Dental Tribune Asia Pacific No. 6, 2016

15 Dental Tribune Asia Pacific Edition | 6/2016 TRENDS & APPLICATIONS worn by 43 patients with an estab- lished diagnosis of respiratory sleep disorders. No adverse events related to the micro-sensors were recorded, nor were problems in reading of the compliance data. In this study, the mean time of Lirón use was 6.3 ± 1.1 hours per day, with an 86 per cent compliancerateafterathree-month follow-up. Statistical analysis found no differences between the data on objective and subjective use of Lirón. In conclusion, the results demonstrated the safety and the ef- ficacy profile of the objective meas- urement of compliance with MAD wearing. 2. Intra-oral therapeutic device: Electrostimulation device to treat xerostomia The commonly accepted clinical definition of xerostomia is the sub- jective sensation of dry mouth. The presence of xerostomia may indi- catethatsalivaryoutputisdecreased or altered, placing patients at a higher risk of developing a number of oral diseases and complications. Increasingsecretionofnaturalsaliva is the most efficient means of reliev- ing xerostomia, as natural saliva both alleviates dryness and contains essential dental decay-fighting fac- tors and other components critical for oral health.5 The prevalence of xerostomia in the adults’population is estimated at 10 per cent. Salivary gland secretion is regu- lated by the autonomic nervous sys- tem, by means of the salivary reflex. The latter is composed of (a) salivary nuclei, located in the brain; (b) affer- ent nerve fibres, carrying stimuli (such as taste and mastication) from the peripheral to the salivary nuclei; and (c) efferent nerve fibres, convey- ing stimulatory signals from the sal- ivary nuclei to the salivary glands. Application of electrical impulses to one or more of the three compo- nents of the salivary reflex increases salivary secretion. Saliwell6 has developed a line of intra-oral electrostimulation devices for which the principle of action is based on applying stimulatory sig- nals in the vicinity of the lingual nerve, which is the main nerve con- trolling salivary function, as it car- ries both afferent and efferent fibres. Electrostimulation intensifies the impulses transmitted through the afferent and efferent nerve fibres, in- ducing the salivary glands to secrete more saliva. To this end, the device electrodes are placed at the lingual side, close to the mandibular third molar, an advantageous location owing to the close proximity to the lingual nerve, allowing effective stimulation by the use of lower volt- age and current (Fig. 4). The most recently developed device (SaliPen) has an intra-oral stimulating unit and an extra-oral control unit (Fig. 5).7 The electrodes protrude at the end of two flexible silicone arms that are gently in- serted underneath the tongue. In a typical usage profile, due to its long lasting effect, the device is worn about 4 times a day and about 4 min- utes every time (Fig. 6). A double-blind study, carried out at three medical centres in Eu- rope, tested the device performance with short-term use, using a built-in moisture sensor.8 As the primary outcome, measured oral dryness changes as a result of 10 minutes of wearing the device were assessed and compared between the usage of the device either switched on or switched off. Twenty-three patients with xerostomia due to different causes (primary Sjögren’s syn- drome, medications and idiopathic) were evaluated. The decrease in oral dryness (as measured by the moisture sensor) was significantly superior (p < 0.0001) when induced by the device in switched-on mode. No significant side-effects were ob- served. In a multi-national randomised clinical trial, long-term (11-month) intra-oral electrostimulation was tested in a mixed sample of xerosto- mia patients (Sjögren’s syndrome, radiotherapy, medication-induced, graft-versus-host disease and idio- pathic). In Stage I of the study, switched-on versus switched-off de- vices were compared, for a period of one month in a double-blind design (96 patients).9 In Stage II, immedi- ately after Stage I, the xerostomia- relieving effects of the switched-on device only, were assessed in an open-label study (56 patients).10 The results of Stage I show that the patient-reported degree of oral moisture improved by 26 per cent when the device was switched on (with a statistical significance level of p < 0.002) versus an 18 per cent improvement when switched off. The results of Stage II show that the level of self-perceived oral moisture improved by 34 per cent (p < 0.001) and the amount of collected saliva increased by 25 per cent (p < 0.001) at rest and by 18 per cent (p < 0.02) during mastication. No severe or ir- reversible systemic or local adverse effects were observed at either stage of the trial. www.dental-tribune.com The Dental Tribune International Magazines Shipping Address Name Address Zip Code, City Country E-mail Date, Signature PayPal Credit Card Credit Card Number Expiration Date Security Code CAD/CAM Clinical Masters* cosmetic dentistry** implants laser ortho** roots Journal of Oral Science & Rehabilitation*** Fax: +49 341 48474 173 E-mail: subscriptions@dental-tribune.com EUR 44 per year (4 issues per year; incl. shipping and VAT for customers in Germany) and EUR 46 per year (4 issues per year; incl. shipping for customers outside Germany). * EUR 12 per year (1 issue per year; incl. shipping and VAT for customers in Germany) and EUR 14 per year (1 issue per year; incl. shipping for customers outside Germany). ** EUR 22 per year (2 issues per year; incl. shipping and VAT for customers in Germany) and EUR 23 per year (2 issues per year; incl. shipping for customers outside Germany). *** EUR 200 per year (4 issues per year; incl. shipping and VAT). 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Dental Tribune Asia Pacific No. 6, 2016

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