Plant-Derived Substances with Antibacterial, Antioxidant, and Flavoring Potential to Formulate Oral Health Care Products

Bacterial diseases and reactive oxygen species can cause dental caries and oral cancer. Therefore, the present review analyzes and discusses the antibacterial and antioxidant properties of synthetic and plant-derived substances and their current and future patents to formulate dental products. The reviewed evidence indicates that chlorhexidine, fluorides, and hydrogen peroxide have adverse effects on the sensory acceptability of oral care products. As an alternative, plant-derived substances have antimicrobial and antioxidant properties that can be used in their formulation. Also, adding plant metabolites favors the sensory acceptability of dental products compared with synthetic compounds. Therefore, plant-derived substances have antibacterial, antioxidant, and flavoring activity with the potential to be used in the formulation of toothpaste, mouth rinses, dentures cleansers-fixatives, and saliva substitutes.

Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline

PURPOSE To provide evidence-based recommendations for prevention and management of salivary gland hypofunction and xerostomia induced by nonsurgical cancer therapies. METHODS Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials published between January 2009 and June 2020. The guideline also incorporated two previous systematic reviews conducted by MASCC/ISOO, which included studies published from 1990 through 2008. RESULTS A total of 58 publications were identified: 46 addressed preventive interventions and 12 addressed therapeutic interventions. A majority of the evidence focused on the setting of radiation therapy for head and neck cancer. For the prevention of salivary gland hypofunction and/or xerostomia in patients with head and neck cancer, there is high-quality evidence for tissue-sparing radiation modalities. Evidence is weaker or insufficient for other interventions. For the management of salivary gland hypofunction and/or xerostomia, intermediate-quality evidence supports the use of topical mucosal lubricants, saliva substitutes, and agents that stimulate the salivary reflex. RECOMMENDATIONS For patients who receive radiation therapy for head and neck cancer, tissue-sparing radiation modalities should be used when possible to reduce the risk of salivary gland hypofunction and xerostomia. Other risk-reducing interventions that may be offered during radiation therapy for head and neck cancer include bethanechol and acupuncture. For patients who develop salivary gland hypofunction and/or xerostomia, interventions include topical mucosal lubricants, saliva substitutes, and sugar-free lozenges or chewing gum. For patients with head and neck cancer, oral pilocarpine and oral cevimeline, acupuncture, or transcutaneous electrostimulation may be offered after radiation therapy. Additional information can be found at www.asco.org/supportive-care-guidelines .

Multifunctional artificial saliva preparation – challenges and needs

Saliva plays a crucial role in maintaining homeostasis not only within the oral cavity but also in further sections of the gastrointestinal tract. Pleiotropic properties of saliva include participation in the digestion of carbohydrates, cleansing and moisturizing the oral cavity, and maintaining the composition of the oral microbiome. The result of impaired function of the salivary gland is reduced salivation – hyposalivation, leading to dry mouth – xerostomia. It is established that numerous physiological factors (age, sex, weight change) and pathological factors (polytherapy, head and neck cancer, coexisting diseases such as diabetes, depression, cardiovascular diseases) lead to the reduction in saliva secretion, and in effect, causing a dry mouth. Treatment of salivary secretion disorders involves pharmacological therapy (including hormone therapy) or replacement therapy which based on the use of saliva substitutes. In the case of disturbances in the secretion of natural saliva, the application of the artificial saliva preparations should support the chewing processes, moisturize the oral cavity, and fulfill the biological functions of saliva. However, to date, on the pharmaceutical market, there are no saliva substitutes that meet the biological criteria and maintaining favorable physicochemical properties and rheological parameters. Taking into account the problems of the patients which are burden by impaired salivary secretion, the aim of our research was to attempt to develop an artificial saliva preparation that reflecting as much as possible the properties of natural saliva, both in terms of mechanical and biological properties. As part of the research, the chemical composition was developed and a detailed study of the physicochemical and rheological parameters of artificial saliva preparations containing mucins as well as their microbiological and biocompatibility assessment, at in vitro level were carried out.

Xerostomia as a cause of impaired digestion

Xerostomia (dryness in the mouth) arises due to inadequate saliva secretion associated with various conditions of the body and, in particular, of the salivary glands. The diagnosis and treatment of xerostomia does not receive due attention in the Russian Federation, whereas saliva forms the food bolus and is responsible for the first stage of food digestion. The causes of xerostomia are varied, and therefore its treatment meets with considerable difficulties. One of the methods of treating xerostomia is replacement therapy, but it is rarely and insufficiently administered in RF. The authors give a detailed description of the clinical picture of a dry mouth in 80 patients, who received a multicomponent formulation «Xerostom » as substitution therapy. The study showed that the best results were obtained by using gel and spray. Key words:salivary glands, xerostomia, saliva substitutes

The results of using xerostom mouthwash in complex treatment of patients with xerostomia

Introduction. Xerostomia is a permanent or temporary feeling of dryness of the oral cavity. It can be objective or subjective and is characterized by complaints of dryness of the oral cavity, discomfort when talking and eating, as well as a decrease in free saliva, which significantly impairs the quality of life. The diverse causes of xerostomia, including diseases of the salivary glands, long-term use of homeopathic, cardiac, etc. remedies, consequences of radiation therapy, etc. Materials and methods. Treatment of patients with xerostomia is mainly symptomatic, using salivozameniteli. In the Russian Federation, various saliva substitutes are presented by foreign companies. Among them, stands out a set (line) of salivozamenitele Xerostom. Therefore, we conducted a study of the effectiveness of the rinse aid, and also studied its antibacterial properties in patients with true xerostomia. Conclusion. It was found that the Xerostom rinse aid was effective in 70% of patients. At the same time, the rinse aid did not have antibacterial properties in relation to gram-positive aerobic S. Aureus and gram-negative anaerobic Klebsiella pneumonia.

Enhancement in Xerostomia Patient Salivary Lubrication Using a Mucoadhesive

Oral lubrication mediated by mucin and protein containing salivary conditioning films (SCFs) with strong water retainability can get impaired due to disease such as xerostomia, that is, a subjective dry mouth feel associated with the changed salivary composition and low salivary flow rate. Aberrant SCFs in xerostomia patient cause difficulties in speech, mastication, and dental erosion while the prescribed artificial saliva is inadequate to solve the complications on a lasting basis. With the growing aging population, it is urgently needed to propose a new strategy to restore oral lubrication. Existing saliva substitutes often overwhelm the aberrant SCFs, generating inadequate relief. Here we demonstrated that the function of aberrant SCFs in a patient with Sjögren syndrome can be boosted through mucin recruitment by a simple mucoadhesive, chitosan-catechol (Chi-C). Chi-C with different conjugation degrees (Chi-C7.6%, Chi-C14.5%, Chi-C22.4%) was obtained by carbodiimide chemistry, which induced a layered structure composed of a rigid bottom and a soft secondary SCF (S-SCF) after reflow of saliva. The higher conjugation degree of Chi-C generates a higher glycosylated S-SCF by mucin recruitment and a lower friction in vitro. The layered S-SCF extends the “relief period” for Sjögren patient saliva over 7-fold, measured on an ex vivo tongue-enamel friction system. Besides lubrication, Chi-C-treated S-SCF reduces dental erosion depths from 125 to 70 μm. Chi-C shows antimicrobial activity against Streptococcus mutans. This research provides a new key insight in restoring the functionality of conditioning film at articulating tissues in living systems.