Evaluation of unstimulated flow rates of whole and palatal saliva in healthy patients wearing complete dentures and in patients with Sjogren's syndrome

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Abstract

Statement of problem

The palate and upper lip are the regions of oral mucosa covered with the least amount of saliva. These areas are important for maxillary denture retention and stability. Thus, patients with xerostomia or hyposalivation may have problems with the stability of maxillary complete dentures.

Purpose

The purpose of this study was to compare the unstimulated whole saliva (UWS) and palatal saliva (PS) flow rates of healthy patients wearing complete dentures and patients with Sjogren's syndrome (SS) and to determine whether xerostomia or hyposalivation has a negative influence on maxillary complete denture stability. A further aim was to determine the influence of new complete dentures on UWS and PS flow rates in healthy individuals.

Material and methods

Thirty-five complete denture wearers, 24 healthy individuals (controls) and 11 patients who fulfilled the diagnostic criteria for primary Sjogren's syndrome (as proposed by the European Community Study Group) were investigated. All participants were questioned about possible subjective oral complaints (xerostomia or instability of the dentures) through use of a standardized questionnaire. In the first part of the study, UWS and PS flow rates of the healthy subjects (controls) and of the SS patients were measured at the initial visit. The flow rate of UWS (mL/min) was collected by the “spitting” method; saliva was collected into preweighed vessels for 5 minutes while subjects were seated in an upright position. Patients were asked to refrain from smoking, eating, and drinking for 2 hours prior to the test session, to avoid swallowing, and to make as few movements as possible during the procedure. The PS flow rate (μL/min/cm2) was measured using previously weighed filter paper discs placed bilaterally in the region of the maxillary second molars, 15 mm palatally from the edentulous ridge, for 30 seconds. The measuring vessels and paper discs were weighed before and after each collection. In the second part of the study, new complete dentures were fabricated for healthy patients. Flow rates of UWS and PS were measured 7 days after the insertion to compare data with prefabrication values. Mann-Whitney and Wilcoxon rank sum tests and chi-square test were used to analyze the data (α=.05).

Results

The UWS flow rates were significantly lower in SS patients compared to healthy controls (0.36 ± 0.33 vs 0.09 ± 0.11 mL/min, P<.05), yet the PS flow rate for both groups was not significantly different. Although every SS patient had xerostomia, and 8 out of 11 had hyposalivation, no patient complained about denture instability. Neither UWS flow rate (0.36 ± 0.33 mL/min and 0.39 ± 0.35 mL/min) nor PS flow rate (1.66 ± 0.99 μL/cm2/min and 1.86 ± 0.45 μL/cm2/min) was different from the preinsertion values after 1 week of new denture insertion in healthy patients.

Conclusion

Palatal mucous saliva may help stabilize the maxillary complete denture in patients with hyposalivation. The results suggest that neither UWS or PS flow rate are influenced by the placement of new dentures in complete denture wearers.

Section snippets

Material and methods

This study included 24 healthy patients referred to the Department of Prosthodontics (Semmelweis University, Dental Faculty, Budapest, Hungary) who served as the study control group, and 11 complete denture-wearing patients with diagnosed Sjogren's syndrome (SS) encountered at the Division of Immunology, (3rd Department of Internal Medicine, Medical and Healthscience Center, University of Debrecen, Hungary). The control subjects were healthy patients with an average age (mean ± SD) of 67 ± 8

Results

None of the control patients but all of the SS patients (11) sensed subjective xerostomia. The ratio of patients with xerostomia was significantly higher in those with SS by the chi-square test (P<.01). Although 3 of the 24 controls and 8 of the 11 SS patients demonstrated hyposalivation (UWS equal to or less than 0.1mL/min), none of the subjects complained of unstable dentures (Table II). The ratio of patients with hyposalivation was significantly higher in the SS group, tested by the

Discussion

Although the UWS flow rate was diminished, it was surprising that the flow rate of PS did not change in patients with SS or in patients with feelings of subjective xerostomia. The null hypothesis that the flow rate of PS is not decreased in SS was accepted. The results of the present study support the results of Lee et al,11 namely, that mucosal wetness and the subjective feeling of xerostomia might be associated more with UWS flow rate than with PS flow rate.

Monsenego et al4 stated that the

Conclusion

The PS flow rate is not significantly decreased in complete denture wearing patients with SS compared to healthy denture wearers. Patients with hyposalivation or xerostomia in the present study did not complain about unstable maxillary dentures because the rate of secretion of palatal mucous saliva was preserved. The placement of new complete dentures did not cause a change in UWS or PS flow rates in healthy patients after 1 week of wear.

Acknowledgements

The authors thank Professor Colin Dawes, Universtiy of Manitoba, for his advice in the preparation of this manuscript.

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This work was supported by OTKA, Hungary Grant No. T-037776 and Grant No. T-034389.

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