Immunosuppressive drugs and other medications may predispose patients to oral diseases. Data on oral mucosal health in recipients of liver transplantation (LT) are limited. We, therefore, recruited 84 LT recipients (64 with chronic liver disease and 20 with acute liver failure) for clinical oral examinations in a cross-sectional, case-control study. Their oral health had been clinically examined before transplantation. The prevalence of oral mucosal lesions (OMLs) was assessed in groups with different etiologies of liver disease and in groups with different immunosuppressive medications, and these groups were compared to controls selected from a nationwide survey in Finland (n 5 252). Risk factors for OMLs were evaluated with logistic regression. OMLs were more frequent in LT recipients versus controls (43% versus 15%, P < 0.001), and the use of steroids raised the prevalence to 53%. Drug-induced gingival overgrowth was the single most common type of lesion, and its prevalence was significantly higher for patients using cyclosporine A (CSA; 29%) versus patients using tacrolimus (TAC; 5%, P 5 0.007); the prevalence was even higher with the simultaneous use of calcium channel blockers and CSA (47%) or TAC (8%, P 5 0.002). Lesions with malignant potential such as drug-induced lichenoid reactions, oral lichen planus-like lesions, leukoplakias, and ulcers occurred in 13% of the patients with chronic liver disease and in 6% of the controls. Every third patient with chronic liver disease had reduced salivary flow, and more than half of all patients were positive for Candida; this risk was higher with steroids. In conclusion, the high frequency of OMLs among LT recipients can be explained not only by immunosuppressive drugs but also by other medications. Because dry mouth affects oral health and OMLs may have the potential for malignant transformation, annual oral examinations are indicated. Liver Transpl 20:72-80, 2014. V C 2013 AASLD.

Recipients of liver transplantation (LT) receive lifelong immunosuppression, which causes side effects. We investigated selfreported oral symptoms and associated risk factors with the following hypothesis: symptoms and signs would differ between LT recipients of different etiology groups and also between LT recipients and a control population. Eighty-four LT recipients (64 with chronic liver disease and 20 with acute liver disease) were recruited for clinical oral and salivary examinations (median follow-up 5 5.7 years). A structured questionnaire was used to record subjective oral symptoms. Matched controls (n 5 252) came from the National Finnish Health 2000 survey. The prevalence of symptoms was compared between the groups, and the risk factors for oral symptoms were analyzed. Xerostomia was prevalent in 48.4% of the chronic LT recipients and in 42.1% of the acute LT recipients. This subjective feeling of dry mouth was only partly linked to objectively measured hyposalivation. The chronic transplant recipients had significantly lower unstimulated salivary flow rates than the acute transplant recipients (0.34 6 0.31 versus 0.61 6 0.49 mL/minute, P 5 0.005). Among the chronic transplant recipients, hyposalivation with unstimulated salivary flow was associated with fewer teeth (17.7 6 8.2 versus 21.9 6 8.4, P 5 0.047) and more dentures (33.3% versus 12.2%, P 5 not significant). The chronic patients reported significantly more dysphagia than their controls (23.4% versus 11.5%, P 5 0.02). Increases in the number of medications increased the symptoms in all groups. In conclusion, dysphagia was significantly more prevalent among the chronic LT recipients versus the controls. The number of medications was a risk factor for dry mouth-related symptoms for both the LT recipients and the controls. The chronic transplant recipients presented with lower salivary flow rates than the acute transplant recipients. Hyposalivation correlated with generally worse oral health among the chronic transplant recipients. These differences between the chronic and acute LT recipients may have been due to differences in their medical conditions due to the different etiologies. Liver Transpl 19:155-163, 2013. V C 2012 AASLD. Received September 3, 2012 accepted November 6, 2012. Liver transplantation (LT) was first performed in Scandinavia at the Helsinki University Central Hospital (HUCH) in Finland already 30 years ago. The 5-year survival rates for LT recipients have improved significantly, with recent rates reaching 85%. Despite fewer rejections and better tolerance, immunosuppressive therapy can still cause side effects, among which infections, cardiovascular disease, posttransplant diabetes, kidney insufficiency, and malignancies are the most serious.

This study does not provide evidence that unfavourable lipid composition can be considered as an important risk for periodontal infection in a general adult population.

Background: Malnutrition, polypharmacy and poor oral health are major concerns among older people living at home, and they contribute to disability and care dependency. This article describes the study protocol of the Nutrition, Oral Health and Medication (NutOrMed) intervention study. Methods/design: This study was a population-based multidisciplinary intervention study. The NutOrMed study sample included home care clients aged 75 years or over living in Eastern and Central Finland. All the participants (n = 275) were interviewed at home at the baseline and after a 6-month intervention. The primary outcomes are nutritional status, oral health status and factors associated with them. These measures were administered at the baseline and after a 6-month follow-up. Agreement between in-home interviews and electronic medical records regarding drug use was checked at the baseline.

Muscarinic receptor-linked increases in intracellular free Ca2+ as measured with quin-2 and Ca2+ release from monolayers of cells have been measured in the human neuroblastoma cell line SH-SY5Y. Induction of differentiation with the phorbol ester 12-O-tetradecanoylphorbol-13-acetate (TPA) leads to a decrease in the sensitivity of the cells to low concentrations of agonists with respect to the induced increase in cytosolic free Ca2+ and stimulation of Ca2+ efflux. No decrease in agonist binding affinity was observed when the displacement of a labelled antagonist, 3H-NMS, by a non-labelled agonist was studied.