ArticleLiterature Review

Xerostomia: An update for clinicians

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Abstract

Saliva plays an important protective role in the oral environment, and reductions in saliva quantity are known to increase the risk of oral diseases. Importantly, xerostomia or the perception of a dry mouth is now being recognized as an important risk factor for dental diseases. Furthermore, the subjective sensation of a dry mouth is a debilitating condition in itself that impacts on the quality of life of sufferers. With approximately 1 in 5 people reporting some form of dry mouth, and an increasing prevalence in the elderly, it is important for clinicians to have a thorough understanding of this problem. The aim of this paper is to review some of the literature relating to xerostomia in order to provide an evidence based update for clinicians.

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... Dry mouth, also known as "xerostomia", is a common medical condition that can complicate a patient's oral health, dietary intake, and quality of life (QoL). It affects an estimated 5.5% to 46% of persons in the United States (US) and is more common in women, Caucasians, and the elderly (1)(2)(3)(4)(5)(6)(7)(8). While common in those over 65 years of age (30%), salivary production and composition are not solely age-dependent (9)(10). ...
... While common in those over 65 years of age (30%), salivary production and composition are not solely age-dependent (9)(10). Oral dryness in a majority of the individuals (tens of millions) is due to the adverse effects of medications (1)(2)(3)(4)(5)(6)(7)(8). Chronic disease and medical treatments, such as chemotherapy and radiotherapy, to the head and neck region are also commonly associated with dry mouth (1)(2)(3)(4)(5)(6)(7)(8)(11)(12)(13)(14). ...
... Oral dryness in a majority of the individuals (tens of millions) is due to the adverse effects of medications (1)(2)(3)(4)(5)(6)(7)(8). Chronic disease and medical treatments, such as chemotherapy and radiotherapy, to the head and neck region are also commonly associated with dry mouth (1)(2)(3)(4)(5)(6)(7)(8)(11)(12)(13)(14). Other etiological factors include dehydration, mouth breathing, caffeine intake, and tobacco use; however, these factors do not necessarily reflect the permanent loss of salivary gland function (15)(16)(17). ...
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Background: Dry mouth, also commonly known as "xerostomia", is a prominent symptom that is often overlooked by dental practitioners and patients. The purpose of this study was to pilot the development of a mobile application for assessing dry mouth symptoms. The application will allow patients to self-assess and enhance knowledge, awareness and communication with dental practitioners in their management of dry mouth. Method: The first phase of the study was to draw on common knowledge and awareness by conducting two focus groups of dental professionals and community members on content, practicality, functionality, design, and effectiveness. The second phase of the study was the development of the dry mouth mobile application followed by the third phase of the study that consisted of face-validity interviews to obtain feedback on the application. Results: Fifty two percent (n=15) of the dental professionals estimated being aware of the prevalence of dry mouth in 40% or more of their patients. Thirty Nine percent of (n=9) community estimated being aware of the prevalence of dry mouth in 40% or more of the community. When asked about their awareness of the etiologies of dry mouth, 100% (n=29) of dental professionals reported that multiple medications and smoking were primary factors whereas the community members indicated that illness and dehydration (87%, n=20) were primary factors in dry mouth. Dental professional's (25% n=7) were very confident in recognizing symptoms and 28% (n=8) were very confident they knew how to manage dry mouth symptoms. Furthermore, 22% (n=5) of the community members were also very confident about recognizing dry mouth symptoms and 13% (n=3) were very confident knowing how managing it. The ToP report generated from the discussions identified "themes" that were utilized in the development of the mobile application. Most individuals who participated in the validity interviews agreed that the dry mouth mobile application was useful, appealing, easy to use and the self-assessment test gave clear and concise information. The application was made available to download from the iTunes Appstore (2019-2020). Conclusion: The dry mouth pilot study indicated that the mobile application was beneficial for self-assessment and easy to use. Development of advanced technology tools such as the dry mouth application can promote communication between patients and their dental practitioners to discuss management options for dry mouth.
... This is term is based on an individual's own sensation of dry mouth, which depending on the cause is not necessarily correlated with an objective decrease in the amount of saliva (hyposalivation) (3). Xerostomia with or without hyposalivation can impair speaking (4,5), chewing (4,5), tasting (6) and swallowing (1,3), having a significant impact on the oral health-related quality of life (OHRQoL) (7). When xerostomia is accompanied with hyposalivation, individuals are at a higher risk of developing dental caries (2,4), gingivitis (4), erosion and ulceration of mucosal tissues (6), oral candidiasis, dys-geusia and dysphagia (6,8), which have also a detrimental effect on the OHRQoL (7,9). ...
... This is term is based on an individual's own sensation of dry mouth, which depending on the cause is not necessarily correlated with an objective decrease in the amount of saliva (hyposalivation) (3). Xerostomia with or without hyposalivation can impair speaking (4,5), chewing (4,5), tasting (6) and swallowing (1,3), having a significant impact on the oral health-related quality of life (OHRQoL) (7). When xerostomia is accompanied with hyposalivation, individuals are at a higher risk of developing dental caries (2,4), gingivitis (4), erosion and ulceration of mucosal tissues (6), oral candidiasis, dys-geusia and dysphagia (6,8), which have also a detrimental effect on the OHRQoL (7,9). ...
... When xerostomia is accompanied with hyposalivation, individuals are at a higher risk of developing dental caries (2,4), gingivitis (4), erosion and ulceration of mucosal tissues (6), oral candidiasis, dys-geusia and dysphagia (6,8), which have also a detrimental effect on the OHRQoL (7,9). Xerostomia affects millions of persons worldwide, with an estimated prevalence that ranges from 10-46% (1,5). Dry mouth sensation is most common in menopausal women and in individuals above 65 years of age (10). ...
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Background: Xerostomia or dry mouth sensation corresponds to a common clinical problem that can significantly impair the oral health related quality of life (OHRQoL). Currently, there is a large variety of local agents available for the treatment of xerostomia, but there is a lack robust evidence supporting the use of one treatment over another. We aimed to compare the effectiveness of a 1% malic acid salivary stimulant spray with a 1.33% betaine-based saliva substitute mouthwash in the improvement of xerostomia. Material and methods: Fifty-one participants with drug induced or idiopathic xerostomia were randomly allocated into three groups, two intervention and one control group (placebo). OHRQoL and severity of xerostomia were assessed with the OHIP-14sp questionnaire and a visual analogue scale (VAS) respectively. Stimulated and non-stimulated salivary flow rates before and after treatments were also measured. Results: All three groups reported a significantly improvement in the dry mouth sensation and non-stimulated salivary flow rates, but only the malic acid spray and the betaine-based mouthwash significantly improved the OHRQoL. There were no significant differences between both intervention groups. Conclusions: This study provides evidence that both tested agents are comparable in improving the dry mouth sensation and OHRQoL of patients with drug induced and idiopathic xerostomia. Key words:Xerostomia, dry mouth, malic acid, betaine, oral-health related quality of life.
... Xerostomia (or dry mouth) is the medical term used to describe the subjective sensation of oral dryness, which commonly exists as a consequence of reduced salivary flow (hyposalivation) [1][2][3]. However, despite its connection to salivation, studies have shown that in various cases, patients with xerostomia appear to have normal salivary flow [4][5][6]. Hence, the term "symptomatic" xerostomia (or else "pseudo" xerostomia) is nowadays used to refer to oral dryness despite the salivary gland function [7][8][9]. In general, patients with xerostomia suffer symptoms that significantly affect their health as well as social and emotional aspects of their life. ...
... Xerostomia is often referred as hyposalivation [4]; however, these two terms do not correspond to identical conditions and should not be used interchangeably. Hyposalivation refers solely to the objective observation of reduced salivary flow due to external or internal influences, while xerostomia encompasses the subjective sensation of oral dryness [23]. ...
... The establishment of the correct diagnosis is considered as the most crucial step in the management of patients with xerostomia, since it encompasses the distinguishment of patients with subjective complaints from those presenting salivary gland hypofunction as well [4]. Once a diagnosis is established and an underlying etiology is identified, a stepwise management approach can be implemented, aiming to institute preventive measures, alleviate symptoms, treat oral manifestations, and improve salivary function. ...
Article
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The medical term xerostomia refers to the subjective sensation of oral dryness. The etiology seems to be multifactorial with the most frequently reported causes being the use of xerostomic medications, neck and head radiation, and systematic diseases (such as Sjögren's syndrome). Xerostomia is associated with an increased incidence of dental caries, oral fungal infections, and difficulties in speaking and chewing/swallowing, which ultimately affect the oral health-related quality of life. The development of successful management schemes is regarded as a highly challenging project due to the complexity of saliva. This is why, in spite of the fact that there are therapeutic options aiming to improve salivary function, most management approaches are alleviation-oriented. In any case, polymers are an integral part of the various formulations used in every current treatment approach, especially in the saliva substitutes, due to their function as thickening and lubricating agents or, in the case of mucoadhesive polymers, their ability to prolong the treatment effect. In this context, the present review aims to scrutinize the literature and presents an overview of the role of various polymers (or copolymers) on either already commercially available formulations or novel drug delivery systems currently under research and development.
... Marcott et al. has recently suggested that the condition affects 10% to 46% of people amongst the US, Mexico, and several countries in Europe [7]. A study that analyzed population-based measures of the condition concluded that the prevalence of xerostomia ranges from 9.7 to 25.8% in men and 10.3 to 33.3% in women [8]. ...
... Patients can also experience sore throat and an altered sense of taste [10]. Because saliva acts to remove excess bacteria and plaque from the teeth, the lack of saliva in xerostomic patients can increase the risk of dental caries and infections [8]. In addition, the subjective perception of xerostomia is frequently, but not always, associated with reduced salivary flow [1,8,11]. ...
... Because saliva acts to remove excess bacteria and plaque from the teeth, the lack of saliva in xerostomic patients can increase the risk of dental caries and infections [8]. In addition, the subjective perception of xerostomia is frequently, but not always, associated with reduced salivary flow [1,8,11]. ...
Article
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Xerostomia (subjective complaint of dry mouth) is commonly associated with salivary gland hypofunction. Molecular mechanisms associated with xerostomia pathobiology are poorly understood, thus hampering drug development. Our objectives were to (i) use text-mining tools to investigate xerostomia and dry mouth concepts, (ii) identify associated molecular interactions involving genes as candidate drug targets, and (iii) determine how drugs currently used in clinical trials may impact these genes and associated pathways. PubMed and PubMed Central were used to identify search terms associated with xerostomia and/or dry mouth. Search terms were queried in pubmed2ensembl. Protein–protein interaction (PPI) networks were determined using the gene/protein network visualization program search tool for recurring instances of neighboring genes (STRING). A similar program, Cytoscape, was used to determine PPIs of overlapping gene sets. The drug–gene interaction database (DGIdb) and the clinicaltrials.gov database were used to identify potential drug targets from the xerostomia/dry mouth PPI gene set. We identified 64 search terms in common between xerostomia and dry mouth. STRING confirmed PPIs between identified genes (CL = 0.90). Cytoscape analysis determined 58 shared genes, with cytokine–cytokine receptor interaction representing the most significant pathway (p = 1.29 × 10−23) found in the Kyoto encyclopedia of genes and genomes (KEGG). Fifty-four genes in common had drug interactions, per DGIdb analysis. Eighteen drugs, targeting the xerostomia/dry mouth PPI network, have been evaluated for xerostomia, head and neck cancer oral complications, and Sjögren’s Syndrome. The PPI network genes IL6R, EGFR, NFKB1, MPO, and TNFSF13B constitute a possible biomarker signature of xerostomia. Validation of the candidate biomarkers is necessary to better stratify patients at the genetic and molecular levels to facilitate drug development or to monitor response to treatment.
... It has been estimated that xerostomia (dry mouth) affects approximately 20% of the population [1][2][3], with prevalences ranging from 12-39% [2][3][4][5][6]. The disorder is more common among the elderly and in individuals receiving multiple drug treatments [4][5][6] and, moreover, women appear to be more susceptible than men [1][2][3]. ...
... It has been estimated that xerostomia (dry mouth) affects approximately 20% of the population [1][2][3], with prevalences ranging from 12-39% [2][3][4][5][6]. The disorder is more common among the elderly and in individuals receiving multiple drug treatments [4][5][6] and, moreover, women appear to be more susceptible than men [1][2][3]. ...
Article
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Objective: xerostomia is a very common problem in the general population. The objective of this study was to determine the efficacy of a new gel and toothpaste in patients with xerostomia, analyze the role of salivary cytokines as biomarkers of xerostomia and assess the possible changes in salivary cytokines following treatment. Materials and methods: A randomized, controlled double-blind clinical study was carried out in 73 patients with xerostomia divided into two groups: placebo and active treatment (cymenol; tocopheryl acetate; D-panthenol; Aloe barbadensis; citrate tribasic dihydrate; fluoride) with oral gel and toothpaste three times a day for four consecutive weeks. The Thomson Xerostomia Inventory was applied, with the assessment of oral quality of life (OHIP-14) at baseline and after four weeks of application of the product. Sialometry was also performed in both groups, with analysis of the IL-1b, IL-6, IL-8 and TNFa levels in saliva. Results: In the active treatment group, the xerostomia scores decreased significantly at the end of the study versus baseline, from 33.47 to 27.93 (p < 0.001). No significant decrease was recorded in the placebo group (34.5 to 32.75; p = 0.190). There were no adverse effects in either group. Regarding the saliva samples, the active treatment group showed significant differences in IL-6 concentration versus the control group (18.55 pg/mL (8-38.28) and 5.83 pg/mL (1.19-12.04), respectively; p = 0.002). No significant differences in salivary cytokines were observed in either the treatment group or the control group. Conclusions: The use of a new toothpaste and gel developed for patients with xerostomia proved effective, with greater symptom relief than in the placebo group. Further clinical studies involving longer time periods and larger samples are advisable in order to confirm the benefits of the described treatment.
... Saliva is produced by the parotid, submandibular and sublingual glands as well as a plethora of solitary minor glands dispersed within the submucosal layer of the oral cavity [12]. Salivary fluid is composed of water, electrolytes, proteins, lipids, buffers and antimicrobial agents, providing a first line of defense against invading organisms [12][13][14][15]. Additionally, saliva as a whole provides hydration of the teeth and mucous membranes, and facilitates initial food digestion, taste, articulation and swallowing [12]. ...
... Patients and controls were all aged 30-80 years (mean age patients 57.8 years, mean age controls 52.9 years), had no other diseases that could explain sicca symptomatology and did not use multiple medications influencing saliva and tear production. The ten patients from whom saliva was analyzed had a mean number of 24 teeth (range 16-28) and mean DMFT (decayed, missing due to caries, and filled teeth) of 17 (range [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. None had dental implants and only one had a partial denture. ...
Article
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The diagnostic work-up of primary Sjögren’s syndrome (pSS) includes quantifying saliva and tear production, evaluation of autoantibodies in serum and histopathological analysis of minor salivary glands. Thus, the potential for further utilizing these fluids and tissues in the quest to find better diagnostic and therapeutic tools should be fully explored. Ten samples of saliva and tears from female patients diagnosed with pSS and ten samples of saliva and tears from healthy females were included for lipidomic analysis of tears and whole saliva using high-performance liquid chromatography coupled to time-of-flight mass spectrometry. In addition, lipidomic analysis was performed on minor salivary gland biopsies from three pSS and three non-SS females. We found significant differences in the lipidomic profiles of saliva and tears in pSS patients compared to healthy controls. Moreover, there were differences in individual lipid species in stimulated saliva that were comparable to those of glandular biopsies, representing an intriguing avenue for further research. We believe a comprehensive elucidation of the changes in lipid composition in saliva, tears and minor salivary glands in pSS patients may be the key to detecting pSS-related dry mouth and dry eyes at an early stage. The identified differences may illuminate the path towards future innovative diagnostic methodologies and treatment modalities for alleviating pSS-related sicca symptoms.
... Additionally, these results lead us to conclude that symptoms and the results of diagnosis differ in several xerostomia patients. In some papers, "xerostomia" is interchangeably associated with "salivary gland hypofunction," but in other papers, association between xerostomia and salivary gland hypofunction is still under investigation [17,18]. Xerostomia is a subjective symptom, and salivary gland hypofunction is an objectively measured condition. ...
... In a systematic review, xerostomia prevalence ranged from 8 to 42%, while salivary gland hypofunction prevalence ranged from 12 to 47%. The prevalence of both conditions existing together is only approximately 2 to 6% [17,19]. Our results also show that several patients experience xerostomia; however, during outpatient consultation, salivary gland hypofunction was not observed. ...
Article
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Objectives To determine the general condition of elderly xerostomia patients, we collected their background and medication data in order to potentially treat their xerostomia. It is critical to identify the drugs causing xerostomia in elderly patients. A total of 521 patients who were examined at the Xerostomia Clinic of Osaka University Dental Hospital were included in the study. We obtained patients’ data on age, sex, number of primary illnesses, Saxon test scores, oral moisture test, subjective symptoms, and drug types from their clinical records. Results The mean age of the patients was 65.2 ± 13.3 years. Although all patients exhibited xerostomia symptoms, there were a lot of patients without hyposalivation. With respect to medication, each elderly xerostomia patient took an average of 6.8 ± 4.4 medicines. A total of 26.1% of patients in their 70 s took more than ten number of drugs. In addition, the number of frequently used medication medicine was different between elderly and young patients. Most of the medicines had xerostomia as a side effect in medical package inserts. Moreover, the quantity of salivation significantly decreased in patients who took more than seven drugs in comparison with the patients who did not take medicine. Conclusions As patients age, the number of medications they take tends to increase, subsequently increasing their risk of xerostomia. For the health of the patients, it is critical that an accurate diagnosis is made. Clinical relevance To establish therapeutic strategies for treatment of xerostomia, this study provides new and important information that will help in the development of xerostomia medical treatment.
... From the clinical aspect, both changes in the composition of saliva and a reduction in the quantity secreted may be an objective finding of dry mouth [17,18]. Dry mouth is a common problem in the general population with a prevalence between 10% and 33%, being more common in females [19,20]. Although xerostomia more frequently affects the elderly, it may also be present in young adults [21,22]. ...
... Some individuals may manage the problems associated with dry mouth through optimal handling of the underlying conditions [23]. For patients with milder symptoms, frequent sips of water and sucking of ice chips may result in sufficient relief [19]. It is recommended to reduce/avoid the consumption of alcoholic drinks, caffeine, and smoking as they additionally dehydrate the oral mucosa [47,48]. ...
Article
Full-text available
Objectives: Xerostomia is a subjective sensation of dry mouth. It is commonly associated with salivary gland hypofunction. Both changes in the composition of the saliva and a reduction in the quantity secreted may be an objective finding of dry mouth. Although there are no currently available cures for the conditions resulting in dry mouth, there are several treatment options that give hope for patients who suffer from xerostomia. Individuals with some residual salivary gland function, which are contraindicated to pharmacological therapies, would benefit the most from identifying novel, alternative effective methods for stimulating production of saliva. The aim of this study was to give an overview of the latest and most relevant data related to treatment modalities for the management of dry mouth conditions. Data Resources and Study Selection. The present review was prepared by searching the National Library of Medicine database using the relevant medical terms and their combinations. A total of thirty-three studies met the inclusion criteria. Data were extracted by one author and verified by another. Conclusion: A number of patients showed positive treatment outcomes, and the adverse effects of both electrical stimulation (ES) and acupuncture have been reported as mild and transient. In patients who have undergone radiotherapy, acupuncture is shown to increase salivation. However, in patients with Sjogren's syndrome, the effects of ES devices seem to be elusive. Moreover, due to the instability of the findings in relation to longevity of clinical effect, patient satisfaction, quality of life, and clinical effectiveness of such treatments, the results remain vague.
... The term "dry mouth" usually covers one of two conditions: xerostomia or hyposalivation [2]. Xerostomia, the most prevalent form of mouth dryness, is defined as a subjective sensation that is usually assessed directly by asking individuals about their dry mouth experience [3]. Hyposalivation is objectively diagnosed and based on the amount of saliva produced [4]. ...
... Hyposalivation is objectively diagnosed and based on the amount of saliva produced [4]. Mouth dryness has been associated with poor oral health, as indicated by higher rates of dental caries, periodontal diseases, and oral infections; prosthetic problems were also observed in patients with dry mouth [3]. Dry Open Access *Correspondence: lina.stangvaltaite@uit.no ...
Article
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Objectives To assess the prevalence and determinants of xerostomia among adults and identify how many of the ones experiencing xerostomia have Sicca and Sjogren's syndromes. Materials and methods This cross-sectional study included 1405 35–74-year-old Lithuanians (51.7% response rate) from the five largest Lithuanian cities and 10 peri-urban and rural areas that were randomly selected from each of the 10 Lithuanian counties. Xerostomia was determined by the self-reported experience of dry mouth as "often" or "always". A dentist diagnosed Sicca syndrome by unstimulated whole sialometry and the Schirmer's test, and all cases were referred to a rheumatologist to confirm Sjogren's syndrome. Self-reported questionnaires collected data about the determinants. Results The prevalence of xerostomia was 8.0% (n = 112), Sicca syndrome was diagnosed for 8 participants (0.60%), and Sjogren's syndrome for 2 participants (0.14%), with this being the first time it was diagnosed. Experiencing xerostomia was associated with older age (OR 1.7, 95% CI 1.1–2.6), urban residence (OR 3.3, 95% CI 1.6–5.0), presence of systemic diseases (OR 2.5, 95% CI 1.4–3.3), and the use of alcohol (OR 0.6, 95% CI 0.4–0.9). The higher proportion of participants with Sicca syndrome involved females, of older age, having systemic diseases, and using medications. Conclusions The prevalence of xerostomia was 8.0% and the determinants of xerostomia were older age, urban residence, systemic diseases, and absence of using alcohol. In total, 0.6% of participants had Sicca syndrome, which was more prevalent among females, older subjects, those with systematic diseases, and those using medications. Sjogren's syndrome was diagnosed in 0.14% of participants . Clinical relevance Dental clinicians need to be trained to identify potential Sjogren's syndrome cases.
... Oral manifestations due to xerostomia are classified into three, namely; the mild, without complaints or severe consequences, have a significant impact on oral health and quality of life of the patient (2,8). In addition, Azambuja et al in 2012 stated that in 71 patients suffering from xerostomia, 42.3% had difficulty in chewing and swallowing food and 67.6% reported an increase in fluid intake (9). ...
... Xerostomia is characterized by hyposalivation of the oral cavity, in which the total flow rate of saliva with stimulation is ≤0.7 ml/min and the total non-stimulation is ≤0.2 ml/min (2). In addition, the mechanism of saliva secretion is the reflex activity of the oral cavity. ...
Article
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Endocrine and biological changes occur in postmenopausal women, the production of steroid sex hormones that affect the health of the oral cavity, with the reduction of all or part of estrogen resulting in xerostomia (dry mouth). The treatment of Xerostomia was carried out using local, mechanical and chemical stimulation. The purpose of this study was to determine the effect of gargling of green tea steeping on salivary flow rates in postmenopausal women with xerostomia at Darussalam Public Health Center in Medan.This is an experimental study using the design of control group, pretest-posttest and the non-probability of purposive sampling. Fourty menopausal women with xerostomia were used as sample. The treatment group gargled with green tea steeping while the control group gargled with distilled water. Saliva was collected into the pots for three minutes before and after treatment by spitting method. The analytical test used was the paired T-test and the unpaired.The results showed that there was an increase in salivary flow rate with green tea brushing rinse by 0.281750 ml/min and with aquades rinsing by 0.03335 ml/min. Furthermore, there was an effect of gargling with green tea steeping, namely an increase in the flow rate of saliva and this research can be an alternative treatment to relieve xerostomia in menopausal women.The green tea gargling was better in stimulating salivary flow rate.
... The same factors may contribute to causing periodontal diseases. Altered immunity, hyposalivation, and physical disability may increase the incidence of periodontal diseases and gingival recession 18 . Autoimmune diseases associated with aging can also accelerate the destruction of periodontal tissues due to the overreaction of the immune cells against periodontal pathogens toxins 19 . ...
Thesis
Current knowledge points to a dysbiosis in root caries, and periodontitis or loss of the balance between the microbial consortia and the host immune and inflammatory responses destroys periodontal and hard tissues. The distinctive synergetic interaction between root caries and periodontal diseases demands innovative interventions to preserve the tooth structure and surrounding soft tissues. An expanding area of research focuses on therapeutic interventions that modulate microbial ecology to restore dental biofilms' homeostasis and thus oral health. This dissertation is composed of a set of manuscripts aiming to advance the anti-biofilm approaches to prevent root caries and periodontal diseases from two perspectives: (i) invasive approach via novel bioactive resin composites, and (ii) non-invasive approach via magnetic field-guided antimicrobial photodynamic therapy (MF-aPDT). In the first chapter, I provided a general introduction to the clinical burden of root caries and periodontal diseases and current treatment modalities for these diseases and their limitations. In the second chapter, I provided an overview of contact- killing monomers and bioactive fillers in restorative dentistry. Then, in chapter three, we developed bioactive resin composite formulations containing dimethylaminohexadecyl methacrylate (DMAHDM) antibacterial monomer and 20% nano-sized amorphous calcium phosphate (NACP) and subjected them to a series of mechanical/physical performance tests and antibacterial assays. We found that the DMAHDM-NACP resin composites were associated with a potent antibacterial action against cariogenic and periodontal biofilms, as 2 to 6-log reduction was observed. Other virulence factors, as lactic acid production, and polysaccharide production, were also reduced. The mechanical properties, physical characteristics, surface features, and polymerization behavior were comparable to the commercial control at baseline testing and after one year of aging. We concluded that the designed bioactive formulations might present a pathway to control recurrent caries and prevent the onset of periodontal diseases around dental restorations. In chapter four, we reviewed the most recent updates related to the implementation of nanotechnology to enhance antimicrobial photodynamic therapy (aPDT). Chapter four reviewed the most recent updates related to the performance of nanotechnology to enhance antimicrobial photodynamic therapy (aPDT). Then, in chapter five, I investigated the impact of encapsulating superparamagnetic iron oxide nanoparticles (SPIONs) and toluidine blue ortho (TBO) inside a microemulsion, named MagTBO, to enhance the TBO’s penetration and antibacterial action against S. mutans and saliva-derived biofilms. Besides, the ability of magnetic field (MF) navigation to serve as a biofilm penetration strategy was also investigated. The MagTBO microemulsions were synthesized successfully and demonstrated excellent biocompatibility and thermodynamic stabilities. Furthermore, when MF is applied, the MagTBO microemulsions demonstrated more remarkable and significant antibacterial action than conventional aPDT, especially when the MF is applied. Thus, this approach can be an adjunctive technique to control dental caries and other oral diseases.
... Oral candidiasis is a common opportunistic infection of the oral cavity caused by an overgrowth of candida species particularly Candida albicans [2]. Numerous risk factors such as age, gender, nutrition, oral hygiene, smoking, dentures, salivary pH disorder, and xerostomia (dry mouth) make diabetic patients more susceptible to oral candidiasis [3,4]. ...
... 158,159 The prevalence of xerostomia, however, varies from 5.5% to 46% depending on the method of assessment used and the population cohorts studied. 160,161 Generally, women and older people suffer more from xerostomia and have lower salivary flow rates than men and younger people due to a higher number of diseases and a higher intake of medication among women and older people. 159 hyposalivation, a term that is based on objective measures of the salivary flow rate (sialometry). ...
Article
Xerostomia and salivary gland hypofunction impact oral health and quality of life and are mainly caused by the intake of medications, chronic disorders like Sjögren's syndrome, and head and neck radiation. Other aetiologies may be local diseases of the salivary glands including infections, cancer, or obstructive diseases of the salivary ducts. Management strategies are primarily alleviating symptoms. Current investigations show promising results in stem cell treatment. In this review, we want to provide comprehension of the aetiologies, evaluation, and management of xerostomia and hyposalivation.
... Xerostomia is defined as subjective oral dryness in contrast to hyposalivation, which is an objective reduction of the salivary flow. [1][2][3] The prevalence of xerostomia in the general population varies from 8% 4 to 13%. 5 The range of the underlying medical conditions leading to hyposalivation is increasing. Whereas Sjögren's syndrome, xerostomia after radiation therapy, and xerogenic medication have been known for a long time, there is rising incidence of other pathologies leading to xerostomia including post radioiodine treatment for thyroid cancer, 6 juvenile recurrent parotitis (JRP), 7 IgG4-related disease, 8 and chronic sialadenitis caused by salivary stones or salivary strictures of unknown etiology. ...
Article
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Objectives First, establishment and validation of a novel questionnaire documenting the burden of xerostomia and sialadenitis symptoms, including quality of life. Second, to compare two versions regarding the answering scale (proposed developed answers Q3 vs. 0–10 visual analogue scale Q10) of our newly developed questionnaire, in order to evaluate their comprehension by patients and their reproducibility in time. Study Design The study is a systematic review regarding the evaluation of the existing questionnaire and a cohort study regarding the validation of our new MSGS questionnaire. Materials and Methods A Multidisciplinary Salivary Gland Society (MSGS) questionnaire consisting of 20 questions and two scoring systems was developed to quantify symptoms of dry mouth and sialadenitis. Validation of the questionnaire was carried out on 199 patients with salivary pathologies (digestive, nasal, or age-related xerostomia, post radiation therapy, post radioiodine therapy, Sjögren's syndrome, IgG4 disease, recurrent juvenile parotitis, stones, and strictures) and a control group of 66 healthy volunteers. The coherence of the questionnaire's items, its reliability to distinguish patients from healthy volunteers, its comparison with unstimulated sialometry, and the time to fill both versions were assessed. Results The novel MSGS questionnaire showed good internal coherence of the items, indicating its pertinence: the scale reliability coefficients amounted to a Cronbach's alpha of 0.92 for Q10 and 0.90 for Q3. The time to complete Q3 and Q10 amounted, respectively, to 5.23 min (±2.3 min) and 5.65 min (±2.64 min) for patients and to 3.94 min (±3.94 min) and 3.75 min (±2.11 min) for healthy volunteers. The difference between Q3 and Q10 was not significant. Conclusion We present a novel self-administered questionnaire quantifying xerostomia and non-tumoral salivary gland pathologies. We recommend the use of the Q10 version, as its scale type is well known in the literature and it translation for international use will be more accurate. Laryngoscope, 2021
... Xerostomia (the feeling of dry mouth) is the fourth most distressing symptom known with a variety of causes and high prevalence rate that approximately 20% in the general population [4,15,16,17]. Little is known about the dental health status of institutionalized Egyptian psychiatric patients. ...
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Background: Xerostomia is a subjective sensation of mouth dryness often occurring as an unwanted effect of antidepressant drugs. These medications used to treat the depression magnify the xerostomia and increase the incidence of dental disease. Aim: The aim of this study was to evaluate the effectiveness of oral nursing interventions on xerostomia-related symptoms among patients with depression. Subjects: A purposive sample of 50 patients with depression was recruited for this study. They were received oral nursing intervention (verbal-written) instructions, regular tooth brushing 3 times a day and follow-up visits for oral hygiene instructions and maintenance care). Tools: 1-Interviewing questionnaire to assess demographic data and xerostomia symptoms. 2-Visual analog scale to assess degree of xerostomia-related symptoms. Results: The results revealed statistical significance improvement of xerostomia after oral nursing intervention, P<0.001. Conclusions: Oral Nursing Intervention exhibited significantly improvement of xerostomia among patient with depression.
... Xerostomia is characterized by a hyposalivation, in which the unstimulated salivary flow rate is less than 0.1 ml / minute and the stimulated salivary flow rate is less than 0.7 ml / minute [21]- [22]- [23]. Xerostomia can be treated and treated using stimuli and saliva. ...
... Flow rates of less than 0.1 mL/min in unstimulated whole saliva and those of 0.7 mL/min in stimulated whole saliva have been suggested as the diagnostic criteria for salivary gland hypofunction (von Bultzingslowen et al., 2007). However, the disproportionality between the actual reduction in salivary secretions and the degree of subjective oral dryness is well known (Hopcraft & Tan, 2010;Lee, Lee et al., 2002;Narhi, 1994;Villa, Connell, & Abati, 2015). Generally, individuals felt dry mouth symptoms when salivary secretions had decreased to one-half of their normal values (Ship, Fox, & Baum, 1991). ...
Article
Objectives The aim of the present study was to review the existing phenomena which could affect subjective oral dryness and to consider the possibility that neural processing is involved in the perception of oral dryness. Design A comprehensive review of scientific literatures relevant to contributing factors of dry mouth symptoms including salivary parameters related with oral dryness and role of neural mechanisms in perception of dry mouth symptoms was conducted. Results Several previous reports suggested the possibility of neural processing mechanisms in perception of oral dryness. The decreased pain threshold in the oral cavity of rats with dry tongue and complaints of subjective oral dryness in patients with burning mouth syndrome, of which lacked an actual decrease in salivary output and mucosal wetness, could support this idea. Sensory changes in the oral mucosa and oral dryness may have a bi-directional influence that patients with oral dryness would be more subject to neuropathic pain in the oral mucosa, and those with neuropathic pain in the oral cavity could have complaints associated with higher levels of dry mouth symptoms. Conclusion A bi-directional influence between sensory change in the oral mucosa and subjective oral dryness could be assumed. We suggest the administration of neuropathic pain medications for controlling subjective oral dryness in patients without objective sign of hyposalivation.
... Determining the epidemiology of xerostomia is complex due to the unclear definitions of dry mouth being used and the different methods for measuring this condition (Ying Joanna & Thomson, 2015). A systematic review reported that the prevalence of xerostomia ranged from 8% to 42%, while the prevalence of hyposyalia varied from 12% to 47% (Hopcraft & Tan, 2010). Xerostomia prevalence is estimated to be approximately 20% in the general population, with an increased prevalence in women (up to 30%) and in elderlies (up to 50%) (Furness, Worthington, Bryan, Birchenough, & McMillan, 2011). ...
Article
Xersotomia is associated with food avoidance and low nutritional assessment. This review seeks to document whether products called “saliva substitutes” or “artificial saliva” can really replace saliva in food oral processing. Pubmed and Science Direct were searched for articles using the keywords “saliva substitutes” and “artificial saliva”. An advanced search was applied using the terms “xerostomia” and/or “food oral processing” and/or “eating” and/or “mastication” and/or “chewing” and/or “swallowing”. The analysis methods and the inclusion criteria were documented in a protocol published in the International prospective register of systematic reviews (PROSPERO with the registration number CRD42019124585). The search included 43 articles, published between 1979 and 2017. Among the included studies, 17 were observational studies, 5 were pilot studies, 21 were crossover studies and 14 of these studies were blinded. The Strobe score for the included articles varied from 7.5 to 20. The possible effects of the use of saliva substitutes on the ingestion function were poorly investigated. No evidence was based on physiological studies. It is unknown whether using a saliva substitute has an effect on the composition and rheological properties of the food bolus, on the lubrication of the oral and laryngeal mucosa or on both phenomena. Moreover, saliva substitutes were not formulated to improve food oral processing and most of them are flavoured. New saliva substitutes and artificial saliva should be designed and formulated to improve food oral processing.
... This suggested that the increased saliva viscosity and reduced amount of saliva observed in Bmi-1 -/mice are similar to the symptoms of xerostomia. Xerostomia is defined as the subjective perception of dry mouth that is typically associated with increased salivary viscosity and reduced salivary flow [33][34][35][36], which cannot only causes oral disease and poor oral hygiene [37,38] but also has systemic adverse effects, such as increased risk of aspiration pneumonia [39,40]. Bmi-1 -/mice have hematopoietic defects and neurological abnormalities, which results in death within 20 weeks after birth [8]. ...
Article
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Mucins, the major components of salivary mucus, are large glycoproteins abundantly modified with O-glycans. Mucins present on the surface of oral tissues contribute greatly to the maintenance of oral hygiene by selectively adhering to the surfaces of microbes via mucin O-glycans. However, due to the complex physicochemical properties of mucins, there have been relatively few detailed analyses of the mechanisms controlling the expression of mucin genes and the glycosyltransferase genes involved in glycosylation. Analysis performed using supported molecular matrix electrophoresis, a methodology developed for mucin analysis, and knockout mice without the polycomb group protein Bmi-1 revealed that Bmi-1 regulates mucin levels in the submandibular gland by suppressing the expression of the mucin Smgc gene, and that Bmi-1 also regulates mucin O-glycosylation via suppression of the glycosyltransferase Gcnt3 gene in the submandibular gland.
... Patients may complain of mouth dryness, a burning sensation of the oral mucosa, halitosis, and impairment in oral function (dysphagia, dysgeusia, and speech disorder) [1]. Furthermore, there is a total or partial decline in the salivary functions of protection, repair, and lubrication due to a reduction in salivary flow rates, poor clinical oral health, and an increase in the prevalence of dental caries [5,6], candidosis [7], periodontal diseases, and mucosal lesion formation [8]. ...
Article
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Objectives To investigate the effects of anti-obesity drug sibutramine hydrochloride (SB) on redox state and biochemical parameters in the salivary glands. Materials and methods Adult male Wistar rats were randomly divided into the following groups (n = 8 per group): control rats treated with vehicle (C) and rats treated with SB (10 mg/kg/day) by intragastric gavage for 28 days. The parotid (PG) and submandibular (SMG) glands were processed using histomorphometric analysis, and total protein, amylase, mucin, and oxidative damage to lipids were determined by measuring the formation of thiobarbituric acid reactive substances (TBARS), total antioxidant capacity (TAC), uric acid (UA), total glutathione (tGSH), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), and AKT phosphorylation. Results SB decreased the acinar area, and increased the stromal area in PG, while no effect on the morphometric parameters was observed in SMG. SB also increased oxidative damage to lipids (TBARs). The SB group showed lower total protein, amylase, TAC, UA, tGSH, SOD, CAT, and GPx than the C group in PG, while in SMG, SB decreased total protein, mucin, tGSH, SOD, CAT, and GPx. However, increased AKT phosphorylation observed in both salivary glands suggests that SB exerts low-intensity oxidative stress. Conclusions SB impaired enzymatic and non-enzymatic antioxidant defenses in the salivary glands of rats. Clinical relevance Chronic treatment with SB could mitigate salivary gland dysfunction due to disturbance of redox state.
... Gura uscată re-prezintă o stare patologică caracterizată prin reducerea semnificativă a secreţiei salivare, sub 0,2 ml/ minut, în cazul salivei nestimulate şi sub 0,7 ml/ minut, în cazul salivei stimulate. Frecvenţa cu care este întâlnită xerostomia în rândul populaţiei generale este variabilă, între 5,5-39%, fiind însă mai des întâlnită la persoanele vârstnice (2)(3)(4)(5). ...
Article
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Introduction. Oral candidiasis is a complication of dry mouth witch is not present in all cases, but its prevalence remains high. Material and method. 29 patients aged 45 to 82 years suffering from dry mouth caused by various general conditions were selected for this study. Clinical examinations were performed and all the lesions of oral mucosa were counted. The accurate diagnosis of oral candidiasis was established by the mycological exam. Results. 66% of patients involved in this study presented oral candidiasis confirmed by the laboratory. The atrophic and hyperplasic oral candidiasis were the most common clinical types found in this study. Conclusions. The prevalence of oral candidiasis remains relatively high among patients suffering from dry mouth; therefore dentists should treat or guide them to a specialist.
... The decrease in salivary secretion is also noticed as a result of dehydration due to profuse sweating, significant hemorrhage, prolonged diarrhea, as well as following the action of substances that paralyze the parasympathetic nerves (atropine) [18][19][20][21]. ...
Article
The progress made in fundamental medical research over the past decades, the scientific acquisitions in the field of genetics, molecular biology and biochemistry in relation to the explosive development of investigative technologies have revolutionized the clinical approach to many pathological entities, practically opening a new era in the evolution of clinical medicine. Dental medicine, as a science, feels the massive impact of the needs for knowledge and relaunches the interest of research in all its subspecialties. From this perspective, these are legitimized not only through the crisis in managing the immense volume of information, but also through the openings offered to the framework of conceptualizing and defining the identity of this branch of medicine, related to the need to particularize the specific problems in this discipline. Digestion is a fundamental process in the survival of an organism. It begins in the oral cavity, where the bolus is formed, and continues in the stomach, forming the chyme, which then reaches the small intestine and transforms into the chyle. Through mastication, the surface of food increases, thus the enzymes are able to act more easily on the substrate. The first enzymes to act on food are the salivary ones - salivary amylase, lingual lipase. Mastication is regulated through the contact of food with receptors in the oral cavity. These will send impulses by way of the trigeminal nerve towards the centre of mastication - located in the bolus. From the bolus, they will start the signals on the efferent pathway (trigeminal, hypoglossal and facial nerves) that will reach the masticatory muscles. Mechanical digestion (mastication) can thus begin. Mechanical digestion in the oral cavity results from mastication. During mastication, the food is manipulated by the tongue, crushed by the teeth and mixed with saliva. Concomitant with mechanical digestion, the chemical digestion takes place through the action of saliva. There are two types of salivary glands in the oral cavity: large glands - parotid, sublingual, submandibular and small glands - disseminated throughout the oral cavity. Within 24 hours, up to 1.5 liters of saliva are secreted, 99% of which is represented by water. The remaining 1% consists of enzymes, mucus, nitrogen content. After finalizing mastication, deglutition begins. This mechanical process consists of thrusting the bolus from the mouth towards the stomach, using the esophagus.
... BPIFA2, belonging to the PLUNC protein family, is a soluble salivary protein secreted in the extracellular region of the salivary glands, especially parotid gland. [22][23][24][25][26][27][28][29] The encoding gene containing 10 exons is located on human chromosome 20, with 750 bp CDS (protein coding region) region encoding 250 amino acid protein sequence. In mice, BPIFA2 containing 9 introns are located on chromosome 2, with 708 bp CDS region encoding 236 amino acid protein sequences. ...
Article
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Background Current dosimeters cannot cope with the two tasks of medical rescue in the early stage of nuclear accident, the accurate determination of radiation exposure and the identification of patients with fatal radiation injury. As radiation can cause alterations in serum components, it is feasible to develop biomarkers for radiation injury from serum. This study aims to investigate whether serum BPIFA2 could be used as a potential biomarker of predicting fatal radiation injury in the early stage after nuclear accident. Methods A rabbit anti-mouse BPIFA2 polyclonal antibody was prepared to detect the expression of BPIFA2. C57BL/6J female mice were exposed to total body radiation (TBI) at different dose and Partial body radiation (PBI) at lethal dose to detect the dynamic changes of BPIFA2 in serum at different time points after irradiation by Western blot assay. Results BPIFA2 in mice serum were significantly increased at 1–12 h post-irradiation at .5–10 Gy, and increased again significantly at 3 d after 10 Gy irradiation with associated with mortality closely. It also increased rapidly after PBI and was closely related to injury degree, regardless whether the salivary glands were irradiated. Conclusions The increase of serum BPIFA2 is a novel early biomarker not only for identifying radiation exposure, but also for fatal radiation injury playing a vital role in rational use of medical resources, and greater efficiency of medical treatment to minimize casualties.
... than women (10.3-33.3%) (3). The common etiologies of xerostomia use of xerogenic medications (such as antidepressants, antihypertensives, anticholinergic agents, antihistamines, and hypoglycemics), ageing, radiochemotherapy and systemic diseases such as diabetes mellitus, chronic renal failure, scleroderma, lupus erythematosus, and Sjögren's syndrome. ...
Article
Background: Topical agents are the mainstay in the treatment of xerostomia, a common complaint most frequently associated with salivary dysfunction. This study aimed to compared the efficacy and safety for xerostomia treatment of 2 artificial saliva preparations containing 0.1% pilocarpine, and, either sodium carboxymethylcellulose (SCMC), or, sodium polyacrylate (SPA). Material and methods: Thirty-one xerostomia patients were randomly allocated into either a SCMC-treated group (15 patients), or, a SPA-treated group (16 patients). The formulations were taken 0.5 ml, 4 times daily for 6 weeks and double-blinded assessed before and after treatments using Xerostomia Inventory (XI) and Clinical Oral Dryness Score (CODs). Unstimulated and stimulated whole salivary flow rates were measured. Results: After treatment, the SCMC-treated group had significantly lower CODs and higher unstimulated and stimulated whole salivary flow rates (p<0.001, p=0.035, and p=0.013, respectively), while the SPA-treated group showed significantly lower CODs only (p=0.004). In contrast, SCMC-treated and SPA-treated groups at the 6th week after treatments showed non-significant differences in all assessments (p>0.05, all). Some adverse events (AEs) were reported, e.g., burning tongue, dizziness and watery eyes, but no severe AEs. Conclusions: This randomized controlled pilot trial demonstrated superior efficacy of SCMC-formula over a SPA-formula after 6 weeks of xerostomia treatment. These formulations with topical pilocarpine proved safe in clinical use with minimal reported AE. Key words:Xerostomia, artificial saliva, sodium carboxymethylcellulose, sodium polyacrylate, pilocarpine.
... Saliva shows antibacterial, antiviral, and antifungal properties.Basal salivary secretion is always present and helps to maintain a steady pH in the oral cavity, protect the integrity of mucosa, and has cleaning action(Golež et al, 2021). Besides that, it contains digestive enzymes and also helps the remineralization of teeth(Hopcraft and Tan, 2010). MUC7 and MUC5b are two types of salivary mucins. ...
... The effects of xerostomia are observed in the quality of life of the patient as it affects their ability to eat, communicate, and interact socially [19]. Dental caries is significantly higher in xerostomic patients [20]. Additionally xerostomic patients prefer to eat foods that are softer and cariogenic [21]. ...
... Although the occurrence and prevalence of taste dysfunction vary by the age of COVID-19 patients [4], the age-dependence of COVID-19 xerostomia remains inconclusive because xerostomia and hyposalivation in non-COVID-19 populations are increasingly frequent with age, especially over 60 years. As described by Hopcraft and Tan [33], aging per se has no significant impact on salivary flow rates, but the prevalence of xerostomia increases in the middle-aged and elderly populations. ...
Article
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Patients with coronavirus disease 2019 (COVID-19) have become known to present with different oral symptoms. However, xerostomia remains poorly recognized compared with taste dysfunction. For better understanding of COVID-19 symptomatology, xerostomia associated withCOVID-19 was characterized and its possible pathogenesis was speculated by a narrative literature review. Scientific articles were retrieved by searching PubMed, LitCovid, ProQuest, Google Scholar, medRxiv and bioRxiv from 1 April 2020 with a cutoff date of 30 September 2021. Results of the literature search indicated that xerostomia is one of prevalent and persistent oral symptoms associated with COVID-19. In contrast to taste dysfunction, the prevalence and persistence of xerostomia do not necessarily depend on ethnicity, age, gender and disease severity of patients. COVID-19 xerostomia is pathogenically related to viral cellular entry-relevant protein expression, renin-angiotensin system disturbance, salivary gland inflammation, zinc deficiency, cranial neuropathy, intercurrent taste dysfunction, comorbidities and medications. Despite a close association with COVID-19, xerostomia, dry mouth and hyposalivation tend to be overlooked unlike ageusia, dysgeusia and hypogeusia. Although mouth dryness per se is not life-threating, it has an impact on the oral health-related quality of life. More attention should be paid to xerostomia in COVID-19 patients and survivors.
... Furthermore, many medications used for HD symptoms, particularly psychiatric symptoms, cause xerostomia (Rada, 2008). Xerostomia directly impacts the patient's quality of life as it is proven to increase dental caries, periodontal disease, and burning sensation in the oral cavity (Hopcraft & Tan, 2010). ...
Article
Objectives The objective of this systematic literature review was to provide a complete panorama of the oral manifestations of Huntington’s disease (HD). Materials and Methods Databases were searched and original research studies or case report manuscripts up to May 2021 were included using keywords that describe HD combined with words related to oral health; MeSH terms were used exclusively. No time or language restrictions were applied. Results Twenty-two investigations (12 original articles and 10 case reports) regarding oral manifestations of HD were included. The subjects examined in the selected research articles were dental health, coordination of oral structures, speech, dysphagia, and swallowing alterations. The case reports described dental treatment procedures, oromandibular dyskinesia, dysphagia, and speech alterations. Conclusions The oral manifestations of HD were found to be associated with the advance of the disease in that the more severe the HD, the worse the alterations affecting the oral cavity. Dysphagia, dysarthria, masticatory problems, oral health impairment, and choreiform movements involving the tongue and other orofacial muscles were the main manifestations of HD in the oral cavity. The PROSPERO systematic review registration number of this study is CRD42021238934.
... The prevalence of xerostomia, defined as the subjective sensation of dry mouth [1], ranges from 20 to 80% of the population [2]. Salivary gland hypofunction may be a symptom of a serious systemic disease and may be related to the use of various drugs. ...
Article
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Introduction Oral and ocular dryness are the most common symptoms reported during ophthalmological and dental examinations. It is becoming a serious and growing problem due to the huge variety of affecting factors and with population aging. Objectives The purpose was to demonstrate an application of the Schirmer test for xerostomia. Subsequently, to compare and correlate the results achieved from the lacrimal Schirmer test and salivary Schirmer test in non-Sjögren patients. Methods Study group consisted of 642 patients with/without subjective or/and objective symptoms of dry eye or mouth who did not fulfill the criteria for diagnosis of Sjögren syndrome. The lacrimal Schirmer test (lST) and the salivary Schirmer tests (sST) were performed (sSTm was put on the floor of the mouth, sSTp in front of the parotid gland duct). The results were recorded after 1 min (sSTm), 3 min (sSTp), and 5 min (lST). Results The lST and sST test scores were considerably higher in the healthy group than in others, p < 0.001. The results of sST1 and sST2 decreased with the appearance of subjective and objective symptoms, p < 0.001. There were positive correlations between lST and sSTm outcomes between the groups, p < 0.001. Conclusions We present the Schirmer test adapted to measure salivary gland hypofunction that is a time-saving tool in our daily practice. Results of this study reveal an excellent correlation between the eye Schirmer test and the salivary Schirmer tests. Clinical relevance The salivary Schirmer tests seem to be rapid, convenient, and reliable objective screening tools for salivary gland hypofunction in non-Sjögren patients.
... In many cases, however, the elderly suffer from poor oral health. This is mainly due to xerostomia, which is defined as the subjective perception of dry mouth typically associated with reduced salivary flow and increased salivary viscosity in many elderly people (Hopcraft & Tan, 2010;Osterberg, Landahl, & Hedegard, 1984;Sreebny, 2000;Zussman, Yarin, & Nagler, 2007). Xerostomia and its associated deterioration in oral hygiene among the elderly not only predisposes this population to oral diseases such as dental caries and periodontal disease (Abdellatif & Burt, 1987;Gilbert, Heft, & Duncan, 1993) but may also have systemic adverse effects such as an increased risk of aspiration pneumonia (Sjogren, Nilsson, Forsell, Johansson, & Hoogstraate, 2008;van der Maarel-Wierink, Vanobbergen, Bronkhorst, Schols, & de Baat, 2013), poor nutritional status, and impaired cognitive function (Harding, Gonder, Robinson, Crean, & Singhrao, 2017;Rhodus & Brown, 1990). ...
Article
Objective Mucins are large glycosylated glycoproteins that are produced in the salivary glands, and their changes may contribute to the development of xerostomia due to aging and the accompanying deterioration of oral hygiene. This study aimed to characterize the changes in the mucins produced in submandibular gland (SMG) during the aging process. Methods SMG mucins derived from mice of each age were separated using supported molecular matrix electrophoresis (SMME). Subsequently, the membranes were stained with Alcian blue (AB) or blotted with MAL-II lectin. The SMME membranes stained with AB were subjected to densitometric analysis and glycan analysis. The detailed structures of O-glycan were investigated by tandem mass spectrometry (MS/MS). Results The SMG of mice secreted three mucins with different glycan profiles: age-specific mucin, youth-specific mucin, and a mucin expressed throughout life, and the expression patterns of these mucins change during aging. Additionally, age-specific mucin began to be detected at about 12 months of age. A mucin expressed throughout life and age-specific mucin had the same mass of major glycans but different structures. Furthermore, the proportion of mucin glycan species expressed throughout life changed during the aging process, and aging tended to decrease the proportion of fucosylated glycans and increase the proportion of sialoglycans. Conclusion There are three secretory mucins with different glycan profiles in the SMG of mice, and their expression patterns change according to the period of the aging process. The proportion of glycan species of mucin expressed throughout life also changes during the aging process.
... mL/min and a stimulated flow lower than 0.7 mL/min. The reduced salivary flow undermines the characteristic of protective factor of saliva for the tooth surface, impairing autoclisis, harming events of demineralization and remineralization dynamics as well as hampering the buffer capacity of saliva [Hopcraft and Tan, 2010]. ...
Article
Objectives: To evaluate whether children with attention deficit/hyperactivity disorder (ADHD) are more affected by dental caries than children without ADHD by means of a systematic review and meta-analysis. Design: Electronic searches was performed in four databases (PubMed, Embase, Scopus, and Web of Science) in July 2021. Grey literature search in OpenGrey, a search in Google Scholar, and searches in the reference list of included articles were also conducted. The eligibility criteria were observational studies in which children with ADHD were compared with children without ADHD with respect to the dental caries. Study selection, data extraction, and risk of bias assessment, applying the Joanna Briggs tool were performed by two reviewers independently. Meta-analysis and assessment of heterogeneity among studies were conducted with the meta-package of RStudio using the R programming language (R Core Team, Vienna, Austria). Results of meta-analysis were provided in mean difference (MD), odds ratio (OR), and confidence intervals (CI). For assessment of heterogeneity, Baujat plot and influence analysis plot were obtained. Results: Thirteen studies were included and 10 were incorporated into meta-analyses. The meta-analysis showed that children with ADHD had a higher decayed, missing, and filled teeth (DMFT) index than their peers without ADHD (I²=42%; MD=0.75 [0.38-1.13]). For decayed, missing, and filled surfaces (DMFS) (I²=0; MD=0.39 [-0.02-0.80]) and decayed surfaces (DS/ds) (I²=0%; MD=0.35 [-0.63-1.33]), no difference between groups was observed. In addition, children with ADHD had higher odds of having dental caries than their healthy peers (OR = 3.31 [1.25, 8.73]; I² = 0%). After assessment of heterogeneity among studies, sensitivity analysis was conducted for DMFT. One study was removed and the significant difference between groups remained. Children with ADHD had a significantly higher DMFT index than their peers without ADHD (MD = 0.98 [CI = 0.75, 1.20]; I² = 0%) Risk of bias ranged from low to high. Conclusion: The main shortcoming of the included studies is the high risk of bias regarding the strategies to deal with confounding factors. Within its limitations, this systematic review and meta-analysis demonstrated that children with ADHD were more likely to develop dental caries than their healthy counterparts. Funding: No funding Registration: CRD42021238923.
Article
The aim of this review is to assess the objective and subjective diagnosis, as well as symptomatic topical treatment of dry mouth conditions with a clear focus on textural perspective. We critically examine both the current practices as well as outline emerging possibilities in dry mouth diagnosis and treatment, including a patent scan for saliva substitutes. For diagnosis, salivary flow rates and patient-completed questionnaires have proven to be useful tools in clinical practice. To date, objective measurements of changes in mechanical properties of saliva via rheological, adsorption and tribological measurements and biochemical properties of saliva such as assessing protein, mucins (MUC5B) are seldom incorporated into clinical diagnostics; these robust diagnostic tools have been largely restricted to application in non-clinical settings. As for symptomatic treatments of dry mouth, four key agents including lubricating, thickening, adhesive and moisturizing agents have been identified covering the overall landscape of commercial saliva substitutes. Although thickening agents such as modified celluloses, polysaccharide gum, polyethylene glycol (PEG) etc. are most commonly employed saliva substitutes, they offer short-lived relief from dry mouth and generally do not provide boundary lubrication properties of real human saliva. Innovative technologies such as self-assembly, emulsion, liposomes, microgels are emerging as novel saliva substitutes that hold promise for alternative approaches for efficient moistening and lubrication of the oral mucosa. Their adoption into clinical practice will be dependent on their efficacies, duration of relief, ease of application by the practitioners and patient compliance.
Chapter
Chapter available at [https://link.springer.com/chapter/10.1007/978-3-030-56934-1_17]. Living longer is not the equivalent to living healthier. The quality of health on ageing is strongly modulated by social barriers. The World Health Organisation implemented the Decade of Healthy Ageing from 2020 to 2030 targeting healthy ageing as a public health priority. However, healthy ageing, especially for people with disabilities, depends on the learning, practice, and adoption of a healthy lifestyle throughout the lifecycle. People with intellectual and developmental disabilities (IDD) have fewer opportunities to take part in health and well-being campaigns and even less as they get older. Health promotion approaches for individuals with disabilities, particularly IDD, are lacking. This chapter discusses the health promotion and wellness in the general population and the perspective of older adults with disabilities, particularly with IDD.
Article
People with drug use disorders (PWDUD) have elevated prevalence of oral diseases, in particular dental caries (tooth decay), periodontal (gum) disease and xerostomia (dry mouth). When left untreated, these oral health conditions may progress and lead to tooth ache, abscesses and tooth loss, and in turn to poor chewing functioning and digestion, dental aesthetic problems, and reduced wellbeing. Illicit drug use may per se cause xerostomia, which in turn increases vulnerability for dental caries; however, the other main drivers of oral diseases and their progression ‐‐ poor oral hygiene, frequent sugar intake, and infrequent dental visits ‐‐ can mainly be ascribed to the irregular lifestyle, poor economy and mental health problems that often accompany illicit drug use. Establishment of good oral health habits is essential in the dental care for PWDUD. Dental treatment is often comprehensive and challenging, as the patients may have extensive treatment needs but also difficulties adhering to preventive measures and dental appointments. An integrated care approach for PWDUD would likely benefit both their oral and general health.
Article
Oral health for older people living in nursing homes has long been an area of interest and concern, with suboptimal oral health often having significant effects on their general health, well-being and quality of life. This article outlines the reasons why oral health can deteriorate in nursing home residents and the potential effects of this, and provides information about relevant national guidance. The article also details practical recommendations for nursing home staff on improving residents' oral hygiene, including undertaking oral health assessments, delivering mouth care and accessing dental services.
Article
Continuous positive airway pressure is a common and effective treatment for obstructive sleep apnea, but adherence remains an issue. Both obstructive sleep apnea and oral diseases are associated with cardiovascular diseases, and as oral dryness contributes to treatment abandonment, oral health is of importance for this patient group. The aim was therefore to explore how persons with continuous positive airway pressure‐treated obstructive sleep apnea experience situations associated with their oral health, and which actions they take to manage these. An explorative and descriptive design was adopted using the critical incident technique. Based on a purposeful selection, 18 adults with long‐term experience of continuous positive airway pressure‐treatment were interviewed using a semi‐structured interview guide. Both negative and positive situations were described. Negative situations consisted of challenges with breathing, including mouth‐breathing, choking sensations, problems with night‐time and daytime oral dryness, changes in the saliva composition, and deteriorating oral health. Positive situations included experiences of reduced mouth‐breathing and oral dryness. The situations were often successfully managed by mimicking daytime movements, changing sleeping position, adjusting the CPAP‐device and mask, increasing oral hygiene efforts, drinking water, using a humidifier or chinstrap, or contacting their oral healthcare clinic. Long‐term experience of persons with continuous positive airway pressure‐treated obstructive sleep apnea regard situations and actions from everyday life. Successful management can contribute to long‐term adherence and decrease negative effects on oral health. More interdisciplinary collaborations could enable identification and adequate recommendations for persons who experience negative situations during their continuous positive airway pressure treatment.
Chapter
The focus of this chapter is to present the basic clinical signs and symptoms, diagnostic strategies, and management approaches of SS for the oral health team. As the disease spectrum for SS is wide and quite variable, diagnosis can be challenging. This chapter will present evidence-based diagnostic and management strategies in a sequential fashion. More specifically, these include published diagnostic criteria, signs and symptoms, selected chairside patient questions suggestive of SS, and distinctions between xerostomia and hyposalivation. Chairside procedures to measure salivary flow rates and perform labial salivary gland biopsies are presented as well. Essential serological screening tests for diagnosis of SS and the subsequent need for interprofessional involvement are reviewed. Pharmacologic and non-pharmacologic treatments provided by the oral health care team for SS are detailed. These include products to relieve dry mouth, caries prevention agents, and medications to manage the oral manifestations SS. The dental management section includes patient counseling, caries management, discussion of TMD symptoms, association of SS and periodontal disease, and implant therapy. A positive and supportive approach to managing SS patients will empower them to take an active role in their oral health and improve their quality of life. Any patient presenting with xerostomia should receive a thorough evaluation. Of significance, the dentist and/or dental hygienist may be the first health care professional to suspect and facilitate the diagnosis of SS. This chapter will sequentially present the key elements in the management of patients with xerostomia, hyposalivation, and rheumatic diseases such as SS. This clinical-based approach will serve as a valuable reference for the oral health team as well as the interprofessional medical team consisting of (at a minimum) rheumatologists, ophthalmologists, and primary care physicians.
Article
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Objective The aim of this study was to evaluate the expression of BPIFA proteins in the saliva and salivary glands of hematopoietic cell transplant (HCT) patients. Material and Methods This longitudinal study included patients who had undergone autologous HCT (auto‐HCT) and allogeneic HCT (allo‐HCT) and unstimulated saliva were collected at three timepoints, with a fourth collection at oral chronic graft versus host disease (cGVHD) onset. BPIFA expression was analysed by Western blotting in saliva and immunostaining in the minor salivary glands of cGVHD patients. Results Auto‐HCT patients showed increased levels of BPIFA1 (P = 0.021) and BPIFA2 at D+7 (P = 0.040), whereas allo‐HCT group demonstrated decreased expression of BPIFA2 at D+8 (P = 0.002) and at D+80 (P = 0.001) and a significant association between BPIFA2 low levels and hyposalivation was observed (P = 0.02). BPIFA2 was significantly lower in the cGVHD patients when compared to baseline (P = 0.04). Conclusions The results of this study show distinct pattern of expression of BPIF proteins in both auto‐HCT and allo‐HCT recipients with decreased levels of BPIFA2 during hyposalivation and cGVHD. Further studies are necessary to elucidate these proteins mechanisms and their clinical implications in these groups of patients.
Article
Xerostomia is a subjective feeling of oral dryness.The effects are limited to the oral cavity or have ramications on the general health of the patients. Recognition of the symptoms and risk factors associated with xerostomia early by the dentist can help relieve the discomfort of the patient. Although many treatment options have been proposed currently there is not any one specic solution for the condition. This review outlines the prevalence,risk factors, symptoms and treatment options of xerostomia.
Article
The aim of this study was to observe the effects of oligonol on submandibular gland dysfunction in ovariectomized rats. We randomly divided female Sprague-Dawley rats into sham-operated, ovariectomized, and oligonol-treated ovariectomized groups. Oligonol was intraperitoneally administered at 30 mg/kg daily for six weeks. Lipogenesis increased after the ovariectomy while fatty acid oxidation increased and intracellular triglyceride levels decreased in response to oligonol treatment. Submandibular gland fibrosis characterized by collagen type I accumulation was observed in the ovariectomized group. However, oligonol markedly reduced fibrosis to a level comparable to that observed in the sham group. Aquaporin 1 and glucose transporter 4 were downregulated in the ovariectomized group. Nevertheless, both factors were significantly upregulated by oligonol treatment. However, aquaporin 5 was significantly downregulated in the oligonol treatment group. Our findings indicate that oligonol protects against damage in postmenopausal rat salivary glands.
Chapter
Cancer survivors encounter several problems and side effects during their cancer therapy. Following initial active treatment for cancer, they experience a variety of medical, physical, and psychosocial consequences that may affect overall health and well-being. Clinicians providing care for cancer survivors should be comfortable addressing the long-term effects of cancer and its treatment.
Chapter
One in two cancer survivors experiences high levels of psychosocial distress as a result of a variety of problems that can affect every aspect of life. Common issues include fear that cancer will come back or progress, body image disturbances that impact self-esteem and sexuality, existential concerns such as purpose in one’s life, as well as cognitive, financial, and occupational problems. While these issues are common and can be seen as part of the adjustment process to managing the stressful events presented by cancer and its treatment, these issues do not necessarily abate over time and can lead to long-term psychological problems such as anxiety and depression if left unaddressed. Timely recognition and responsiveness to these problems are critical as they undermine the ability of the individual to cope with residual symptoms and are associated with reduced adherence to treatment recommendations and a reduction in quality of life. There is evidence that distress screening and psychosocial interventions can reduce the psychosocial impact of cancer and improve the quality of life for people who have had cancer. Given that the number of cancer survivors continues to grow, follow-up requires an emphasis on living well using evidence-based interventions and coordinated and integrated care. Oncology clinicians are well-placed to assist patients to live well after cancer by recognizing and responding to their psychosocial needs.
Article
Purpose Novel drug delivery systems (DDSs) hold great promise for the treatment of oral cavity diseases. The main objective of this article was to provide a detailed overview regarding recent advances in the use of novel and nanostructured DDSs in alleviating and treating unpleasant conditions of the oral cavity. Strategies to maximize the benefits of these systems in the treatment of oral conditions and future directions to overcome these issues are also discussed. Methods Publications from the last 10 years investigating novel and nanostructured DDSs for pathologic oral conditions were browsed in a systematic search using the PubMed/MEDLINE, Web of Science, and Scopus databases. Research on applications of novel DDSs for periodontitis, oral carcinomas, oral candidiasis, xerostomia, lichen planus, aphthous stomatitis, and oral mucositis is summarized. A narrative exploratory review of the most recent literature was undertaken. Findings Conventional systemic administration of therapeutic agents could exhibit high clearance of drugs from the bloodstream and low accumulation at the target site. In contrast, conventional topical systems face problems such as short residence time in the affected region and low patient compliance. Novel and nanostructured DDSs are among the most effective and commonly used methods for overcoming the problems of conventional DDSs. The main advantages of these systems are that they possess the ability to protect active agents from systemic and local clearance, enhance bioavailability and cellular uptake, and provide immediate or modified release of therapeutic agents after administration. In the design of local drug delivery devices such as nanofiber mats, films, and patches, components and excipients can significantly affect factors such as drug release rate, residence time in the oral cavity, and taste in the mouth. Choosing appropriate additives is therefore essential. Implications Local drug delivery devices such as nanofiber mats, nanoparticles, liposomes, hydrogels, films, and patches for oral conditions can significantly affect drug efficacy and safety. However, more precise clinical studies should be designed and conducted to confirm promising in vitro and in vivo results. In recent years, novel and nanostructured DDSs increasingly attracted the attention of researchers as a means of treatment and alleviation of oral diseases and unpleasant conditions. However, more clinical studies should be performed to confirm promising in vitro and in vivo results. To transform a successful laboratory model into a marketable product, the long-term stability of prepared formulations is essential. Also, proper scale-up methods with optimum preparation costs should be addressed.
Article
Purpose To the best of our knowledge, the association between xerostomia and physical frailty has not been studied in Asian countries. This prospective cohort study aimed to investigate the longitudinal association between xerostomia and the incidence of physical frailty in Japan. Methods This study included community-dwelling older adults aged ≥65 years at baseline (n=609). Baseline intraoral examination, physical performance and anthropometric measurements, blood examination, a structured self-administered questionnaire survey, and face-to-face interviews were conducted. Xerostomia was defined using a dichotomous questionnaire. Following the baseline survey, data on the incidence of physical frailty were collected over 5 years. Physical frailty, the outcome variable, was defined as weakness, slowness, weight loss, low physical activity level, and exhaustion. Participants with three or more components were considered frail. The hazard ratio (HR) for physical frailty incidence according to xerostomia was calculated using Cox hazards regression analysis. Results At baseline, 166 participants (27.3 %) complained of xerostomia. During follow-up, 109 participants (17.9 %) developed physical frailty. After adjusting for confounding factors, such as sex, age, educational level, polypharmacy, comorbidities, and smoking habit, xerostomia was significantly associated with the incidence of physical frailty (adjusted HR 1.58; 95 % confidence interval [CI] 1.04–2.42). Conclusions Xerostomia is one of the key predictors of physical frailty. Our results suggested that assessing and preventing xerostomia is important for preventing physical frailty.
Article
Examination of the oral cavity can identify clinical signs indicative of underlying systemic disease. Key features to examine include the general appearance and number of the teeth, signs of inflammation of the mucosa or gingival tissues including bleeding of the gums and redness, swelling or hyperplasia. Additionally, the tongue should be assessed for any ulceration or discolouration and the presence of excessive build‐up (coating). Cardiovascular disease and diabetes, together known as cardiometabolic disease have an impact on oral health. Similarly, oral health conditions, such as gum disease (periodontitis) and dryness of the mouth (xerostomia), are associated with an increased risk for both cardiovascular disease and type 2 diabetes mellitus. The aim of this narrative review is to outline both the impact of periodontitis and xerostomia on cardiometabolic disease and the impact of cardiometabolic health on these oral health conditions. Key features of periodontitis and xerostomia will be provided along with a brief discussion of current concepts in early prevention and management of these oral health conditions. The biological mechanisms linking cardiometabolic disease and periodontitis will be outlined and the evidence supporting the association between cardiometabolic disease and oral health conditions will be presented together with an identification of areas where further research is indicated. Last, guidance for general practitioners to assess and support early diagnosis and management of oral health conditions by raising awareness of the relationship between oral health and cardiometabolic disease, providing simple oral health advice and referring to a dental practitioner will be presented.
Article
Objective: This study aimed to assess the transcultural adaptation and psychometric properties of the French-language version of the Xerostomia Inventory (XI-Fr). Methods: In total, 65 patients aged 65 years or older were recruited from three departments of a single French hospital. Patients had to have a Mini Mental State Examination score of 10 or more and be able to read and write French. The XI-Fr was administered to all patients after transcultural adaptation, at the start of the study, and again at 7 days after inclusion. We assessed reliability, acceptability, validity, internal consistency and reproducibility of the instrument in its French-language version. Results: The XI-Fr showed good internal consistency (Cronbach's alpha 0.79) and good reliability (intra-class correlation 0.83) at 7 days. Convergent validity showed no relation between salivary flow and XI-Fr score, as with the original instrument. Discriminant validity showed a positive correlation between the XI-Fr and the GOHAI, but no difference for the MNA or miniGDS scores. Conclusion: The XI-Fr is a valid and reliable measure of xerostomia in French, with psychometric properties comparable to those of the original English-language version.
Article
Objectives: To determine the prevalence and severity of dry mouth by age, gender, presence of disease, and medication intake for patients aged 18 years and over, seeking primary health care on the west coast of Sweden (Region of Västra Götaland, VGR). Materials and methods: Cross-sectional study conducted among patients (n = 374, age ≥ 18) visiting primary health care providers (n = 4) in VGR for any medical reasons. Patients were invited to participate by answering a single-item question, 'Have you experienced dry mouth in the last six months?' Patients giving positive answers (n = 163) were asked to fill in the 11-item Xerostomia Inventory (XI) questionnaire to determine the variability and severity of xerostomia. Patients replying 'No' (n = 211) to the single-item question were considered not to have xerostomia and included in the non-xerostomia group. Results: The overall prevalence of xerostomia was 43.6% with a female dominance (61.2%). The prevalence in different age groups among females and males was similar. The number of medications and/or diseases are positively associated with xerostomia. Medication was a significant predictor of the prevalence of xerostomia, regardless of age and gender (p < .001). Patients with five or more medications had the highest prevalence of xerostomia (71.2%). Conclusion: Patients seeking primary care on the west coast of Sweden have a high prevalence of xerostomia. Factors associated with xerostomia were female gender and medications and/or diseases. Awareness is required to manage patients with xerostomia in medical and dental care.
Article
Oral dysfunctions are common in the elderly but the literature lacks a multidisciplinary approach on the relationship between polypharmacy, saliva flow, xerostomia, taste, and swallowing complaints. This cross‐sectional study included 204 non‐institutionalized elderly (>60 years; 123 women/81 men), free of severe disabilities and non‐alcohol/tobacco consumers, from whom specific pharmacological therapies were evaluated, as well xerostomia (Xerostomia Inventory‐XI) and swallowing complaints (EAT‐10 questionnaire), salivary flow rate and gustatory sensitivity. Statistical analysis included Chi‐square, Mann–Whitney, Two‐way ANCOVA, and linear multiple regression. Polypharmacy (≥5 drugs daily), hyposalivation, and severe taste dysfunction were found in 18, 46, and 10% of the participants, respectively. Polypharmacy was related with xerostomia (p = .041) and swallowing complaints (p < .001; power = 94%), but not with taste dysfunction. Dry mouth complaint and higher risk of swallowing disorders were found in 50 and 12% of the elderly, respectively, and angiotensin‐converting enzyme (ACE) inhibitors users (n = 36) showed higher EAT‐10 scores (p = .038). Regression models showed that stimulated salivary flow rate was dependent on gender and diuretic use, while xerostomia scores were dependent on the number of medications and unstimulated saliva flow (p < .001). In conclusion, the results draw attention to the high frequency of oral and maxillofacial dysfunctions found in non‐institutionalized elderly, especially polypharmacy, xerostomia and swallowing complaints, and the side effects of drugs that can disturb the oral functions, the acceptance of food, and the adherence to oral therapies.
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Objectives: This study examined the association between chronic medication exposure and 5-year dental caries increment among older people, using a theoretical model whereby xerogenic medication is thought to lead to increased caries by either (i) chronically lowering salivary flow, thus reducing salivary buffering of plaque acids, or (ii) producing the symptoms of dry mouth, leading to symptomatic relief through the use of cariogenic drinks and foodstuffs. Methods: Data were obtained from participants remaining at the 5-year follow-up phase of a cohort study of community-dwelling South Australians aged 60 +. Medication information was available at baseline and at 5 years, enabling only those medications taken on both occasions to be included in the analyses. Dental examinations were conducted at baseline and 5 years, and a reversal-adjusted 5-year caries increment was computed. Multivariate modelling was used to control the effects of potential confounders. Results: Of the original sample, 528 (62.3%) remained after 5 years, with those remaining tending to be younger, healthier and less medicated than those lost to follow-up. Five-year coronal caries incidence was 66.9%. The adjusted coronal caries increment (AdjCI) was higher among males and among those taking a β-blocker or an antiasthma drug for the previous 5 years. The 5-year incidence of root surface caries was 59.3%. A lower root surface AdjCI was associated with taking daily aspirin. Of the medications shown in earlier analyses to predict dry mouth, only the antiasthma drugs were associated with higher caries experience, and they had predicted more severe xerostomia symptoms. Conclusions: This study offers no strong evidence for a medication–caries relationship, as only one of the observed medication–caries associations was explicable in terms of the theoretical model. However, it should be acknowledged that older people taking antiasthma drugs may be at higher risk of coronal caries, possibly through measures taken for the symptomatic relief of dry mouth.
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Objectives: The aim of this study was to examine the association between medication exposure and (1) unstimulated whole-salivary flow rate and (2) the severity of xerostomia among older people while adjusting for multiple medication use. Methods: Data were obtained from participants remaining at the five-year follow-up phase of a cohort study of community-dwelling older South Australians. Medication exposure information was available at baseline and at five years, enabling examination of the effects on dry mouth of long-term exposure to medications. At the five-year follow-up, unstimulated salivary flow was estimated using the spit method, and xerostomia severity was estimated using the 11-item Xerostomia Inventory. Because of the potential difficulties posed by polypharmacy, a two-stage analytical approach was employed: (1) Classification and Regression Tree (CART) analysis was used as an exploratory device to elucidate the relationships among the dependent and independent variables, and (2) linear regression analysis was used as a complementary procedure. Results: Unstimulated flow rate was lower among individuals who were female or taking antidepressants at both baseline and five years, and higher among smokers or people who were taking hypolipidemic drugs. Xerostomia severity was higher among females, or individuals taking: (1) an anginal at baseline and five years, (2) an anginal without a concomitant betablocker at five years, (3) thyroxine and a diuretic at five years, or (4) antidepressants or antiasthma drugs at both baseline and at five years. Conclusions: These results suggest that polypharmacy can be accounted for to a certain extent by using CART analysis in conjunction with more conventional approaches; and that the relationship between medications and dry mouth is a complex one, and differs according to which aspect of dry mouth is being examined.
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The aim of this study was to examine salivary flow rate and its association with the use of medication in a representative sample of 76-, 81-, and 86-year-old subjects, totaling 368. In this study, 23% (n = 80) of the subjects were unmedicated. From one to three daily medications were used by 47% (n = 168) and more than four medications by 30% (n = 104). The most commonly used medications were nitrates, digitalis or anti-arrhythmic drugs (47.7%), analgesics and antipyretics (32.6%), and diuretics (29.5%). The mean number used daily was significantly higher in 86-year-olds than in the two younger age groups (p < 0.01). No significant differences in this respect were found between genders. Among the unmedicated subjects, 76-year-olds had significantly higher stimulated salivary flow rates than did the 81-year-olds (p < 0.05). Unmedicated women showed significantly lower unstimulated (p < 0.01) and stimulated flow rates than did men (p < 0.05). Stimulated salivary flow rate was also significantly higher in the 76-year-old medicated subjects than in the medicated 86-year-old subjects (p < 0.05). No statistically significant differences were found in unstimulated salivary flow rates among the three age groups. Medicated women showed significantly lower unstimulated salivary flow rates than men (p < 0.001), although the difference in stimulated saliva flow was not significant. A statistically significant difference in unstimulated and stimulated salivary flow rates was found between unmedicated persons and those who took from four to six, or more than seven, prescribed medications daily.
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There is considerable difficulty in the making of initial clinical decisions as to whether a given patient has salivary gland hypofunction, and hence requires additional salivary gland evaluation. This study identified a set of four clinical measures that, together, successfully predicted the presence or absence of salivary gland hypofunction. The four measures were: dryness of lips, dryness of buccal mucosa, absence of saliva produced by gland palpation, and total DMFT; they were derived from discriminant analysis of data collected from 71 individuals with normal and low salivary flow rates. These measures are proposed as criteria for clinical decision-making, as well as for classification of patients in studies of salivary gland dysfunction syndromes. This study also identified unstimulated whole salivary flow rates of 0.12-0.16 mL/min as the critical range separating individuals with salivary gland hypofunction from those with normal gland function.
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Patients with candidiasis had greater than 400 colony-forming units per ml of saliva, whereas carriers of Candida albicans had less than 400 colony-forming units per ml. Thus, quantitative cultures of saliva may aid in the diagnosis of oral candidiasis.
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This paper examines the prevalence of and concurrence between the symptoms of dry mouth (xerostomia) and reduced salivary flow (SGH) among a population-based sample of older South Australians. Participants in a longitudinal dental study of older people were asked a global question about their experience of dry mouth ("How often does your mouth feel dry?"), and those who responded "Always" or "Frequently" were categorized as xerostomic. Unstimulated whole salivary flow rate was measured, and individuals whose flow rate was less than 0.1 mL/min were categorized as SGH cases. Saliva samples were collected from 700 individuals, of whom 683 (97.7%) answered the dry-mouth question. The mean unstimulated salivary flow rate was 0.27 mL/min (SD 0.22). The prevalence of SGH was 22.1%, and the prevalence of xerostomia was 20.5%, but only 5.7% of participants had both conditions. Almost two-thirds of the sample had neither condition. Males and females differed in the degree of concurrence between the two conditions. It appears that, in the group studied, xerostomia and SGH were largely discrete conditions, supporting the assertion by other workers that low salivary flow may not be the key factor in the etiology of xerostomia among older people.
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To examine the concurrent validity and temporal stability of the xerostomia inventory (XI), an 11-item summated rating scale that was developed to enable measurement of the severity of dry mouth symptoms in epidemiologic and clinical studies. A prospective cohort study design was used. Measurements of the severity of dry-mouth symptoms were made with the use of the XI and a standard dry-mouth question ("How often does your mouth feel dry?") on 2 groups of people at baseline, 2, 4, and 6 months. The 2 groups were chosen for their differing symptom trajectories: the onset group (N = 57) comprised patients who were about to undergo radiotherapy for head and neck cancer; and the normal group (N = 55) was a convenience sample of middle-aged and older individuals who were not expected to undergo changes in mouth dryness over the study period. The sex distributions of the 2 groups were similar, but the onset group was younger than the normal group overall. Baseline XI scores were higher among the onset group. The mean XI scores of the normal group did not differ over the observation period, indicating acceptable temporal stability of the XI. The scores of the onset group showed a substantial increase between baseline and 2 months, after which the 2-month level was sustained over the remainder of the study period. That these patterns were mirrored in the percentage responding "frequently" or "always" to the standard question provided further evidence for the concurrent validity of the XI. Linear regression was used to estimate the difference between the final scores after adjusting for age, sex, and initial difference in scores between the 2 groups. This was found to be 9.17 (95% CI 6.24, 12.10) and confirmed that undergoing radiotherapy for head/neck cancer was associated with a substantial increase in the severity of xerostomia symptoms. The xerostomia inventory appears to be a valid multi-item method for measuring the severity of the symptoms of dry mouth in clinical and epidemiologic studies.
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To develop a valid multi-item method of measuring the symptoms of xerostomia which includes the wide range of xerostomia symptoms in a single quantitative measure. A combination of qualitative and quantitative approaches. A cohort study in South Australia. Older people aged 65 years or more who were taking part in the South Australian Dental Longitudinal Study. Xerostomia symptoms were evaluated using a multi-item inventory format and, for comparison purposes, a standard single dry-mouth question. Resting whole-salivary flow rate was estimated using the 'spit' method. Xerostomia and flow-rate data were available for 636 individuals. Factor analysis revealed the presence of a discrete xerostomia dimension, represented by 11 items whose responses were summated to give a single Xerostomia Inventory (XI) scale score. This had a very low correlation with resting flow rate but a much stronger, positive correlation with the standard dry-mouth question responses. The XI shows adequate content and concurrent validity, and appears to be a promising advance on previous approaches to xerostomia symptomatology although further testing is required.
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To describe the prevalence and associations of xerostomia among adults in their early thirties, with particular attention to medication exposure as a putative risk factor. The prevalence and associations of xerostomia were investigated among 32-year-old participants in a long-standing prospective cohort study. Some 950 individuals were assessed at ages 26 and 32 years, with medications being recorded on both occasions. The prevalence of xerostomia was 10.0% (with no apparent gender difference), and was significantly higher among those taking antidepressants (odds ratio = 4.7), iron supplements (OR = 4.1) or narcotic analgesics (OR = 2.4). Those taking antidepressants at both ages 26 and 32 years had 22 times the odds of reporting xerostomia. Xerostomia may be a problem for a sizeable minority of young adults.
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Recent research has suggested that chronic dry mouth affects the day-to-day lives of older people living in institutions. The condition has usually been considered to be a feature of old age, but recent work by our team produced the somewhat surprising finding that 10% of people in their early thirties are affected. This raises the issue of whether dry mouth is a trivial condition or a more substantial threat to quality of life among younger people. The objective of this study was to examine the association between xerostomia and oral-health-related quality of life among young adults while controlling for clinical oral health status and other potential confounding factors. Cross-sectional analysis of data from a longstanding prospective observational study of a Dunedin (New Zealand) birth cohort: clinical dental examinations and questionnaires were used at age 32. The main measures were xerostomia (the subjective feeling of dry mouth, measured with a single question) and oral-health-related quality of life (OHRQoL) measured using the short-form Oral Health Impact Profile (OHIP-14). Of the 923 participants (48.9% female), one in ten were categorised as 'xerostomic', with no apparent gender difference. There was a strong association between xerostomia and OHRQoL (across all OHIP-14 domains) which persisted after multivariate analysis to control for clinical characteristics, gender, smoking status and personality characteristics (negative emotionality and positive emotionality). Xerostomia is not a trivial condition; it appears to have marked and consistent effects on sufferers' day-to-day lives.
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To describe the incidence of xerostomia among a population of older people over a 6-year period, with particular attention to medications as risk factors. Understanding the natural history of xerostomia requires longitudinal epidemiological research, but only one study has examined changes in xerostomia over time. While medication is a recognised risk factor for dry mouth, the role of particular medication categories continues to be controversial. Older South Australians (aged 60+) underwent an interview and dental examination at baseline, and these assessments were repeated 2, 5 and 11 years afterward. Medication data were collected at baseline, 5 and 11 years. Xerostomia data were collected at 5 and 11 years using the Xerostomia Inventory (XI) and a standard question. Of the 1205 dentate participants assessed at baseline, 669 remained after 5 years, and 246 were assessed at 11 years. Medication prevalence increased over the observation period, such that 94.8% of the cohort were taking at least one medication by 11 years. The prevalence of xerostomia increased from 21.4% to 24.8% between 5 and 11 years (p > 0.05), and the mean XI score increased from 20.0 (SD, 6.7) to 21.5 (SD, 7.9; p < 0.001). Some 14.7% of participants were incident cases of xerostomia, while 11.4% were remitted cases; 10.1% were cases at both 5 and 11 years. After controlling for gender and 'baseline' xerostomia severity (represented by the XI score at 5 years), participants who commenced taking daily aspirin after 5 years had over four times the odds of becoming incident cases, while those who commenced taking a diuretic after 5 years had nearly six times the odds of doing so. While the overall prevalence of xerostomia increased during the observation period, there was considerable instability, with one-quarter of the cohort changing their status. Medication exposure was strongly associated with the incidence of the condition, with recent exposure to diuretics or daily aspirin strongly predicting it.
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To examine the responsiveness to change of the Xerostomia Inventory (XI). The XI is an 11-item summated rating scale which results in a single continuous scale score representing the severity of chronic xerostomia. While the XI has been used as an outcome measure in clinical research, the magnitude of a clinically meaningful change score has yet to be determined. This study comprises a secondary analysis of data from a longitudinal study of changes in xerostomia symptoms in two groups whose symptom trajectories were likely to differ substantially: the normal group was a convenience sample of asymptomatic middle-aged and older individuals with otherwise stable perceptions of mouth dryness; and the onset group comprised patients who were about to undergo radiotherapy for head/neck cancer (and would therefore be expected to develop more severe xerostomia after the baseline measurements). Statistical analyses examined cross-sectional construct validity and internal consistency, test-retest reliability and the measure's responsiveness and longitudinal construct validity. The mean change scores of those for whom 'a little' improvement was reported were used to determine the minimally important difference for the XI. Over two-thirds of the onset group members reported dry mouth 'frequently' or 'always' at follow-up (2 months) and there was a concomitant increase in their mean XI score. Test-retest reliability was acceptable. Examination of within-individual change among those who changed and those for whom stability was observed, showed that only those who worsened had significantly greater XI scores at follow-up. The minimally important difference to reflect deterioration in xerostomia symptoms was determined to be 6 scale points. Between baseline and 2 months, the XI scores of 32 participants (33.7%) deteriorated by the minimally important difference (7.1% and 54.7% respectively among the normal and onset groups; p < 0.0001). The validity and responsiveness of the XI appear to be acceptable, and a change in XI score of 6 or more points is clinically meaningful.
Article
A representative systematic selection of 30% of all 70-year-olds (1148 persons) in Göteborg were invited to a population study. The participation rate was 85%. Sixteen per cent of the men and 25% of the women reported dryness in the mouth (sex. diff. P<0.01). There was a significant correlation between the number of drugs consumed by the subjects and subjective dryness (in both sexes P<0.001). Intake of drugs from the groups of anticholionergics, antihistamines, sedatives, hypnotics or phenothiazines respectively seemed to have the highest predicative value for dryness in the mouth (men P<0.05 and women P<0.01). There was also a positive correlation between subjective dryness and number of definable diseases in both sexes (P<0.01). In a consecutive sample (fifty-eight men and fifty-three women) a study of salivary flow, direct pH and buffer effect were performed. The mean value of unstimulated salivary secretion was in men 0.25 and in women 0.18ml/min. Corresponding figures for stimulated secretion was 1.65 and 1.04ml/min (sex. diff. P<0.01). A significantly lower unstimulated secretion was noted in women with subjective dryness (P<0.01). A negative significant correlation were found between dental invalidity, according to Eichner's classification, and stimulated secretion when drug treatment had been considered (men P<0.05 and women P<0.01). Only weak relations were noted between salivary secretions and drug treatment. Only intake of drugs with diuretic effect were negatively correlated to stimulated secretion (P<0.01). Diseases of the circulatory system were correlated to subjective dryness (P<0.01).
Article
The purpose of this investigation was to determine the mean salivary flow rate and the prevalence of mouthdryness and its relation to some background variables, such as oral condition, state of health and drug intake, among patients in somatic longterm hospitals. From 154 randomly selected patients salivary samples were taken from both parotid glands with Lashley cannules and 5 min stimulation with citric acid 2%. The sampling was repeated 3 times at a few days interval. The mean parotid flow rate among women was 0.28 ml/min and among men 0.47 ml/min. Forty-three% of the patients had a rate ≤ 0.2 ml/min and 44% of these reported an almost constant sensation of dryness of mouth. Background factors with a significant effect on salivary flow rate could be found only among men taking tricyclic antidepressents especially in combination with diuretics. The flow rates among these institutionalized, old patients as a group were found to be consistently lower than rates found in earlier investigations among healthy old people.
Article
Complaints of xerostomia and salivary hypofunction are common in older adults. However, recent studies reported that dehydration-induced salivary hypofunction caused fewer xerostomic complaints in older compared with young adults. This may predispose older adults to developing oral problems that will subsequently not receive attention from health care providers. Since many medications are known to inhibit salivation, this study attempted to determine if an anticholinergic drug (glycopyrrolate) had a differential effect on xerostomic complaints in young vs. older adults. Eighteen young (age 20–38 yrs) and 18 older (age 60–77 yrs) healthy adults were given a 4.0 g/kg dose of IV glycopyrrolate. For 6 hrs after drug administration, stimulated parotid salivary flow was collected, and an eight-item Visual Analogue Scale (VAS) subjective xerostomia test was given. At several time points post-IV glycopyrrolate, salivary flow rates were consistently lower in older compared with young adults. For some measures of xerostomic complaint (time to first complaint; time to maximum complaint; mean maximum complaint), there were no age-related differences for all VAS items. However, a trend for increased xerostomic complaints in older adults was demonstrated (time to recovery; total duration of complaint; number xerostomic at 6 hrs). These findings suggest that, given equal doses of an anti-sialogogue, salivary hypofunction is greater in healthy older adults, while increased complaints of xerostomia are not as consistent.
Article
This paper examines the prevalence of and concurrence between the symptoms of dry mouth (xerostomia) and reduced salivary flow (SGH) among a population-based sample of older South Australians. Participants in a longitudinal dental study of older people were asked a global question about their experience of dry mouth (“How often does your mouth feel dry?”), and those who responded “Always” or “Frequently” were categorized as xerostomic. Unstimulated whole salivary flow rate was measured, and individuals whose flow rate was less than 0.1 mL/min were categorized as SGH cases. Saliva samples were collected from 700 individuals, of whom 683 (97.7%) answered the dry-mouth question. The mean unstimulated salivary flow rate was 0.27 mL/min (SD 0.22). The prevalence of SGH was 22.1%, and the prevalence of xerostomia was 20.5%, but only 5.7% of participants had both conditions. Almost two-thirds of the sample had neither condition. Males and females differed in the degree of concurrence between the two conditions. It appears that, in the group studied, xerostomia and SGH were largely discrete conditions, supporting the assertion by other workers that low salivary flow may not be the key factor in the etiology of xerostomia among older people.
Article
The design of environmentally-sensitive products and manufacturing facilities is considered by some members of the industrial community to be one of the current frontiers of engineering practice, while others consider it to be another fad. Here today but gone tomorrow. This paper examines this topic from a biological stance by asserting that humankind's activities should emulate nature's flora and fauna, and the ecosystems that support them. Leonardo da Vinci's profound words of some five centuries ago concerning nature's inventive genius provides the motivation. Subsequently these words are buttressed by a set of fundamental biological canons that provide the basis for engineering design rules governing the efficient management of natural resources.
Article
To estimate the prevalence of dry mouth symptoms and their correlation with saliva production in a population based sample of elderly people in the United States. Two dry mouth questions were administered to and a modified Saxon test was performed in participants in a population based prevalence survey conducted among 2520 noninstitutionalized community dwelling residents of Salisbury, Maryland, aged 65-84 years. Seventeen percent reported having either dryness of mouth or waking at night feeling dryness in the mouth and needing to drink fluids often or all the time; 10.7% noted the former and 11.5% the latter. The prevalence of dry mouth symptoms increased with increasing age, was greater in women than men, and was greater in whites than blacks. The mean (SD) amount of saliva production was 2.38 (1.00) g/min; mean saliva production decreased with increasing age and was lower in women than men; no difference was noted by race. Persons with dry mouth symptom either often or all the time had significantly lower salivary production, even after adjustment for age and sex. Symptoms of dry mouth are common in the community dwelling elderly population, especially in white women, and correlate with decreased salivary production.
Article
Saliva is important for the preservation and maintenance of oral health. It is unclear, however, how much saliva is required to maintain normal oral function. Major salivary gland flow rates, objective measurements of oral health, and subjective complaints of oral problems were assessed in different-aged, healthy persons. Results suggest that the comparison of major salivary gland flow rates of an individual with population standards to identify patients susceptible to the effects of salivary dysfunction is unreliable. Changes in salivary function over time are a more meaningful gauge of the impact of saliva on oral health. The clinician should monitor salivary production to identify patients with declining salivary gland output.
Article
This study involves collecting saliva under unstimulated and stimulated conditions and asking standardized questions of 100 patients with xerostomia. The study examines which questions are useful in identifying and predicting current major salivary gland output deficiency or dysfunction.
Article
A representative systematic selection of 30% of all 70-year-olds (1148 persons) in Göteborg were invited to a population study. The participation rate was 85%. Sixteen per cent of the men and 25% of the women reported dryness in the mouth (sex. diff. P less than 0.01). There was a significant correlation between the number of drugs consumed by the subjects and subjective dryness (in both sexes P less than 0.001). Intake of drugs from the groups of anticholionergics, antihistamines, sedatives, hypnotics or phenothiazines respectively seemed to have the highest predicative value for dryness in the mouth (men P less than 0.05 and women P less than 0.01). There was also a positive correlation between subjective dryness and number of definable diseases in both sexes (P less than 0.01). In a consecutive sample (fifty-eight men and fifty-three women) a study of salivary flow, direct pH and buffer effect were performed. The mean value of unstimulated salivary secretion was in men 0.25 and in women 0.18 ml/min. Corresponding figures for stimulated secretion was 1.65 and 1.04 ml/min (sex. diff. P less than 0.01). A significantly lower unstimulated secretion was noted in women with subjective dryness (P less than 0.01). A negative significant correlation were found between dental invalidity, according to Eichner's classification, and stimulated secretion when drug treatment had been considered (men P less than 0.05 and women P less than 0.01). Only weak relations were noted between salivary secretions and drug treatment. Only intake of drugs with diuretic effect were negatively correlated to stimulated secretion (P less than 0.01). Diseases of the circulatory system were correlated to subjective dryness (P less than 0.01).
Article
Seventy-one persons (48 women, 23 men; mean age, 51.76 years) were evaluated for salivary flow rates and Candida albicans counts. Each person was seen on three different occasions. Samples of unstimulated whole, chewing-stimulated whole, acid-stimulated parotid, and candy-stimulated parotid saliva were collected under standardized conditions. An oral rinse was also obtained and evaluated for Candida albicans counts. Unstimulated and chewing-stimulated whole flow rates were negatively and significantly (p < 0.001) related to the Candida counts. Unstimulated whole saliva significantly (p < 0.05) differed in persons with Candida counts of 0 versus <500 versus < or = 500. Chewing-stimulated saliva was significantly (p < 0.05) different in persons with 0 counts compared with those with a > or = 500 count. Differences in stimulated parotid flow rates were not significant among different levels of Candida counts. The results of this study reveal that whole saliva is a better predictor than parotid saliva in identification of persons with high Candida albicans counts.
Article
Oral side-effects and their respective prevalence rates for the 200 most frequently prescribed drugs for 1992, as measured by IMS America's National Prescription Audit is reviewed. Accounting for duplication due to brand and generic name listings, the actual number of different medications covered was 131. The results of this review are presented in a table and include the oral side-effects and prevalences as reported in the literature. The three most frequent side-effects encountered with these medications were xerostomia (80.5%), dysgeusia (47.5%), and stomatitis (33.9%). The included table should fill the need for a ready reference for dentists in monitoring and counseling patients regarding the potential oral side-effects of the medications.
Article
Dry mouth is a common disorder in elderly individuals. It is not, however, necessarily related to decreased salivary flow rate, since subjective feelings of oral dryness have also been found in those with normal flow rates. The aim of this study was to examine in elderly individuals the prevalence of subjective complaints related to dry mouth, and their association with salivary flow rates and the use of systemic medication. In 1990 and 1991, 368 elderly inhabitants of Helsinki, Finland, had their oral health status examined. In addition to the clinical examination, 341 subjects were interviewed regarding different oral and non-oral complaints related to dry mouth. Findings showed that 46% (n = 158) of the subjects had noticed subjective symptoms of dry mouth. Continuous oral dryness was reported by 12% (n = 40) of the subjects, 6% of the men and 14% of the women (p < 0.05). In these 40, the oral and non-oral symptoms were more frequent in subjects reporting continuous dry mouth compared with controls. Continuous dry mouth was clearly associated with the female gender, with mouth breathing and with the use of systemic medications.
Article
Thirty-nine percent of 600 community-dwelling older Floridians (mean age of 78 yr) reported having mouth dryness. Seventy-nine percent of respondents reported at least one medical condition, 57% were taking at least one prescribed or over-the-counter medication, and 33% were taking at least one potentially xerostomic medication. Reported mouth dryness was highly associated with the number of potentially xerostomic medications. After stratification by medication usage, age, diabetes, arthritis, perceived medical health, and dependence in physical functioning were significantly associated with mouth dryness. Persons with dry mouth were also more likely to have reported dental symptoms, signs of dental disease, sensory changes, and other oral symptoms. Ten percent of those who reported mouth dryness also said that their mouths felt dry when eating a meal, 10% said that they had difficulties swallowing foods, and 15% of persons with dry mouth also said that the amount of saliva in their mouths was too little. Sixty-five percent of persons with dry mouth reported doing one or more dryness-related behaviors. These results suggest that the prevalence of xerostomia was high, and the impact of dry mouth on individuals' daily behaviors was significant.
Article
In this study of an older adult population almost one-fifth reported oral dryness. It was the most common of 22 oral symptoms and complaints. In a logistic regression analysis of predictors of oral dryness three variables had significant independent effects: income, taking prescribed medications and experiencing a stressful life change within the previous 6 months. Subjects with oral dryness had more decayed crown surfaces than those without but there was no association with decayed root surfaces. Nor were there any significant associations between reports of oral dryness and a number of indicators of periodontal health. Those with dryness were more likely to report other oral symptoms such as unpleasant taste, a burning sensation in the tongue and other parts of the mouth and pain from dentures. They were also more likely to report problems chewing food, problems with eating and communication and were more likely to be dissatisfied with their oral health. Given its prevalence and effects, oral dryness constitutes an important health issue among older adults.
Article
Xerostomia provoked in rats by surgical removal of the major salivary glands favoured the development of oral candidiasis. After 32 weeks of inoculation, 20% of normal and 70% of xerostomic rats showed candidal infection on the tongue but only in xerostomic rats did candidiasis affect the pharyngeal aspect of the tongue.
Article
A new model for classifying the clinical disease manifestations of primary Sjögren's syndrome is introduced. Three "exocrine' and four "nonexocrine' subgroups of disease manifestations are defined. Accordingly, "surface exocrine disease' includes the diagnostic features from eyes, mouth, and the manifestations from the upper airways, skin and genital tract. Involvement of the excretory parenchyma of the lungs, hepatobiliary system, pancreas, gastrointestinal tract and kidneys is designated "internal organ exocrine disease'. We suggest "monoclonal B lymphocyte disease' to be an exocrine disease manifestation because it originates mostly from the immunoinflammatory foci of the autoimmune exocrinopathy. The nonexocrine manifestations are subgrouped into "inflammatory vascular disease'. "noninflammatory vascular disease', "mediator-induced disease' and "autoimmune endocrine disease'.
Article
The aim of the study was to evaluate the prevalence of subjective perception of dry mouth in an adult population and to determine the prevalence of pharmacotherapy in this population. An additional aim was to assess a possible co-morbidity between symptoms of dry mouth and continuing pharmacotherapy. Four-thousand-two-hundred persons were selected at random from the national census register of the adult population of the southern part of the province of Halland, Sweden. The sample was stratified according to age and sex, and 300 men and an equal number of women aged 20, 30, 40, 50, 60, 70 and 80, were included. A newly developed questionnaire was mailed to each individual. In addition to questions about subjective perception of dry mouth, the subjects were asked to report on present diseases and continuing pharmacotherapy. Three-thousand-three-hundred and thirteen (80.5%) evaluable questionnaires were returned. The estimated prevalence of xerostomia in the population was 21.3% and 27.3% for men and women, respectively. This difference between the sexes was statistically significant. In non-medicated subjects, women tended to report a higher prevalence of xerostomia compared with men, 18.8% vs. 14.6%, and also among medicated subjects the estimated prevalence of dry mouth was higher for women than for men, 32.5% vs. 28.4%. There was a strong association between xerostomia and increasing age and also between xerostomia and continuing pharmacotherapy. The average prevalence of dry mouth among medicated and non-medicated subjects was 32.1% and 16.9%, respectively, the difference being statistically significant. There was also a strong association between xerostomia and the number of medications. In a logistic regression, the probability of reporting mouth dryness was significantly greater in older subjects and in women, and the probability increased with the number of medications taken. In conclusion, this epidemiological survey of an adult population has demonstrated that women, independent of age, do report a higher prevalence of xerostomia than men and that the symptom of dry mouth is strongly associated with age and pharmacotherapy. It is, however, not possible to discriminate between disease and pharmacotherapy as causal factors.
Article
The purpose of this survey was to study the sensation of oral dryness and its underlying factors in the 55-year-old population of Oulu (a medium-sized Finnish town), 780 of whom (77%) participated. In addition to the examination of oral health status and salivary flow rate measurements, depressive symptoms were determined on the basis of the Zung Self-Rating Depression Scale (ZSDS). The participants were also interviewed about their health, medication, physical health, physical activity, smoking habits, alcohol consumption, and factors related to their work. The prevalence of subjective sensations of dry mouth was 25.8% among men and 33.3% among women (p = 0.025). A statistically significant association was found between a subjective sensation of dry mouth and a low unstimulated flow rate, regular smoking, xerogenic medication, and the presence of at least one illness connected with dry mouth. Those who had a sensation of dry mouth also thought their physical condition and their health to be poorer and more often had a high rate of depressive symptoms. After the confounding factors had been added stepwise into the logistic regression model, depressive symptoms were still significantly associated with the sensation of oral dryness. When evaluating the causes of the sensation of dry mouth, the possibility of depression as an underlying factor should be considered.
Article
Saliva plays an important role in maintaining oral health and functions. In the present study, unstimulated and stimulated whole salivary flow and various oral complaints were surveyed in 1427 individuals, 669 men (47%) and 758 women (53%). These individuals, aged 20 to 69 years and from different socioeconomic backgrounds, were recruited from 2000 randomly selected men and women in the register of the public dental health service in northern Sweden. The unstimulated salivary flow rate ranged from 0 to 2.07 mL/min (mean 0.33+/-SD 0.26) for men, and from 0 to 1.35 mL/min (mean 0.26+/-SD 0.21) for women. The stimulated salivary flow rate ranged from 0.17 to 7.3 mL/min (mean 2.50+/-SD 1.06) for men, and from 0 to 6.40 mL/min (mean 2.02+/-SD 0.93) for women. Women over 55 years of age had a reduced unstimulated salivary flow (P<0.05). Individuals with many teeth had a higher stimulated salivary flow than those with fewer teeth (P<0.001). Male smokers had a lower unstimulated salivary flow than male non-smokers (P<0.05). Women with oral lesion complaints had a lower unstimulated salivary flow (P<0.05), and women with burning mouth had a lower stimulated salivary flow (P<0.01). Individuals with subjective oral dryness had reduced salivary flow, both unstimulated (men P<0.01, women P<0.001) and stimulated (P<0.001). Subjective oral dryness was associated with complaints of burning mouth (P<0.001), muscle pain (P<0.01), taste disturbances (P<0.01), and dry eyes (P<0.05). Individuals with subjective oral dryness had fewer teeth than individuals with no such complaints (P<0.001). Information regarding salivary flow rate in adults is important in understanding and evaluating the relationship between salivary flow and various types of oral complaints in patients.
Article
The purpose of this study was to investigate the prevalence of self-reported symptoms of dry mouth and burning mouth in the frail elderly. We expected to find the studied symptoms more frequently in the frail elderly than in those who were healthier. We examined 175 home-living elderly patients (mean age with SD, 82 +/- 5.7 years) hospitalized because of sudden worsening of their general health. For comparison, 252 elderly outpatients (mean age with SD, 77 +/- 5.7 years) from the same community were studied. The subjects' medical diagnoses and prescribed drugs used daily were recorded, their oral health examined, and saliva samples taken for analyses of flow rates, yeasts, and a variety of biochemical factors. The results showed that 63% of the hospitalized patients and 57% of the outpatients complained of dry mouth. The respective percentages of burning mouth were 13% in the hospitalized and 18% in the outpatients. The dentate status affected the feeling of dry mouth and burning mouth, but there were no consequent differences in concentrations of salivary biochemical constituents, yeast counts, and buffering capacity between patients with or without the symptoms except that hospitalized patients complaining of dry mouth more often had low salivary buffering than those without the symptom. Dry mouth was also more prevalent among the hospitalized patients who used several drugs daily, whereas no such association was found with the burning-mouth symptom. Use of analgesics appeared to safeguard against both the symptoms. Dry mouth and burning mouth were seldom reported simultaneously, although low salivary flow rate was a common finding in patients with burning mouth. The strongest explanatory factors for burning mouth were psychiatric disease among the outpatients (OR 8.7, CI 1.4-54.1, P <.05) and use of psychiatric drugs among the hospitalized (OR 4.2, CI 0.9-20.0, P =.07). For dry mouth, the strongest explanatory factors were respiratory disease in the outpatients (OR 2.0, CI 1.0-3.8, P <.05) and low salivary flow rate in the hospitalized elderly (OR 3.7, CI 1.4-10, P <.05). In all patients (n = 427), use of psychiatric drugs was the strongest explanatory factor for dry mouth (OR 2.1, CI 1.2-3.5, P <.01), whereas analgesic medication was found to protect against burning mouth (OR 0.5, CI 0.3-0.9, P <.05). The subjective feelings of dry mouth and burning mouth appeared to be a complex issue among the elderly population studied. The 2 symptoms were seldom reported at the same time. The appearance of symptoms did not directly correlate with general health, except in the case of psychiatric diseases and medications, which should be taken into account.
Article
Complaints of xerostomia and salivary hypofunction are common in older adults. However, recent studies reported that dehydration-induced salivary hypofunction caused fewer xerostomic complaints in older compared with young adults. This may predispose older adults to developing oral problems that will subsequently not receive attention from health care providers. Since many medications are known to inhibit salivation, this study attempted to determine if an anticholinergic drug (glycopyrrolate) had a differential effect on xerostomic complaints in young vs. older adults. Eighteen young (age 20-38 yrs) and 18 older (age 60-77 yrs) healthy adults were given a 4.0 micrograms/kg dose of i.v. glycopyrrolate. For 6 hrs after drug administration, stimulated parotid salivary flow was collected, and an eight-item Visual Analogue Scale (VAS) subjective xerostomia test was given. At several time points post-i.v. glycopyrrolate, salivary flow rates were consistently lower in older compared with young adults. For some measures of xerostomic complaint (time to first complaint; time to maximum complaint; mean maximum complaint), there were no age-related differences for all VAS items. However, a trend for increased xerostomic complaints in older adults was demonstrated (time to recovery; total duration of complaint; number xerostomic at 6 hrs). These findings suggest that, given equal doses of an anti-sialogogue, salivary hypofunction is greater in healthy older adults, while increased complaints of xerostomia are not as consistent.
Article
The purpose of this study was to determine the association of stimulated salivary flow rate with perceived salivary flow and various oral symptoms among a group of independently living elderly persons. The subjects were 351 persons (189 men and 162 women) with a mean age of 66.7 +/- 4.3 years. Stimulated whole saliva was collected with the mastication method. Self-assessed chewing ability and satisfaction with oral function also were evaluated. A multiple logistic regression analysis was used to determine whether an independent variable was statistically significant. Hyposalivation (< 0.5 mL/min) was significantly associated with gender (odds ratio, 1.67; P < .05). Hyposalivation (odds ratio, 3.40; P <.05) and low perceived salivary flow (odds ratio, 5.35; P <.05) were significantly associated with dissatisfaction with tasting. Low perceived salivary flow was also significantly associated with self-assessed chewing ability (odds ratio, 3.32; P <.01). This study suggested that hyposalivation and low perceived salivary flow were related to chewing ability and satisfaction with tasting foods.