Zhraa Hayder Al-faloji
5th year, group 15The affect of salivary flow rate of before and after denture placement
Systematic review
Supervisor:
Lecturer, Rimantas Oziunas
LITHUANIAN UNIVERSITY OF HEALTH SCIENCES MEDICAL ACADEMY FACULTY OF ODONTOLOGY PROSTHODONTICS CLINIC
Seilėtekio pokyčiai po protezavimo plokšteliniais protezais
Sesteminė apžavalga
The thesis was done
by student... Supervisor... (signature) (signature)
EVALUATION TABLE OF THE MASTER’S THESIS OF THE TYPE OF SYSTEMIC REVIEW OF SCIENTIFIC LITERATURE Evaluation:
...
Reviewer: ...
(scientific degree. name and surname)
Reviewing date: ...
No. MT parts MT evaluation aspects Compliance with MT requirements and
evaluation
Yes Partially No
1
Summary (0.5 point)
Is summary informative and in compliance withthe
thesis content and requirements? 0.3 0.1 0
2 Are keywords in compliance with the thesis essence? 0.2 0.1 0
3 Introduc-
tion, aim and tasks (1 point)
Are the novelty, relevance and significance of the
work justified in the introduction of the thesis? 0.4 0.2 0 4 Are the problem, hypothesis, aim and tasks formed clearly and properly? 0.4 0.2 0
5 Are the aim and tasks interrelated? 0.2 0.1 0
6 Selection criteria of the studies, search methods and strategy (3.4 points)
Is the protocol of systemic review present? 0.6 0.3 0 7
Were the eligibility criteria of articles for the
selected protocol determined (e.g., year, language,
publication condition, etc.) 0.4 0.2 0
8
Are all the information sources (databases with dates of coverage, contact with study authors to identify additional studies) described and is the last search day indicated?
0.2 0.1 0
9
Is the electronic search strategy described in such a way that it could be repeated (year of search, the lastsearchday;keywordsandtheircombinations; number of found and selected articles according to the combinations of keywords)?
0.4 0.1 0
10 Is the selection process of studies (screening, eligibility, included in systemic review or, if applicable, included in the meta-analysis) described?
0.4 0.2 0
11
Is the data extraction method from the articles (types of investigations, participants, interventions,
analysed factors, indexes) described? 0.4 0.2 0 12
Are all the variables (for which data were sought and any assumptions and simplifications made)
information is to be used in data synthesis, described?
14 Were the principal summary measures (risk ratio,
difference in means) stated? 0.4 0.2 0
15 Systemiza- tion and analysis of data (2.2 points)
Is the number of studies screened: included upon assessment for eligibility and excluded upon giving
the reasons in each stage of exclusion presented? 0.6 0.3 0 16
Are the characteristics of studies presented in the included articles, according to which the data were extracted (e.g., study size, follow-up period, type of respondents) presented?
0.6 0.3 0
17
Are the evaluations of beneficial or harmful outcomes for each study presented? (a) simple summary data for each intervention group; b) effect estimates and confidence intervals)
0.4 0.2 0
18
Are the extracted and systemized data from studies presented in the tables according to individual
tasks? 0.6 0.3 0
19
Discussion (1.4 points)
Are the main findings summarized and is their
relevance indicated? 0.4 0.2 0
20 Are the limitations of the performed systemic review discussed? 0.4 0.2 0 21 Does author present the interpretation of the results? 0.4 0.2 0 22
Conclusions (0.5 points)
Do the conclusions reflect the topic, aim and tasks
of the Master’s thesis? 0.2 0.1 0
23 Are the conclusions based on the analysed material? 0.2 0.1 0
24 Are the conclusions clear and laconic? 0.1 0.1 0
25
References (1 point)
Is the references list formed according to the
requirements? 0.4 0.2 0
26
Are the links of the references to the text correct? Are the literature sources cited correctly and
precisely? 0.2 0.1 0
27 Is the scientific level of references suitable for
Master’s thesis? 0.2 0.1 0
28
Do the cited sources not older than 10 years old form at least 70% of sources, and the not older than
5 years – at least 40%? 0.2 0.1 0
Additional sections, which may increase the collected number of points
29 Annexes Do the presented annexes help to understand the analysed topic? +0.2 +0.1 0
30
Practical recommen-
dations
Are the practical recommendations suggested and
are they related to the received results? +0.4 +0.2 0
31
Were additional methods of data analysis and their results used and described (sensitivity analyses,
*Remark: the amount of collected points may exceed 10 points.
Reviewer’scomments: 32
Was meta-analysis applied? Are the selected statistical methods indicated? Are the results of each meta-analysispresented?
+2 +1 0
General requirements, non-compliance with which reduce the number of points
33
General require- ments
Is the thesis volume sufficient (excluding
annexes)? 15-20 pages (-2 points) <15 pages (-5 points) 34 Is the thesis volume increased artificially? -2 points -1 point
35 Does the thesis structure satisfy the requirements of Master’s thesis? -1 point -2 points 36 Is the thesis written in correct language, scientifically, logically and laconically? -0.5 point -1 points 37 Are there any grammatical, style or computer literacy-related mistakes? -2 points -1 points
38 Is text consistent, integral, and are the volumes of its structural parts balanced? -0.2 point -0.5 points 39 Amount of plagiarism in the thesis. (not evaluated) >20%
40
Is the content (names of sections and sub- sections and enumeration of pages) in compliance with the thesis structure and aims?
-0.2 point -0.5 points
41
Are the names of the thesis parts in compliance with the text? Are the titles of sections and sub-sections distinguished logically and correctly?
-0.2 point -0.5 points
42 Are there explanations of the key terms and abbreviations (if needed)? -0.2 point -0.5 points
43 Is the quality of the thesis typography (quality of printing, visual aids, binding) good?
-0.2 point -0.5 points
CONTENT
SUMMARY ... 9
INTRODUCTION ... 10
SELECTION CRITERIA OF THE STUDIES. SEARCH METHOD AND STRATEGY ... 13
SYSTEMIZATION AND ANALYSIS OF DATA ... 17
DISCUSSION ... 21
CONCLUSION ... 25
REFERENCE ... 27
9
SUMMARY
Saliva is a form of watery substance that is secreted by major and minor salivary glands. The saliva plays major role in maintenance of oral hygiene as well as digestion of food. Absence of saliva could lead to dental caries as well as gingivitis and periodontitis and many other oral problems.
Aim:
The purpose of this systematic review was to find different articles that carried out an investigation in order to determine whether there is an affect of salivary flow before and after denture placement. Some of the articles that were collected had clinical trial in order to estimate how much saliva there is in each patient in resting (unstimulated) and stimulated position. In order to obtain this
information the research method was carried out on online database.
Material and methods:
The sources that were used were the following: ScienceDirect, NCBI (PMC), and
WileyOnlineLibrary. The articles that were chosen were filtered into dates from 2008-2018, as well as keywords were used in order to narrow the search.
Results
The results have shown that the salivary flow has increased immediately after denture placement for 24 hours. During follow up adjustment was obtained and salivary flow normalized.
Conclusion
10
INTRODUCTION
As we to get older we tend to loose our teeth, for some people tooth loss occurs faster than others and that would lead them to wanting to receive dentures in order for them to have a confidence while interacting with people. There are other options such as implants however they are much more expensive therefore the majority of patients prefer dentures. Therefore this study will allow identifying how the dentures could affect the amount of salivary flow. There could be partial or complete dentures depending on the patient’s situation such as the amount of teeth they have. Dentures are required as they help with masticatory processes such as chewing, swallowing, and speech. In this study the aim is to determine the salivary flow that affects patients with dentures. Whether it has major affect or minor affect and how it could be resolved. This review also would determine whether medicated patients would affect the result of salivary flow testing. This is due to some medication that is taken tending to cause either hypo salivation or hyper salivation.
Saliva plays a huge role in denture wearing patients as it helps with the adhesion and stabilization of the dentures. Saliva also plays a very important role in preserving denture integrity by keeping the denture surfaces clean and in maintaining proper oral hygiene by physically washing away food and other debris from the soft tissues and from the polished surface of the prosthesis. [1]
The composition and consistency of saliva in edentulous patient is very important as it helps with the aid of prosthesis. Therefore prosthodontists are required to pay very careful attention to the edentulous patients, as they will not know what they have or whether they have excess saliva or barely any salivary secretion. If there are any alterations in the amount of saliva that is being produced there could be serious damage as well as huge affect in the oral health such as speech difficulties, problems with degulation and mastication as well as the taste perception will also be affected and other problems such as halitosis, xerostomia etc. [2]
Salivary secretion average range normally is around 500-1500 ml on daily bases of everyday life. [3] The saliva is secreted from major salivary glands as well as minor salivary glands. The major salivary glands are the parotid, sublingual and the submandibular gland. As for the minor salivary glands they are scattered around in the oral mucosa.
11 Generally, dentures don’t rest on bare mucosa but on the interposed salivary film. The functions of this film include protection of tissues from forces of the denture base and hydration of these tissues so that the prosthesis can rest on this layer rather than directly on oral tissues. Therefore patients with xerostomia tend to get soreness and ulceration in the denture-bearing tissues, decreased denture retention, burning sensation, alteration in taste perception, and difficulty in mastication and swallowing this is the cause of lack of saliva. [5] Therefore the saliva plays a large role in denture wearing patients.
The majority of the denture-wearing patients are over 70 and tends to have many systemic diseases, which causes them to have hypo-salivation or xerostomia. This could be caused from the disease or the medication that has been consumed by the patients. The medication that patients consume could cause side affects affecting the rate of saliva and this would lead to bias information. As the author should state in every clinical trial whether the patient is a medicated patient as well as indications to what type of diseases the patients have. This is done as the disease would also affect the secretion of saliva as well as the rate of the saliva.
There are a few methods, which allow determining saliva flow rate, such as unstimulated or stimulated saliva, whole saliva, and saliva from individual glands, and there are different views on their clinical values. [5] This is done in order to collect accurate results. Saliva flow is termed unstimulated when no exogenous or pharmacological stimulation is present, and is termed stimulated when secretion is promoted by mechanical or gustatory stimuli or pharmacological agents.[6]
The unstimulated saliva is the saliva that is being secreted at rest in order to moisture the oral mucosa. This is called resting saliva and it is a very important at maintaining the health of the oral mucosa. As for the stimulated saliva is when it is stimulated by the sence of taste, and smell. [6] For about 70% of the resting whole saliva is derived from submandibular/sublingual glands, aboout 15–20% from parotid, and 5–8% from minor glands. When it is as stimulated conditions, 40–50% of whole saliva comes from parotid and from submandibular and sublingual glands and smaller amounts from minor glands. The accepted range for very low, low, and normal unstimulated whole salivary flow rate are less than 0.1, 0.1–0.2, and >0.2 ml/min, respectively. [7,8]
12 values in experienced complete denture wearers. [5, 9]
There have also been several studies that have been carried out in order to determine what affect the saliva has on denture wearing patients. The result turned out that the saliva is the main source of maintaining the oral mucosa’s health. This is what will be discussed as well as presented in this review.
Unlike the articles that have been agreeing that the rate of saliva decreases as we get older, [9, 13, 14] the author B. C. Muddugangdhar disagrees, as he believes that the age doesn’t have as much effect on the rate of saliva as the medication that the patients take tend to make an affect on the rate of saliva. [9] It is believed that the patients to tend to have increase or decrease of saliva flow according to the medication they are taking in which could affect the salivary flow production.
Aim:
The aim of this systemic review is to determine the affect of the salivary flow rate on patientsin different age groups of before and after denture placement.
Tasks:
1. To compare the different types of experiments taken on patients with and without dentures. 2. To find out whether dentures affect the rate of salivary flow.
3. To determine if there are any affects on salivary flow depending on intake of other factors
such as medication.
Keywords:
Saliva denture; saliva rate;full dentures and salivary flow; partial dentures and salivary flow.
Filter: from 2008 till present.
13
SELECTION CRITERIA OF THE STUDIES. SEARCH METHODS AND STRATEGY
Different key words and phrases were typed in Google website to get a general perspective and academicals articles. In order to obtain better research more specific words were searched such as: Saliva Denture (Denture and saliva), saliva rate (saliva flow rate), full dentures, (full dentures and salivary flow), partial dentures (partial denture and saliva).
In the research different websites were visited in order to find the articles that would defend the systemic review. Such as NCBI (PMC), ScienceDirect, and Wiley Online Library. In order to obtain useful articles keywords and filters were used. To narrow the article search results the year filter was used from the year 2008 till2018, this is done in order to obtain more reliable articles as well as more recent discoveries.
The search resulted in a very large number of articles, the majority of the articles that were resulted didn’t have the same topic as this systematic review. However there were a few articles that have clinical trials based on the topic chosen for this review.
In the beginning, the titles were read, and as soon as the title fit the information of the research, the article was then read briefly. After brief reading the abstract and making sure the article is providing the necessary information, the article was then read more thoroughly.
According to the research that was carried out there had to be inclusion as well as exclusion criteria in which allowed to have the research set in organised categories.
Inclusion criteria:
• Not older than 10 year
• The articles should be published in English • Studies on humans
• Original articles full text
14
Exclusion criteria:
• Studies older than 10 years
• Study that doesn’t match with my study • Systematic review
• Summaries
• Articles that required to be purchased • Studies on animals
• Literature review • Case study
Results I
Research in the online database:
Table 1.NCBI (PMC)
Keywords Filter Results Date searched
Denture and salivary flow No filter 734 10.04.18 Denture and salivary flow 10 years 612 10.04.18 Denture and
salivary flow 10 years open access 431 10.04.18
Denture saliva No filter 1482 10.04.18
Denture saliva 10 years 1416 10.04.18
Filter was used from 10 years as well as key words such as : denture saliva, denture and salivary flow.
15
Table 2.ScienceDirect
Keywords Filter Results Date searched
Denture and salivary flow No filter 1,243 10.04.18 Denture and salivary flow 10 years 488 10.04.18
Denture saliva No filter 3,238 10.04.18
Denture saliva 10 years 1,018 10.04.18
In this web page the search results were significatly high after the search. As filters were added such as from 10 years till present the result amount decreased and made search result more narrow. As other keywords were added more results showedin which wasnt an advantage as most of the results weren’t related to the topic. As for the articles that were found suited to the topic they were breifly read in order to see if the abstract was a slight match to the topic and this is done in order to obtain the articles that are more reliable for this review.
Table 3.WileyOnlineLibrary
Keywords Filter Result Date searched
Denture saliva No filter 3,900 10.04.18
Denture saliva 10 years 1,434 10.04.18
Full denture saliva No filter 1,909 10.04.18
Full denture saliva 10 years 621 10.04.18
Denture and salivary flow No filter 1,955 10.04.18 Denture and salivary flow 10 years 708 10.04.18
As filters were used it allowed to narrow the search and a few suited articles showed in the results. Using filters from 2008 till 2018 (present). Many of the articles were off topic as the abstracts were carefully observed even when narrowed they were still not suited to the topic chosen.
16
Structure of the review
The articles and studies that have been chosen for this research were carefully selected according to the method and requirement of a PRISMA diagram. The PRISMA diagram gives an overview of the evidence collected as well as the strength of the case that has been presented. This is done in order to avoid any design or scheme that is bias.In the following PRISMA diagram (fig. 1) presented the articles searched as well as how the inclusion and exclusion criteria was carried out during the process of obtaining suitable articles for the study.
Fig. 1.PRISMA diagram
Studies identified through database searching: 3,932 PubMed: 734 ScienceDirect: 1,243 WileyOnlineLibrary: 1,955 Identification Screening
Studies after duplicated removed: 1,569 PubMed: 414 ScienceDirect: 475 WileyOnlineLibrary: 680 1,544 were excluded 1,544 Title of the topic
Eligibility 25 Full-text articles assessed for eligibility
Included
5 studies included in qualitative analyses
Pubmed: 2 ScienceDirect: 2 WileyOnline Library: 1
20 studies excluded:
17
SYSTEMIZATION AND ANALYSIS OF DATA Data extraction and management
Each article has been read very carefully as well as analyzed in order for it to match the criteria of the review. Titles and abstracts were carefully selected in order to have reliable information as well as accurate review. If the articles title and abstract did not provide the information that is required according to the inclusion criteria the article would be dismissed.
During the search of articles there were a very large number of articles that showed up in results in different websites that were used in order to search for the articles. The articles were excluded from the review once they had a match with the exclusion criteria that was enlisted.
Using the Cochrane template allowed the review to assess the quality of the articles and studies that were selected. This template allows identifying the “risk of bias” as some articles contain bias information. The higher the bias result is the weaker the accuracy of the results provided. [10] The necessary domains for this review were the following:
Table 4: Assessment risk of bias in included studies
(+ = low risk of bias, - = high risk of bias)
18 The articles that were selected for the review were evaluated accordance to the following criteria: low risk of bias (when the bias will not affect the results); unclear risk of bias (when the bias plays a role in the results that have been provided); and high risk of bias (when the bias highly affects the results provided). According the review all of the domains were assessed as low risk of bias.
Results II
Table 5:Characteristics of included studies Author Study type Time trial taken No. pati ents Pati ents age Prati al/ full dentu res Upper/ lower/ both jaws Medicate d/ non-medicated . Mean range of saliva in unstimulated. Before (B)/ 24h after (A) denture placement. Follow up (F) (ml/min) Mean range of saliva in stimulated Before (B)/ 24h after (A) denture placement. Follow up (F) (ml/min) Abhay Sonthali a et al. 2016 Clinical study 9:00 – 11:00 am 42 35-70
full both Medicated & non-medicated Med (B) -0,2130 ml/min Med (A)- 0,3275 Med (F) 3mnths- 0,2285 Non-med (B)- 0,2414 Non-med (A) – 0,3568 Non-med (F)3 mnths- 0,2600 - M. Ryu et al. 2010 Clinical study 9:30 – 11:30 am 68
74-81 full both Medicated (B) 0,1 (A) 0,472 -
B. C. Muddug angadha r Et al. 2015 Clinical study 9:00 - 11:00 am 50
19 Age 61 + (B)- 0,34 (A)- 0,86 (F) 2-3 months- 0,69 Age 61 + (B)- 0,65 (A)- 0,99 (F)2-3 months- 0,77 Matsud a K et al. 2009 Clinical study
22 - full both
non-medicated & medicated (B)- 0,06 (A)– 0,10 (B)- 0,45 (A)– 0,75 Ayaka Kawaha ra 2013 original article Clinical 9:00 am – noon 33 65-80 partial Upper or lower or both Non-medicated (denture & non-denture wearer) Denture wearer- 0,12 ml/min (B) Non denture wearer- 0,04 ml/min (B) Denture wearer (F) 1 month- 0,10 Non-denture wearer (F) 1 month- 0,08 Denture wearer- 1,20 (B) Non denture wearer- 1,25 (B) Denture wearer (F)- 1,30 Non-denture wearer (F)- 1,15
Most of the cases had 22 and above patients that were admitted into the clinical trial and this helps with the study in order to be provided with valid information. The more patients that are admitted to the experiment the more reliable the results would be and that would make the article have a valid case as well as more reliable as it would state what results the majority of patients had in the clinical trial.
In the table shown above it has stated whether the patient is medicated or non-medicated as well as whether the patient is edentulous. According to the articles that were selected the majority of the patients where edentulous. The patients that were selected for each of the articles weren’t younger than the age of 30. All of the patients were 30 and above as this is the age range where some people tend to loose their teeth and require dentures.
As it is shown in the table above the salivary flow rate is slightly changes during the process of denture placement and follow up. The rate of saliva increases at the period of time when the denture is immediately placed. However for the follow up the salivary flow rate showed a decrease.
20 The results in the stimulated saliva from the article by the author Ayaka Kawahara [11] were
21
DISCUSSION
The majority of the articles that were included in this review had similar method in obtaining the result of the salivary flow. However there were a few differences as each author had a different group set of patients. Most of the articles had an agreement on their results, as they were vaguely alike.
Different methods were used in order to obtain the results of the stimulated and unstimulated salivary flow. Therefore the results aren’t reliable, as most of the articles didn’t specify which method or technique was used in order to obtain the results that are presented in (table 5). The author Matsuda K [16] and article by Ayaka Kawahara [11] the results in stimulated were at lowest compared to the other results in other articles. However in the stimulated results by Ayaka
Kawahara [11] the results of rate of saliva is higher than all of the results. These results are unreliable as the author didn’t specify from which patients results were obtained whether it was upper partial denture or lower. It was also unknown to what triggered the stimulation of the salivary flow as there was a great increase of salivary flow compared to other results obtained.
According to the author Ayaka Kawahara[11] his study was based on partial denture patients and how the salivary flow is affected according to the occlusal force that is being applied by the patient, during the research it was discovered that there has been a small influence on the environment of occlusal force. It has also been discovered that the saliva secretion in men is higher than woman and this is due to the size of the salivary glands as they are larger in men. [11]. It has also been stated that the older the patient gets the more acinar cells decrease.[3]
Within time the dentures would require to be cleaned his is done in order to avoid accumulation of bacteria as that could affect the rate of saliva and that would lead to hypo salivation. [2, 3, 14] Partial or full removable dentures are more prone to have bacteria accumulation, which would require frequent hygiene in order for it to affect the oral mucosa. Due to the lack of hygiene the patients can get many diseases such as pneumonia. [15] The cleaner the denture is the less bacteria is accumulated and the better the state of the oral cavity. [12,13,14]
22 As a result of the research it was discovered that the denture replacement improved their maximal occlusion force, which lead to an increase stimulation of the salivary flow. This resulted in fewer patients had hypo-salivation condition. [14] According to Matsudas K. et al. findings it has shown that the occlusal force is connected with the increase of salivary flow. [16]
In the results it was found that there was a positive correlation between the stimulated and
unstimulated salivary flow rates both before and after denture replacement. The maximal occlusion force which could only be obtained with dentures caused an increase in the rate of saliva. [12, 13, 14, 15]
Most of the articles that were collecting samples as well as data from patient they were always focusing on the difference between stimulated saliva and unstimulated saliva. [9, 11, 16] In one of the procedures the authorshad the patients with unstimulated salivary flow spit into a funnel, which then lead to a test tube. As for the stimulated saliva count they made each patient chew on paraffin wax in order to get the saliva stimulated and this is the mechanical method that was used. [9] Each patient that has been entered for the clinical trial has been asked not to eat or drink 2 hours before the experiment. [5, 9, 11, 14, 16]
The experiment was taken thoroughly of patients in 3 stages for the unstimulated salivary flow. Tests were taken before the denture placement, after denture placement, and 1 or 2 – 3 months after denture placement. [5, 9, 11]
The increase of whole salivary flow rate, which was found immediately after placement of denture, was discovered that it had a negative effect on the retention which is a sign of excessive amount of saliva. According to the study it was discovered that once the denture was placed there was a significant increase of saliva flow rate. However, after some time the salivary flow decreased a normal amount of salivary flow. [5, 9, 11, 16] This process could indicate that as the denture was placed on the dental arch irritation developed on the gingiva and oral moucosa, which lead to an increase of salivary flow. Within time the oral mucosa would adapt to the denture and there would be a saliva film between denture and oral mucosa for the stability of dentures.
23 statement, as the patients that were on trial were mainly non-medicated patients. Overall the results have shown that after 2 to 3 months of complete denture placement the rate of salivary flow rate were higher while stimulated. [9]
Another article that has been used for this review has tested the salivary flow rate on medicated and non-medicated denture wearing patients. This study will allow comparing the reliability of the other articles as well as how affective the results would be. The medicated patients had their history and their health problems presented in a short description. The medicated patients were taking the following medications: analgesics, angiotensin-converting-enzyme inhibitors, antihypertensive, oral hypoglacemic and other.
As for the non-medicated patients they were the patients that weren’t taking any medication that could affect the rateof salivary flow. [5]. The method of saliva collection in this clinical case was slightly different to the method in the article that B. C. Muddugangadhar[9]. However the
correlation difference wasn’t significant.
The patients undergoing this clinical trial have been asked to not eat or drink 2 hours before the saliva collection. [5, 9, 11, 14, 16]As for the medicated patients they were not permitted to receive their medication until after the saliva sample has been collected. Similar results were shown compared to the results that were obtained by B. C. Muddugangadhar [9]. The salivary flow rate was lower in medicated patients before the insertion of the denture and then it was higher after 24 hours after denture insertion. As for the follow up results there wasn’t a significant difference. [5]. This is due to the oral mucosa adapting to the foreign object that has been inserted. In the non-medicated patients there was a minor difference between the before denture insertion and the 24 hour later after denture insertion. However the salivary flow rate increased after the 24hours of insertion. [5, 9, 16]
24 In order to spit into the tube it would require a patient to have full energy as well as the patients didn’t all have the same muscle strength as the other patients that were participating in the trial. After 3 months of testing the saliva flow rate of before denture placement and after denture placement it has been found that in both medicated and non-medicated patients didn’t show significant difference.
Each article had concluded that the affect of denture on salivary flow is not very significant. The difference wasn’t substantial however when the saliva was stimulated there was an increase of the flow.[11] Comparing these results with another article that obtained similar experiment but on denture wearing patients only. The results were higher at the resting position compare to the first article that obtained the results as for the stimulated results in the other article had a lower amount. [16]
Some patients with dry mouth or patients who suffer from xerostomia couldget mucosal damages as well as blisters as the patient is a denture-wearing patient and this is due to the lack of saliva. Saliva aids in cleaning of the debris or left over food between teeth or dentures. Therefor patient that don’t have the ability to produce normal amount of saliva would have a problem with the denture as well as the patient would have to be prescribed medication. [15, 16]
Dryness of the mouth could also cause problems to the patient environmental as well as the patient would have dryness in throat as well as lack of ability of speech. Due to the lack of saliva the mouth would be very dry and the masticatory muscles would have limited movement, as well as there would be irritation in the gingival ridges and margins. [15,2, 17]
25
CONCLUSION
1. According to the research that has been undergone as well as the different articles that were included and analysed there wasn’t a significant difference in taking the experiment on patients. The clinical trials that were taken from each of the articles consisted on focusing on taking samples of stimulated saliva secretion and unstimulated saliva secretion. This is done in order to determine the amount of the salivary flow with and without stumilation as well as whether there is a change in salivary flow before and after denture placement. In the clinical trials they all resulted with a higher mean of stimulated salivary flow compared to the unstimulated saliva.
2. Due to the research that has been undergone some articles may disagree about the effect of dentures on saliva and some believe that the salivary flow does get affected due to the dentures. Other articles and experiments suggested that there wasn’t any change in the rate of saliva. The change took place immediately after denture placement as the salivary flow had a major increase. Its believed that this could have resulted in excess salivary flow due to the foreign object which makes the patient anxious and nervous as the patient wouldn’t be used to the idea of something else is getting replaced instead of their natural teeth.
3. The medicated and non-medicated patients have slightly similar results however the medicated patients had slightly lower amount of salivary flow.
Practical recommendation
Salivary flow rate is extremely important for the stomatognatic system in the way that it helps with the masticatory process, speech, swallowing and many other processes. Therefore a patient with low salivary production will require artificial saliva, in order to prevent mucosal blisters, irritations and other problems.
Limitation of study
The articles had different methodic studies in how the results were obtained. One study used paraffin wax in order to stimulate the salivary flow while other articles did not mention the method that was used in order to stimulate the salivary flow rate.
26 medicated patients, each patient were receiving different medication which could have an impact on the results.
27
REFERENCES:
1. Lakhyani R, Wagdargi SS. Saliva and its Importance in Complete Denture Prosthodontics. Nat J Integ Res Med. 2012;3(1):139-146.
2. Shabina Sachdeva, Rana Noor, Rizwana Mallick, Eram Perwez. Role of saliva in complete dentures: an overview. Annals of Dental Specialty Vol. 2; Issue2. Apr – Jun 2014: 51. 3. Lakhyani R, Wagdargi SS. Saliva and its Importance in Complete Denture Prosthodontics.
Nat J Integ Res Med. 2012;3(1):139-146.
4. Hardy IR, Kapur KK. Posterior border seal-Its rationale and importance. J Prosthet Dent. 1958;8:386–97.
5. Abhay Sonthalia, Arun P. Chandrasekaran, Sheetal P. Mhaske, Mayank Lau, V. R.
Joshy,and George Attokaran. Comparative evaluation of effect of complete denture wears on the flow rate of saliva in both medicated and apparently healthy patients. J Int Soc Prev Community Dent. 2016 May-jun; 6(3): 219-223.
6. Yurdukoru B, Terzioğlu H, Yilmaz T. Assessment of whole saliva flow rate in denture wearing patients. J Oral Rehabil. 2001;28:109–12.
7. Sreebny LM. Saliva in health and disease: An appraisal and update. Int Dent J. 2000;50:140–61.
8. Anil S, Vellappally S, Hashem M, Preethanath RS, Patil S, Samaranayake LP. Xerostomia in geriatric patients: A burgeoning global concern. J Investig Clin Dent. 2016;7:5–12. 9. B. C. Muddugangadhar, Rajashekar Sangur, I.V. Rudraprasad, D. B. Nandeeshwar, and B.
H. Dhanya Kumar. A clinical study to compare between resting and stimulated whole salivary flow rate and pH before and after complete denture placement in different age groups. J Indian Prosthodont Soc. 2015 Oct-Dec; 15(4): 356-366.
10. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011.
11. Ayaka Kawahara. The Insertation of a Removable Partial Denture Increases Unstimulated Salivary Flow Rates in Non-Denture Wearers. Int J Oral-Med Sci. 12(3):147-153, 2013. 12. Junko Tanaka DDS*, Masahiro Tanaka DDS, PhD, Takayoshi Kawazoe DDS, PhD.
Longitudinal research on the oral environment of elderly wearing fixed or removable prostheses. Journal of Prosthodontic Research. 53 (2009) 83-88.
28 14. M. Ryu*, T. Ueda*, T. Saito*, M. Yasui*, K. Ishihara* & K. Sakurai. Oral environmental
factors affecting number of microbes in saliva of complete denture wearers. Journal of Oral Rehabilation. 2010 37; 194-201.
15. Adachi M, Ishihara K, Abe S, Okuda K, Ishikawa T. Effect of professional oral health care on the elderly living in nursing homes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:191–195.
16. Matsuda K, Ikebe K, Ogawa T, et al: Increase of salivary flow rate along with improved occlusal force after the replacement of complete dentures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 108:211-215, 2009
17. Humphrey SP, Williamson RT. A review of saliva: Normal composition, flow, and function. J Prosthet Dent. 2001;85(2):162-9.
18. Sreebny LM, Valdini A: Xerostomia. A neglected symptom. Arch Intern Med. 147: 1333-1337, 1987.
