title: Design of a randomized controlled double-blind crossover clinical trial to assess the effects of saliva substitutes on bovine enamel and dentin in situ.
abstract: BACKGROUND
  Hyposalivation is caused by various syndromes, diabetes, drugs, inflammation, infection, or radiotherapy of the salivary glands. Patients with hyposalivation often show an increased caries incidence. Moreover, hyposalivation is frequently accompanied by oral discomfort and impaired oral functions, and saliva substitutes are widely used to alleviate oral symptoms. However, preference of saliva substitutes due to taste, handling, and relief of oral symptoms has been discussed controversially. Some of the marketed products have shown demineralizing effects on dental hard tissues in vitro. This demineralizing potential is attributed to the undersaturation with respect to calcium phosphates. Therefore, it is important to modify the mineralizing potential of saliva substitutes to prevent carious lesions. Thus, the aim of the present study was to evaluate the effects of a possible remineralizing saliva substitute (SN; modified Saliva natura) compared to a demineralizing one (G; Glandosane) on mineral parameters of sound bovine dentin and enamel as well as on artificially demineralized enamel specimens in situ. Moreover, oral well-being after use of each saliva substitute was recorded.
  
  
  METHODS
  Using a randomized, double-blind, crossover, phase II/III in situ trial, volunteers with hyposalivation utilize removable dentures containing bovine specimens during the experimental period. The volunteers are divided into two groups, and are required to apply both saliva substitutes for seven weeks each. After both test periods, differences in mineral loss and lesion depth between values before and after exposure are evaluated based on microradiographs. The oral well-being of the volunteers before and after therapy is determined using questionnaires. With respect to the microradiographic analysis, equal mineral losses and lesion depths of enamel and dentin specimens during treatment with SN and G, and no differences in patients' experienced oral comfort after SN compared to G usage are expected (H0).
  
  
  CONCLUSIONS
  Up to now, 14 patients have been included in the study, and no reasons for early termination of the trial have been identified. The design seems suitable for determining the effects of saliva substitutes on dental hard tissues in situ, and should provide detailed information on the oral well-being after use of different saliva substitutes in patients with hyposalivation.
  
  
  BACKGROUND
  ClinicalTrials.gov ID. NCT01165970.
authors.affiliation: Department of Operative Dentistry and Periodontology, University School of Dental Medicine, CharitéCentrum 3, Charité - Universitätsmedizin Berlin (Assmannshauser Strasse 4-6), Berlin (14197), Germany. peter.tschoppe@charite.de
authors.forename: Peter
authors.initials: P
authors.lastname: Tschoppe
authors.forename: Olivia
authors.initials: O
authors.lastname: Wolf
authors.forename: Michael
authors.initials: M
authors.lastname: Eichhorn
authors.forename: Peter
authors.initials: P
authors.lastname: Martus
authors.forename: Andrej M
authors.initials: AM
authors.lastname: Kielbassa
mesh_terms: D000818:Animals; D002266:Carboxymethylcellulose Sodium / Q000494:pharmacology; D002417:Cattle; D018592:Cross-Over Studies; D003743:Dental Enamel / Q000000981:diagnostic imaging / Q000187:drug effects*; D003804:Dentin / Q000000981:diagnostic imaging / Q000187:drug effects*; D004311:Double-Blind Method; D006801:Humans; D008852:Microradiography; D009077:Mucins / Q000494:pharmacology; D012107:Research Design; D012464:Saliva, Artificial / Q000494:pharmacology*; D011795:Surveys and Questionnaires; D017001:Tooth Demineralization / Q000139:chemically induced*; D014089:Tooth Remineralization / Q000379:methods*; D014987:Xerostomia / Q000188:drug therapy
chemical_list: D009077:Mucins; D012464:Saliva, Artificial; C535155:saliva natura; D002266:Carboxymethylcellulose Sodium