Purpose Saliva is integral to swallowing and necessary for oral health. Understanding saliva's origin and properties is important for swallowing assessment and management. Diseases such as Sjögren's syndrome (SS) can affect saliva negatively, often contributing to dysphagia. Our objectives are to (a) highlight saliva's fundamental role in swallowing, (b) provide a bibliometric overview of literature pertaining to SS pathophysiology and effects on saliva, (c) explore implications of salivary changes on swallowing and quality of life in SS and other populations, and (d) provide suggestions for systematic saliva assessment in practice. Method This tutorial reviews saliva production, composition, and involvement in swallowing within health and disease. Using rapid review methodology, we outline the effect of SS on saliva and describe SS etiology, diagnosis, and treatment. We discuss formal saliva assessments and a multidisciplinary approach. Results Saliva plays a vital role in swallowing, particularly lubrication, bolus formation, and oral health. SS affects the salivary glands altering salivary flow rate and composition. We identified 55 studies ( N ) measuring salivary changes, grouping them according to four strata demarcated by SS classification criteria updates. For some, xerostomia, dysphagia, and reduced life quality result. Formal saliva assessments include the Clinical Oral Dryness Score, Xerostomia Inventory, and Secretion Rating Scale. Multidisciplinary care is optimal for patients with salivary changes. Conclusion Understanding salivary changes in disease may enhance understanding of swallowing and inform dysphagia practice. Expanding swallowing assessments with formal saliva evaluations, and patient perspectives thereof, may aid in developing bespoke treatments, ultimately improving outcomes and quality of life. Supplemental Material https://doi.org/10.23641/asha.12456449
Purpose: Swallowing impairments (dysphagia) following severe COVID-19 are complex, as is recovery from the disease itself. Like other critical illnesses, dysphagia management requires multidisciplinary involvement owing to the interaction between numerous physiological systems. Our objectives are to (a) propose a literature-based network medicine framework highlighting multisystem considerations for dysphagia management following critical illness including COVID-19 and (b) discuss clinician innovation and the evolution of dysphagia practice during a global pandemic. Method: A literature search identified current and relevant studies in areas pertinent to speech-language pathologists caring for patients with COVID-19. Our tutorial presents a network medicine framework of critical illness dysphagia and its “phenotypic” presentation with application to COVID-19. We also consider the individual and collective burden of the illness and global pandemic. Results: Iatrogenic and complex pathophysiologies likely contribute to dysphagia during critical illness. Upper aerodigestive tract functions, specifically swallowing, rely upon multiple systems for safe execution. Critical illness comorbidities, particularly respiratory challenges and supportive ventilation, are features of COVID-19 often exacerbating dysphagia risk. Throughout the pandemic, increased demands on and reallocation of resources have led to clinical adaptations across settings and placed significant burden on those who deliver care. Conclusions: Care provision for patients with COVID-19 relies on dynamic knowledge about disease mechanisms and effective interventions. Dysphagia management should employ a multidisciplinary and multisystem approach. Together, clinicians and health care systems should endeavor to proactively establish robust infrastructure and appropriate funding streams to optimize outcomes when considering the cumulative impacts of COVID-19.
Background: The autoimmune disease Sjogren's syndrome (SS) is often characterized by salivary changes that may affect swallowing. No known study has investigated the association between salivary biomarkers and perceptions of swallowing in individuals with SS. Our objectives were to explore: (1) the operational feasibility of investigating saliva volume and composition, along with perceptions of swallowing, in those with and without SS; and (2) the relationship between saliva composition and perceptions of oral dryness, swallowing, and quality of life. Methods: We conducted a prospective, case-control feasibility study, collecting feasibility data (recruitment rate and optimal saliva collection methods) and whole mouth saliva samples (unstimulated and stimulated). We measured total protein content and conducted sialochemical (α-amylase, cortisol, C-reactive protein [CRP], and mucins), sialometric (flow rate), and perceptual (oral dryness and swallowing-related quality of life [SWAL-QOL]) assessments. Our exploratory analyses focused on the main and fixed effects. We summarized all data descriptively, comparing: (a) outcomes between groups (t tests or Mann-Whitney U) and (b) salivary and perceptual data across participants (partial least-squares correlation [PLSC]). Results: We enrolled 12 (N) participants (6 per group), all providing analyzable saliva. Cases had lower flow rate (p = 0.003) and higher total protein, cortisol, and CRP concentrations (p < 0.02) than controls. PLSC revealed inverse covariance between sialochemical and SWAL-QOL data across participants. Conclusion: Our study was feasible as designed. We explored novel relationships between salivary outcomes and participant-reported perceptions, distinguishing individuals with and without SS. Our findings support further study of saliva's role in perceptions of swallowing, specifically analytes with lubricative properties.
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