Electrostimulation of the lingual nerve by an intraoral device may lead to salivary gland regeneration: A case series study

Abstract

BackgroundSalivary gland function is controlled by the salivary reflex, whose efferent arm is composed by the parasympathetic and the sympathetic divisions of the autonomic nervous system. Parenchymal injury is the main salivary gland involvement of Sjögren’s syndrome and head and neck radiotherapy, but neural damage has been reported as well. Recently an intraoral device for electrostimulation of the lingual nerve in vicinity to the lower third molar has been introduced. At this point this nerve carries efferent fibers for the innervation of the submandibular, sublingual and several minor salivary glands and afferent fibers of the salivary reflex. Therefore, excitation of these fibers potentially leads to increased secretion of all salivary glands. Thus, the study objective was to assess whether comprehensive neural activation by electrostimulation of the lingual nerve carries the potential to induce the regeneration of damaged salivary glands.Material and MethodsThe device was tested on three patients with no collectable resting and stimulated secretion of saliva during a double blind, sham controlled period of two months and nine open-label months.ResultsAll three subjects developed the capacity to spit saliva, not only in direct response to the electrostimulation but also after free intervals without electrostimulation. In addition, their symptoms of dry mouth severity and frequency improved.ConclusionsThis recovery is probably due to the combined effect of increase in secretory functional gland mass and regain of nervous control of the secretory elements and blood vessels. Both are phenomena that would contribute to gland regeneration. Key words:Xerostomia, dry mouth, saliva, electrostimulation, regeneration.

A Stimulator of the Salivary Excretion Based on Physical Vibration of the Parotid Glands

“…It is a small intraoral splint, removable, and fully portable by the patient, with two electrodes connected to an electronic module, emerging from a plastic sheet and meeting the lower dental arch of the lingual side to stimulate the lingual nerve. Its use significantly reduces dry mouth not only in direct response to the electrostimulation but also after free intervals without electrostimulation [ 21 ]. The other device of this generation is called Salipen®, and it has two arms, which are flexible, with an electrode at the tip of each one, which patients place under their tongue [ 18 ].…”

Improvement of dry mouth following intraductal irrigation of salivary glands

“…At present, available treatment modalities for mouth dryness include the following: altering the intake of xerogenic medication when possible; shifting the radiation field to protect the salivary glands in head and neck cancer patients [i.e., intensity-modulated radiation therapy (IMRT)] (Wang & Eisbruch, 2016); local application of saliva substitutes and stimulants; systemic intake of muscarinic agonists (sialogogues), such as pilocarpine and cevimeline (Aframian, Helcer, Livni, & Markitziu, 2006;Mercadante, Al Hamad, Lodi, Porter, & Fedele, 2017); and electrostimulation devices (Wolff et al, 2018). Since the prevalence of salivary gland impairment is relatively common (Ship et al, 2002), more cost-effective modalities are needed to overcome this morbidity.…”

Long‐term effectiveness of a novel intra‐oral electro‐stimulator for the treatment of dry mouth in patients with Sjogren's syndrome: A randomised sham‐controlled feasibility study (LEONIDAS‐1)

“…This is in keeping with the suggestion that neuro-electrostimulation may have regenerative potential upon the salivary gland parenchyma. 27 A minimal, not fully convincing evidence of benefit was identified for the other patient-centred outcomes or salivary flow, which is expected considering the small scale of this feasibility study not designed to demonstrate efficacy.…”