Search Results (42)

Background and Objectives: Halitosis can impair psychosocial well-being, and orthodontic appliances may modify plaque retention and oral ecology. We compared patient-perceived halitosis burden, clinician-rated malodor, and oral health-related quality of life (OHRQoL) among clear aligner users, fixed-brace patients, and untreated controls, and explored oral and salivary correlates of worse malodor severity. Methods: This cross-sectional study (March 2024–November 2025) enrolled 184 participants aged 15–35 years (aligners n = 62; fixed braces n = 64; controls n = 58). Outcomes were HALT (0–100), organoleptic score (0–5), and OHIP-14 (0–56). Plaque index, gingival inflammation, tongue coating, and unstimulated salivary flow were recorded; low flow was defined as <0.25 mL/min. Organoleptic score ≥ 2 was used descriptively for clinically relevant malodor prevalence, whereas organoleptic score ≥3 defined a moderate-to-severe malodor phenotype for secondary exploratory internal modeling. Multivariable robust linear models (HALT) and proportional-odds ordinal logistic regression (organoleptic severity) were used. Results: Fixed braces showed higher HALT (53.7 ± 6.2) than controls (46.3 ± 6.4) and aligners (41.7 ± 7.4) (p < 0.001), higher organoleptic scores (2.9 ± 0.4 vs. 2.4 ± 0.6 vs. 2.2 ± 0.6; p < 0.001), and worse OHIP-14 (18.6 ± 4.7 vs. 15.9 ± 4.3 vs. 13.8 ± 4.8; p < 0.001). Clinically relevant malodor prevalence (organoleptic ≥ 2) was 96.9% in fixed braces, 79.3% in controls, and 66.1% in aligners (p < 0.001); because ≥2 was used as a broad descriptive threshold, these values should be interpreted as descriptive rather than diagnostic prevalence estimates. In adjusted models, greater tongue coating, higher plaque, and low salivary flow were associated with worse organoleptic severity, whereas appliance category did not remain independently associated with HALT once concurrent clinical correlates were included. Conclusions: Fixed braces showed higher unadjusted malodor burden and worse OHRQoL than aligners and untreated controls, but appliance category should be interpreted as a contextual exposure linked to plaque-retentive conditions rather than as a standalone causal determinant. Plaque accumulation, tongue coating, and lower salivary flow showed the strongest associations with worse malodor severity. These findings should be interpreted in light of the cross-sectional design, possible observer and selection bias, and residual confounding. Full article

Background/Objectives: Saliva plays an essential role in maintaining the oral ecological balance, and its quantitative and qualitative characteristics may influence susceptibility to dental caries. The aim of this study was to determine susceptibility to dental caries based on the DMFT index and to establish a correlation between caries experience and salivary parameters in a group of young adults. Methods: This cross-sectional study was conducted between July and November 2025 on a sample of 87 fourth-year students from the Faculty of Dentistry in Craiova. Each participant underwent an intraoral clinical examination to determine the DMFT index. The salivary parameters assessed included unstimulated salivary flow rate, saliva consistency, salivary pH, stimulated salivary flow rate, and buffering capacity, using the GC Saliva-Check Buffer kit. Statistical analyses were performed using SPSS (Statistical Package for Social Sciences) software, version 26 (SPSS Inc., Armonk, NY, USA). Results: The mean DMFT index value for the entire sample was 8.26 ± 4.481, with higher values observed among female participants. Low salivary pH was significantly associated with higher DMFT values. Participants with low or very low buffering capacity exhibited higher DMFT values compared to those with normal capacity, indicating that a reduced ability to neutralize salivary acidity is associated with increased caries activity. Conclusions: The results indicate that salivary pH and buffering capacity are important factors in dental caries susceptibility among young adults. The integration of salivary testing into the diagnostic assessment of caries risk may contribute to personalized and effective preventive strategies. Full article

Background/Objective: Diabetes mellitus type 2 (T2DM) is a significant global public health concern. This analytical cross-sectional study aimed to evaluate the impact of T2DM on the severity of dental caries and salivary properties. Methods: A total of 182 participants (n = 91 per group) were recruited into the T2DM and non-diabetes (ND) groups. Unstimulated whole saliva (UWS) and blood samples for HbA1c were collected. Clinical assessments included plaque index, SoproLIFE, ICDAS, and severity index for root caries. Results: A total of 92 male and 89 female participants were recruited in this study. The results showed that the mean of UWS pH was slightly lower in the T2DM (6.65 ± 1.12) than the ND group (6.88 ± 0.49), however the difference was statistically insignificant (p = 0.065). The mean saliva buffer capacity was almost identical between the two groups, with values of 7.38 ± 3.2 in T2DM and 7.37 ± 2.83 in the ND groups (p = 0.973), indicating an insignificant difference. The mean saliva spinnbarkeit was slightly high and insignificant in the T2DM (4.57 ± 4.34) compared to the ND group (3.69 ± 3.6) (p = 0.141). The T2DM group had a significantly high proportion of participants with very low saliva flow rate (<0.1 mL/min) in comparison to ND (20.9% vs. 5.5%) (p = 0.004). ICDAS scores were significantly higher in T2DM (0.67 ± 0.32) when compared to the ND group (0.57 ± 0.24) (p = 0.014). ICDAS scores 3 and 6 were significantly higher in T2DM (2.76 ± 2.66; 0.86 ± 2.61) in comparison to ND (2.10 ± 2.00, 0.26 ± 0.96). Conclusions: Within the limitations of this analytical cross-sectional study, participants with T2DM demonstrated a higher risk of developing severe carious lesions and exhibited low salivary pH and flow rate when compared with non-diabetic individuals, supporting a possible association between glycemic status, salivary alterations, and caries severity. Full article

Oral squamous cell carcinoma (OSCC) is an aggressive epithelial malignancy with high local invasiveness and a tendency for early cervical lymph node metastasis. Conventional prognostic markers often lack precision. This study evaluated the expression of putative cancer stem cell markers—CD44, CD133, and CD166—in OSCC tissues and explored their associations with clinical parameters, including salivary flow rates. Twelve patients with histologically confirmed OSCC (9 males, 3 females; mean age: 65 years) were included. Clinical TNM staging and tumor dimensions were recorded. Depth of invasion was measured histologically. Tumor tissues were enzymatically dissociated to establish primary cell cultures, and flow cytometry was used to quantify putative cancer stem cell markers expression. Unstimulated salivary flow rates were measured using sialometry. CD44 expression was uniformly high (median: 96.4%) and CD166 showed moderate to high expression (median: 85.5%), while CD133 was low (median: 1.5%). Co-expression levels were the highest for CD44+/CD166+ (median: 86.6%). Triple-marker co-expression had a median of 2.0%. Depth of invasion was positively correlated with CD133+ and its co-expression with CD44+ and CD166+ (p ≤ 0.05). Salivary flow rates were negatively correlated with CD166+ and CD44+/CD166+ expression (p ≤ 0.01). These findings suggest putative cancer stem cell markers, particularly CD133, may have prognostic value in OSCC and warrant further investigation. Full article

Background/objectives: Aging is associated with a decline in physiological and cognitive functions. Periodontitis, a disease affecting the periodontal tissues, increases in prevalence with age. Bacteria and inflammatory mediators resulting from periodontitis can trigger neuroinflammation and potentially accelerate the progression of neurodegenerative diseases. This study aimed to evaluate the association between periodontal status, salivary flow rate, salivary cortisol levels, and cytokine levels with cognitive status in elderly Indonesian subjects. Methods: This cross-sectional study involved 70 participants aged ≥ 60 years from several social institutions in Jakarta and the Dental Hospital, Faculty of Dentistry, Universitas Indonesia. All participants provided written informed consent before the examination. Periodontal parameters, including plaque score, calculus index, bleeding on probing, number of remaining teeth, and functional tooth units, were assessed. Unstimulated salivary flow was collected over five minutes, and salivary cortisol levels were measured. Gingival crevicular fluid samples from the deepest periodontal pockets were collected to measure cytokine levels (TNF-α and IL-1β). Both cortisol and cytokine levels were analyzed using ELISA. Cognitive function was evaluated using the Hopkins Verbal Learning Test. Results: Plaque score, calculus index, and bleeding on probing were moderately associated with cognitive scores (p < 0.05). In contrast, the number of remaining teeth, functional tooth units, periodontitis severity, salivary flow rate, salivary cortisol, and cytokine levels were not significantly associated with cognitive scores (p > 0.05). Conclusions: These findings suggest that elderly individuals with cognitive impairment tend to have poorer periodontal health than those with normal cognitive function. Full article

Background/Objectives: During kidney failure, chronic hemodialysis therapy (HD) is required to replace lost renal function, and patients on regular HD frequently report xerostomia. This systematic review and meta-analysis aims to compare salivary flow rates between patients with kidney failure on HD and healthy controls and to evaluate acute changes in salivary secretion before and after a dialysis session. Methods: A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Web of Science, and Embase were searched for observational studies quantifying salivary flow rates in adult patients with kidney failure on chronic hemodialysis versus healthy controls or pre- versus post-dialysis. Data on salivary flow rates were extracted and stratified by subtype (whole or gland-specific) and condition (stimulated or unstimulated), along with key study characteristics including participant demographics, saliva collection methods, and dialysis duration. Study quality was appraised using NHLBI tools and categorized as poor, fair, or good. Where ≥2 homogeneous datasets existed, random-effects meta-analyses (α = 0.05) were performed to estimate mean differences (95% CI) for each salivary parameter; heterogeneity was evaluated via I². Results: A total of 20 studies (13 cross-sectional, 7 before-after) met inclusion, of which 17 studies (with a total of 1224 HD patients and 548 controls) were meta-analyzed. Compared with controls, HD patients showed lower secretion rates of unstimulated whole saliva (UWS: MD −0.11 mL/min; 95% CI −0.20 to −0.02; I² = 94%) and stimulated whole saliva (SWS: MD −0.77 mL/min; 95% CI −0.94 to −0.60; I² = 92%), whereas stimulated parotid saliva (SPS) did not differ significantly (MD −0.08 mL/min; 95% CI −0.77 to 0.60; I² = 96%). In before-after analyses, both UWS (MD +0.15 mL/min; 95% CI 0.02–0.28; I² = 90%) and SWS (MD +0.20 mL/min; 95% CI 0.14–0.26; I² = 0%) increased immediately post-HD. Conclusions: Despite methodological challenges and population heterogeneity, the evidence indicates salivary hypofunction in HD patients and improvement after hemodialysis. The magnitude of these effects seems influenced by underlying comorbidities (notably diabetes), HD duration, and methodological factors. Since saliva is of major importance to maintaining good oral health, recognizing and managing dry mouth should therefore be part of the comprehensive care of patients with kidney failure. Full article

Background and Objectives: Morning halitosis undermines social well-being, yet the combined influence of basal salivary flow and tongue coating in healthy adults is unclear. Methods: In a cross-sectional study of 92 university students (18–35 years), we measured unstimulated salivary flow rate (uSFR), tongue-coating index (TCI), total volatile sulfur compounds (VSCs; Halimeter^®), organoleptic score (0–5), and self-perceived halitosis (yes/no) under standardized early-morning conditions. Results: Thirty-seven participants (40.2%) reported morning halitosis and showed lower uSFR (0.2 ± 0.1 vs. 0.3 ± 0.1 mL·min⁻¹) and higher TCI (2.3 ± 0.5 vs. 1.9 ± 0.4), with higher organoleptic scores (3.4 ± 0.6 vs. 2.1 ± 0.7) and VSCs (272.9 ± 39.8 vs. 163.7 ± 45.9 ppb; all p < 0.001). VSCs correlated inversely with uSFR (ρ = −0.58) and positively with TCI (ρ = 0.44). In multivariable models, uSFR (β = −0.53) and TCI (β = 0.31) explained 54% of VSC variance; each 0.1 mL·min⁻¹ fall in uSFR increased the odds of self-perceived halitosis 1.9-fold (p = 0.001). Conclusions: Even among healthy young adults, lower basal saliva and heavier tongue coating are independent contributors to morning malodor. Hydration, daily tongue cleaning, and addressing mouth breathing are pragmatic, first-line strategies. Full article

Background/Objectives: The impact of nutritional interventions on Sjögren disease (SD) remains uncertain, and no standardized guidelines currently exist for managing its sicca symptoms. This systematic review evaluated the effects of dietary interventions on the symptoms of dry mouth and dry eyes in individuals with SD. Methods: Electronic searches were performed in four databases, supplemented by manual searches and searches of the gray literature. Both human and animal studies were included. The methodological quality of the selected studies was appraised, and the data were analyzed descriptively. Results: A total of nineteen studies (ten in humans and nine in animal models) were included. The treatments evaluated were dietary supplements, vitamins, medicinal herbs, and specially modified diets. The primary outcomes assessed included unstimulated and stimulated whole salivary flow rates, salivary-gland inflammation, and ocular dryness (Schirmer test). In animal models of SD, interventions such as caloric restriction, gluten-free diets, low-fat diets, and supplements (e.g., resveratrol, triptolide, and Lycium barbarum polysaccharide) were associated with increased salivary flow and reduced glandular inflammation. Conversely, diets rich in saturated fats were associated with reduced salivary flow and increased lymphocytic infiltration in salivary glands. Human studies yielded mixed results, with some reporting improvements in salivation following interventions with vitamins, herbal supplements, gluten-free diets, liquid diets, and whole-food, plant-based diets. Conclusions: Although dietary management may alleviate sicca symptoms and improve nutritional status in SD, the current evidence is insufficient to support specific recommendations for the management of oral symptoms. Full article

Institutionalized psychiatric patients on chronic psychotropic medication are prone to xerostomia due to reduced salivary flow. This study evaluated the effectiveness of a topical sialogogue gel (Xeros Dentaid^®) in relieving drug-induced dry mouth in 81 residents at the Lisbon Psychiatric Hospital Centre (C.H.P.L.). Over 15 days, unstimulated and stimulated salivary flow rates, pH, and buffer capacity were measured before and after application. Results showed a significant increase in salivary flow (p < 0.001) and improved subjective symptoms. Topical sialogogues may represent an accessible and effective strategy for managing xerostomia in this vulnerable population. Full article

Objectives: Stomatitis is a broad term for oral mucosal inflammation, and oral candidiasis represents one of its common subtypes caused by fungal infection. This study aimed to investigate the relationship between oral candidiasis and reduced salivary flow in patients diagnosed with stomatitis and to identify clinical predictors of oral candidiasis. Methods: A total of 259 patients (mean age 59.77 ± 15.93 years; range 10–87 years; 201 females) with stomatitis were evaluated for oral candidiasis through Candida albicans culture testing. Clinical characteristics were compared between Candida-positive and Candida-negative groups. Unstimulated salivary flow rate (UFR) and stimulated salivary flow rate (SFR) were measured to assess xerostomia. Results: Among the 259 patients, 81 (31.3%) were diagnosed with oral candidiasis. Patients with candidiasis were significantly older (64.25 ± 14.66 years) than those without (57.73 ± 16.10 years; p = 0.002). Both UFR (0.36 ± 0.32 vs. 0.47 ± 0.28 mL/min, p = 0.006) and SFR (1.21 ± 0.68 vs. 1.41 ± 0.69 mL/min, p = 0.032) were significantly lower in the candidiasis group. The prevalence of xerostomia was significantly higher among Candida-positive patients, based on UFR ≤ 0.2 mL/min (49.4% vs. 18.5%, p < 0.001) and SFR ≤ 0.7 mL/min (27.2% vs. 10.7%, p < 0.001). The predictive accuracy for oral candidiasis was 62.2% based on age (AUC = 0.622; cutoff 64.50 years), 65.8% for UFR (AUC = 0.658; cutoff 0.335 mL/min), and 58.7% for SFR (AUC = 0.587; cutoff 1.150 mL/min). In the generalized linear model, xerostomia, as defined by UFR, was a significant predictor of oral candidiasis (B = 0.328, 95% CI: 0.177–0.480, p < 0.001). Conclusions: Oral candidiasis in patients with stomatitis was more strongly associated with decreased UFR than with aging alone. Among the factors assessed, reduced unstimulated salivary flow may serve as a useful clinical indicator for predicting oral candidiasis, particularly in elderly individuals. Full article

Objective: To evaluate the effect of a probiotic combination on clinical and oral microbiological parameters in patients with head and neck cancer (HNC) undergoing radiotherapy. Materials and Methods: A randomised, double-blind, placebo-controlled clinical trial was conducted with 72 HNC patients who had received radiotherapy within the past year. Participants were randomly assigned to receive either daily probiotic sachets or placebo for 30 days. Salivary parameters—including unstimulated and stimulated flow rates and pH—were evaluated alongside oral microbiota profiles, including total bacterial load and selected periodontopathogens. Assessments were performed at baseline and post-intervention using sialometry, pH analysis, bacterial culture, and quantitative real-time PCR (qPCR). Results: Sixty-one patients completed the study (31 in the probiotic group, 30 in the placebo group). Stimulated salivary flow increased significantly in the probiotic group (p = 0.0016), while unstimulated flow improved in both groups (p < 0.05). Salivary pH decreased significantly in the probiotic group (p = 0.0209); however, no intergroup differences were observed at the end of the intervention (p = 0.9839). qPCR showed significant reductions in total bacterial load (p = 0.0209) and Fusobacterium nucleatum (p = 0.0080). Culture confirmed the reduction of F. nucleatum (p = 0.0026), with a trend towards significance for total cultivable bacterial count (p = 0.0502). Conclusions: Daily supplementation with a probiotic combination may serve as a practical and well-tolerated adjunctive measure in clinical settings to improve salivary function and reduce key oral pathogens, particularly Fusobacterium nucleatum, in patients undergoing or recovering from radiotherapy for head and neck cancer. These findings support its potential integration into routine supportive care protocols to mitigate xerostomia and oral dysbiosis in this population. Full article

Primary Sjögren’s syndrome (pSS) exhibits considerable clinical and immunological heterogeneity, complicating personalized management. We aimed to delineate the demographic, functional, serological, histopathological, and therapeutic features of a Romanian pSS cohort and to identify biomarker–treatment correlations that could inform patient-oriented strategies. Thirty-two patients meeting the 2016 ACR/EULAR classification criteria for pSS were retrospectively analyzed. Data collected included demographics, autoantibody profiles (Anti-Ro/SSA, Anti-La/SSB, ANA, RF, Anti-CCP), immunoglobulin levels, complement consumption (C3/C4), minor salivary gland biopsy (focus score), salivary flow tests, and systemic inflammation markers (CRP). Pearson correlation matrices were constructed to explore the associations between serological markers and prescribed therapies. The cohort was predominantly female (87.5%) with a mean age of 52.8 ± 9.9 years. Seropositivity rates were 50% for Anti-Ro/SSA, 77% for Anti-La/SSB, and 40% for ANA. Clinically significant glandular dysfunction was evident in 65% of patients (unstimulated flow ≤ 0.1 mL/min), and all biopsies demonstrated focus scores > 1. Methotrexate use correlated strongly with Anti-Ro/SSA and Anti-La/SSB positivity (p ≤ 0.05), indicating its targeted application in seropositive sub-phenotypes. Conclusion: These findings underscore the immunologic and clinical diversity of pSS and support a biomarker-driven, multidisciplinary framework for personalized treatment. Larger prospective and multicenter studies are warranted to validate these correlations and to refine precision medicine approaches in pSS. Full article

Background: Halitosis is frequently observed in patients undergoing orthodontic treatment with multibracket appliances, primarily due to volatile sulfur compounds (VSCs) produced by oral anaerobic bacteria. Cetylpyridinium chloride (CPC) is a widely used antimicrobial agent in oral care products and may help alleviate halitosis.This study aimed to evaluate the effects of 0.05% CPC mouthwash on halitosis, oral hygiene indices, and the tongue microbiota in orthodontic patients with elevated VSC levels. Methods: In this randomized, double-blind, placebo-controlled clinical trial, 30 orthodontic patients with elevated VSCs (≥150 ppb) were assigned to a CPC mouthwash group or a placebo group. Participants used the assigned mouthwash three times daily for 1 month. Halitosis was quantitatively assessed by gas chromatography (Oral Chroma™), and oral hygiene parameters including Plaque Index (PI), Gingival Index (GI), Tongue Coating Index (TCI), and unstimulated salivary flow rate were evaluated at baseline and after the intervention. The tongue microbiota was analyzed by 16S rRNA sequencing. Results: The CPC mouthwash group showed significant reductions in total VSCs, hydrogen sulfide, methyl mercaptan, PI, GI, and TCI (p < 0.05), while salivary flow rate and dimethyl sulfide remained unchanged. Microbiome analysis revealed decreases in halitosis-associated genera (Actinomyces, Corynebacterium, Tannerella) and increases in beneficial species such as Streptococcus salivarius. Conclusions: CPC mouthwash (0.05%) effectively reduced halitosis and improved oral hygiene parameters in orthodontic patients, likely through modulation of the tongue microbiota. This mouthwash may serve as a safe and practical adjunct to conventional oral hygiene practices during orthodontic treatment. Full article

Background: Sjögren’s disease (SD) is an autoimmune condition causing progressive salivary and lacrimal glands dysfunction following lymphocytic infiltration in the glandular tissue. SD patients are more prone to oral health impairment due to a reduction in salivary flow. This study evaluated the relationship between oral health, functional tests, and patient reported outcomes in a cohort of SD patients. Methods: Patients diagnosed with SD underwent complete dental examination, with the recording of the decayed–missing–filled teeth index (DMFT), probing pocket depth (PPD), full mouth bleeding score (FMBS), and full mouth plaque score (FMPS). Hyposalivation was assessed using the unstimulated whole saliva flow rate (UWS). Patients were administered the European League Against Rheumatism (EULAR) Sjögren’s Syndrome Patient Reported Index, EULAR Sjögren’s syndrome disease activity index, Oral Health Impact Profile-14 (OHIP-14), Patient Acceptable Symptom State questionnaires, and a visual analog scale for xerostomia (VASx). Results: Fifty patients in total were enrolled. Reduced UWS was associated with higher DMFT, FMBS, and FMPS. Significant correlation was observed for UWS with VASx and OHIP-14 (p < 0.05). Conclusions: Quality of life and oral health appear mildly impaired in SD patients as an effect of reduced salivary flow, with higher DMFT and tendency towards gingival inflammation and plaque accumulation. Full article

Background/Objectives: Tooth wear is a progressive and multifactorial condition influenced by mechanical and chemical factors. Saliva plays a crucial role in modulating erosive wear through its buffering capacity and remineralization potential. This study aimed to assess the prevalence and severity of erosive tooth wear among dental students and explore its correlation with salivary factors such as flow rate and pH. Methods: A cross-sectional study was conducted on 96 individuals from the Egas Moniz School of Health & Science. Erosive wear was evaluated using the Basic Erosive Wear Examination (BEWE) index. Unstimulated and stimulated saliva samples were collected to measure salivary flow rate and pH. Statistical analyses included Spearman’s correlation and multinomial logistic regression. Results: All individuals were classified as no risk (BEWE Score 0–2) or low risk (BEWE Score 3–8). The most affected teeth were the lower first molars and the 4th and 6th sextants. Salivary analysis showed a mean unstimulated flow rate of 0.5 mL/min and stimulated flow of 1.7 mL/min. A significant negative correlation (rho = −0.224, p = 0.029) was found between stimulated salivary pH and BEWE score, indicating that higher acidity contributes to greater erosive wear. Conclusions: This study highlights the impact of salivary properties on erosive tooth wear, emphasizing the protective role of higher salivary pH. Regular monitoring of saliva and preventive strategies should be integrated into early diagnosis and management of erosive wear in young adults. Full article