UCSF

We hypothesized that there was a difference in the unstimulated whole salivary flow rate (UWSR) in chronic HCV subjects compared to those with chronic liver disease (CLD) due to other causes.

Purposes of this study:

1. To compare UWSR and the prevalence of salivary hypofunction (UWSR<0.1mL/min) in chronic HCV and non-HCV subjects with CLD.

2. To examine possible factors that may affect UWSR in subjects with CLD.

3. To compare the correlation between UWSR and patient's subjective assessment of oral dryness, oral discomfort, difficulty in swallowing dry food and any food without additional liquids, difficulty in speaking and lip dryness, in patients with CLD.

Methods: A case-control study examined 76 chronic HCV and 52 non-HCV subjects from a tertiary-referral liver clinic (n=128). None had known predisposing factors for salivary hypofunction. UWSR was measured and a 6-item visual analog scale (VAS) questionnaire was used to assess subjective symptoms of salivary gland dysfunction. An oral examination was done to identify lichenoid lesions. The Student's t-test and Pearson's correlation tests were used to compare groups and linear regression was used to identify predictors of salivary flow. Results: Mean age, proportion of male subjects and proportion with cirrhosis were comparable in chronic HCV and non-HCV groups. Mean UWSR (mL/min±S.D) and prevalence of salivary hypofunction were lower in the HCV versus non-HCV group (0.26±0.15 versus 0.30±0.21, p=0.22 and 10% versus 17%, p = 0.17). HCV status was associated with lower UWSR but in multivariate analysis only female gender, use of anticholinergic medication and presence of cirrhosis were statistically significant predictors of UWSR. All VAS scores were significantly higher in the HCV than non-HCV group (p<0.05). A moderately strong correlation between UWSR and VAS scores was shown amongst HCV subjects (r values -0.45 to -0.30). Conclusions: Reduced salivary flow is frequent in CLD patients and associated with cirrhosis, using anticholinergic medication and being female. Amongst patients with HCV, the moderately strong correlation between UWSR and VAS scores suggest the VAS questionnaire maybe a useful tool to screen for salivary hypofunction and lead to early implementation of preventive measures to avoid dental complications.