R J Billings

University of Rochester, Rochester, New York, United States

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Publications (33)57.03 Total impact

  • Dorota T Kopycka-Kedzierawski, Ronald J Billings
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    ABSTRACT: Abstract Background: Dental caries affecting the primary dentition of U.S. children continues to be the most prevalent chronic childhood disease. Preventive screening for dental caries in toddlers by dental professionals is labor-intensive and costly. Studies are warranted to examine innovative screening modalities that reduce cost, are less labor-intensive, and have the potential to identify caries in high-risk children. Subjects and Methods: Two hundred ninety-one children were randomized into two groups: Group 1 received a traditional, visual tactile examination initially and follow up-examinations at 6 and 12 months, and Group 2 received a teledentistry examination initially and follow-up examinations at 6 and 12 months. The mean primary tooth decayed and filled surfaces (dfs) scores were calculated for all children at baseline and 6 and 12 months. Results: At baseline, the mean dfs score for children examined by means of teledentistry was 2.19, and for the children examined by means of the traditional method, the mean was 1.27; the means were not significantly different. At the 12-month examination, the mean dfs score for the children examined by means of teledentistry was 3.02, and for the children examined by means of the clinical method, the mean dfs was 1.70; the means were not significantly different. At 12 months the mean fillings score for the children examined by means of teledentistry was 1.43 and for the children examined by means of the clinical method was 0.51; the means were statistically significantly different (p<0.001). Conclusions: These results suggest that the teledentistry examinations were comparable to clinical examinations when screening for early childhood caries in preschool children. The data further showed that color printouts of teeth with cavities provided to parents of children who received teledentistry screenings promoted oral healthcare utilization, as children from the teledentistry study group received more dental care than children from the clinical study group.
    Telemedicine and e-Health 09/2013; · 1.40 Impact Factor
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    Puerto Rico health sciences journal 12/2011; 30(4):165-6. · 0.71 Impact Factor
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    ABSTRACT: Recent cross-sectional studies suggest that reduced ability to generate alkali via the urease pathway in dental plaque may be an important caries risk factor, but it has not been assessed prospectively. To evaluate the effect of plaque and saliva urease activity on the risk for developing new caries over a three-year period in children. A panel of 80 children, three to six years of age at recruitment, was followed prospectively for three years. Plaque urease activity, saliva urease activity and dental caries were measured every six months. Survival analysis methodology was used to evaluate the effect of urease on caries development during the study period adjusted for gender, age, baseline caries levels, sugar consumption, amount of plaque, and mutans streptococci levels. The risk for developing new caries increased in a dose-responsive manner with increasing levels of urease activity in saliva (adjusted HR(Q4 vs. Q1): 4.98; 95% CI: 1.33, 18.69) and with decreasing urease activity in plaque (adjusted HR(Q4 vs. Q1): 0.29; 95% CI: 0.11, 0.76). Multiple measurements of urease activity were conducted to overcome the variability of urease activity in this study. Baseline caries and mutans streptococci in saliva were also important predictors of caries risk. Increased urease activity in saliva can be an indicator of increased caries risk in children, whilst increased urease activity in plaque may be associated with reduced caries risk. The reproducibility of urease measurements must be improved before these findings can be further tested and clinically applied.
    Archives of oral biology 07/2011; 56(12):1560-8. · 1.65 Impact Factor
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    D T Kopycka-Kedzierawski, R J Billings
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    ABSTRACT: To assess dental caries prevalence and dental care utilisation in pre-school children enrolled in urban childcare centres that participated in a comparative effectiveness study. Cross-sectional study. Caries prevalence was determined in a cohort of children 12-60 months of age. Eligible children were randomised into two groups: group one received a traditional visual/tactile oral examination and group two received a teledentistry examination. Questionnaires were administered to the children's parents/guardians to gather demographics and information about using dental and medical services. Of 234 children examined, approximately 28% had caries experience. The mean dfs score was 1.56 with a range of 0-34 carious surfaces. The mean dfs score for the children examined by means of teledentistry was 1.75 and for the children examined by means of the traditional visual/tactile method mean dfs was 1.40; the means between the two groups were not significantly different. Twenty-six children showed evidence of being treated for dental caries. According to the parents, 31.5% of the children had never had a dental check-up before, only 3% of the children were lacking dental insurance and majority of the parents (92%) did not perceive accessing dental care for the children as a problem. The Wilcoxon Mann-Whitney test and the Kruskal-Wallis test were used to assess statistical differences among groups of children. The data showed that 28% of the children had caries and, of these, 61% had never been treated for caries, thus indicating that continued efforts are needed to improve oral health care utilisation by inner-city preschool children.
    European Archives of Paediatric Dentistry. Official Journal of the European Academy of Paediatric Dentistry. 06/2011; 12(3):133-8.
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    ABSTRACT: Bacterial urease activity in dental plaque and in saliva generates ammonia, which can increase the plaque pH and can protect acid-sensitive oral bacteria. Recent cross-sectional studies suggest that reduced ability to generate ammonia from urea in dental plaque can be an important caries risk factor. In spite of this proposed important clinical role, there is currently no information available regarding important clinical aspects of oral ureolysis in children. The objective of this study was to evaluate the distribution and pattern of urease activity in the dental plaque and in the saliva of children during a three-year period, and to examine the relationship of urease with some important caries risk factors. A longitudinal study was conducted with repeated measures over a three-year period on a panel of 80 children, aged 3-6 years at recruitment. The dynamics of change in urease activity were described and associated with clinical, biological, and behavioural caries risk factors. Urease activity in plaque showed a trend to remain stable during the study period and was negatively associated with sugar consumption (P<0.05). Urease activity in unstimulated saliva increased with age, and it was positively associated with the levels of mutans streptococci in saliva and with the educational level of the parents (P<0.05). The results of this study reveal interesting and complex interactions between oral urease activity and some important caries risk factors. Urease activity in saliva could be an indicator of mutans infection in children.
    Archives of oral biology 05/2011; 56(11):1282-9. · 1.65 Impact Factor
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    ABSTRACT: To determine the relapse rate within one year for a cohort of children treated for severe early childhood caries (S-ECC). In an earlier report, we assessed the suppressive effect of 10 percent povidone-iodine and the elimination of active caries on salivary mutans streptococci (MS) populations in 77 children with S-ECC; 49 children returned for a 6-month recall exam that occurred 5 to 12 months post dental surgery. Relapse declaration required at least one caries lesion needing a restoration. Contrasts of relapse (R) and non-relapse (NR) to the covariates of gender, race, ethnicity, age, surfaces available for relapse (SAR), time to appointment, and baseline salivary mutans streptococci (MS) counts were statistically evaluated. 19 children (39%) were declared R and 30 (61%) were NR. The 2 groups did not statistically differ on: gender, race, ethnicity, age, SAR, baseline salivary MS counts and time to recall appointment. Statistical analyses also showed the covariates had no significant effect on probability of relapse or time to relapse (P>0.05). None of the covariates were related to R. The R rate (39%) observed is consistent with earlier reports. Novel approaches are needed to improve relapse prevention.
    Pediatric dentistry 01/2011; 33(7):510-4. · 0.56 Impact Factor
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    ABSTRACT: The aim of the present study was to analyse the association between socioeconomic and behavioural factors and the presence of active non-cavitated caries lesions in 12-year-old adolescents in Piracicaba, São Paulo, Brazil. A cross-sectional study was carried out in 1001, 12-year-old adolescents who were selected by the cluster sampling method. A modified version of the World Health Organization criteria for identifying lesions including white lesions (WL) in enamel was used. Information on behavioural and socioeconomic factors was obtained using a semi-structured questionnaire. The outcome variables were DMFS, DMFS+WL and WL. The data obtained were analysed using the chi-square test and a logistic regression model. The mean DMFS was 1.87 (SD = 3.05) and DMFS+WL was 2.27 (SD = 3.66). The logistic regression model showed that income was statistically significantly associated with DMFS, DMFS+WL and WL, whereas educational level of the father, number of residents in the house and number of dental visits were associated with DMFS and DMFS+WL. The onset of toothbrushing was associated with WL. The present study showed that economic factors are associated with all stages of caries development. In addition to these factors, family size, number of dental visits, educational level of the father and onset of toothbrushing could be considered markers of dental health risk.
    Oral health & preventive dentistry 01/2010; 8(4):361-7. · 0.52 Impact Factor
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    ABSTRACT: To determine the oral health status of US women of childbearing age and to analyze the effect of tobacco smoke on their oral health. Data from the 1999-2004 National Health and Nutrition Examination Survey were evaluated for women 15-44 years of age. The association of exposure to tobacco smoke with untreated caries, mean DMFS, gingivitis, and periodontitis were examined in bivariate and regression analyses controlling for potential confounders. The prevalence of untreated caries was 25%, for gingivitis 49%, and for periodontitis 6%. After adjusting for potential confounders, self-reported current smoking was a strong independent risk indicator for untreated caries, periodontitis, and to a lesser extent for greater DMFS count. Women with detectable cotinine levels below 15 ng/mL presented with an increased risk for gingivitis. Independent factors associated with increased risk for untreated caries were being Black, having less than a high school education, Medicaid or no health insurance, previous live births, and infrequent and episodic dental visits. Characteristics associated with gingivitis were being Mexican-American, obese, pregnant, and having infrequent dental visits. Older age, no insurance, and the last dental visit for treatment were independently associated with periodontitis. Dental caries and periodontitis were prevalent among certain subgroups of women of reproductive age. Smoking was found to be a significant risk indicator for various negative oral health outcomes. Barriers to accessing to dental care that were manifested by untreated caries among Black women, mothers, and Medicaid beneficiaries must be better understood.
    Journal of Public Health Dentistry 05/2009; 69(4):231-41. · 1.21 Impact Factor
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    ABSTRACT: This investigational study assessed the suppressive effect of 10 percent povidone iodine (PI) coupled with elimination of active carious lesions on salivary mutans streptococci (MS) populations in children with severe early childhood caries (S-ECC). 77 children (38 females, 39 males) were treated for S- ECC in one session; a 0.2 ml PI solution was applied to the dentition after dental surgery was completed and immediately wiped off. The subjects aged from 2 to 5 years (mean = 3.78 years) at baseline. Whole nonstimulated saliva samples were obtained at baseline, 30 days, 60 days, and 90 days post dental surgery. Samples were placed on ice and processed within 2 hours. The MS level in each sample was expressed as colony forming units (CFUs) per ml of saliva. Approximately 50 percent of subjects had a >95 percent reduction in CFU/ml of saliva at each time point after baseline. The percentages of subjects with a >50 percent reduction in MS level were 85 percent at 30 days, 83 percent at 60 days, 84 percent at 90 days. The median (25th, 75th percentiles) CFUs/ml of saliva counts were 8.40 x 10(5) (1.49 x 10(5), 5.00 x 10(6)) at baseline (n= 77), 4.12 x 10(4) (8.40 x 10(3), 1.89 x 10(5)) at 30 days (n = 74), 4.62 x 10(4) (7.00 x 10(3), 1.36 x 10(5)) at 60 days (n = 70), and 5.09 x 10(4) (1.16 x 10(4), 1.00 x 10(5)) at 90 days (n = 70). The changes from baseline to 30 days, 60 days, and 90 days were statistically significant (P < 0.0001). PI coupled with dental surgery has a significant suppressive effect on salivary MS levels in the setting of S-ECC for at least 90 days. These data strongly suggest that treatment with PI may be an important adjunct to dental surgery for S-ECC.
    Journal of Public Health Dentistry 03/2009; 69(3):163-7. · 1.21 Impact Factor
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    ABSTRACT: The prevalence of overweight children in the United States continues to increase. To examine the relationship between being overweight and caries in primary and permanent dentition in a nationally representative sample of children. Data from the NHANES III (1988-1994) were analyzed using logistic regression and controlling for potential confounders for 10 180 children 2-18 years of age and from the NHANES 1999-2002 for 7568 children 2-18 years of age. For children 2-5 years of age, there was no difference in caries experience among normal weight, at risk for overweight or overweight children for NHANES III and for NHANES 1999-2002. For children 6-11 years of age (NHANES III), at risk for overweight and overweight children were less likely to have caries experience in the primary dentition than normal weight children; overweight children were less likely to have caries experience in the permanent dentition than normal weight children. For children 12-18 years of age (NHANES III), overweight children were less likely to have caries experience in the permanent dentition than normal weight children. For children 6-11 years of age and 12-18 years of age (NHANES 1999-2002), there was no difference in having caries experience among normal, at risk for overweight and overweight children. The data from NHANES III and NHANES 1999-2002 provide no evidence to suggest that overweight children are at an increased risk for dental caries. Although no differences in caries rates by weight were found in younger children, interestingly results from NHANES III suggest that being overweight may be associated with decreased rates of caries in older children.
    Community Dentistry And Oral Epidemiology 05/2008; 36(2):157-67. · 1.80 Impact Factor
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    ABSTRACT: Despite limited epidemiologic evidence, concern has been raised that breastfeeding and its duration may increase the risk of early childhood caries. The objective of this study was to assess the potential association of breastfeeding and other factors with the risk for early childhood caries among young children in the United States. Data about oral health, infant feeding, and other child and family characteristics among children 2 to 5 years of age (N = 1576) were extracted from the 1999-2002 National Health and Nutrition Examination Survey. The association of breastfeeding and its duration, as well as other factors that previous research has found associated with early childhood caries, was examined in bivariate analyses and by multivariable logistic and Poisson regression analyses. After adjusting for potential confounders significant in bivariate analyses, breastfeeding and its duration were not associated with the risk for early childhood caries. Independent associations with increased risk for early childhood caries were older child age, poverty, being Mexican American, a dental visit within the last year, and maternal prenatal smoking. Poverty and being Mexican American also were independently associated with severe early childhood caries, whereas characteristics that were independently associated with greater decayed and filled surfaces on primary teeth surfaces were poverty, a dental visit within the last year, 5 years of age, and maternal smoking. These data provide no evidence to suggest that breastfeeding or its duration are independent risk factors for early childhood caries, severe early childhood caries, or decayed and filled surfaces on primary teeth. In contrast, they identify poverty, Mexican American ethnic status, and maternal smoking as independent risk factors for early childhood caries, which highlights the need to target poor and Mexican American children and those whose mothers smoke for early preventive dental visits.
    PEDIATRICS 11/2007; 120(4):e944-52. · 4.47 Impact Factor
  • D T Kopycka-Kedzierawski, R J Billings
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    ABSTRACT: Markov modeling is a useful mathematical procedure for calculating probabilities of disease prognosis. Increasingly, Markov models are being applied in medical and health services research and also in social sciences research. The purpose of our study was to use the Markov process to determine time-dependent transition probabilities for caries-free children to convert to a caries-active state and to assess the impact of salivary mutans streptococci (MS) levels on caries status. Our analysis was based on data obtained from a 6-year longitudinal study of risk factors associated with caries onset in children. Based on a two-state Markov model, the probability that a caries-free child would convert to a caries-active state during the study ranged between 0.0046 and 0.0471. The highest probability of converting from a caries-free state to a caries-active state was 0.0471 at age 8.5 years. In addition to standard statistical methods of analyzing longitudinal caries data, Markov models show promise for use in the analysis of caries risk.
    Community Dentistry And Oral Epidemiology 05/2006; 34(2):123-9. · 1.80 Impact Factor
  • Dorota T Kopycka-Kedzierawski, Ronald J Billings
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    ABSTRACT: In Rochester, NY, telehealth centres were established in six inner-city elementary schools and seven child-care centres. The teledentistry project complemented the existing telehealth model. Using an intraoral camera, telehealth assistants record digital images of children's teeth (768 x 494 pixels) and send the images to a computer at the expert dental site (the Eastman Department of Dentistry at the University of Rochester). The paediatric dentist at the expert site reviews the images, and provides referral and treatment recommendations. Subsequently, the telehealth assistant contacts the child's parents or guardians and assists them to obtain appropriate dental care for their child. In the pilot study, we screened 50 children. In the first nine months of 2005, we screened 123 children. The results of our initial teledental screenings of children aged 12-48 months attending inner-city child-care centres revealed that almost 40% had active dental caries, mainly early childhood caries (ECC). For the first time, many children attending inner-city child-care centres have had their teeth examined at an early age and been given prompt feedback on the need for dental care.
    Journal of Telemedicine and Telecare 02/2006; 12(4):176-81. · 1.47 Impact Factor
  • Dorota Kopycka-Kedzierawski, Ronald J Billings
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    ABSTRACT: Original Article Dye BA, Shenkin JD, Ogden CL, Marshall TA, Levy SM, Kanellis MJ. The relationship between healthful eating practices and dental caries in children aged 2-5 years in the United States, 1988-1994. J Am Dent Assoc 2004;135(1):55-66. Level of Evidence 2b Purpose To investigate the relationship between healthful eating practices (such as breast feeding, eating breakfast, and consuming 5 servings of fruits and vegetables a day) and dental caries in the primary dentition among children aged 2 to 5 years Source of Funding Information not available Type of Study/Design Cross-Sectional
    The journal of evidence-based dental practice 04/2005; 5(1):35-6.
  • Dorota T Kopycka-Kedzierawski, Ronald J Billings
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    ABSTRACT: To apply survival analysis to a longitudinal study of the relationship between salivary mutans streptococci (MS) levels at baseline in initially caries-free children and caries onset in deciduous, mixed, and permanent dentition. The Kaplan-Meier survival analysis method was used to compare survival times to caries onset for initially caries-free children with low levels of MS at baseline with survival times to caries onset for initially caries-free children with high levels of MS at baseline. Data from a 6-year longitudinal study of caries risk in initially caries-free children in Rochester and the Finger Lakes Region of western New York were utilized for this study. Of 464 children analyzed, 327 had a low level of MS and 137 had a high level of MS at baseline. Survival analyses showed that children with a low level of MS at baseline remained caries-free for a longer period than children with a high level of MS at baseline. Statistically significant relationships [hazard ratios (HR)] with onset of caries in deciduous, mixed and permanent teeth were found with high and low levels of salivary MS. Based on our analysis, we concluded that children who were caries-free at baseline and who had high salivary MS levels at baseline would be at greater risk, i.e. more susceptible to caries onset, at any given time than caries-free children who had low salivary MS levels at baseline. Survival functions for deciduous, mixed and permanent dentitions with their 95% confidence limits have been calculated. Survival analysis for the exploration of longitudinal caries studies has an advantage over traditional statistical methods, as it takes into account censored observations and incorporates the concept of risk over time. Hence, survival analysis is well suited for studying transitions from one health state to another, in this case, from a caries-free state to a caries-active state.
    Community Dentistry And Oral Epidemiology 07/2004; 32(3):201-9. · 1.80 Impact Factor
  • Article: Teeth.
    Ronald J Billings, Robert J Berkowitz, Gene Watson
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    ABSTRACT: Common environmental chemicals, drugs, or physical agents can adversely affect human teeth during their embryonic development and after their eruption into the oral cavity. One of the more common elemental toxicants is lead. Teeth are known to accumulate lead during their development. Both animal and human studies have shown that teeth with high lead levels are generally more susceptible to dental caries. Similarly, although inorganic fluorides have long been recognized for their potential to prevent dental caries, exposure to excessive amounts of fluoride when enamel is forming often leads to a type of enamel hypoplasia referred to as dental fluorosis or mottled enamel. Teratogenic agents, such as tetracyclines, a class of antibiotic drugs commonly administered to infants and children, will often result in the discoloration of tooth enamel when prescribed during tooth development. It has recently been suggested that childhood exposure to passive smoking increases the risk for dental caries. Environmental tobacco smoke has previously been linked to periodontal disease in adults. However, this is the first report of an association between passive tobacco smoke and increased susceptibility to dental caries. Last, an often-overlooked source of damage to teeth among all age groups after their eruption into the oral cavity is physical trauma from a variety of sources, especially sports-related injuries. Epidemiologic data suggest that up to one third of all dental injuries are sports related.
    PEDIATRICS 05/2004; 113(4 Suppl):1120-7. · 4.47 Impact Factor
  • Ronald J. Billings, Dorota Kopycka-Kedzierawski
    Journal of Evidence Based Dental Practice. 01/2004; 4(3):242-243.
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    ABSTRACT: To address whether there are associations between the peptide composition of human parotid saliva and dental decay (caries) experience, we have characterized the peptides from parotid ductal saliva collected from nine adults who have remained free from dental caries (mean age = 59.2; Decayed Missing Filled Surfaces index [DMFS] = 0) and nine individuals who have experienced caries (mean age = 51.2; mean DMFS = 38.4). Ethanol-soluble peptides were size-fractionated on columns of Bio-Gel P-2; the salivary peptides derived from caries-susceptible subjects appeared larger than those found in the saliva of caries-free subjects. Peptides were then resolved into 19 species by cation exchange HPLC. Sequence analysis identified 18 peptides that appear to be proteolytic cleavage products of the basic proline-rich proteins IB-4, IB-5, IB-7, IB-8b, and P-B. The peptides that were more abundant in saliva obtained from the caries-free group differed from those isolated from the caries-susceptible group. The median peptide concentration of one possible precursor protein, IB-7, was found to be higher in saliva collected from caries-free individuals than in that from caries-susceptible individuals. Although differences were found in the phenotypes of proline-rich proteins expressed by these groups of caries-free and caries-susceptible subjects, no statistically significant associations were observed among proline-rich phenotypes and the level of any peptide. Collectively, our results indicate that proteolytic processing of parotid salivary proteins differs among individuals who have remained caries-free and those who have experienced dental decay.
    Journal of Dental Research 05/2000; 79(4):976-82. · 3.83 Impact Factor
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    R J Billings, S M Adair, C P Shields, M E Moss
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    ABSTRACT: Intraoral fluoride-releasing (IFR) devices provide elevated levels of fluoride in the mouth for extended periods of time. However, retention and protection of the devices have posed major challenges for clinical applications. The objectives of this study were to develop new methods for retaining and protecting IFR devices in the mouth and to assess their effects on salivary fluoride levels and distribution in adolescents. Four different IFR systems (combinations of an IFR device and its retainer) were evaluated in four groups of 10 adolescents each, 12-15 years of age, for a period of six months. Each child wore two IFR systems of a given type affixed to the buccal surface of each permanent maxillary first molar. Unstimulated saliva samples were collected at each clinical examination and analyzed for fluoride. A significant increase in salivary fluoride concentration from a baseline mean of 0.07-0.69 microgram/mL was observed on day 14 postinsertion. IFR system retention was 85% after 6 months and, of the systems retained, 100% were functional. These findings suggest that IFR devices can be successfully protected and retained in the mouth for prolonged periods of time.
    Pediatric dentistry 01/1998; 20(1):17-24. · 0.56 Impact Factor
  • R J Billings, H M Proskin, M E Moss
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    ABSTRACT: Xerostomia is the subjective sensation of dry mouth. Estimates on the occurrence of xerostomia in community-dwelling adults have ranged from 10% among persons over age 50 to 40% for persons over age 65. Virtually no data are available for persons under age 50. To begin to establish a database on the occurrence of xerostomia and factors associated with it, a cross-sectional assessment of self-reported symptoms and salivary function was conducted across a broad age-range of generally healthy community-dwelling adults. A convenience sample of 710 adults who ranged from 19 to 88 years of age was drawn from various sources in the greater-Rochester, New York area. Study volunteers were administered a standardized questionnaire on general and oral health, which included questions on the symptoms of xerostomia, and were provided an oral screening examination, which included measurement of unstimulated and stimulated whole saliva flow rates. Overall, the observed prevalence of xerostomia was 24% among females and 18% among males. While xerostomia was more commonly observed in women than men, this association was only clear after age 50. Xerostomia was associated with: use of medications with hyposalivatory side-effects; difficulty with dry foods; cracked lips; dry eyes; difficulty swallowing; and, among males, current cigarette smoking. Results indicated a tendency for salivary flow rates to be lower for older persons, particularly the stimulated flow rate. There was a tendency in the younger cohorts for flow rates to be lower among individuals who reported sensation of dry mouth than among those who did not. This tendency was not apparent among older persons, suggesting that younger persons may be more likely to experience symptoms of oral dryness when salivary flow was low while older persons may relate symptoms of dry mouth to a more complex constellation of factors where salivary flow is only one component. These findings need to be examined further.
    Community Dentistry And Oral Epidemiology 11/1996; 24(5):312-6. · 1.80 Impact Factor