The Effects of The Royal Jelly On Dry Mouth Sensation With Normal Saliva Function: A Double-Blind, Placebo-Controlled, Cross-Over Trial Clinical Study

Background: Because there are no standardized treatment methods for dry mouth sensation with normal salivary function, cases of dry mouth sensation continually suffer. The aim of this clinical study was to evaluate the effects of a royal jelly tablets on dry mouth sensation, in patients with normal salivary function. Methods: This double-blind randomized clinical trial was carried out in the Department of Oral and Maxillofacial Surgery, Tokyo Medical and Dental University Hospital between November, 2019 and April, 2020. This clinical trial was randomized, double-blind, and of a crossover design, with a four-week washout period. Each participant received either 800 mg of royal jelly tablets or placebo, daily for 12 weeks. Results: Differences in VAS scores between royal jelly tablets and placebo were evaluated at 4 and 12 weeks, and were significant. Differences in HADS and GHQ12 scores between those exposed to royal jelly tablets and placebo, at the evaluation period of 12 weeks, were statistically significant. A statistically significant decrease in HADS scores in the royal jelly tablet group, was observed over time. Conclusions: These findings show that daily consumption of royal jelly (800 mg) for 12 weeks was effective in alleviating dry mouth sensation with normal saliva function.Clinical trial registration numbers and the full date of first registration: ClinicalTrials.gov (jRCTs031190067); 02/08/2019

Oral Complications of Head and Neck Cancer Therapy

Current therapies for Head and Neck cancer treatment are extremely advanced. Though, they cause oral complications which have deleterious effects on basic life functions, affect oral and overall health, may lead to significant morbidity and treatment discontinuation and have an impact on survivorship and quality of life. As new therapies are introduced, a new spectrum of oral complications is rising, compromising the mucosal integrity and the salivary function, that may not be recognized, reported and treated properly. Oral complications, often permanent and extremely painful, may include mucositis, xerostomia, dysgeusia, infections, trismus and fibrosis, risk of dental disease and necrosis of the jaw, neurosensory disorders and when targeted therapies and immunotherapy are involved, aphthoid and lichenoid lesions can also be reported. Increased awareness is required for the prevention and management of these complications, which can be best provided by a multidisciplinary team.

Yap activation in irradiated parotid salivary glands is regulated by ROCK activity

Radiotherapy plays a major role in the curative treatment of head and neck cancer, either as a single modality therapy, or in combination with surgery or chemotherapy, or both. Despite advances to limit radiation-induced side-effects, the major salivary glands are often affected. This frequently leads to hyposalivation which causes an increased risk for xerostomia, dental caries, mucositis, and malnutrition culminating in a significant impact on patients’ quality of life. Previous research demonstrated that loss of salivary function is associated with a decrease in polarity regulators and an increase in nuclear Yap localization in a putative stem and progenitor cell (SPC) population. Yap activation has been shown to be essential for regeneration in intestinal injury models; however, the highest levels of nuclear Yap are observed in irradiated salivary SPCs that do not regenerate the gland. Thus, elucidating the inputs that regulate nuclear Yap localization and determining the role that Yap plays within the entire tissue following radiation damage and during regeneration is critical. In this study, we demonstrate that radiation treatment increases nuclear Yap localization in acinar cells and Yap-regulated genes in parotid salivary tissues. Conversely, administration of insulin-like growth factor 1 (IGF1), known to restore salivary function in mouse models, reduces nuclear Yap localization and Yap transcriptional targets to levels similar to untreated tissues. Activation of Rho-associated protein kinase (ROCK) using calpeptin results in increased Yap-regulated genes in primary acinar cells while inhibition of ROCK activity (Y-27632) leads to decreased Yap transcriptional targets. These results suggest that Yap activity is dependent on ROCK activity and provides new mechanistic insights into the regulation of radiation-induced hyposalivation.

Effect of homeopathy in the function and morphology of salivary parotid glands of irradiated rats

Objective: To evaluate the radioprotective effect of a homeopathic solution in salivary function and in parotid glands morphology of irradiated rats. Materials and Methods: The sample consisted of 150 rats randomly divided in 6 groups. The groups were named based on the substance administered: Control- saline solution; Irradiated Control- saline solution and 15 Gy of X radiation; Alcohol-hydroalcoholic solution dynamized at 15 CH; Irradiated Alcohol- hydroalcoholic solution dynamized at 15 CH and 15 Gy of X radiation; Homeopathy- 0.25 ml (1mL/kg) of the irradiated hydroalcoholic solution and dynamized at 15 CH; Irradiated homeopathy- homeopathic solution and 15 Gy of X radiation. Each group was subdivided in 5 different subgroups, based on the time point of euthanasia: 12 hours, 3, 10, 17, and 24 days. The medication was administered for 7 days before and 7 days after the radiation treatment. On the day of euthanasia, salivation was induced with pilocarpine and collected. The animals were then sacrificed and the parotid glands were removed. Results: Salivary function analysis showed that only group irradiated homeopathy euthanized on day 17 had a statistical significant difference when compared to other irradiated groups, presenting a higher salivation flow rate. The only group that showed statistical significant difference in the number of acini over the time was the irradiated alcohol group, which presented a tendency of reduction. Conclusion: The homeopathic solution presented a late radioprotective effect based on salivary function and morphological analysis of the parotid gland.

Salivary gland function in women with Hashimoto’s thyroiditis without xerostomia and the correlation with auto-thyroid antibodies

Background Hashimoto’s thyroiditis (HT) may cause salivary dysfunction in patients resulting in xerostomia, but little is known about changes in salivary function in patients with no obvious dry mouth symptoms. In this study we assessed salivary function in women with HT, who had not experienced xerostomia and, for the first time, evaluated the effects of thyroid auto-antibodies on this function. Methods Sixty consecutive subjects were included, comprising 32 women (mean age, 36 ± 12 years) diagnosed with HT accompanied by differentiated thyroid cancer (DTC) in the study group (HT group), along with a control group (DTC group) of 28 women (mean age, 40 ± 12 years) diagnosed with DTC only. Salivary gland scintigraphy was used to assess salivary function with the semi-quantitative parameters of maximum absorption ratio and maximum secretion ratio, the decrease of which indicate impaired salivary function. Moreover, the HT and DTC groups were divided into four subgroups (Anti– HT, Anti+ HT, Anti– DTC, and Anti+ DTC), based on the presence of anti-thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb). Finally, salivary gland semi-quantitative parameters were correlated with levels of thyroid-stimulating hormone (TSH), TGAb, and TPOAb in the HT and DTC groups. Results None of the semi-quantitative parameters examined in parotid or submandibular glands differed significantly between the HT and DTC groups. However, the maximum secretion ratio for the parotid and submandibular glands were significantly different in the subgroup comparison (p < 0.05). Furthermore, the TgAb, TPOAb, and TSH values correlated significantly with salivary excretive function (p ≤ 0.05). Conclusion Women with HT without xerostomia may not have salivary functional impairment during hypothyroidism. Serum thyroid autoantibody and TSH levels may mainly influence salivary excretive function but not uptake function.

Impact of radiotherapy to the head and neck region on the oral condition

Investigations of the oral function of patients undergoing radiotherapy (RT) to the head and neck region are relevant for the overall quality of life. Considering the possible impact of the side-effects on nutrition, the recovery of these patients might be impaired. This study aimed at investigating the oral condition of patients submitted to RT to the head and neck region. A single-center, cross-sectional mixed analysis assessing the oral conditions of patients before RT (group 1) and after 12-months of RT (group 2) was performed. Following inclusion and exclusion criteria consideration, fifty (n=25) patients were included in this study. A calibrated examiner conducted the oral examination, the following variables were assessed: a) DMF index: decayed, missing and filled teeth; b) xerostomia and dysgeusia, subjective assessment of salivary function and taste; c) simplified oral hygiene index – OHI-S, with plaque disclosing solution; d) unstimulated sialometry, assessment of salivary function. Statistical analysis compared the groups considering a significance level of 5%. The group evaluated after 12 months of RT showed high rate of dry mouth (92%) and dysgeusia complaint (72%) while no patient reported in group 1. Statistically significant difference was observed in the comparison of group 1 and 2 regarding DMF index (> 64%), OHI-S index (>38%), and unstimulated sialometry (<70%). Patients submitted to RT to the head and neck region for the treatment of cancer experience oral complications even at 12 months after the last session of RT.