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Biomedical subjects

L M Sreebny

Publications and source records attributed to L M Sreebny.

At least 19 recordsLinked to original sources
PubMed2000

Saliva in health and disease: an appraisal and update.

Saliva plays an important role in oral health monitoring, regulating and maintaining the integrity of the oral hard tissues and some soft tissues. This paper reviews the role of saliva, the prevalence of oral dryness and the consequent importance of salivary flow as well as the relationship between xerostomia and salivary gland hypofunction amongst the causes of oral dryness. Other aspects of oral conditions associated with saliva are also reviewed including Sjögren's Syndrome and oesophageal function. Finally, knowledge, and the current use of salivary tests and the utilisation of saliva as a diagnostic fluid are surveyed.

Adolescent↗
PubMed1997

A reference guide to drugs and dry mouth--2nd edition.

Xerostomia (dry mouth) is an uncomfortable and potentially harmful oral symptom which is usually caused by a decrease in the secretion rate of saliva (salivary gland hypofunction, or SGH). It is more prevalent in the elderly population, primarily due to their increased use of drugs and their susceptibility to disease. Many drugs and drug classes have been linked to xerostomia; the xerogenic effect increases when many drugs are taken concurrently. This Reference Guide to Drugs and Dry Mouth is designed to allow the reader to rapidly identify those pharmacologic agents which have the capacity to induce xerostomia and SGH. Xerogenic drugs can be found in 42 drug categories and 56 sub-categories. A guide to the management of drug-induced SGH and xerostomia is also provided.

Aged↗
PubMed1996

The use of whole saliva in the differential diagnosis of Sjögren's syndrome.

Sjögren's Syndrome (SS) is a chronic, multisystem, autoimmune disorder. It is characterized by (1) generalized exocrine gland dysfunction, (2) serologic abnormalities, and (3) organ-system changes. Oral changes are a prominent feature of this disease. Among these are xerostomia and hypofunction of the salivary glands. Given the intimate relationship between SS and the salivary glands, it is reasonable to postulate that whole saliva (WS) contains the stigmata associated with the presence of this disease. But few studies have been conducted on this secretion. Indeed, WS has largely been neglected and ignored by physicians, dentists, and scientists. Objections to its use have included the fact that it is "impure", that it does not adequately represent what is present in the salivary glands, that no standards have been established for its rate of flow, and that findings based on it lack specificity. Yet, it is this secretion which coats and protects the hard and soft oral tissues, enables us to prepare our food for digestion, and assists our speech. This review will demonstrate that there is a uniqueness and constancy to whole saliva and that it may be used to diagnose the presence of SS. "Screening tests", which include several simple-to-perform sialometric, chemical, and microbiologic procedures, may be conducted in doctors' offices to establish the "profile" of an SS patient. Electrophoretic studies may be used to study the nature of the salivary proteins, and an immunologic test, which is performed on WS and utilizes Western Blot Autoantibody Strips (ImmunoVision, Springdale, AR), may be used to establish the definitive diagnosis of SS.

Adult↗
PubMed1995

Sodium dodecyl sulphate-polyacrylamide gel electrophoresis of human whole saliva.

The purpose of this study was to characterize the electrophoretic patterns of human resting and stimulated whole saliva. Pooled and individual, uncentrifuged, unprocessed whole saliva from 20 healthy, unmedicated individuals was run on sodium dodecyl sulphate-polyacrylamide gel electrophoresis and stained with Coomassie blue R-250. Similar and characteristic patterns for whole saliva were observed for all samples, consisting of over 34 blue- and pink-violet-staining bands. Individual differences were usually in the size (or density) of the bands, not in the number. Repeat sampling of stimulated whole saliva over a period of weeks from the same individuals revealed a striking consistency of protein patterns, indicating a profound physiological stability of whole saliva. These results provide baseline data for whole saliva and suggest its use for future studies.

Adult↗
PubMed1995

The preparation of an autologous saliva for use with patients undergoing therapeutic radiation for head and neck cancer.

PURPOSE: At the present time there is no general agreement about how to prevent the symptoms and clinical signs that accompany therapeutic irradiation for head and neck cancer. Because saliva is the principal protector of the oral tissues, it is logical to assume that many of these changes are due to the radiation-induced damage to the salivary glands. We have observed that the flow and composition of saliva is normal in most patients before their irradiation. Theoretically, it should, therefore, be possible to collect their saliva before they commence their course of radiation, store it in a "saliva bank," and give it back to them when they undergo radiation. The key to the use of such an autologous saliva is the fabrication of a technique that disinfects or sterilizes the saliva yet preserves its protective properties. The objective of this study was to prepare an autologous saliva that would be used by patients during their irradiation for head and neck cancer. MATERIALS AND METHODS: Stimulated saliva was obtained from healthy subjects; none of the subjects consumed any medications. The saliva was treated by a variety of techniques. Included among them were heat, radiation, filtration, centrifugation, and an antibacterial agent. The samples were analyzed for total protein, amylase, viscosity, and sterility; individual salivary proteins were assessed by sodium dodecylsulfate-polyacrylamide gel electrophoresis. RESULTS: The results showed that beta radiation (> 2.5 kGy) and lyophilization + chlorhexidine (0.03% to 0.12%) could be used to prepare a sterile autologous saliva that retained most of its protective properties.

Adult↗
PubMed1992

Management for the highly caries-susceptible patient.

Despite dramatic improvement in caries treatment during the past 30 years, a substantial number of patients remain highly susceptible and do not respond to conventional treatment. It is possible, using simple chairside caries-susceptibility tests, to identify the etiologic factors responsible for the disease and to design a rational approach to treatment that addresses the specific needs of the patient.

Buffers↗
PubMed1992

Xerostomia in diabetes mellitus.

OBJECTIVE: To determine the prevalence of xerostomia in a group of ambulatory diabetic patients and to compare the following in patients with and without xerostomia: 1) flow rates of saliva and lacrimal fluid, 2) the presence of other symptoms suggestive of oral and extraoral dryness, 3) indexes of glycemic control, and 4) noninvasive measures of cardiovagal autonomic nervous system function. RESEARCH DESIGN AND METHODS: Forty adult diabetic patients and an equal number of age- and sex-matched healthy nondiabetic control subjects were studied. Subjects who consumed xerogenic drugs or had other significant diseases were excluded from the study. A questionnaire was administered to all patients, and the following tests were performed: resting and stimulated flow rates on whole saliva; Schirmer's test (lacrimal fluid), serum glucose and HbA1, expiration-inspiration ratio, 30:15 ratio, Valsalva ratio, and the systolic blood pressure response to standing. RESULTS: Forty-three percent of diabetic patients complained of xerostomia, of which 82% were women. The oral dryness was not related to age or the type and duration of diabetes. Symptoms of water loss and oropharyngeal, ocular, and vaginal dryness were much more common in the xerostomic than the nonxerostomic diabetic patients. The salivary flow rates of the diabetic subjects was consistently lower than those of healthy, nondiabetic control subjects. The mean, resting, and whole-saliva flow rate was abnormally low in the diabetic patients who complained of xerostomia; no significant differences were observed for the stimulated salivary and the lacrimal flow rates. Significant inverse relationships were shown between salivary flow and the level of HbA1; none were shown between flow and autonomic function. CONCLUSIONS: Dry mouth is a common complaint among ambulatory diabetic patients. It is strongly associated with objective measurements of poor salivary flow and with other oral and extraoral symptoms of desiccation. The oral dryness is not associated with cardiovagal autonomic system dysfunction but may be due to disturbances in glycemic control.

Adult↗
PubMed1989

Xerostomia. Part II: Relationship to nonoral symptoms, drugs, and diseases.

Five hundred twenty-nine adult outpatients were studied to determine the relationship of xerostomia to other oral symptoms and salivary flow (reported in part I) and to nonoral symptoms, drugs, and select diseases (reported here in Part II). It was observed that dry throat, blurred vision, dry eyes, dry skin, and vaginal itching and fungal infections are prominently associated with oral dryness. These nonoral symptoms were positively correlated with the oral symptoms cited in part I of this study and were inversely related to the flow of resting, but not stimulated, whole saliva. Several classes of drugs were associated with dry mouth. In addition, diabetes mellitus and hypertension were significantly associated with it. Approximately half of the diabetic and hypertensive patients complained of dry mouth. Although a majority of them were taking medications, the association between xerostomia and these diseases cannot be completely attributed to drugs, since many of these patients did not take any xerogenic medicaments. The data show that xerostomia and several other oral symptoms are valid indicators of salivary gland hypofunction. They suggest, moreover, that select nonoral symptoms are an indicator of generalized xerosis.

Adolescent↗
PubMed1989

Recognition and treatment of salivary induced conditions.

Salivary problems, particularly in the aged, are frequent but often not well recognized. Symptomatic dryness (xerostomia) is accompanied by objective evidence of reduced salivary secretion in about half the cases. Dry mouth is not an age change but most often follows salivary gland disturbance of external origin or due to systemic disease. It may herald the presence of widespread symptoms of exocrine gland hypofunction. Resting and stimulated salivary flow rates are useful measures of dryness. Xerostomia may be accompanied by an increase in caries rate, candidosis, cheilitis, dysgeusia or dysphagia. Prominent causes of salivary gland hypofunction are drugs, irradiation, organic diseases, psychogenic factors and decreased mastication. However, a cause cannot always be found and even when identified its effects cannot always be reversed, e.g. in Sjögren's syndrome. Locally acting stimulants of salivary flow or saliva substitutes may alleviate symptoms but systemically acting sialogogues need to be used with caution. The dentist has an important role in identifying xerostomia, an identification that can lead to the diagnosis of previously unrecognized disease.

Adolescent↗
PubMed1987

Xerostomia. A neglected symptom.

Xerostomia, the subjective feeling of dry mouth caused by a severe reduction in the flow of saliva, is a common problem that is particularly prevalent among the aged. It has become increasingly evident that dry mouth is associated with a number of serious systemic conditions and diseases. Among these are the intake of commonly prescribed medications, autoimmune diseases, and irradiation to the head and neck. The diminution in the flow of saliva may profoundly affect oral health, disturb digestion and speech, and seriously impair the patient's quality of life. Food avoidance, nonabsorption of sublingually placed drugs, and noncompliance with medication may also result. Sialometry can be used to confirm the presence of dry mouth. Treatment is aimed at increasing the flow of saliva, when possible, or providing oral moisture by other means.

Aged↗
PubMed1985

Clearance of glucose and sucrose from the saliva of human subjects.

The ability of 20 healthy people to clear test solutions of sucrose (0.73 M) and glucose (1.4 M) from the mouth was examined. Both sugars were cleared within 20 min in a two-step manner. Rapid clearance occurred between 0 and 6 min; much slower clearance occurred thereafter. It took 7.2 min with glucose and 6.3 min with sucrose for the saliva-sugar concentration to fall to 1 mg/ml. Salivary flow, stimulated during sugar exposure, decreased in a two-step pattern similar to sugar clearance. Evidently, clearance was dependent on the rate of flow of saliva which took about 1 h to return to its resting flow level. Comparison of the pattern of sugar clearance to the Stephan curve (the rapid pH fall followed by a slow pH rise seen after rinsing with sugar solutions) indicated that the pH-fall phase of the curve occurs during the initial period of rapid sugar clearance and salivary flow, and the pH-rise phase occurs during the subsequent period of slower clearance and slow saliva flow. Comparison with the data of Swenander-Lanke (1957) [Acta odont. scand. 15, 3-156], indicated that the clearance of sugar solutions also reflects the clearance of sugar-containing solid foods from the mouth.

Adult↗
PubMed1983

Cereal availability and dental caries.

The present study examines the relation between three cereals: wheat, rice, and maize, to dental caries in 12-year-old children in 47 nations of the world. DMFT data were obtained from the World Health Organization's Oral Epidemiology Bank; data on cereal supplies were obtained from the Food and Agriculture Organization (Rome). The relation between these functions was examined by the methods of correlational and rank order analysis. The data show that: 1) the relation of each of the cereals to caries is different; 2) the consumption of wheat is positively correlated to the DMFT values obtained for the 47 nations: 3) maize consumption is negatively associated with caries; and 4) the consumption of rice shows no correlation. In keeping with these observations, nations in the upper quintile of caries prevalence consumed more wheat and less maize than those in the lower quintile. Although these findings do not ipso-facto demonstrate any cause and effect relationships between cereal availability and caries, they do suggest that starch in the form of wheat may contribute to the prevalence of dental caries in nations throughout the world.

Child↗
PubMed1982

Sugar availability, sugar consumption and dental caries.

This study was conducted to update our knowledge about the relation between sugar consumption and dental caries in nations throughout the world. Data on the prevalence of dental caries for 6- and 12-year-old children in, respectively, 23 and 47 nations were obtained from the World Health Organization's Global Oral Epidemiology Bank. Information on sugar supplies was obtained from Food Balance Sheet data prepared by the Food and Agriculture Organization of the United Nations. The study indicates that for the 12-, but not for the 6-, year-old-children there is a significant positive correlation between the per capita availability of sugar and dental caries. The data also suggest that the availability, and presumably the ingestion, of 50 g of sugar per day may represent an outer limit of "safe" or "acceptable" sugar consumption. Furthermore, a comparison of data obtained from Food Balance Sheets for the per capita daily "consumption" of sugar with data for consumption obtained from Household Consumption Surveys in six countries, shows that these data collection methods frequently do not give comparable results. Accurate, total, age-specific consumption figures with information on frequency and the manner of use are needed if the relationship between oral disease and dietary sugar is to be clarified.

Child↗