About Xerostomia

XEROSTOMIA is defined as the subjective perception of dry mouth. It can harm oral health and quality of life of the patient.

Saliva plays an important role in oral health. It acts to protect against bacteria and fungi, transport of nutrients and digestive enzymes, lubrication of the oral cavity and remineralisation of the teeth, as well as helping to chew, swallow and speak.

Saliva helps prevent tooth decay by neutralizing acids produced by bacteria, limiting bacterial growth and washing away food particles. In addition, enzymes in saliva aid in digestion.

Decreased saliva and dry mouth can range from being merely a nuisance to something that has a major impact on your general health and the health of your teeth and gums, as well as your appetite and enjoyment of food.

Symptoms

Symptoms of xerostomia include halitosis (bad breath), mouth pain and burning, difficulty swallowing and speaking, and taste disturbances (early clinical manifestations) and it can increase the risk of tooth decay and contribute to periodontal diseases and oral infections such as candidiasis (infection caused by the fungus Candida albicans).

  • Dryness or a feeling of stickiness in your mouth
  • Saliva that seems thick and stringy
  • Bad breath
  • Difficulty chewing, speaking and swallowing
  • Dry or sore throat and hoarseness
  • Dry or grooved tongue
  • A changed sense of taste
  • Problems wearing dentures

Causes

The causes that can trigger xerostomia include:

The elderly, those with neurodegenerative diseases, head and neck cancer patients, and those with autoimmune conditions such as Sjögren’s syndrome are disproportionately affected. Oropharyngeal dysphagia refers specifically to difficulty in initiating a swallow due to dysfunction at or above the upper esophageal sphincter, and represents a large proportion of dysphagia cases.

Chemotherapy and radiation therapy – head and neck cancer. Despite major improvements in radiation therapy for head and neck cancer (HNC), the most prevalent long-term complications are radiation-induced salivary gland hypofunction and xerostomia.
The major salivary glands (SGs) are highly radiosensitive; ionizing radiation leads to reduced saliva flow rate and changes in both the composition and function of saliva.Consequently, patients may suffer from dental decay, oral infections, difficulties with speaking, chewing, and swallowing, sleep disturbance, worsened nutritional state, and impaired quality of life (QoL).
The pathophysiology behind radiation injury of SGs is multifactorial and includes an acute and late response that may continue for years, characterized by chronic inflammation, acinar, local progenitor and stem cell loss and the development of fibrosis and im- paired environment for surviving acinar cells.

Other causes

  • Tobacco and alcohol use. Drinking alcohol and smoking or chewing tobacco can increase dry mouth symptoms
  • Other health conditions. Dry mouth can be due to certain health conditions, such as diabetes, stroke, yeast infection (thrush) in your mouth or Alzheimer’s disease, or due to autoimmune diseases, such as Sjogren’s syndrome or HIV/AIDS. Snoring and breathing with your mouth open also can contribute to dry mouth.
  • Recreational drug use. Methamphetamine use can cause severe dry mouth and damage to teeth, a condition also known as “meth mouth.” Marijuana also can cause dry mouth.

Treatment

A large number of irradiated head and neck cancer patients worldwide are suffering from the harsh and long-lasting side effect of salivary gland (SG) hypofunction and xerostomia, hence the importance of reaching a curative treatment.
No efficient TREATMENT exists to alleviate the burden of radiation-induced salivary gland hypofunction and xerostomia. Currently, only sparse symptomatic treatment is available to ease the discomfort of xerostomia.

Regenerative Stem Cell Therapy

REGENERATIVE STEM CELL THERAPY is considered a prospective curative treatment for salivary gland (SG) hypofunction and xerostomia. Stem cell therapy is a new and novel advancement that may fill a much-needed role in our treatment regimen. Preclinical studies indicate that MSCs can restore radiation damaged lesions, and regenerate radiation-damaged SGs to produce more saliva through the release of hepatocyte growth factor, vascular endothelial growth factor, cyclooxygenase-2, and matrix metalloproteinase-2 and by increasing the density of blood vessels in the SGs. In a recent randomized trial, we found that autologous adipose tissue-derived mesenchymal stem cells injected into the submandibular glands of patients with radiation-induced xerostomia to be safe with a promising tendency to restore submandibular gland function.

Methods

Twenty-five million MSCs are injected into each submandibular and 50 million MSCs into each parotid gland.
It is already demonstrated that an allogeneic and autologous MSC therapy is safe and feasible and has a tendency toward clinical efficacy in patients with radiation-induced salivary gland hypofunction and xerostomia.

Results

A significant and clinically meaningful increase in unstimulated and stimulated whole saliva flow rate was observed along with decrease in xerostomia with improved patient-reported quality of life.
The current literature topics regarding stem cell treatments for oropharyngeal dysphagia includes tissue regeneration advancements.
Functionally, they observed a 42% increase in saliva production in the cell injection group compared to untreated irradiated glands.

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