Oral dryness in relation to film-forming properties of saliva

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Oral dryness in relation to film-forming properties of saliva


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Publication Doctoral Thesis
Title Oral dryness in relation to film-forming properties of saliva
Author Diogo Löfgren, Christina
Date 2016
English abstract
Dry mouth, or oral dryness, is a complex and quite common condition, reported with a varying prevalence of 10-80 %, expressed as a physiological deficiency with or without perceived dysfunction. This condition can severely affect oral health, oral function and quality of life.This t hesis is based on f our s tudies: Study I is a systematic review of the scientific literature and an evaluation of the quality of the evidence for diagnostic methods used to identify oral dryness. The literature included publications during the time period January 1966 to February 2011. Results and conclusions : The database searches resulted in 224 titles and abstracts. A total of 18 original studies were judged relevant and interpreted for this review . When evaluating the included studies with a quality assessment tool for diagnostic accuracy , many of the studies exhibited shortcomings. The most common shortcomings were that the patient selection criteria were not clearly described and the test or reference methods were not described in sufficient detail. Seven of the included studies presented their results as a percentage of correct diagnoses. The evidence for the efficacy of clinical methods to assess oral dryness is sparse and improved standards for the reporting of diagnostic accuracy are needed in or der to assure the methodological quality of studies. Furthermore, a global consensus regarding the terminology of oral dryness is needed in order to facilitate diagnostic procedures, choice of treatment and research design. Salivary dysfunction has mainly been described as being related to low salivary flow rate but the correlation between salivary flow rate and symptoms has shown to be weak. This suggests that not only quantity as a parameter , but also qualitative parameters of saliva, are needed to be included as factors of importance in evaluating the perception of oral dryness. The protective functions of saliva are performed both through and within the bulk liquid phase of saliva, but maybe more implicit through saliva components being dynamically associated as a thin intermediary film on all surfaces exposed in the oral cavity . For instance, examples of qualitative protective functions of surface associated saliva would be the film- forming capacity and rheological characteristics of saliva. T oday there is a lack of clinical diagnostic methods that systematically combine individual’ s perception of saliva and tests of protective functions of s a li v a , w h i ch i n c om b i na t i on m a y id e n t if y i n di v id u a ls a t r is k a n d need of directed preventive regimens. The overall aim of this thesis was to evaluate scientifically reported diagnostic methods in use to identify oral dryness and to explore methods for clinical monitoring of protective functional characteristics of salivary films Study II surveyed the occurrence of subjective and objective oral dr yne ss i n t wo po pul at ion s, on e r an dom ly se le cte d gr oup a nd one dental care-seeking group. The relationship between subjective and objective oral dryness to clinical parameters was analyzed and individuals were designated into one of four groups depending on the occurrence of subjectively described and /or clinically measured oral dryness. Results and conclusions: No association between subjective oral dryness and flow rates of unstimulated and stimulated saliva was found in either of the two populations studied. Individuals identified with subjective oral dryness or objective oral dryness presented to a greater extent a history of oral rehabilitation compared to individuals who showed no indications of oral dryness. Results and conclusions: Individuals with subjective oral dryness exhibited lower values for saliva viscosity and elasticity , when compared to the other groups. Additionally , the amount of saliva associated to a germanium prism was the lowest measured in this group, even if the total protein concentration was not extremely low . These test results in combination with a moderate decrease in surface tension after 600 s may be indicative of a lower film forming capacity of saliva from individuals expressing subjective oral dryness.
Publisher Malmö university, Faculty of Odontology
Series/Issue Doctoral dissertation in odontology
ISBN 978-91-7104-658-1
Pages 119
Language eng (iso)
Subject Sciences
Research Subject Categories::ODONTOLOGY
Included papers
  1. I. Löfgren CD, W ickström C, Sonesson M, Lagunas PT , Christersson C. A systematic review of methods to diagnose oral dryness and salivary gland dysfunction. BMC Oral Health 2012; 12:29.

  2. II. Löfgren CD, Isberg P-E, Christersson C. Screening for Oral Dryness in Relation to Salivary Flow Rate Addresses the Need Functional Tests of Saliva. Oral Health Prev Dent 2010; 8-243-252.

  3. III. Diogo Löfgren C, Johansson D, Bohlin L, Sahlström A, Christersson C. The Challenge of Measuring Viscoelastic Properties of Human Whole Saliva to Fit Clinical Purpose. Int J Dent Health 2015; 1:4.

  4. IV. Diogo Löfgren C and Christersson C. Clinical characterization of oral dryness by a multiple methodological approach. In manuscript.

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