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Relation between idiopathic glossodynia and salivary flow rate and content
Int. J. Oral Surg. 1976: 5:161-165 (Key words: sore tongue; saliva; hormonal balance)
Relation between idiopathic glossodynia and salivary flow rate and content D. GLICK, H. BEN-ARYEH, D. G U T M A N A N D R. S Z A R G E L
Department of Oral and Maxillo-facial Surgery and Laboratory of Oral Biology, Rambam University Hospital and Aba Khoushy School of Medicine, Haifa, Israel
From a series of 50 patients complaining of sore tongue, 13 were found to be suffering from idiopathic glossodynia. All were women in the postmenopausal stage. The salivary flow rate, protein, phosphate, and electrolyte content (No, K, Ca, Mg) were measured in unstimulated saliva of these patients. Protein, potassium and phosphate concentrations were significantly higher than in the control group. T h e results indicate that hormonal disbalance might be a factor in the etiology of this type of sore tongue.
ABSTRACT
- -
(Received for publication 10 October 1975, accepted 2 February 1976)
idiopathic glossodynia c a n be d e f i n e d as sore t o n g u e u n r e l a t e d to a n y p a t h o l o g i c findings. Diagnosis a n d t r e a t m e n t are diffic u l t a n d the etiology n o t clear. S o r e t o n g u e h a s b e e n d e s c r i b e d as one of the s y m p t o m s o f the climacterium4. H o r m o n a l d i s b a l a n c e r a n d e m o t i o n a l factors~,10,t3 h a v e b e e n considered as etioIogic factors. C o r r e l a t i o n bet w e e n salivary c o m p o s i t i o n a n d h o r m o n a l b a l a n c e h a s also b e e n r e p o r t e d in t h e literat u r e I, 9 < i T h e p u r p o s e of this study is to d e t e r m i n e if a c o r r e l a t i o n exists b e t w e e n t h e p a t i e n t ' s c o m p l a i n t a n d the s a l i v a r y c o n t e n t s .
Material and methods Fifty patients referred during a 6-month period to our outpatient clinic complaining of a sore tongue were examined. A medical history was
taken and an oral examination made. The dental condition and all lesions of the oral m u c o s a were recorded; 26 patients did not have any visible oral pathology. In this last group, b l o o d was analyzed for serum iron, hemoglobin, vitam i n B 12 level and fasting blood sugar. Those patients showing pathologic blood values like those seen in anemia or diabetes were excluded from this study. The remaining group consisted of 13 healthy patients complaining of a sore tongue. It was observed that all were women of postmenopausal age. The control group consisted of 13 postmenopausal women volunteers with no complaint of sore tongue. Total mixed saliva was collected following a standard method 8. The saliva was collected in a test tube over a 10-rain period, the volume was measured and rate of flow calculated; p H and electrolyte concentration were analyzed: sodium and potassium by the use of flame photometry (PERKIN ELiXiR), calcium and magnesium by atomic absorption (PERKIN ELMER). P h o s p h a t e and protein were analyzed by spectrophotometric methods 8,12.
162
G L I C K , BEN-ARYEH, G U T M A N A N D S Z A R G E L
T a b l e 1. The content in saliva in patients with idiopathic glossodynia No.
Sex
Age
Na
K
Ca
Mg
Protein
Phosphate
Flow rate
232 238 268 368 368B 374 386 394 404 404C 416 434 446 462 553
F F F F F F F F F F F F F F F
75 -68 60 60 64 61 54 50 50 65 51 59 50 48
30.0 03.0 12.0 5.0 9.4 14.5 14.5 6.8 7.6 9.6 >44.0 04.4 14.0 19.0 12.0
44.0 25.0 20.0 47.0 20.0 -14.2 34.0 26.4 28.8 38.0 44.0 52.0 21.0 19.0
8.6 2.4 7.8 11.3 6.1 4.0 5.0 3.6 2.0 17.0 8.6 6.8 5.4 2.7
1.18 0.20 --1.60 1.88 0.46 0.48 1.00 0.75 1.30 0.34 1.25 0.82 0.47
400.0 136.5 235.0 620.0 740.0 305.0 175.0 355.0 285.0 370.0 870.0 105.0 560.0 210.0 180.0
--15 63.6 65.0 75.7 26.0 55.0 30.0 25.0 68.0 13.5 41.0 23.0 11.0
0.25 0.40 0.60 0.20 0.26 0.62 0.16 0.24 0.32 0.35 0.03 0.30 0.18 0.18 0.40
Results T a b l e s 1 a n d 2 show t h e a m o u n t of N a , K, Ca, M g , p r o t e i n , p h o s p h a t e a n d flow r a t e of saliva of I3 patients suffering from idiop a t h i c g l o s s o d y n i a a n d 13 h e a l t h y v o l u n teers. I n p a t i e n t s N o s . 368 and 404, a seco n d s a m p l e o f saliva w a s o b t a i n e d a n d a n a l y z e d 3 m o n t h s later. N o s i g n i f i c a n t difference was found. I n Fig. 1, t h e age a n d flow r a t e of s a l i v a o f p a t i e n t s s u f f e r i n g f r o m i d i o p a t h i c glosso-
d y n i a a n d the h e a l t h y c o n t r o l g r o u p a r e c o m p a r e d . T h e m e a n age o f o u r test g r o u p was 58, t h e c o n t r o l g r o u p 62. M e a n salivary flow rate was 0.30 m l / m i n i n t h e test g r o u p , a n d 0.325 m l / m i n in t h e c o n t r o l group. In Fig. 2, t h e m a g n e s i u m a n d c a l c i u m c o n t e n t o f saliva is shown. M e a n m a g n e s i u m c o n t e n t o f the sore t o n g u e p a t i e n t s a n d of t h e c o n t r o l s was 0.90 m E q / 1 a n d 0.91 mEq/1, respectively. T h e m e a n c a l c i u m c o n t e n t was 5.5 m g % a n d 6.4 m g % , respectively.
T a b l e 2. The content in saliva in healthy w o m e n No.
Sex
Age
Na
K
Ca
Mg
Protein
Phosphate
Flow rate
521 523 524 530 531 532 535 537 538 539 540 541 401
F F F F F F F F F F F F F
50 61 65 65 61 54 66 60 73 64 65 70 49
6.0 5.2 13.0 12.4 08.4 02.8 1.4.8 09.6 06.0 06.8 06.4 08.4 07.6
21.2 16.0 20.0 23.6 28.4 24.6 33.6 23.0 24.6 20.0 27.5 31.0 16.0
5.8 6.2 4.9 6.9 6.6 5.7 8.7 5.4 6.7 5.6 7.8 10.5 2.9
0.89 0.58 0.76 1.10 1.15 1.17 1.30 1.00 0.87 0.63 0.90 1.40 0.14
250 170 165 250 200 195 280 180 165 180 150 560 160
26.5 13.0 11.0 19.0 20.0 20.0 13.0 10.0 20.5 20.0 22.2 22.2 16.0
-----0.3 0.24 0.33 0.30 0.45 0.11 0.55
SALIVA AND GLOSSODYNIA
163
dL
_~
Z
75-
e~ ii
L~
E
2
z
~70. 7
,,,65 -
~
i
I
~E
i
551 -
50-
i
9
A
B 0.5 " |m
E
a
E "-~
L
t~
I
0 I9
L~ 0.'7
7'
'I
it
OL
7" u p
0
.d t.L
0.5
E 16-
0.4
..J 0.3 012
01 9
Z
0.2 mG 0.1
E3 0
8
-
i
0
?
a
A
Fig. 1. The age and flow rate of saliva in patients suffering from idiopathic glossodynia (A) and in the control group (B).
I
4
-
ma
I n Fig. 3, sodium and potassium concentrations in saliva are given. The m e a n sodiu m content in patients suffering from idiopathic glossodynia as compared with the control group was 8.2 mEq/1 and 12.7 mEq/1, respectively. The mean potassium content was 31 mEq/I and 24 mEq/l, respectively. I n Fig. 4, protein and phosphate concert-
A
Fig. 2. The concentration of magnesium and calcium in the saliva of patients suffering from idiopathic glossodynia (A) and in the control group (B).
trations in saliva are shown. Mean protein levels in the saliva of women suffering from
164
GLICK, BEN-ARYEH, GUTMAN AND SZARGEL
E
z
E
s
_Zsor
me ~1.
6o
40 I
2 Z W
9
=w ..
~,,
:.
..
*-... A
B
~nn
9
3O
300
9
20
2~Q
|
9
~--
9
10
,oo
9
!
'~
"~-
9
ISO lOO
0
__
B
B o
A
Fig. 4. The concentration of protein and phosphate in the saliva of patients suffering from idiopathic glossodynia (A) and in the control group (B).
idiopathic glossodynia was 370 mg%, in the control group 224 mg%. M e a n phosphate levels were 40 rag% in the test group and 18 mg% in the control group. In Table 3, results of Student's t-test6 for the difference of salivary contents between patients suffering from idiopathic glosso-
3O
20
~
,.~
i B
Fig. 3. The concentration of sodium and potassium in the saliva of patients suffering from idiopathic glossodynia (A) and in the control group (B).
Table 3. "t"-test for the significance of the difference in content in saliva of patients suffering from idiopathic glossodynia and healthy women of the same age Salivary contents Na K Ca Mg Protein Phosphate
t
P
1.80 2.02 0,62 0.07 2.17 3.39
2>0.10 -<~0.05 ~-0.50 2>0.50 <:0,05 "~0.01
SALIVA AND GLOSSODYNIA dynia and healthy women volunteers of the same age are presented. The differences in the concentrations of potassium, protein, and phosphate are statistically significant.
Discussion H a l f of the 50 patients had pathologic changes, either in the medical history, oral condition, or blood chemistry in addition to their complaint of sore tongue. These patients were eliminated from this study. It is significant that all the remaining patients were women in the postmenopausal stage. In view of this finding and the existing correlation between salivary contents and hormonal balance~,0-~, an attempt was made to close the triangle. In this study, correlation between salivary content of different components, flow rate, and idiopathic glossodynia was sought. The salivary flow rate both in the study group and controls was similar (Fig. 1). This differs from the work of HERTZ, STEINER, ZUCKERMAN t~ PIZANTI5. A change in salivary content was found. Potassium, protein and phosphate concentrations were significantly higher in these patients than in the control group. The concentration of phosphate is of special interest in view of our previous finding that phosphate levels in saliva reflect changes in hormonal balance. W e have shown that during ovulation there is a striking increase in phosphate secretion by the saIivary glands t, The highly significant change in the phosphate levels of women suffering from idiopathic glossodynia found in the present study infers that hormonal balance might be a factor in the etiology of their sore tongue. F u r t h e r research is planned to clarify the mechanism causing the phosphate rise in saliva, and to study the possibility of clinical application of hormonal therapy for treatment of idiopathic glossodynia.
165
References 1. BEN-ARYEH, H., FILMAR, S., GUTMAN, D., SZARGEL, R. & P~J~DI, E.: Salivary phosphate as an indicator of ovulation. Am. J. Obstet. GynecoL 1976: 125: in press. 2. DONOVAN,J. C.: The menopausal syndrome: A study of case histories. Am. J. Obstet. GynecoL 1951: 62: 1281-1291. 3. G t r I ~ , D. & BnN-ARX'~H, H.: The influence of age on salivary content and rate of flow. Int. J. Oral Surg. 1974-: 3: 314-317. 4. Goss, A. N.: Sore tongue. N. Z. Dent. J. 1973: 69: 194-201. 5. HERTZ, D. G., STEr~R, J. E., ZUCKERMAN, H. & PIZANTZ,S.: Psychological and physical symptom-formation in menopause. Psychother. Psychosom. 1971'. 19: 47-52. 6. HILL, A. B.: Principles of medical statistics. Oxford University Press 1966, p. 146. 7. KULLANDER,S. & SONESSON, B.: Studies on saliva in menstruating, pregnant and postmenopausal women. Aeta Endocrinol. 1965: 48: 329-336. 8. LOWRY, O. H., ROSEBROUGH, N. J., FARR, A. L & IL~NDALL,R. J.: Protein measurement with the Folin phenol reagent, d. Biol. Chem. 1959: 193: 265-275. 9. MARDER,M. Z., WOTMAN,S. • MANDEL, ]2 Salivary electrolyte changes during pregnancy. Am. J. Obstet. Gyneeol. 1968: 112: 233-236. 10. NntJa~'mN, B. L. & K_v~irc~s,R. J.: Menopausal symptoms in women of various ages. Psyehosom. Med, 1965: 27: 266-273. 11. PUSHKULIAN, L.: Salivary electrolyte changes during the normal menstrual cycle. J. Dent. Res. 1972: 51: 1212-1216. 12. SH~OWA~, G. Y., JONES, L. M. & R~mHArtT, H. L.: Estimation of serum inorganic phosphate and "acid" and "alkaline" phosphatase activity. J. Biol. Chem. 1942: 142: 921-933. 13. SIMON, A.: Emotional problems of women. The mature years and beyond. Psyehosomatics 1968: 9: 2-6. 14. WmsoN, R. A. & WILSON, T.: The fate of the non-treated menopausal woman. J. Am. Geriat. Soc. 1963: 11: 347-354. Address: D. Gutman Dept. o/Oral and Maxillo-/acgal Surgery Rambam University Hospital Hai]a, Israel
Relation between idiopathic glossodynia and salivary flow rate and content D. GLICK, H. BEN-ARYEH, D. G U T M A N A N D R. S Z A R G E L
Department of Oral and Maxillo-facial Surgery and Laboratory of Oral Biology, Rambam University Hospital and Aba Khoushy School of Medicine, Haifa, Israel
From a series of 50 patients complaining of sore tongue, 13 were found to be suffering from idiopathic glossodynia. All were women in the postmenopausal stage. The salivary flow rate, protein, phosphate, and electrolyte content (No, K, Ca, Mg) were measured in unstimulated saliva of these patients. Protein, potassium and phosphate concentrations were significantly higher than in the control group. T h e results indicate that hormonal disbalance might be a factor in the etiology of this type of sore tongue.
ABSTRACT
- -
(Received for publication 10 October 1975, accepted 2 February 1976)
idiopathic glossodynia c a n be d e f i n e d as sore t o n g u e u n r e l a t e d to a n y p a t h o l o g i c findings. Diagnosis a n d t r e a t m e n t are diffic u l t a n d the etiology n o t clear. S o r e t o n g u e h a s b e e n d e s c r i b e d as one of the s y m p t o m s o f the climacterium4. H o r m o n a l d i s b a l a n c e r a n d e m o t i o n a l factors~,10,t3 h a v e b e e n considered as etioIogic factors. C o r r e l a t i o n bet w e e n salivary c o m p o s i t i o n a n d h o r m o n a l b a l a n c e h a s also b e e n r e p o r t e d in t h e literat u r e I, 9 < i T h e p u r p o s e of this study is to d e t e r m i n e if a c o r r e l a t i o n exists b e t w e e n t h e p a t i e n t ' s c o m p l a i n t a n d the s a l i v a r y c o n t e n t s .
Material and methods Fifty patients referred during a 6-month period to our outpatient clinic complaining of a sore tongue were examined. A medical history was
taken and an oral examination made. The dental condition and all lesions of the oral m u c o s a were recorded; 26 patients did not have any visible oral pathology. In this last group, b l o o d was analyzed for serum iron, hemoglobin, vitam i n B 12 level and fasting blood sugar. Those patients showing pathologic blood values like those seen in anemia or diabetes were excluded from this study. The remaining group consisted of 13 healthy patients complaining of a sore tongue. It was observed that all were women of postmenopausal age. The control group consisted of 13 postmenopausal women volunteers with no complaint of sore tongue. Total mixed saliva was collected following a standard method 8. The saliva was collected in a test tube over a 10-rain period, the volume was measured and rate of flow calculated; p H and electrolyte concentration were analyzed: sodium and potassium by the use of flame photometry (PERKIN ELiXiR), calcium and magnesium by atomic absorption (PERKIN ELMER). P h o s p h a t e and protein were analyzed by spectrophotometric methods 8,12.
162
G L I C K , BEN-ARYEH, G U T M A N A N D S Z A R G E L
T a b l e 1. The content in saliva in patients with idiopathic glossodynia No.
Sex
Age
Na
K
Ca
Mg
Protein
Phosphate
Flow rate
232 238 268 368 368B 374 386 394 404 404C 416 434 446 462 553
F F F F F F F F F F F F F F F
75 -68 60 60 64 61 54 50 50 65 51 59 50 48
30.0 03.0 12.0 5.0 9.4 14.5 14.5 6.8 7.6 9.6 >44.0 04.4 14.0 19.0 12.0
44.0 25.0 20.0 47.0 20.0 -14.2 34.0 26.4 28.8 38.0 44.0 52.0 21.0 19.0
8.6 2.4 7.8 11.3 6.1 4.0 5.0 3.6 2.0 17.0 8.6 6.8 5.4 2.7
1.18 0.20 --1.60 1.88 0.46 0.48 1.00 0.75 1.30 0.34 1.25 0.82 0.47
400.0 136.5 235.0 620.0 740.0 305.0 175.0 355.0 285.0 370.0 870.0 105.0 560.0 210.0 180.0
--15 63.6 65.0 75.7 26.0 55.0 30.0 25.0 68.0 13.5 41.0 23.0 11.0
0.25 0.40 0.60 0.20 0.26 0.62 0.16 0.24 0.32 0.35 0.03 0.30 0.18 0.18 0.40
Results T a b l e s 1 a n d 2 show t h e a m o u n t of N a , K, Ca, M g , p r o t e i n , p h o s p h a t e a n d flow r a t e of saliva of I3 patients suffering from idiop a t h i c g l o s s o d y n i a a n d 13 h e a l t h y v o l u n teers. I n p a t i e n t s N o s . 368 and 404, a seco n d s a m p l e o f saliva w a s o b t a i n e d a n d a n a l y z e d 3 m o n t h s later. N o s i g n i f i c a n t difference was found. I n Fig. 1, t h e age a n d flow r a t e of s a l i v a o f p a t i e n t s s u f f e r i n g f r o m i d i o p a t h i c glosso-
d y n i a a n d the h e a l t h y c o n t r o l g r o u p a r e c o m p a r e d . T h e m e a n age o f o u r test g r o u p was 58, t h e c o n t r o l g r o u p 62. M e a n salivary flow rate was 0.30 m l / m i n i n t h e test g r o u p , a n d 0.325 m l / m i n in t h e c o n t r o l group. In Fig. 2, t h e m a g n e s i u m a n d c a l c i u m c o n t e n t o f saliva is shown. M e a n m a g n e s i u m c o n t e n t o f the sore t o n g u e p a t i e n t s a n d of t h e c o n t r o l s was 0.90 m E q / 1 a n d 0.91 mEq/1, respectively. T h e m e a n c a l c i u m c o n t e n t was 5.5 m g % a n d 6.4 m g % , respectively.
T a b l e 2. The content in saliva in healthy w o m e n No.
Sex
Age
Na
K
Ca
Mg
Protein
Phosphate
Flow rate
521 523 524 530 531 532 535 537 538 539 540 541 401
F F F F F F F F F F F F F
50 61 65 65 61 54 66 60 73 64 65 70 49
6.0 5.2 13.0 12.4 08.4 02.8 1.4.8 09.6 06.0 06.8 06.4 08.4 07.6
21.2 16.0 20.0 23.6 28.4 24.6 33.6 23.0 24.6 20.0 27.5 31.0 16.0
5.8 6.2 4.9 6.9 6.6 5.7 8.7 5.4 6.7 5.6 7.8 10.5 2.9
0.89 0.58 0.76 1.10 1.15 1.17 1.30 1.00 0.87 0.63 0.90 1.40 0.14
250 170 165 250 200 195 280 180 165 180 150 560 160
26.5 13.0 11.0 19.0 20.0 20.0 13.0 10.0 20.5 20.0 22.2 22.2 16.0
-----0.3 0.24 0.33 0.30 0.45 0.11 0.55
SALIVA AND GLOSSODYNIA
163
dL
_~
Z
75-
e~ ii
L~
E
2
z
~70. 7
,,,65 -
~
i
I
~E
i
551 -
50-
i
9
A
B 0.5 " |m
E
a
E "-~
L
t~
I
0 I9
L~ 0.'7
7'
'I
it
OL
7" u p
0
.d t.L
0.5
E 16-
0.4
..J 0.3 012
01 9
Z
0.2 mG 0.1
E3 0
8
-
i
0
?
a
A
Fig. 1. The age and flow rate of saliva in patients suffering from idiopathic glossodynia (A) and in the control group (B).
I
4
-
ma
I n Fig. 3, sodium and potassium concentrations in saliva are given. The m e a n sodiu m content in patients suffering from idiopathic glossodynia as compared with the control group was 8.2 mEq/1 and 12.7 mEq/1, respectively. The mean potassium content was 31 mEq/I and 24 mEq/l, respectively. I n Fig. 4, protein and phosphate concert-
A
Fig. 2. The concentration of magnesium and calcium in the saliva of patients suffering from idiopathic glossodynia (A) and in the control group (B).
trations in saliva are shown. Mean protein levels in the saliva of women suffering from
164
GLICK, BEN-ARYEH, GUTMAN AND SZARGEL
E
z
E
s
_Zsor
me ~1.
6o
40 I
2 Z W
9
=w ..
~,,
:.
..
*-... A
B
~nn
9
3O
300
9
20
2~Q
|
9
~--
9
10
,oo
9
!
'~
"~-
9
ISO lOO
0
__
B
B o
A
Fig. 4. The concentration of protein and phosphate in the saliva of patients suffering from idiopathic glossodynia (A) and in the control group (B).
idiopathic glossodynia was 370 mg%, in the control group 224 mg%. M e a n phosphate levels were 40 rag% in the test group and 18 mg% in the control group. In Table 3, results of Student's t-test6 for the difference of salivary contents between patients suffering from idiopathic glosso-
3O
20
~
,.~
i B
Fig. 3. The concentration of sodium and potassium in the saliva of patients suffering from idiopathic glossodynia (A) and in the control group (B).
Table 3. "t"-test for the significance of the difference in content in saliva of patients suffering from idiopathic glossodynia and healthy women of the same age Salivary contents Na K Ca Mg Protein Phosphate
t
P
1.80 2.02 0,62 0.07 2.17 3.39
2>0.10 -<~0.05 ~-0.50 2>0.50 <:0,05 "~0.01
SALIVA AND GLOSSODYNIA dynia and healthy women volunteers of the same age are presented. The differences in the concentrations of potassium, protein, and phosphate are statistically significant.
Discussion H a l f of the 50 patients had pathologic changes, either in the medical history, oral condition, or blood chemistry in addition to their complaint of sore tongue. These patients were eliminated from this study. It is significant that all the remaining patients were women in the postmenopausal stage. In view of this finding and the existing correlation between salivary contents and hormonal balance~,0-~, an attempt was made to close the triangle. In this study, correlation between salivary content of different components, flow rate, and idiopathic glossodynia was sought. The salivary flow rate both in the study group and controls was similar (Fig. 1). This differs from the work of HERTZ, STEINER, ZUCKERMAN t~ PIZANTI5. A change in salivary content was found. Potassium, protein and phosphate concentrations were significantly higher in these patients than in the control group. The concentration of phosphate is of special interest in view of our previous finding that phosphate levels in saliva reflect changes in hormonal balance. W e have shown that during ovulation there is a striking increase in phosphate secretion by the saIivary glands t, The highly significant change in the phosphate levels of women suffering from idiopathic glossodynia found in the present study infers that hormonal balance might be a factor in the etiology of their sore tongue. F u r t h e r research is planned to clarify the mechanism causing the phosphate rise in saliva, and to study the possibility of clinical application of hormonal therapy for treatment of idiopathic glossodynia.
165
References 1. BEN-ARYEH, H., FILMAR, S., GUTMAN, D., SZARGEL, R. & P~J~DI, E.: Salivary phosphate as an indicator of ovulation. Am. J. Obstet. GynecoL 1976: 125: in press. 2. DONOVAN,J. C.: The menopausal syndrome: A study of case histories. Am. J. Obstet. GynecoL 1951: 62: 1281-1291. 3. G t r I ~ , D. & BnN-ARX'~H, H.: The influence of age on salivary content and rate of flow. Int. J. Oral Surg. 1974-: 3: 314-317. 4. Goss, A. N.: Sore tongue. N. Z. Dent. J. 1973: 69: 194-201. 5. HERTZ, D. G., STEr~R, J. E., ZUCKERMAN, H. & PIZANTZ,S.: Psychological and physical symptom-formation in menopause. Psychother. Psychosom. 1971'. 19: 47-52. 6. HILL, A. B.: Principles of medical statistics. Oxford University Press 1966, p. 146. 7. KULLANDER,S. & SONESSON, B.: Studies on saliva in menstruating, pregnant and postmenopausal women. Aeta Endocrinol. 1965: 48: 329-336. 8. LOWRY, O. H., ROSEBROUGH, N. J., FARR, A. L & IL~NDALL,R. J.: Protein measurement with the Folin phenol reagent, d. Biol. Chem. 1959: 193: 265-275. 9. MARDER,M. Z., WOTMAN,S. • MANDEL, ]2 Salivary electrolyte changes during pregnancy. Am. J. Obstet. Gyneeol. 1968: 112: 233-236. 10. NntJa~'mN, B. L. & K_v~irc~s,R. J.: Menopausal symptoms in women of various ages. Psyehosom. Med, 1965: 27: 266-273. 11. PUSHKULIAN, L.: Salivary electrolyte changes during the normal menstrual cycle. J. Dent. Res. 1972: 51: 1212-1216. 12. SH~OWA~, G. Y., JONES, L. M. & R~mHArtT, H. L.: Estimation of serum inorganic phosphate and "acid" and "alkaline" phosphatase activity. J. Biol. Chem. 1942: 142: 921-933. 13. SIMON, A.: Emotional problems of women. The mature years and beyond. Psyehosomatics 1968: 9: 2-6. 14. WmsoN, R. A. & WILSON, T.: The fate of the non-treated menopausal woman. J. Am. Geriat. Soc. 1963: 11: 347-354. Address: D. Gutman Dept. o/Oral and Maxillo-/acgal Surgery Rambam University Hospital Hai]a, Israel