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Published in: BMC Oral Health 1/2023

Open Access 01-12-2023 | Research

Salivary stimulatory effect of novel low level transcutaneous electro neurostimulator in geriatric patients with xerostomia

Authors: Ramya Ramadoss, Rajkumar Krishnan, Swarnalakshmi Raman, Rajashree Padmanaban, Nagarathinam Anbuelangovan, Rajalakshmanan Eswaramoorthy

Published in: BMC Oral Health | Issue 1/2023

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Abstract

Background

Xerostomia (dryness of the mouth) is one of the most common long-term consequences of ageing, and it causes a tremendous impact on the function and morphology of the salivary ductal system. As a consequence, it leads to a decrease in the amount of salivary output and also affects the overall quality of life. The purpose of this study was to determine whether electrostimulation using a custom designed transcutaneous electrical nerve stimulation (TENS) device will help to improve the quality of secreted saliva following electrostimulation.

Methods

One hundred thirty-five participants underwent the intervention for three months, twice daily (80 Hz). Pre-intervention and post-intervention unstimulated saliva were collected. Parameters such as salivary pH, cortisol level, salivary antioxidants, total protein, the viscosity of saliva, and microbial carriage were analysed.

Results

Salivary pH, cortisol, microbial cultures, viscosity, and antioxidants showed a significant difference at the end of the 3rd month (p < 0.05). Irrespective of the patient's age, gender, and common underlying systemic illnesses (diabetes and hypertension), a significant change in the quality of the salivary analytes was observed.

Conclusion

The study emphasises the use of a custom designed TENS device in improving the quality of secreted saliva among old patients with oral dryness.
Literature
1.
go back to reference Wiener RC, Wu B, Crout R, Wiener M, Plassman B, Kao E, et al. Hyposalivation and xerostomia in dentate older adults. J Am Dent Assoc. 2010;141(3):279–84.PubMedPubMedCentralCrossRef Wiener RC, Wu B, Crout R, Wiener M, Plassman B, Kao E, et al. Hyposalivation and xerostomia in dentate older adults. J Am Dent Assoc. 2010;141(3):279–84.PubMedPubMedCentralCrossRef
3.
go back to reference Xu F, Laguna L, Sarkar A. Aging-related changes in quantity and quality of saliva: Where do we stand in our understanding? J Texture Stud. 2019;50(1):27–35.PubMedCrossRef Xu F, Laguna L, Sarkar A. Aging-related changes in quantity and quality of saliva: Where do we stand in our understanding? J Texture Stud. 2019;50(1):27–35.PubMedCrossRef
4.
go back to reference Ship JA. Xerostomia LRJ. Encyclopedia of Gastroenterology: Elsevier; 2004. p. 649–50. Ship JA. Xerostomia LRJ. Encyclopedia of Gastroenterology: Elsevier; 2004. p. 649–50.
5.
go back to reference Millsop JW, Wang EA, Fazel N. Etiology, evaluation, and management of xerostomia. Clin Dermatol. 2017;35:468–76.PubMedCrossRef Millsop JW, Wang EA, Fazel N. Etiology, evaluation, and management of xerostomia. Clin Dermatol. 2017;35:468–76.PubMedCrossRef
6.
go back to reference Närhi TO. Prevalence of subjective feelings of dry mouth in the elderly. J Dent Res. 1994;73:20–5.PubMedCrossRef Närhi TO. Prevalence of subjective feelings of dry mouth in the elderly. J Dent Res. 1994;73:20–5.PubMedCrossRef
7.
go back to reference Challacombe SJ, Osailan SM, Proctor- GB. Clinical Scoring Scales for Assessment of Dry Mouth - Dry Mouth - A Clinical Guide on Causes. Effects and Treatments: Springer; 2015. p. 119–28. Challacombe SJ, Osailan SM, Proctor- GB. Clinical Scoring Scales for Assessment of Dry Mouth - Dry Mouth - A Clinical Guide on Causes. Effects and Treatments: Springer; 2015. p. 119–28.
8.
go back to reference Rayman S, Dincer E, Almas K. Xerostomia. Diagnosis and management in dental practice. N Y State Dent J. 2010;76(2):24–7.PubMed Rayman S, Dincer E, Almas K. Xerostomia. Diagnosis and management in dental practice. N Y State Dent J. 2010;76(2):24–7.PubMed
9.
go back to reference Johnson M. Transcutaneous Electrical Nerve Stimulation: Mechanisms. Clinical Application and Evidence Rev Pain. 2007;1(1):7–11.PubMed Johnson M. Transcutaneous Electrical Nerve Stimulation: Mechanisms. Clinical Application and Evidence Rev Pain. 2007;1(1):7–11.PubMed
10.
go back to reference Vance CGT, Dailey DL, Chimenti RL, Van Gorp BJ, Crofford LJ, Sluka KA. Using TENS for Pain Control: Update on the State of the Evidence. Medicina (Kaunas). 2022;58(10):1332. Vance CGT, Dailey DL, Chimenti RL, Van Gorp BJ, Crofford LJ, Sluka KA. Using TENS for Pain Control: Update on the State of the Evidence. Medicina (Kaunas). 2022;58(10):1332.
11.
go back to reference Han S, Park KS, Lee H, Zhu X, Lee JM, Suh HS. Transcutaneous electrical nerve stimulation (TENS) for pain control in women with primary dysmenorrhoea. Cochrane Database of Systematic Reviews. 2019;2019(5):CD03331. Han S, Park KS, Lee H, Zhu X, Lee JM, Suh HS. Transcutaneous electrical nerve stimulation (TENS) for pain control in women with primary dysmenorrhoea. Cochrane Database of Systematic Reviews. 2019;2019(5):CD03331.
12.
go back to reference Johnson MI, Claydon LS, Herbison GP, Jones G, Paley CA. Transcutaneous electrical nerve stimulation (TENS) for fibromyalgia in adults. Cochrane Database Syst Rev. 2017;10(10):CD012172.PubMed Johnson MI, Claydon LS, Herbison GP, Jones G, Paley CA. Transcutaneous electrical nerve stimulation (TENS) for fibromyalgia in adults. Cochrane Database Syst Rev. 2017;10(10):CD012172.PubMed
13.
go back to reference Hansson P, Ekblom A. Transcutaneous electrical nerve stimulation (TENS) as compared to placebo TENS for the relief of acute oro-facial pain. Pain. 1983;15:157–65.PubMedCrossRef Hansson P, Ekblom A. Transcutaneous electrical nerve stimulation (TENS) as compared to placebo TENS for the relief of acute oro-facial pain. Pain. 1983;15:157–65.PubMedCrossRef
14.
go back to reference Fedele S, Wolff A, Strietzel F, López RM, Porter KSR, YT. Neuroelectrostimulation in treatment of hyposalivation and xerostomia in Sjögren’s syndrome: a salivary pacemaker. J Rheumatol. 2008;35(8):1489–94.PubMed Fedele S, Wolff A, Strietzel F, López RM, Porter KSR, YT. Neuroelectrostimulation in treatment of hyposalivation and xerostomia in Sjögren’s syndrome: a salivary pacemaker. J Rheumatol. 2008;35(8):1489–94.PubMed
15.
go back to reference Kasat V, Aditi. Transcutaneous electric nerve stimulation (TENS) in dentistry- A review. J Clin Exp Dent. 2014;6(5):562–8.CrossRef Kasat V, Aditi. Transcutaneous electric nerve stimulation (TENS) in dentistry- A review. J Clin Exp Dent. 2014;6(5):562–8.CrossRef
16.
go back to reference Proctor GB, Carpenter GH. Regulation of salivary gland function by autonomic nerves. Auton Neurosci. 2007;133(1):3–18.PubMedCrossRef Proctor GB, Carpenter GH. Regulation of salivary gland function by autonomic nerves. Auton Neurosci. 2007;133(1):3–18.PubMedCrossRef
17.
go back to reference Hargitai IA, Sherman RG, Strother JM. The effects of electrostimulation on parotid saliva flow: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(3):316–20.PubMedCrossRef Hargitai IA, Sherman RG, Strother JM. The effects of electrostimulation on parotid saliva flow: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(3):316–20.PubMedCrossRef
18.
go back to reference Sivaramakrishnan G, Sridharan K. Electrical nerve stimulation for xerostomia: a meta-analysis of randomised controlled trials. J Tradit Complement Med. 2017;7:409–13.PubMedPubMedCentralCrossRef Sivaramakrishnan G, Sridharan K. Electrical nerve stimulation for xerostomia: a meta-analysis of randomised controlled trials. J Tradit Complement Med. 2017;7:409–13.PubMedPubMedCentralCrossRef
19.
go back to reference Rajkumar K, Ramya R, Swarna Lakshmi R. A single – unit wireless device for salivary stimulation. BMJ Innov. 2020;0:1–7. Rajkumar K, Ramya R, Swarna Lakshmi R. A single – unit wireless device for salivary stimulation. BMJ Innov. 2020;0:1–7.
20.
go back to reference Challacombe S. The Challacombe Scale of clinical oral dryness. King’s College London. 2011;17:109–14. Challacombe S. The Challacombe Scale of clinical oral dryness. King’s College London. 2011;17:109–14.
21.
go back to reference Whitcher JP, Shiboski CH, Shiboski SC, Heidenreich AM, Kitagawa K, Zhang S, et al. A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren’s syndrome international registry. Am J Ophthalmol. 2010;149:405–15.PubMedCrossRef Whitcher JP, Shiboski CH, Shiboski SC, Heidenreich AM, Kitagawa K, Zhang S, et al. A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren’s syndrome international registry. Am J Ophthalmol. 2010;149:405–15.PubMedCrossRef
22.
go back to reference Navazesh M, Kumar SK. Measuring salivary flow: challenges and opportunities. J Am Dent Assoc. 2008;139:35–40.CrossRef Navazesh M, Kumar SK. Measuring salivary flow: challenges and opportunities. J Am Dent Assoc. 2008;139:35–40.CrossRef
24.
go back to reference Alkhateeb AA, Mancl LA, Presland RB, Rothen ML, Chi DL. Unstimulated saliva-related caries risk factors in individuals with cystic fibrosis: a cross-sectional analysis of unstimulated salivary flow, pH, and buffering capacity. Caries Res. 2017;51:1–6.PubMedCrossRef Alkhateeb AA, Mancl LA, Presland RB, Rothen ML, Chi DL. Unstimulated saliva-related caries risk factors in individuals with cystic fibrosis: a cross-sectional analysis of unstimulated salivary flow, pH, and buffering capacity. Caries Res. 2017;51:1–6.PubMedCrossRef
25.
go back to reference Gholami N, Hosseini Sabzvari B, Razzaghi A, Salah S. Effect of stress, anxiety and depression on unstimulated salivary flow rate and xerostomia. J Dent Res Dent Clin Dent Prospects. 2017;11(4):247–52. Gholami N, Hosseini Sabzvari B, Razzaghi A, Salah S. Effect of stress, anxiety and depression on unstimulated salivary flow rate and xerostomia. J Dent Res Dent Clin Dent Prospects. 2017;11(4):247–52. 
26.
go back to reference Tóthová L, Kamodyová N, Červenka T, Celec P. Salivary markers of oxidative stress in oral diseases. Front Cell Infect Microbiol. 2015;5:1–23.CrossRef Tóthová L, Kamodyová N, Červenka T, Celec P. Salivary markers of oxidative stress in oral diseases. Front Cell Infect Microbiol. 2015;5:1–23.CrossRef
27.
go back to reference Oliveira VN, Bessa A, Lamounier RP, Santana MG, Mello MT, Espindola FS. Changes in the salivary biomarkers induced by an effort test. Int J Sports Med. 2010;31(6):377–81.PubMedCrossRef Oliveira VN, Bessa A, Lamounier RP, Santana MG, Mello MT, Espindola FS. Changes in the salivary biomarkers induced by an effort test. Int J Sports Med. 2010;31(6):377–81.PubMedCrossRef
28.
go back to reference Lee JY, Chung JW, Kim YK, Chung SC, Kho HS. Comparison of the composition of oral mucosal residual saliva with whole saliva. Oral Dis. 2007;(v;13(6):550-4).CrossRef Lee JY, Chung JW, Kim YK, Chung SC, Kho HS. Comparison of the composition of oral mucosal residual saliva with whole saliva. Oral Dis. 2007;(v;13(6):550-4).CrossRef
29.
go back to reference Animireddy D, Reddy Bekkem VT, Vallala P, Kotha SB, Ankireddy S, Mohammad N. Evaluation of pH, buffering capacity, viscosity and flow rate levels of saliva in caries-free, minimal caries and nursing caries children: An in vivo study. Contemp Clin Dent. 2014;5(3):324–8.PubMedPubMedCentralCrossRef Animireddy D, Reddy Bekkem VT, Vallala P, Kotha SB, Ankireddy S, Mohammad N. Evaluation of pH, buffering capacity, viscosity and flow rate levels of saliva in caries-free, minimal caries and nursing caries children: An in vivo study. Contemp Clin Dent. 2014;5(3):324–8.PubMedPubMedCentralCrossRef
30.
go back to reference Ahmed Yas B, Nada Jafer MH, Radhi. Salivary viscosity in relation to oral health status among a group of 20–22 years old dental students. Iraqi J Comm Med. 2013;3:219–24. Ahmed Yas B, Nada Jafer MH, Radhi. Salivary viscosity in relation to oral health status among a group of 20–22 years old dental students. Iraqi J Comm Med. 2013;3:219–24.
32.
go back to reference Murineanu R, Ştefãnescu C, Zaharia A, Davidescu C, Popşor S. Evaluation of total unstimulated saliva viscosity incomplete edentulous patients. Rom J Oral Rehabil. 2011;3:53–7. Murineanu R, Ştefãnescu C, Zaharia A, Davidescu C, Popşor S. Evaluation of total unstimulated saliva viscosity incomplete edentulous patients. Rom J Oral Rehabil. 2011;3:53–7.
33.
go back to reference Astor FC, Hanft KL, Ciocon JO. Xerostomia: a prevalent condition in the elderly. Nascimento ML, Farias AB, Carvalho AT, Albuquerque RF, Ribeiro LN, Leao JC, et al., editors. Ear Nose Throat J. 1999;78(7):476–479 20. Astor FC, Hanft KL, Ciocon JO. Xerostomia: a prevalent condition in the elderly. Nascimento ML, Farias AB, Carvalho AT, Albuquerque RF, Ribeiro LN, Leao JC, et al., editors. Ear Nose Throat J. 1999;78(7):476–479 20.
34.
go back to reference Rajkumar K, Ramya R, Lakshmi SR. Non pharmacological management for xerostomia- a systematic review. J Clin Diagn Res. 2019;13:1–5. Rajkumar K, Ramya R, Lakshmi SR. Non pharmacological management for xerostomia- a systematic review. J Clin Diagn Res. 2019;13:1–5.
36.
go back to reference Dalbem Paim É, Costa Batista Berbert M, Gonzales Zanella V, Beatris Martins V, Edler Macagnan F. Effects of transcutaneous electrical nerve stimulation on the salivary flow of patients with hyposalivation induced by radiotherapy in the head and neck region-A randomised clinical trial. J Oral Rehabil. 2019;46(12):1142–50. https://doi.org/10.1111/joor.12851.CrossRefPubMed Dalbem Paim É, Costa Batista Berbert M, Gonzales Zanella V, Beatris Martins V, Edler Macagnan F. Effects of transcutaneous electrical nerve stimulation on the salivary flow of patients with hyposalivation induced by radiotherapy in the head and neck region-A randomised clinical trial. J Oral Rehabil. 2019;46(12):1142–50. https://​doi.​org/​10.​1111/​joor.​12851.CrossRefPubMed
37.
go back to reference Yang LY, Chen HM, Su YC, Chin CC. The effect of transcutaneous electrical nerve stimulation on increasing salivary flow rate in hemodialysis patients. Oral Dis. 2019;25:133–41.PubMedCrossRef Yang LY, Chen HM, Su YC, Chin CC. The effect of transcutaneous electrical nerve stimulation on increasing salivary flow rate in hemodialysis patients. Oral Dis. 2019;25:133–41.PubMedCrossRef
38.
go back to reference Vijayalaxmi N, Sudhakara Reddy R, Ramesh T, Lavanya RR. Symptoms of Xerostomia. Int J Curr Res. 2016;8:41086–91. Vijayalaxmi N, Sudhakara Reddy R, Ramesh T, Lavanya RR. Symptoms of Xerostomia. Int J Curr Res. 2016;8:41086–91.
39.
go back to reference Aggarwal H, Pal-Singh M, Mathur H, Astekar S, Gulati P, Lakhani S. Evaluation of the effect of transcutaneous electrical nerve stimulation (TENS) on whole salivary flow rate. J Clin Exp Dent. 2015;7(1):e13-7.PubMedPubMedCentralCrossRef Aggarwal H, Pal-Singh M, Mathur H, Astekar S, Gulati P, Lakhani S. Evaluation of the effect of transcutaneous electrical nerve stimulation (TENS) on whole salivary flow rate. J Clin Exp Dent. 2015;7(1):e13-7.PubMedPubMedCentralCrossRef
40.
go back to reference Wolff A, Koray M, Campisi G, Strietzel FP, Lafaurie GI, Beiski BZ, et al. Electrostimulation of the lingual nerve by an intraoral device may lead to salivary gland regeneration: A case series study. Medicina oral, patologia oral y cirugia bucal. 2018;23(5):552–9. Wolff A, Koray M, Campisi G, Strietzel FP, Lafaurie GI, Beiski BZ, et al. Electrostimulation of the lingual nerve by an intraoral device may lead to salivary gland regeneration: A case series study. Medicina oral, patologia oral y cirugia bucal. 2018;23(5):552–9.
41.
go back to reference Carpenter GH, Khosravani N, Ekström J, Osailan SM, Paterson KP, Proctor GB. Altered plasticity of the parasympathetic innervation in the recovering rat submandibular gland following extensive atrophy. Exp Physiol. 2009;94(2):213–9.PubMedCrossRef Carpenter GH, Khosravani N, Ekström J, Osailan SM, Paterson KP, Proctor GB. Altered plasticity of the parasympathetic innervation in the recovering rat submandibular gland following extensive atrophy. Exp Physiol. 2009;94(2):213–9.PubMedCrossRef
42.
go back to reference Mitroulia A, Gavriiloglou M, Athanasiadou P, Bakopoulou A, Poulopoulos A, Panta P, et al. Salivary Gland Stem Cells and Tissue Regeneration: An Update on Possible Therapeutic Application. J Contemp Dent Pract. 2019;20(8):978–86.PubMedCrossRef Mitroulia A, Gavriiloglou M, Athanasiadou P, Bakopoulou A, Poulopoulos A, Panta P, et al. Salivary Gland Stem Cells and Tissue Regeneration: An Update on Possible Therapeutic Application. J Contemp Dent Pract. 2019;20(8):978–86.PubMedCrossRef
44.
go back to reference Sim C, Soong YL, Pang E, Lim C, Walker GD, Manton DJ, et al. Xerostomia, salivary characteristics and gland volumes following intensity-modulated radiotherapy for nasopharyngeal carcinoma: a two-year follow up. Aust Dent J. 2018;63(2):217–23.PubMedCrossRef Sim C, Soong YL, Pang E, Lim C, Walker GD, Manton DJ, et al. Xerostomia, salivary characteristics and gland volumes following intensity-modulated radiotherapy for nasopharyngeal carcinoma: a two-year follow up. Aust Dent J. 2018;63(2):217–23.PubMedCrossRef
45.
go back to reference Wolff M, Kleinberg I. Oral mucosal wetness in hypo-and normosalivators. Arch Oral Biol. 1998;43:455–62.PubMedCrossRef Wolff M, Kleinberg I. Oral mucosal wetness in hypo-and normosalivators. Arch Oral Biol. 1998;43:455–62.PubMedCrossRef
48.
go back to reference Matsuda K, Ikebe K, Ogawa T, Kagawa R, Maeda Y. 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. 2009;108(2):211–5.PubMedCrossRef Matsuda K, Ikebe K, Ogawa T, Kagawa R, Maeda Y. 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. 2009;108(2):211–5.PubMedCrossRef
49.
go back to reference Peluso I, Raguzzini A. Salivary and urinary total antioxidant capacity as biomarkers of oxidative stress in humans. Pathol Res Int. 2016;2016:1–14.CrossRef Peluso I, Raguzzini A. Salivary and urinary total antioxidant capacity as biomarkers of oxidative stress in humans. Pathol Res Int. 2016;2016:1–14.CrossRef
51.
go back to reference Bozovic D, Racic M, Ivkovic N. Salivary cortisol levels as a biological marker of stress reaction. Med Arch. 2013;67:374–7.PubMedCrossRef Bozovic D, Racic M, Ivkovic N. Salivary cortisol levels as a biological marker of stress reaction. Med Arch. 2013;67:374–7.PubMedCrossRef
53.
go back to reference Preoteasa E, Tâncu AM, Iosif L, Melescanu Imre M, Murariu-Măgureanu C, Preoteasa CT. Salivary changes related to systemic diseases in the edentulous patients. J Med Life. 2014;7(4):577–80.PubMedPubMedCentral Preoteasa E, Tâncu AM, Iosif L, Melescanu Imre M, Murariu-Măgureanu C, Preoteasa CT. Salivary changes related to systemic diseases in the edentulous patients. J Med Life. 2014;7(4):577–80.PubMedPubMedCentral
54.
go back to reference Furquim CP, Soares GM, Ribeiro LL, Azcarate-Peril MA, Butz N, Roach J, et al. The Salivary Microbiome and Oral Cancer Risk: a Pilot Study in Fanconi Anemia. J Dent Res. 2017;96(3):292–9.PubMedCrossRef Furquim CP, Soares GM, Ribeiro LL, Azcarate-Peril MA, Butz N, Roach J, et al. The Salivary Microbiome and Oral Cancer Risk: a Pilot Study in Fanconi Anemia. J Dent Res. 2017;96(3):292–9.PubMedCrossRef
56.
go back to reference Teare JP, Spedding C, Whitehead MW, Greenfield SM, Challacombe SJ, Thompson RP. Omeprazole and dry mouth. Scand J Gastroenterol. 1995;30(3):216–8.PubMedCrossRef Teare JP, Spedding C, Whitehead MW, Greenfield SM, Challacombe SJ, Thompson RP. Omeprazole and dry mouth. Scand J Gastroenterol. 1995;30(3):216–8.PubMedCrossRef
Metadata
Title
Salivary stimulatory effect of novel low level transcutaneous electro neurostimulator in geriatric patients with xerostomia
Authors
Ramya Ramadoss
Rajkumar Krishnan
Swarnalakshmi Raman
Rajashree Padmanaban
Nagarathinam Anbuelangovan
Rajalakshmanan Eswaramoorthy
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-023-03049-0

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