Several oral mucosal abnormalities have been reported to occur more frequently in patients with liver disease. It has, however, not been determined if these conditions are related to the disease or are manifestations of extraneous factors not associated with the liver pathology. To identify and quantify oral abnormalities in candidates for liver transplantation, and to determine whether these conditions were correlated with the type of liver disease or were the result of other patient variables. Oral examinations were performed on 300 candidates for liver transplantation to assess their oral health and to record the presence and types of oral mucosal pathologies. Abnormalities most frequently encountered were analyzed for significant associations with classification of liver disease, hyposalivation, diuretic therapy, edentulism, or smoking. Among these subjects, 175 (58%) had one or more abnormalities. The anomalies most frequently found were fissured tongue (37%), atrophy of the papillae of the tongue (18%), angular cheilitis (4%) and manifestations of clinical candidiasis (2%). Clinical hyposalivation was found in 28.7% of all patients and 70% of those who were on diuretic therapy. Fissured tongue and atrophy of the tongue papillae were significantly associated with hyposalivation (p<0.001); hyposalivation was correlated to diuretic therapy (p=0.028). Pathologies suggestive of candidiasis were significantly associated with hyposalivation and total edentulism. Several oral mucosal abnormalities that have previously been linked with liver diseases were found to be primarily associated with diuretic-induced hyposalivation, smoking, and total edentulism.

The potential association between asthma and various oral and dental conditions such as caries, tooth wear, periodontal diseases, and alterations in the oral mucosa remains a topic of ongoing debate among dental professionals. This study sought to assess the prevalence of hyposalivation and dry mouth in children aged 3 to 12 years with asthma, who were referred to Bu Ali Sina Hospital in Sari in 2023.

This descriptive-analytical epidemiological study was conducted on pediatric asthma patients at Bu Ali Sina Hospital in Sari. Data on each patient’s asthma severity, duration of the condition, and medication usage were collected through questionnaires and interviews with patients’ parents. Unstimulated salivary flow was measured using the gravimetric method. Statistical analyses were performed using Spearman's correlation coefficient, Mann-Whitney, Kruskal-Wallis, and Chi-square tests to compare the data, with a significance level set at 0.05.

A total of 66 children (32 boys and 34 girls) participated in this study. Hyposalivation was observed in 33.3% of the children (22 out of 66), while 42.4% (28 out of 66) experienced dry mouth. A statistically significant association was found between gender and hyposalivation, with boys being more affected than girls (P<0.05). Furthermore, dry mouth was notably more prevalent among children with hyposalivation (P<0.001). Children with hyposalivation were approximately 16 times more likely to report dry mouth compared to those without hyposalivation (Odds Ratio=16.35, P=0.001).

This study highlights the higher prevalence of hyposalivation in boys compared to girls, though no significant association was found between gender and presence of dry mouth. A strong, statistically significant link between hyposalivation and dry mouth was confirmed through multiple logistic regression analysis. These findings suggest that children with hyposalivation are at a markedly increased risk of experiencing dry mouth, underscoring the need for early detection and management in pediatric asthma patients.

This evidence-based article reviews risk indicators and management of unknown-origin xerostomia. Xerostomia and hyposalivation refer to different aspects of dry mouth. Xerostomia is a subjective sensation of dry mouth, whilst hyposalivation is defined as an objective assessment of reduced salivary flow rate. About 30% of the elderly (65 years and older) experience xerostomia and hyposalivation. Structural and functional factors, or both may lead to salivary gland dysfunction.Study Selection: The EBM literature search was conducted by using the medical literature database MEDLINE via PubMed and OvidMedline search engines. Results were limited to English language articles (1965 to present) including clinical trials (CT), randomized controlled trials (RCT), systematic reviews and review articles. Case control or cohort studies were included for the etiology. Neuropathic etiology such as localized oral alteration of thermal sensations, saliva composition change (for example higher levels of K, Cl, Ca, IgA, amylase, calcium, PTH and cortisol), lower levels of estrogen and progesterone, smaller salivary gland size, and illnesses such as lichen planus, are risk indicators for unknown-origin xerostomia. The management is palliative and preventative. Management of symptoms includes drug administration (systemic secretogogues, saliva substitutes and bile secretion-stimulator), night guard, diet and habit modifications. Other managements may be indicated to treat adverse effects. Neuropathic etiology, saliva composition change, smaller salivary gland size, and illnesses such as oral lichen planus can be suggestive causes for unknown-origin xerostomia. However, longitudinal studies will be important to elucidate the causes of unknown-origin xerostomia.

This study investigated the relationship between oral health related quality of life and hyposalivation and dry mouth in patients with chronic renal failure (CRF) undergoing hemodialysis.

This descriptive-analytical study was conducted in 200 patients with CRF undergoing hemodialysis attending the dialysis department in Sari Imam Khomeini Hospital, 2021. Patients completed oral health-related quality of life questionnaires (OHIP-14) with additive and simple count assessment methods. To diagnose dry mouth, unstimulated saliva was collected and patients were asked nine questions, of which five positive answers indicated dry mouth. Data analysis was done in SPSS V18. Pearson's or Spearman's correlation coefficient were applied to investigate the association between quality of life score and unstimulated salivary flow, and t-test or Mann-Whitney test were used to compare the quality of life scores between the groups with and without dry mouth.

Hyposalivation was observed in 66 patients (33%). The OHIP-14 score was significantly higher in both additive and simple count methods in patients with dry mouth and hyposalivation (P<0.05). Comparing different variables, the findings showed that 66.7% of the patients with hyposalivation were older than 58 years of age (P=0.007). In addition, 60.6% of patients with dry mouth had diabetes (P=0.01).

Dry mouth and hyposalivation reduce the quality of life in patients with CRF undergoing hemodialysis. Also, dry mouth and hyposalivation were relatively common problems in these patients. The treatment of these problems is necessary because of their impact on patients' quality of life.

Psychological status is one of the quality of life (QOL) domains which can be affected by hyposalivation caused by head and neck radiotherapy. This study aimed to evaluate the psychological status of head and neck cancer (HNC) patients who were suffering from hyposalivation after at least one week of receiving radiotherapy.

This descriptive-analytic study was performed on 44 HNC patients with history of hyposalivation caused by radiotherapy, in 5 Azar hospital from 1397-1398. General Health Questionnaire (GHQ-28) was used for data collection. Shapiro-Wilk test, parametric and nonparametric tests and SPSS 18 software were used for statistical analysis.

The average psychological status of patients was 27.50 out of 84 (lower score indicated better psychological status). The mean score of physical health was 7.39, social functioning was 6.16, anxiety/insomnia were 12.64 and depression was 1.33 with the maximum being 21. Psychological status was not significantly different between genders. Ageing caused all subscales to increase except depression. A direct relationship between social functionality and psychological status was reported.

Hyposalivation due to radiotherapy affects psychological status and its components in patients. Also, various factors such as ageing and lower education level can be effective in reducing psychological status in the patients with head and neck cancer who were suffering from hyposalivation due to receiving radiotherapy.

Radiation-induced hyposalivation is a common complication of radiotherapy for head and neck cancers. The most commonly prescribed medication for hyposalivation is pilocarpine. However, due to the numerous systemic side-effects associated with pilocarpine, there has been a proposal to use it as a mouthwash. This study aimed to evaluate the impact of 1% pilocarpine mouthwash on salivary flow in patients with radiation-induced xerostomia. This double-blind, randomized clinical trial involved 63 patients with radiation-induced xerostomia. The patients were randomly allocated into the pilocarpine hydrochloride 1% mouthwash group and the placebo one. Patients were instructed to use these mouthwashes four times a day, with 30 drops each time, for two minutes. Unstimulated saliva production in patients was measured using the spitting method at three stages: two weeks before the commencement of radiotherapy, two weeks after, and four weeks after the completion of radiotherapy. These measurements were then compared between the two groups. Statistical analysis included chi-square, independent t-test, and Analysis of Variance (ANOVA) with repeated measures and the Sidak post hoc test. Statistical analysis was conducted using SPSS 17, and a significance level of P < 0.05 was applied. A comparison of saliva secretion between the pilocarpine mouthwash group and the control group at various time points after radiotherapy revealed that saliva secretion in the control group significantly decreased compared with the pilocarpine mouthwash group (P < 0.001). 1% pilocarpine mouthwash is recommended for managing radiationinduced xerostomia.

The aim of this study was to determine the effect of xerostomia and hyposalivation on quality of life in patients receiving chemotherapy and evaluating unstimulated salivary flow rate in these patients.

This descriptive-analytic study was conducted in 80 cancer patients with xerostomia undergoing chemotherapy. The Health Impact Profile-14 (OHIP-14) was administered to evaluate the effect of xerostomia and hyposalivation on patients’ quality of life. Data analysis was done in SPSS V22.

The additive and simple count OHIP-14 scores were 20.66 and 3.10, respectively. Among 80 patients with xerostomia, 50 had hyposalivation (P<0.001).

Xerostomia and hyposalivation in patients undergoing chemotherapy have negative effects on oral health-related quality of life and these patients require more attention.

Hyposalivation is one of the most common complications during menopause, which affects the quality of life. The aim of the present study was to assess the correlation between menopause and salivary flow rate. This historical-cohort study was conducted on 80 healthy women. Forty postmenopausal women were placed in the case group, while 40 premenopausal women were selected as the control group. The participants were selected from among non-smokers and non-alcoholics and had no systemic diseases. The saliva level of the participants was measured by using the Modified Schirmer’s Test (MST) and modified Fox questionnaire. The participants were asked to sit upright, swallow their saliva and hold up their tongue. A strip was placed on the floor of the mouth, and the length of the wet and discolored area on the strip was measured after 3 minutes. Data were analyzed using SPSS 22 according to Mann-U-Whitney and Chi-square tests. According to the MST, the prevalence of hyposalivation was 35% in premenopausal women and 65% in postmenopausal women, with a statistically significant difference between the two groups (P<0.001). According to the modified Fox questionnaire, the prevalence of normal salivary flow and mild xerostomia in premenopausal women was 90%, while this rate was equal to 62.5% in postmenopausal women. The prevalence of severe xerostomia was 15% in postmenopausal women, while none of the premenopausal subjects had severe xerostomia. The incidence of hyposalivation in postmenopausal women is significantly higher than that in premenopausal women (P<0.005). It seems that the unstimulated salivary flow rate decreases after menopause.

Oral lichen planus (OLP) is a chronic mucocutaneous disease that commonly involve oral mucosa. In this disease, frequent lesions in different areas of the mouth can be seen bilaterally and mostly with a similar pattern. The World Health Organization (WHO) classifies OLP as a potentially premalignant disorder with an uncertain risk of malignant transformation, and recommends that patients should be carefully examined. Xerostomia and hyposalivation are common complications of OLP. Saliva composed of water, electrolytes and organic micro and macro molecules and plays many roles. It is one of the main factors in maintaining the health and integrity of the oral mucosa and teeth. Helping to digest food and have a sense of taste, mechanical protection of the oral mucosa, and eliminating oral microbes are other important roles of saliva. The symptoms of xerostomia and hyposalivation include bad breath, burning feeling in the mouth, trouble swallowing or speaking, and altered sense of taste. As a result, xerostomia and hyposalivation can significantly reduce the quality of life of people with OLP. The main mechanism of xerostomia in OLP patients is still unknown, and there is scant research in this field. This study aims to review the studies related to xerostomia in patients with OLP and its related possible mechanisms.

 To find articles related to OLP, a search was conducted in Medline, Scopus, Embase and Web of Science databases on studies related published from 1965 to 2021 using the keywords oral lichen planus, xerostomia, hyposalivation, salivary gland hypofunction, and Oral dryness. include articles were clinical studies on the relationship between OLP and dry mouth/xerostomia with well defined study design and methodology (e.g. diagnosis of OLP by clinical and histopathological studies, use of age- and gender-matched case and control groups since they can affect the characteristics of saliva, and correct saliva extraction).

In this study, 8 articles were finally selected based on entry criteria. These articles were about the histopathological examination of salivary glands, evaluation of salivary compositions, saliva flow rate assessment, and feeling of dry mouth using a questionnaire. Their specifications are presented in Table 1.

Discussion :

The relationship between OLP and xerostomia has been shown in many studies. Various mechanisms have been proposed in this regard. The mentioned mechanisms were the inflammatory and autoimmune disorders of the sensory nervous system, changes in saliva composition, and changes in saliva flow rate. The changes in the surface characteristics of the oral mucosa due to the presence of inflammation cause the sensation of dry mouth in patients with OLP. It was shown that the presence of inflammation in the oral mucosa causes xerostomia even with normal saliva flow rate in patients with OLP. Chronic mucosal inflammation in OLP can endanger the integrity and function of the oral mucosa by affecting the normal absorption and secretion of mucous fluid and electrolytes, which is effective in the occurrence of xerostomia. The loss of the epithelium of the oral mucosa, which is observed in the wounds, causes disturbance in the formation of oral mucosal pellicle, which has a role in making the oral mucosa slippery. The heat associated with the inflammatory response can increase the surface evaporation of mucus and eventually cause xerostomia. Therefore, patients with OLP experience some degree of xerostomia. The control of xerostomia in patients with OLP should be taken into consideration by the clinicians; it can greatly help relieve the symptoms of OLP.

Saliva plays a crucial role in preserving and maintaining oral health. Hyposalivation due to head and neck radiation therapy may induce changes to the biochemical properties of the saliva. The aim of this study was to analyze and compare saliva properties before and after radiation therapy in patients with head and neck cancers. In this quasi experimental study, 18 patients (13 male, 5 female) with head and neck cancers were evaluated regarding the flow rate of saliva, buffering capacity, amylase, total protein, IgM, IgA, IgG and albumin concentration of saliva prior to and following radiotherapy by schirmer test, pH meter, biuret, turbidometry and spectrophotometry. The oral symptoms due to radiotherapy (xerostomia, loss of taste, difficulty in swallowing, eating and speaking) were evaluated according to the patient's complaints. S tatistical analysis of the results was performed with paired t test. There was statistically significant changes in flow rate (28.27±7.8 Vs 10.94±12.2), salivary buffering capacity (6.47±0.68 Vs 5.06±0.52), amylase (2536.5±707.9 Vs 1053.23±343.5) and IgM concentration (0.87±1.8 Vs 0.04 ±0.07) before and after radiation therapy (p≤0.05). There were no significant changes in total protein, albumin, IgA and IgG concentration after radiotherapy. Clinical manifestations of xerostomia, loss of taste, difficulty in swallowing and eating, and difficult speaking were detected in 100%, 100%, 83.3% and 16.7% of the cases, respectively. Based on the results of this study, head and neck radiation therapy leads to reduction in salivary flow rate, buffering capacity, amylase and IgM concentration.