoresis (isoelectric point, 3.5-5.0). RESULTS Most of the patients with Sjögrens syndrome exhibited an electrophoretic profile that was different from that of the healthy control subjects. Among the three gel electrophoresis systems examined, the immobilized pH gradient system appeared to be the most reliable for Sjögrens syndrome. Tests of accuracy revealed that the immobilized pH gradient system exhibits high specificity (97%), sensitivity (95%), positive predictive value (97%), and negative predictive value (95%) in the diagnosis of Sjögrens syndrome. CONCLUSIONS Our results suggest that salivary electrophoresis is a potentially useful test for the diagnosis of Sjögrens syndrome.

Prevalence of oral lesions of autoimmune etiology in patients with primary Sjogren's syndrome

OBJECTIVE The primary objective of this study was to determine the prevalence of oral lesions of autoimmune etiology (OLAIE) in a cohort of patients with primary Sjögrens syndrome (pSS). MATERIALS AND METHODS A multi-center retrospective cohort study was conducted at the oral medicine practices of Carolinas Medical Center (CMC), Baylor College of Dentistry (BCD), and the University of Florida (UF). Each site performed a chart review of patients with well-characterized pSS. Clinical variables such as OLAIE, traumatic lesions, and medical conditions were compiled at each site. The association between clinical variables and the presence of OLAIE was then assessed for significance. RESULTS We evaluated 155 patients diagnosed with pSS. Nineteen patients with pSS (12.3%) had an OLAIE. CMC reported 11 (21.2%) patients with OLAIE, while BCD and UF reported 4 (7.3%) and 4 (8.3%), respectively. Eleven of the 19 (58%) patients with OLAIE had lichen planus, 6 (32%) had aphthous stomatitis, 1 (5%) had chronic ulcerative stomatitis, and 1 (5%) had lesions of systemic connective tissue disease by immunofluorescence. CONCLUSION The results of our analysis suggest that patients with pSS have a 12% prevalence of OLAIE with a wide range (7.3-21.2%) found between practices. This difference is likely related to the different screening protocols for oral dryness between sites.

Advanced Nanomaterials: Promises for Improved Dental Tissue Regeneration

Nanotechnology is emerging as an interdisciplinary field that is undergoing rapid development and has become a powerful tool for various biomedical applications such as tissue regeneration, drug delivery, biosensors, gene transfection, and imaging. Nanomaterial-based design is able to mimic some of the mechanical and structural properties of native tissue and can promote biointegration. Ceramic-, metal-, and carbon-based nanoparticles possess unique physical, chemical, and biological characteristics due to the high surface-to-volume ratio. A range of synthetic nanoparticles such as hydroxyapatite, bioglass, titanium, zirconia, and silver nanoparticles are proposed for dental restoration due to their unique bioactive characteristic. This review focuses on the most recent development in the field of nanomaterials with emphasis on dental tissue engineering that provides an inspiration for the development of such advanced biomaterials. In particular, we discuss synthesis and fabrication of bioactive nanomaterials, examine their current limitations, and conclude with future directions in designing more advanced nanomaterials.

Sjögren's syndrome: diagnosis and management.

This article reviews current understanding of the clinical manifestations, diagnosis and treatment of Sjögrens syndrome. Sjögrens syndrome is a chronic inflammatory disorder of the exocrine glands with multiple nonexocrine features. It is found predominantly in middle-aged women but exists throughout the population. The diagnosis of Sjögrens syndrome can be challenging because the cardinal sicca symptoms may be subclinical or attributed to other causes, such as medications or aging. Differential diagnosis of Sjögrens syndrome can be confounded by the multiple exocrine manifestations in the mouth, eyes, ears, nose, skin, vagina, and respiratory and gastrointestinal tracts, as well as seemingly unrelated nonexocrine involvement in the thyroid, liver, kidneys and the musculoskeletal, vascular and nervous systems. This article concludes that early diagnosis of Sjögrens syndrome is crucial to prevent and/or minimize potentially life-threatening complications. Periodic follow-up of patients’ status and collaboration between the primary-care physician and the rheumatologist, dentist, ophthalmologist and other specialists are indispensable.

A pilot study on the effect of radiation on calmodulin in rat submandibular salivary glands

Xerostomia and loss of salivary gland secretion is one of the most common complications of the radiation treatment of head-and-neck malignancies. The secretory mechanism in the salivary glands can be modulated by the concentration of intracellular Ca2+. Calmodulin is a calcium-binding protein that is widely distributed in nature and is involved in regulating intracellular calcium. In this study the effect of radiation on the concentration of calmodulin in rat salivary glands was investigated. Fourteen rats were divided into three groups: R1 (n = 4) and R2 (n = 5) received a single dose of 15 Gy and group C (n = 5) received no radiation. R1 and R2 animals were killed at weeks 2 and 10 post-irradiation, respectively. The submandibular glands were removed, homogenized and their total calmodulin was determined. The mean calmodulin concentrations were 6.4+/-1.1 microg/gland for controls, 14.1+/-3.7 microg/gland for R1 and 68.2+/-14.4 microg/gland for R2. Kruskal-Wallis ANOVA revealed a significant increase in the concentration of calmodulin following irradiation (p = 0.003). The relationship between this increase and the loss of salivary gland function is not yet clear.

The Role of Occlusion in the Dental Implant and Peri-implant Condition: A Review

Dental implants have become a widely used dental treatment approach. It is important to identify factors that can be detrimental to dental implants and the peri-implant complex. There is controversy regarding whether occlusion plays a role in the implant and peri-implant condition. The present study aims to review the scientific literature regarding this topic. Animal and human studies, and previous reviews on the topic are included and presented. There is a wide heterogeneity among study designs. Several articles demonstrated that occlusion and occlusion overload could detrimentally affect the peri-implant condition, while other articles did not support these results. More studies are needed to help understand the mechanisms by which occlusion might play a role in the peri-implant condition.