Previous epidemiological studies have shown that the diabetic population has a poor oral status compared to healthy subjects. While changes of the local microcirculation observed during diabetes can somehow explain periodontal pathologies this hypothesis does not stand for the carious decay. We propose the hypothesis that the increase of carious incidence might be linked to changes in the salivary composition, such as an increase of salivary glucose concentrations.The amount of glucose in saliva has been widely discussed in various scientific articles. Subsequently, we performed an initial study that allowed us to confirm that the concentration and excretion of glucose in the saliva were higher in diabetic patients compared to normal patients. In diabetic patients, the relative increase in salivary glucose concentration is even comparable to the rise of blood glucose.We conducted experimental studies in animals in order to investigate the presence and the level of expression of glucose transporters (GLUT1, GLUT2, GLUT4, SGLT1) in rat parotid glands. Through immunohistochemical labeling techniques, gene expression studies and protein expression studies, we demonstrated that GLUT1, GLUT4 and SGLT1 were found in rat parotid glands of normal and diabetic rats. Functional studies targeting the activity and the flux through those glucose transporters strengthened our hypothesis on the potential role of glucose transporter in salivary glucose.This original work introduce for the first time the hypothesis of a secretion mechanism of glucose by the salivary glands through GLUT1 & SGLT1 transporters, the first one being located on the apical and baso-lateral membranes of acinar cells, while the second one is located on the baso-lateral membrane. Secretion of glucose by the parotid gland is no longer at any doubt even though further studies must now specify the specific mechanisms. / Doctorat en Sciences dentaires / info:eu-repo/semantics/nonPublished

Syftet med litteraturstudien var att undersöka den orala hälsans påverkan på ätandet hos äldre personer. Vetenskapliga artiklar söktes i databasen PubMed med begränsning till artiklar inom tidsperioden 2000-2010, åldersgruppen 60 år och äldre. Totalt 11 artiklar inkluderades i studien. Resultatet visade att försämrad munhälsa, nedsatt tuggförmåga, många saknade tänder, smärta och obehag i munnen, illasittande tandproteser och muntorrhet ger problem med ätandet. Detta leder till att äldre med försämrad oral hälsa ändrar på sina val av livsmedel och ofta avstår från livsmedel som är problematiska att äta på grund av svårigheter med att tugga och svälja eller rädsla för att orsaka ytterligare skada på bräckliga tänder.   Studiens slutsats är att en genomgång av litteraturen visade att äldre människor med nedsatt oral status hade risk för ätsvårigheter. Att ersätta förlorade tänder tycks ha betydelse för att upprätthålla en optimal tuggfunktion. / The purpose of this literature review was to investigate the oral health’s impact on eating among older people.Scientific articles were searched in PubMed, limited to articles published between 2000-2010,age 60 years and older. In total were 11 articles included in the study. The results showed that eating difficulties can be linked to impaired oral health, poormastication, partial tooth loss or edentulism, oral pain and discomfort, ill-fitting dentures anddry mouth. Elderly with impaired oral health change their eating habits and often refrain fromtough food items due to chewing and swallowing difficulties and fear of further damage tofragile teeth.  The conclusion of the study was that older people with poor oral status had a risk for eating difficulties. Replacement of missing teeth might play an important role in the maintenance ofan optimal chewing function.

<p>Oral complications and symptoms are common among patients with cancer. The aim of this thesis is to study several aspects of oral status, oral health and its relation to quality of life, and oral care among patients treated with radiotherapy or chemotherapy. Descriptive, comparative and correlational designs were used. </p><p>A series of consecutive patients admitted to a university hospital or a regional hospital to receive radiotherapy for head and neck cancer or chemotherapy for haematological malignancies, were studied prospectively with regard to oral symptoms and their relation to health-related quality of life using interviews and questionnaires, examination of the oral cavity and saliva tests. All nurses and enrolled nurses who worked with these patients or with patients with lung cancer were interviewed about their education and knowledge in oral care and performed oral care. The medical and nursing records on patients with these cancer diseases at the two hospitals were reviewed. </p><p>The results indicate that patients receiving radiotherapy experienced increasing oral symptoms, which remained to a large extent one month after treatment. Patients receiving chemotherapy did not experience oral symptoms to the same extent. The oral symptoms were significantly related to patients' health-related quality of life, particularly among those receiving radiotherapy. Data also indicate that there is a lack of adequate education and continuing education in oral care among nursing staff. All patients were not examined orally before or during treatment, nor did they receive sufficient information or instruction related to oral hygiene. Patient compliance with oral hygiene procedures was acceptable, although some patients reported difficulties. Oral status and oral care were insufficiently documented, particularly in nursing records. The attitudes to oral examination and discussion on oral hygiene differed between nursing staff and patients. Nursing staff objected to examining the oral cavity referring to patient integrity. This was not considered as a hindrance among patients. In conclusion, oral health is related to health-related quality of life, which motivates a multi-disciplinary approach to oral care. </p>

Oral complications and symptoms are common among patients with cancer. The aim of this thesis is to study several aspects of oral status, oral health and its relation to quality of life, and oral care among patients treated with radiotherapy or chemotherapy. Descriptive, comparative and correlational designs were used. A series of consecutive patients admitted to a university hospital or a regional hospital to receive radiotherapy for head and neck cancer or chemotherapy for haematological malignancies, were studied prospectively with regard to oral symptoms and their relation to health-related quality of life using interviews and questionnaires, examination of the oral cavity and saliva tests. All nurses and enrolled nurses who worked with these patients or with patients with lung cancer were interviewed about their education and knowledge in oral care and performed oral care. The medical and nursing records on patients with these cancer diseases at the two hospitals were reviewed. The results indicate that patients receiving radiotherapy experienced increasing oral symptoms, which remained to a large extent one month after treatment. Patients receiving chemotherapy did not experience oral symptoms to the same extent. The oral symptoms were significantly related to patients' health-related quality of life, particularly among those receiving radiotherapy. Data also indicate that there is a lack of adequate education and continuing education in oral care among nursing staff. All patients were not examined orally before or during treatment, nor did they receive sufficient information or instruction related to oral hygiene. Patient compliance with oral hygiene procedures was acceptable, although some patients reported difficulties. Oral status and oral care were insufficiently documented, particularly in nursing records. The attitudes to oral examination and discussion on oral hygiene differed between nursing staff and patients. Nursing staff objected to examining the oral cavity referring to patient integrity. This was not considered as a hindrance among patients. In conclusion, oral health is related to health-related quality of life, which motivates a multi-disciplinary approach to oral care.

Syftet med studien var att sammanställa vetenskaplig litteratur angående patienternas livskvalitet samt sjuksköterskans omvårdnadsåtgärder med avseende på orala komplikationer som är ett vanligt förekommande problem hos patienter inom palliativ vård. Våra frågeställningar var: Hur påverkar orala komplikationer livskvalitet hos patienter inom palliativ vård? Vilka omvårdnadsåtgärder kan sjuksköterskan utföra dels för att patienter ska bibehålla god oral status och dels för att patienternas resurser stärks och balansen mellan dagliga livets krav och inre respektive yttre resurser upprätthålls? Metod: En litteraturstudie baserad på elva vetenskapliga artiklar. Som teoretisk referensram valdes Carnevalis balansmodell, Dagligt liv - Funktionellt hälsotillstånd. Resultatet visar att fysiska besvär och psykosocialt lidande till följd av orala komplikationer påverkade patienternas livskvalitet i stor utsträckning. Detta medförde obalans mellan dagliga livets krav och patienternas resurser. Till de omvårdnadsåtgärder som sjuksköterskan kan tillämpa inkluderas prevention, undervisning, dokumentation och rapportering samt behandling av orala komplikationer. Resultat från denna studie kan användas vid omvårdnad av patienter inom palliativ vård som upplever orala problem. / The purpose of this literature review was to compile research evidence on patients’ quality of life and nurse’s interventions with regard to oral complications which are problems seen frequently in patients within palliative care. Our questions were: How do oral complications influence quality of life in patients within palliative care? What kind of interventions can a nurse do on the one hand to help patients maintain good oral status, and on the other hand to help patients strengthen their resources to maintain the balance between demands in daily life and resources, internal as well as external? Method: A literature review based on eleven research articles. The authors chose as theoretical reference Carnevali’s balance model, Daily life - Functional state of health. The results showed that physical labour and psychosocial suffering in consequence of oral complications affected patients’ quality of life to a great extent. This resulted in imbalance between the daily life demand and the patients’ resources. The interventions that nurses can use are prevention, patient education, documentation, reports and treating of oral complications. Results from this review can be used in care of patients within palliative care who experience oral complications.