EFFECT OF AROMA IN SALIVARY STIMULATION FOR BETTER

DENTURE RETENTION
DEPT: PROSTHODONTIC AND PHYSIOLOGY


MINOR THESIS
Submitted to the Faculty of Dentistry Universitas Padjadjaran in partial
fulfillment of the requirement for a Sarjana Kedokteran Gigi


SIA JO ANN
160110113027



UNIVERSITAS PADJADJARAN
FAKULTAS KEDOKTERAN GIGI
BANDUNG




1.1 Research background
In the field of prosthodontic, removable dentures play an important role in
preserving the integrity of the overall occlusion for missing tooth cases. Patient
use of removable denture, either partial removable denture or complete removable
denture have been high in the past and is expected to continue in the future.(Alan
B. Carr, Glen P.McGivney 2008)
One of the concerns of making an ideal removable denture is dentures retention.
Retention is quality inherent in the denture that resists the vertical forces of
dislodgement. Sufficient salivary production is vital for adhesion thus achieve
retentive denture. Unfortunately, most of the elderly and cancer patients as well as
patients who undergo radiotherapy suffer decreased salivary production known as
xerostomia. Patients with xerostomia usually have reduction in saliva flow of less
than 50% with clinical manifestation. (Gupta et al. 2006)Symptoms included
difficulty in talking and swallowing, oral discomfort and altered taste. It also
increases the risk of getting angular cheilitis and candidiasis. (D. L.
Sarandha, Sarandha D. L., Zakir Hussain, Uthkarsh, 2008)

Olfaction is one of the aspects that closely related to salivary secretion mechanism.
Olfactory receptors can be found at the cribriform plate, at the roof of the nasal
cavity. (Lee & Linden 1991)Increasing airflow by sniffing and thereby the access
of stimuli to the receptor area. The epithelium containing the olfactory receptors
has a rich blood supply. Interestingly, blood-borne odorants may pass through the
vessel walls and stimulate these receptors. The submandibular glands, but not the
parotid glands, are regulated by an olfactory salivary reflex. Irritating odors
enters the parotid gland, as well as the submandibular gland and thus stimulate
epithelial trigeminal irritant receptors. (Khosravani et al. 2012)
However, due to aging, our smell perception might have changed or decreases.
(Nishat & Ehtaih 2011) Laboratory studies of smell perception in the elderly
indicate that there are significant chemosensory losses with age
Psychophysical tests indicate the factor causes the changes:
1) elevated thresholds for smell
2) reduced intensity of suprathreshold stimuli
3) diminished ability to discriminate among suprathreshold stimuli
4) deficits in the ability to identify odors on the smell
5) distorted taste or smell.
(Navazesh & Christensen 1982)
Aromatherapy or essential oils therapy is using a plant's aroma-producing oils
essential to treat disease. Essential oils are taken from a plant's flowers, leaves,
stalks, bark, rind, or roots. (Nichols n.d.)The oils are mixed with another
substance (such as oil, alcohol, or lotion) and then put on the skin, sprayed in the
air, or inhaled. Practitioners of aromatherapy believe that fragrances in the oils
stimulate nerves in the nose. Those nerves send impulses to the part of the
brain that controls memory and emotion. Depending on the type of oil, the result
on the body may be calming or stimulating. The oils are thought to interact with
the body's hormone and enzyme to cause changes in appetite, blood pressure
stimulation of nervous system and other body functions.

Tomyam originated from Thailand. It is widely spread in Malaysia, Singapore and
now has been popularised around the world due to its exotic sour and spicy
flavour. The basic broth is made of a blend of herbs such as lemongrass, kaffir
lime leaves, galangal, mint, chillies. (Hugh T. W. Tan, 2005)

By using the blend of herbs in tomyam, this research focuses the properties of
each herbs that carries the effect in aromatherapy on patient who suffers reduced
saliva.

1.2 Problem identification
From the description above, there are still questions to be asked:
1) Can tomyam aroma stimulate parasympathetic nervous system?
2) Can tomyam aroma increase salivation?




1.3 Purpose and aim
The purpose of this research is to find out the effect of aroma in increasing
salivation. The aim of the research is to recertain tomyam blended aroma in
increasing salivation so that it can be an alternative treatment for xerostomia
patient

1.4 Benefits of research
1) It can determine the effectiveness of aroma in stimulating saliva secretion
2) It can help to increase dentures retention for denture wearer
3) It gives an alternate way for mild xerostomia patient since some of them
might undergoing medication and contraindicated with saliva stimulant
4) It increases appetite in elderly people and cancer patient

1.5 Conceptual framework
In present, limited xerostomia therapeutic procedures are carried out.
Supplemental use of artificial saliva and the use of stimulants such as pilocarpine
and cevimeline has reported to have some side effects. Patient complains
discomfort during talking after using artificial saliva.(Fox 2004)(Nieuw
Amerongen & Veerman 2003)
Therapeutic use of muscarinic agents is sometimes avoided due to underlying
diseases. The use of artificial saliva may bother patients during talking. Clinical
research on the gene transfer of aquaporin has recently taken place,and is still in
progress.(Nieuw Amerongen & Veerman 2003)
As we have learnt the physiology of salivation process, it can be affected by sense
of sight and smell, mastication process and parasympathetic as well as
sympathetic activities. However, the threshold of aroma or odor to stimulate
salivation increased with increasing of age. Aroma from food cannot efficiently
trigger saliva secretion. In order to meet the point of minimum threshold, essential
oil can be used since its concentration is higher than food aroma.
Tomyam herbs blended essential oil was chosen due to the exotic mixture that can
increase appetite. Salivation is induced when appetite increase. Besides, there are
some finding ingredients in tomyam herbs such as lemongrass and kaffir leaves
aroma can stimulate parasympathetic nervous system which leads to increase in
salivation.
Instead of extracting the aroma by using distillation process, the essential oil is
made by stewing the mixture of herbs in sunflower oil for 5 hours and keeps it in
a tight jar for at least two days before separating the herbs and oil. It is more
convenient and cost saving than distillation process although distillation can yield
higher concentration of oil.
The research will be carried out by measuring patients initial saliva volume.
Technique used to measure is by suction method. Essential oil will be rubbed
gently below and edges of nose. Meanwhile, patient is instructed to be relaxed,
close their eyes and lying in a comfort posture. Final saliva volume will be
measured after 5minutes.

1.6 Research methodology
Method used in this thesis is exploratory research. There is evidence that aroma
can induce salivation but there is no current findings regarding to food aroma
stimulant. It will be experimented on elderly people who are wearing denture and
has healthy salivary gland. Data is analysed in data form.
1.7 Hypothesis
Tomyam blended aroma can stimulate saliva secretion but not in a significant
quantity. It is effective on mild xerostomia patients without salivary gland disease

3.1 Types of research
The method of this research is experimental research or empirical research. Initial
and final saliva are collected and analyse into table form.
3.2 Place and time of research
The research will be carried out in Rumah Sakit Gigi dan Mulut, Sekeloa, starting
from November 2014
3.3 Population and sample
The population of this research is prosthodontic patients in RSGM. Targeted
samples are elderly denture wearer with healthy salivary gland. Sample collected
is in convenience form and only 30 patients required in this research.
3.4 Inclusion and exclusion criteria
Inclusion criteria of this research included
1) Elderly denture wearer
2) Lack of salivary secretion
3) Willing to participate this research
Exclusion criteria of this research included
1) Salivary gland diseases
2) Good retention of denture
3.5 Identification of variable
In this research, the independent variable is the use of tomyum aroma as
salivary stimulant whereas the dependent variable is the quantity of
stimulated saliva. Fixed variable included patients who suffer from
xerostomia and the time taken after application of tomyam aroma.
3.6 Materials and tool for research
Slow cooker, spatula, suction pump, eye cover, extra olive oil, measuring cylinder
3.7 Operational definition
Xerostomia is defined as dryness of the mouth owing to salivary gland secretion
dysfunction that caused by multiple conditions such as autoimmune disorders,
medications and oncologic treatment. (Sai-Ching Jim Yeung, Carmen P.
Escalante, Robert F. Gagel, 2009)
Saliva collection via suction technique is by subjects began a trial by swallowing
to void the mouth of saliva, and -then a plastic dental saliva ejector tip (attached
via plastic tubing to a vacuum pump) was placed under the tongue. The salivary
secretions were collected in a test tube. At the end of a trial, the ejector tip was
moved in a uniform manner around the vestibules and floor of the mouth in order
to collect residual saliva
3.8 Research procedure
Permission letter has to be submitted and approved by ethical department of
UNPAD a month before the experiment. After the approval of permission letter,
informed consent letter are prepared for patients and my benefits.
The research will be carried out by measuring patients initial saliva volume.
Technique used to measure is by suction method.(Navazesh & Christensen 1982)
Subjects began a trial by swallowing to void the mouth of saliva, and -then a
plastic dental saliva ejector tip (attached via plastic tubing to a vacuum pump) was
placed under the tongue. The salivary secretions were collected in a test tube. At
the end of a trial, the ejector tip was moved in a uniform manner around the
vestibules and floor of the mouth in order to collect residual saliva. (Navazesh &
Christensen 1982) Essential oil will be rubbed gently below and edges of nose.
Meanwhile, patient is instructed to be relaxed, close their eyes and lying in a
comfort posture. Final saliva volume will be measured after 5 minutes.
3.9 Plans of analysis
Both initial and final volumes of patient saliva are recorded. Stimulated saliva is
determined by subtraction of final and initial volume. It is recorded and presented
in table form.







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