School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada.
Department of Critical Care Medicine, University of Alberta, Edmonton, Canada.
Am J Speech Lang Pathol. 2020 Aug 4;29(3):1307-1319. doi: 10.1044/2020_AJSLP-19-00083. Epub 2020 Jun 12.
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 () 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.
目的 唾液对吞咽至关重要，对口腔健康也必不可少。了解唾液的来源和性质对于吞咽评估和管理非常重要。某些疾病（如干燥综合征）会对唾液产生负面影响，常常导致吞咽困难。我们的目标是：(a) 强调唾液在吞咽中的基本作用；(b) 对与干燥综合征病理生理学和唾液影响相关的文献进行文献计量学概述；(c) 探讨唾液变化对干燥综合征和其他人群吞咽和生活质量的影响；(d) 就临床实践中系统的唾液评估提供建议。
方法 本教程回顾了健康和疾病状态下唾液的产生、成分和吞咽参与情况。我们采用快速综述方法，概述了干燥综合征对唾液的影响，并描述了干燥综合征的病因、诊断和治疗。我们讨论了正式的唾液评估和多学科方法。
结果 唾液在吞咽中起着至关重要的作用，特别是在润滑、形成食团和口腔健康方面。干燥综合征会影响唾液腺，改变唾液流速和成分。我们确定了 55 项测量唾液变化的研究，根据干燥综合征分类标准更新划分的四个层次对它们进行分组。有些患者会出现口干、吞咽困难和生活质量下降。正式的唾液评估包括临床口腔干燥评分、口干症量表和分泌评分量表。多学科护理是有唾液变化患者的最佳选择。
结论 了解疾病中的唾液变化可能有助于深入了解吞咽，并为吞咽实践提供信息。通过正式的唾液评估以及患者对此的看法扩展吞咽评估，可以帮助制定个性化治疗方案，最终改善结果和生活质量。
