Abstract
Non-food gustatory stimulation has multiple potential therapeutic benefits for people with dysphagia and xerostomia. This study examined palatability and saliva flow associated with dissolvable flavored films. Taste strips with real-food flavors dissolved on the tongues of 21 persons with dysphagia and/or xerostomia and 21 healthy age- and sex-matched adults while sublingual gauze pads absorbed saliva over randomized 3-min trials. Participants rated taste enjoyment for each trial on a hedonic general labeled magnitude scale. Flavored strips elicited more saliva than baseline for both groups, and production was higher for controls than patients (M = 2.386 and 1.091 g, respectively; p = 0.036). Main effects of flavor were observed for saliva production (p = 0.002) and hedonics (p < 0.001). Hedonic ratings and saliva production were weakly correlated (r = 0.293, p < 0.001). Results support dissolvable taste strips as a tool for providing low-risk taste stimulation in dysphagia and for eliciting an increase in saliva flow that may provide temporary relief from dry mouth symptoms. The preferred flavors were, on average, also the ones that elicited greater saliva production. Taste strips have the potential to be beneficial for swallowing-related neural activity, timing, and safety in dysphagia. Further, they may ameliorate complications of xerostomia.
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References
Hector MP, Linden RWA. Reflexes of salivary secretion. In: Garrett JR, Ekström J, Anderson LC, editors. Neural mechanisms of salivary gland secretion. Basel: Karger; 1999. p. 196–217.
Smeets PAM, Erkner A, De Graaf C. Cephalic phase responses and appetite. Nutr Rev. 2010;68(11):643–55.
Baum BJ, Wellner RB. Receptors in salivary glands. In: Garrett JR, Ekström J, Anderson LC, editors. Neural mechanisms of salivary gland secretion. Basel: Karger; 1999. p. 44–58.
Gustafsson B, Tibbling L. Dysphagia, an unrecognized handicap. Dysphagia. 1991;6:193–9.
Langmore SE. An important tool for measuring quality of life. Dysphagia. 2000;15:134–5. https://doi.org/10.1007/s00450010014.
Humbert IA, Joel S. Tactile, gustatory, and visual biofeedback stimuli modulate neural substrates of deglutition. Neuroimage. 2012;59:1485–90. https://doi.org/10.1016/j.neuroimage.2011.08.022.
Logemann JA, Pauloski BR, Colangelo L, Lazarus C, Fujiu M, Kahrilas PJ. Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia. J Speech Hear Res. 1995;38:556–63.
Lee JY, Abugharib A, Nguyen R, Eisbruch A. Impact of xerostomia and dysphagia on health-related quality of life for head and neck cancer patients. Expert Rev Qual Life Cancer Care. 2016;1:361–71. https://doi.org/10.1080/23809000.2016.1236661.
Scott BJ, Hassanwalia R, Linden RW. The masticatory-parotid salivary reflex in edentulous subjects. J Oral Rehabil. 1998;25:28–33.
Villa A, Connell CL, Abati S. Diagnosis and management of xerostomia and hyposalivation. Ther Clin Risk Manag. 2015;11:45–51. https://doi.org/10.2147/TCRM.S76282.
Atkinson JC, Brisius M, Massey W. Salivary hypofunction and xerostomia: diagnosis and treatment. Dent Clin North Am. 2005;49:309–26. https://doi.org/10.1016/j.cden.2004.10.002.
Briggs ER. Taste disturbances related to medication use. Consult Pharm. 2009;24:538–43.
Ohara Y, Hirano H, Watanabe Y, et al. Factors associated with self-rated oral health among community-dwelling older Japanese: a cross-sectional study. Geriatr Gerontol Int. 2015;15:755–61. https://doi.org/10.1111/ggi.12345.
Saintrain MV, Guimarães AV, Honório VA, de Almeida PC, Vieira AP. Depression symptoms and oral discomfort in elderly adults. J Am Geriatr Soc. 2013;61:651–2. https://doi.org/10.1111/jgs.12181.
Affoo RH, Foley N, Garrick R, Siquiera WL, Martin RE. Meta-analysis of salivary flow rates in young and older adults. Am J Geriatr Soc. 2015;63:2142–51. https://doi.org/10.1111/jgs.13652.
Hodson N, Linden R. The effect of monosodium glutamate on parotid salivary flow in comparison to the response to representatives of the four other basic tastes. Physiol Behav. 2006;89:711–7. https://doi.org/10.1016/j.physbeh.2006.08.011.
Silletti E, Bult JH, Stieger M. Effect of NaCl and sucrose tastants on protein composition of oral fluid analyzed by SELDI-TOF-MS. Arch Oral Biol. 2012;57:1200–10. https://doi.org/10.1016/j.archoralbio.2012.04.004.
Uneyama H, Kawai M, Sekine-Hayakawa Y, Torii K. Contribution of umami taste substances in human salivation during meal. J Med Investig. 2009;56:197–204.
Yamamoto T. Central mechanisms of taste: cognition, emotion, and taste-elicited behaviors. Jpn Dent Sci Rev. 2008;44:91–9.
Herz RS. The role of odor-evoked memory in psychological and physiological health. Brain Sci. 2016;6:E22. https://doi.org/10.3390/brainsci6030022.
Cola PC, Gatto AR, da Silva RG, Spadotto AA, Schelp AO, Henry MA. The influence of sour taste and cold temperature in pharyngeal transit duration in patients with stroke. Arq Gastroenterol. 2010;47:18–21.
Lee KL, Kim DY, Kim WH, et al. The influence of sour taste on dysphagia in brain injury: blind study. Ann Rehabil Med. 2012;36:365–70. https://doi.org/10.5535/arm.2012.36.3.365.
Palmer PM, McCulloch TM, Jaffe D, Neel AT. Effects of a sour bolus on the intramuscular electromyographic (EMG) activity of muscles in the submental region. Dysphagia. 2005;20:210–7. https://doi.org/10.1007/s00455-005-0017-x.
Pauloski BR, Logemann JA, Rademaker AW, et al. Effects of enhanced bolus flavors on oropharyngeal swallow in patients treated for head and neck cancer. Head Neck. 2012;35:1124–31. https://doi.org/10.1002/hed.23086.
Pelletier CA, Lawless HT. Effect of citric acid and citric acid-sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. Dysphagia. 2003;18:231–41. https://doi.org/10.1007/s00455-003-0013-y.
Babaei A, Kern M, Antonik S, Mepani R, Ward BD, Li SJ, Hyde J, Shaker R. Enhancing effects of flavored nutritive stimuli on cortical swallowing network activity. Am J Physiol Gastrointest Liver Physiol. 2010;299:G422–9. https://doi.org/10.1152/ajpgi.00161.2010.
Wahab NA, Jones RD, Huckabee ML. Effects of olfactory and gustatory stimuli on neural excitability for swallowing. Physiol Behav. 2010;101:568–75. https://doi.org/10.1016/j.physbeh.2010.09.008.
Bartoshuk L (2012) The sensory aspects of swallowing: what do we know? Meet the Masters Symposium, Annual Convention of the American Speech-Language-Hearing Association (Atlanta GA).
Bartoshuk LM, Snyder DJ, Duffy VB. Hedonic gLMA: valid comparisons for food liking/disliking across obesity, age, sex and PROP status. Chem Senses. 2006;31:A50.
Kalva JJ. Comparison of the hedonic general labeled magnitude scale to the hedonic 9-point scale. J Food Sci. 2014;79:S238–45. https://doi.org/10.1111/1750-3841.12342.
Delwiche J, O’Mahony M. Changes in secreted salivary sodium are sufficient to alter salt taste sensitivity: use of signal detection measures with continuous monitoring of the oral environment. Physiol Behav. 1996;59:605–11.
Vallès A, Granic I, De Weerd P, Martens GJ. Molecular correlates of cortical network modulation by long-term sensory experience in the adult rat barrel cortex. Learn Mem. 2014;21:305–10. https://doi.org/10.1101/lm.034827.114.
Acknowledgements
This research was supported in part by the United States Army Medical Research and Development Program (W81XWH-12-2-0021; WRNMMC Protocol 357205; PI: Solomon). The authors sincerely thank Katie Dietrich-Burns and Jessica Steiner for contributions to data collection, and the clinical speech-language pathologists and rheumatologists at Walter Reed National Military Medical Center who facilitated participant recruitment. The views expressed in this paper are those of the authors and do not reflect the official policy or position of the Department of Defense or the US Government. The identification of specific products or scientific instrumentation does not constitute endorsement or implied endorsement on the part of the authors, Department of Defense, or any component agency.
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The authors declare that they have no conflicts of interest. Tasteful Advances/First Flavor, LLC, provided the taste strips according to a Cooperative Research and Development Agreement (CRADA #382400-12).
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Dietsch, A.M., A. Pelletier, C. & Solomon, N.P. Saliva Production and Enjoyment of Real-Food Flavors in People with and Without Dysphagia and/or Xerostomia. Dysphagia 33, 803–808 (2018). https://doi.org/10.1007/s00455-018-9905-8
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DOI: https://doi.org/10.1007/s00455-018-9905-8