Perception of dry mouth in a sample of community-dwelling older adults in Japan

Xerostomia and oral health-related quality of life in peri- and postmenopausal women

OBJECTIVE

The menopausal transition triggers hormonal changes that can manifest in oral symptoms such as xerostomia, which can substantially impact women's quality of life. Our study examined the prevalence and severity of xerostomia and its association with menopausal status. Furthermore, we evaluated the impact of xerostomia on oral health-related quality of life in peri- and postmenopausal women.

METHODS

This study was a cross-sectional investigation based on the results of a REDCap survey, involving 3211 women aged between 40 and 90 years. The survey recorded age, menopause status, age at menopause, smoking status, and being treated with xerogenic drugs and included two instruments: the Xerostomia Inventory, used to evaluate the oral symptoms; and the Oral Health Impact Profile-14 (OHIP-14), used to assess the related quality of life. Student's t-test, the chi-squared test, Pearson's correlation coefficient, and multivariable logistic and linear regressions were performed for data analysis. Odds ratio (OR), beta coefficient (β), and their 95 % confidence intervals (CIs) were applied to assess associations.

RESULTS

The global prevalence of xerostomia was 71.2 %. The Xerostomia Inventory score correlated with the OHIP-14 score (r = 0.686; p = 0.000). Smoking was significantly associated with the probability of xerostomia (OR = 1.36; 95 % CI = 1.02-1.82), as were the following OHIP-14 domains: functional limitation (OR = 1.43; 95 % CI = 1.30-1.50), physical pain (OR = 1.17; 95 % CI = 1.06-1.29), psychological discomfort (OR = 1.21; 95 % CI = 1.13-1.29), physical disability (OR = 1.11; 95 % CI = 1.02-1.20), psychological disability (OR = 1.18; 95 % CI = 1.09-1.29), and social disability (OR = 1.15; 95 % CI = 1.01-1.32). There were no significant differences in the probability of xerostomia according to the menopausal status. In women with xerostomia the OHIP-14 score was higher than in women without xerostomia (β = 5.50; 95 % CI = 4.69-6.31).

CONCLUSIONS

Peri- and postmenopausal women have a high prevalence of xerostomia. There were no differences in the probability of xerostomia between peri- and postmenopausal women. There was a strong association between xerostomia symptoms and poor oral health-related quality of life.

A rural teledentistry care experience: a geriatric approach to assessing oral health status and treatment needs in older adults from a Mapuche community in Chile

Background

Limited attention has been given to oral health challenges faced by older Indigenous populations, especially in rural settings, where disparities exist. This study aims to assess oral health in a rural Mapuche community in southern Chile, utilizing geriatric technology support, and exploring the connection between geriatric health and oral well-being to fill a gap in this context.

Methods

A cross-sectional study was conducted involving 76 independent older adults from a rural Mapuche community who required dental care. Assessments were in a remote care setting gathering extensive data including comprehensive geriatric assessments, medical and dental conditions using a geriatric teledentistry platform (TEGO®). Statistical analysis involved descriptive analysis, logistic regression, and both multiple correspondence analysis and k-means cluster analysis.

Results

The sample comprised individuals with limited formal education and a high degree of vulnerability. Geriatric assessments unveiled cognitive deterioration, frailty, depression risk, and multimorbidity. A distribution of the DMFT index, number of remaining teeth, number of occluding pairs, number of teeth with restorative needs and other relevant clinical findings was conducted based on sociodemographic, and medical-geriatric-dental characteristics, and additionally, a Multinomial Logistic Regression Analysis of Dentition Variables in Relation to Geriatric Assessments was performed. The dental burden was substantial, with an average DMFT index of 25.96 (SD 4.38), high prevalence of non-functional dentition (89.3%), periodontal disease (83%), xerostomia (63.2%) and oral mucosal lesions (31.5%). Age, lower education, depression, daily medication number and sugary consumption frequency were associated with a decreased average number of teeth (p < 0.05). Multiple correspondence analysis and k-means cluster analysis identified 4 clusters, with the edentulous and functional dentition groups being the most distinct.

Conclusion

This study uncovers a substantial dental burden and intricate medical-geriatric conditions interlinked among Indigenous older adults in a rural Chilean Mapuche community. The implementation of a geriatric technological ecosystem in the community enabled the resolution of less complex oral health issues and facilitated remote consultations with specialists, reducing the necessity for travel to health centers. This underscores the need for innovative dental public health initiatives to address health disparities and improve the overall well-being of older Indigenous adults.

Prevention of oral diseases for the older person (Part 1)

Older adults often experience poorer levels of oral health than younger adults, especially if they have become dependent on a third party to support their daily oral care routine. However, the deterioration of oral health does not need to be a part of the ageing process. Most oral diseases are largely preventable with the daily removal of dental plaque that forms on teeth and dentures, using a fluoride toothpaste, eating a healthy diet and reducing any tobacco consumption. The dental team have a duty of care to ensure that older people receive evidence-based oral health preventative advice tailored to the individual, taking into account individual risk factors that can increase with age. This can include the clinical application of topical fluoride and minimally invasive dentistry. Older people at an increased risk of poor oral health include those with cognitive conditions, physical impairments and certain medical conditions. Care home residents face particular barriers to attaining a satisfactory standard of oral care which are discussed herein. Good oral health preventative routines must be established early after the diagnosis of progressive chronic conditions and will help to prevent the need for dental intervention later in life when treatment can be more difficult to tolerate. Inclusion of oral health prevention within health policy and legislation is necessary to improve the oral health for older people living in all health and care settings.

Anticholinergic Burden and Xerostomia in Critical Care Settings

BACKGROUND

Although previous studies have established the association of medications with anticholinergic adverse effects and xerostomia, anticholinergic burden and xerostomia in critical care settings are poorly characterized. The objective of this study was to determine the impact of medication burdens associated with anticholinergic adverse effects, particularly the occurrence of xerostomia (dry mouth) in a critical care setting. In addition, this study explored the correlation between the timing of the first instance of xerostomia and the administration timing of medication known to have anticholinergic adverse effects.

METHODS

A retrospective case-control study was used with the MIMIC (Medical Information Mart for Intensive Care) III database. The MIMIC-III clinical database is a publicly available, deidentified, health-related database with more than 40 000 patients in critical care units from 2001 to 2012. Cases of xerostomia (n = 1344) were selected from clinical notes reporting "dry mouth," "xerostomia," or evidence of pharmacological treatment for xerostomia; control (n = 4032) was selected using the propensity analysis with 1:3 matching on covariates (eg, age, sex, race, ethnicity, and length of stay). The anticholinergic burden was quantified as the cumulative effect of anticholinergic activities using the Anticholinergic Burden Scale.

RESULTS

Anticholinergic burden significantly differed between xerostomia patients and control subjects (P = .04). The length of stay was a statistically significant factor in xerostomia. The probability of developing the symptom of xerostomia within 24 hours was .95 (95%) for patients of xerostomia.

CONCLUSIONS

Anticholinergic Burden Scale is associated with xerostomia in the critical care setting, particularly within 24 hours after admission. It is crucial to carefully evaluate alternative options for medications that may have potential anticholinergic adverse effects. This evaluation should include assessing the balance between the benefits and harms, considering the probability of withdrawal reactions, and prioritizing deprescribing whenever feasible within the initial 24-hour period.

Diagnostic role of minor salivary glands biopsy in Sjögren's syndrome: correlations between histology and autoimmunity in a large, monocentric cohort

Introduction

Based on ACR/EULAR classification criteria, minor salivary glands biopsy (MSGB) is a useful diagnostic tool for the diagnosis of primary Sjögren's syndrome (SS). The main objective of our study was to evaluate the diagnostic role of MSGB, as well as to highlight correlations between histological findings and autoimmune profiles.

Material and methods

We retrospectively evaluated histological and autoimmunity data from patients who underwent MSGB in our department in cases of suspected SS, from March 2011 to December 2018. Salivary gland samples were evaluated using Chisholm and Mason (CM) grading and the focus score (FS).

Results

A total of 1,264 patients (108 males, 1,156 females) were included. The median age was 55.22 ±13.51 years (range: 15-87). In univariate binary logistic regression, CM ≥ 3 and FS ≥ 1 were significantly predicted by antinuclear antibodies (ANA), anti-extractable nuclear antigens (ENA) and anti-Ro/SSA titer as well as anti-La/SSB, anti-Ro/SSA, rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) positivity. In multivariate analysis, CM ≥ 3 and MSGB positivity were significantly associated with ANA titer; FS ≥ 1 was not associated with laboratory findings. A positive biopsy was associated with laboratory findings, as ANA and ENA titers, anti-Ro/SSA, anti-La/SSB, RF and ACPA positivity may discriminate patients with SS-related histological findings.

Conclusions

Minor salivary glands biopsy is a useful tool to diagnose SS in cases of highly suggestive clinical symptoms but in the absence of a specific autoimmunity.

World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia

OBJECTIVE

The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth.

STUDY DESIGN

A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized.

RESULTS

From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains.

CONCLUSION

There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.

The Association between Malnutrition and Oral Health in Older People: A Systematic Review

The aim of this systematic review was to examine the association between malnutrition and oral health in older people (≥ 60 years of age). A comprehensive systematic literature search was performed in four databases (PubMed, CINAHL, Dentistry and Oral Sciences Source, and Embase) for literature from January 2000 to May 2020. Both observational and intervention studies were screened for eligibility. Two reviewers independently screened the search results to identify potential eligible studies, and assessed the methodological quality of the full-text studies. A total of 3240 potential studies were identified. After judgement for relevance, 10 studies (cross-sectional (n = 9), prospective cohort (n = 1)) met the inclusion criteria. Three studies described malnourished participants as having fewer teeth, or functional (tooth) units (FTUs), compared to well-nourished participants. Four studies reported soft tissue problems in malnourished participants, including red tongue with blisters, and dry or cracked lips. Subjective oral health was the topic in six studies, with poorer oral health and negative self-perception of oral health in malnourished elderly participants. There are associations between (at risk of) malnutrition and oral health in older people, categorized in hard and soft tissue conditions of the mouth, and subjective oral health. Future research should be focused on longitudinal cohort studies with proper determination of malnutrition and oral health assessments, in order to evaluate the actual association between malnutrition and oral health in older people.

Salivary secretion and salivary stress hormone level changes induced by tongue rotation exercise

PURPOSE

Prevention of xerostomia and stress is important to prolong healthy life expectancy and improve the quality of life. We aimed to investigate the effects of tongue rotation exercise for increasing salivary secretions and stabilizing salivary stress hormone levels.

MATERIALS AND METHODS

Twenty four participants without subjective oral dryness were enrolled. The exercises comprised tongue rotation exercise and empty chewing. The salivary stress hormone level was measured using a Salivary Amylase Monitor. Unstimulated whole saliva volume and salivary amylase activity were measured before tongue rotation exercise or empty chewing and subsequently 5, 10, and 15 minutes after these exercises. Differences in the rates of change of unstimulated whole saliva volume and salivary amylase activity were analyzed by repeated measure analysis of variance.

RESULTS

Statistically significant differences among the rates of change were not observed after empty chewing for unstimulated whole saliva volume and salivary amylase activity at the four measurement times. However, the rate of change of unstimulated whole saliva volume and salivary amylase activity were statistically significantly different among the four time points: before the tongue rotation exercise and 5, 10, and 15 minutes post-exercise (P< .05 and P<.01, respectively).

CONCLUSION

Tongue rotation is effective in increasing saliva secretion, reducing stress, improving oral function, and extending healthy life expectancy.

The Differential Diagnosis of Dry Eyes, Dry Mouth, and Parotidomegaly: A Comprehensive Review

Primary Sjögren's syndrome (pSS) is a frequent autoimmune systemic disease, clinically characterized by eyes and mouth dryness in all patients, salivary gland swelling or extraglandular systemic manifestations in half of the patients, and development of lymphoma in 5 to 10 % of the patients. However, patients presenting with sicca symptoms or salivary gland swelling may have a variety of conditions that may require very different investigations, treatments, or follow-up. Eye and/or mouth dryness is a frequent complaint in clinical setting, and its frequency increases with age. When evaluating a patient with suspected pSS, the first step is to rule out its differential diagnoses, before looking for positive arguments for the disease. Knowledge of normal and abnormal lachrymal and salivary gland physiology allows the clinician to prescribe the most adapted procedures for evaluating their function and structure. New tests have been developed in recent years for evaluating these patients, notably new ocular surface staining scores or salivary gland ultrasonography. We describe the different diagnoses performed in our monocentric cohort of 240 patients with suspected pSS. The most frequent diagnoses are pSS, other systemic autoimmune diseases, idiopathic sicca syndrome and drug-induced sicca syndrome. However, other diseases are important to rule out due to their specific management, such as sarcoidosis, granulomatosis with polyangeitis, IgG4-related disease, chronic hepatitis C virus or human immunodeficiency virus infections, graft-versus-host disease, and head and neck radiation therapy. At the light of these data, we propose a core of minimal investigations to be performed when evaluating a patient with suspected pSS.

Factors associated with self-rated oral health among community-dwelling older Japanese: A cross-sectional study

OBJECTIVES

A cross-sectional study was carried out to investigate the determinants of self-rated oral health among community-dwelling older people in Japan.

METHODS

The participants were 897 (357 men and 540 women) aged 65 years and over who participated in a comprehensive geriatric health examination, which included an oral examination, a face-to-face interview assessing cognitive function, questionnaires regarding depressive symptoms and functional capacity, and a medical examination. The oral examination measured indices of oral health status: number of present teeth, number of functional teeth, occlusal force and amount of resting saliva. Multiple logistic regression analyses were carried out to determine the factors associated with poor self-rated oral health.

RESULTS

The mean age of the participants was 73.5 ± 5.0 years. The prevalence of poor and rather poor self-rated oral health was 11.5% and 29.5%, respectively. Multiple logistic regression analyses showed that the number of present teeth (odds ratio [OR] 0.97, 95% confidence intervals [CI] 0.95-0.99), difficulty in mastication (OR 3.20, CI 2.18-4.70), presence of xerostomia (OR 1.43, CI 1.02-2.01), total score on the MoCA-J (OR 1.06, CI 1.01-1.11), and reduction in frequency of leaving the house (OR 1.64, CI 1.12-2.41) were significantly associated with poor self-rated oral health.

CONCLUSIONS

The present results suggested that self-rated oral health was a significant factor in oral health status as well as overall well-being among community-dwelling older Japanese people.

Effectiveness of an oral health educational program on community-dwelling older people with xerostomia

AIM

The purpose of the present study was to evaluate the changes in oral health and function through an oral health educational program for the independent older people with xerostomia.

METHODS

Community-dwelling older people with xerostomia aged over 65 years who participated in a preliminary comprehensive health survey in 2011 were recruited for the educational program. A total of 47 participants were randomly assigned into two groups, the intervention group (n = 26) and the control group (n = 21). The intervention group attended a 90-min oral health education program every 2 weeks for 3 months. The program consisted of oral hygiene instruction, facial and tongue muscle exercise, and salivary gland massage. The control group was provided only general information about oral health. The assessments of oral function, such as oral diadochokinesis of articulation, swallowing, taste threshold and salivary flow rate, were carried out before and after 3 months with or without intervention.

RESULTS

A total of 38 participants (21 of intervention group and 17 of control group) completed the study protocol. In the intervention group, resting salivation significantly improved after the program. The second and third cumulated Repetitive Saliva Swallowing Test times significantly improved in the intervention group. The threshold for bitterness significantly lowered in the intervention group, whereas the sour threshold significantly heightened in the control group after 3 months (P < 0.05).

CONCLUSIONS

The present study suggests that the educational program targeting oral function improvement is effective among the independent older population.

Prevalence and factors associated with xerostomia and hyposalivation among community-dwelling older people in Japan

OBJECTIVE

This study investigated the prevalence and factors associated with xerostomia and hyposalivation among community-dwelling older people.

BACKGROUND

Xerostomia and hyposalivation are common symptoms in the older population.

MATERIALS AND METHODS

This study included with 894 community-dwelling, Japanese older people (355 men, 539 women; age 65-84 years) who participated in a comprehensive geriatric health examination, which included questionnaires and interviews regarding medical history, medications, Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), depressive condition. The Zung Self-Rating Depression Scale (SDS) was used to evaluate depression. Resting salivary flow rate was evaluated by the modified cotton roll method.

RESULTS

In this study, 34.8% of the participants (mean age, 73.5 ± 5.0 years) complained about xerostomia, while the prevalence of hyposalivation was 11.5%. Multiple regression analysis revealed hypnotics use [odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.13-2.61], SDS (OR = 1.05, CI = 1.04-1.07) and TMIG-IC total points (OR = 0.87, CI = 0.76-0.99) to be significantly associated with xerostomia. In contrast, female gender (OR = 2.59, CI = 1.55-4.31) and the use of agents affecting digestive organs (OR = 1.78, CI = 1.11-2.86) were associated with hyposalivation.

CONCLUSION

Our findings showed that the prevalence of xerostomia and hyposalivation were approximately 1 in 3 and 1 in 10 respectively. The factors associated with psychological factors and high-level functional competence, while hyposalivation was associated with medications and gender, as well as systemic and/or metabolic differences. It is important to consider these multidimensional factors associated with xerostomia and hyposalivation.

Xerostomia in complete denture wearers: prevalence, clinical findings and impact on oral functions

OBJECTIVES

To investigate the prevalence of dry mouth in a select sample of edentulous Jordanian older population wearing complete dentures and to evaluate its impact on oral functions.

BACKGROUND

The prevalence and impact of Xerostomia as a cofactor in causing denture problems in Jordanians have not been previously investigated.

MATERIALS AND METHODS

This study included 455 participants (253 men and 202 women). Perception of dry mouth was measured by a pilot-tested questionnaire. Xerostomic status was confirmed clinically. Complete denture function was also assessed.

RESULTS

One hundred and thirty six subjects (29.9%) had reported a subjective feeling of dry mouth with a prevalence of 24.9% in men (n = 63) and 36.1% in women (n = 73) (p < 0.01). 136 of the 145 subjects with satisfactory dentures showed one or more signs suggestive of Xerostomia. The majority of xerostomic participants with different sets of complete dentures were dissatisfied with oral functions (p < 0.05). There was a significant association between dry mouth and increasing age, female gender and smoking status (p < 0.05).

CONCLUSION

Among complete denture wearers, Xerostomia is significantly more prevalent in women and associated with increased age and smoking. Xerostomia adversely affects oral functions and overall satisfaction with dentures.

Factors associated with dry mouth in dependent Japanese elderly

OBJECTIVES

To identify factors associated with dry mouth.

BACKGROUND

Dry mouth adversely affects oropharyngeal health, particularly in elderly, and can lead to pneumonia. A better understanding of the epidemiology of dry mouth is therefore important in improving treatment strategies and oral health in high-risk elderly patients.

METHODS

We conducted a cross-sectional study involving 383 dependent Japanese elderly individuals (65-84 [n = 167] and ≥85 [n = 216] years) at eight long-term care facilities and hospitals. Thirty-four potential factors associated with dry mouth were examined by multiple logistic regression analysis. The primary outcome was dry mouth, as diagnosed by tongue dorsum moisture.

RESULTS

We identified that body mass index and severity of physical disability were identified as a potential factors associated with dry mouth in the super-elderly (≥85 years) group, whereas severity of physical disability, outcome measurement time, high daily water consumption, mouth breathing, use of antidepressants and diuretics, and high frequency of daily brushing (≥2 times per day; Odds ratio: 5.56; 95% Confidence Interval: 1.52-20.00) were associated with dry mouth in the 65- to 84-year-old group.

CONCLUSION

To our knowledge, this is the first study to identify a link between frequency of daily brushing and dry mouth and suggests that tooth brushing should be encouraged in high-risk dependent Japanese elderly (65-84 years), particularly those taking antidepressants and/or diuretics.

Dental patients' self-reports of xerostomia and associated risk factors

BACKGROUND

Most studies regarding xerostomia focus on elderly people. Therefore, the authors conducted a study of dental patients 18 years or older to determine the prevalence of self-reported xerostomia and associated risk factors.

METHODS

The authors sent a total of 2,200 questionnaires to four dental clinics to assess patients' self-reported xerostomia. They also collected sociodemographic data and information regarding personal behavior. They used logistic regression models to estimate odds ratios (OR) and 95 percent confidence intervals (CI) to explore the relationship between self-reported xerostomia and risk factors that reasonably might be expected to be associated with self-reported xerostomia.

RESULTS

The overall prevalence of xerostomia in participants was 7 percent. Participants with burning-mouth sensations were associated with having higher odds of experiencing dry mouth (OR, 2.1; 95 percent CI, 0.9-5.2). Participants 51 years or older were significantly more likely to report having dry mouth than were younger participants (P < .04). The prevalence of self-reported xerostomia increased with increasing numbers of medications patients reported using.

CONCLUSION

The authors found that medication use and age were highly significant risk factors for dental patients reporting xerostomia.

CLINICAL IMPLICATIONS

Clinicians should interview their patients carefully regarding their use of medications and provide proper oral health care to improve xerostomia resulting from medication use.

Poor chewing ability is associated with lower mucosal moisture in elderly individuals

Oral dryness is common among aging individuals and its objective evaluation is an important issue for improving their oral health. In the present study, we measured the objective mucosal moisture in elderly individuals with a moisture checker and evaluated its relation with laboratory findings and subjective oral status. The subjects were 502 adults (244 men and 258 women), with a mean age of 72.3 +/- 6.7 years, who participated in a regular medical screening program in Nagasaki Prefecture, Japan. We evaluated the moisture of the oral mucosa by measuring the weight percentage of water content in the oral epithelium, subjective oral dryness, self-assessed chewing ability ["good" ("able to chew all foods") or "poor" ("able to chew soft foods only" and "unable to chew any foods")], and laboratory findings. The values obtained with a moisture checker, which represent objective oral mucosal moisture, were significantly lower in women with poor chewing ability than those with good chewing ability (28.2 +/- 2.4% vs. 29.2 +/- 2.0%, p = 0.004) and in all subjects (28.4 +/- 2.4% vs. 29.1 +/- 2.0%, p = 0.004), but not in men (28.6 +/- 2.5% vs. 29.0 +/- 2.0%, p = 0.27). When multiple logistic regression analysis was performed on confounding factors, older age (OR: 1.24, p = 0.015), women (OR: 1.70, p = 0.016), and anemia (OR: 1.96, p = 0.030) were significantly associated with self-assessed chewing ability. Our current study indicates that poor chewing ability is associated with lower mucosal moisture in elderly individuals.

Green tea polyphenols reduce autoimmune symptoms in a murine model for human Sjogren's syndrome and protect human salivary acinar cells from TNF-alpha-induced cytotoxicity

Sjogren's syndrome (SS) is a relatively common autoimmune disorder. A key feature of SS is lymphocytic infiltration of the salivary and lacrimal glands, associated with the destruction of secretory functions of these glands. Current treatment of SS targets the symptoms but is unable to reduce or prevent the damage to the glands. We reported previously that the major green tea polyphenol (GTP) epigallocatechin-3-gallate (EGCG) inhibits autoantigen expression in normal human keratinocytes and immortalized normal human salivary acinar cells (Hsu et al. 2005). However, it is not known whether GTPs have this effect in vivo, if they can reduce lymphocytic infiltration, or protect salivary acinar cells from tumor necrosis factor-alpha (TNF-alpha)-induced cytotoxicity. Here, we demonstrate that in the NOD mouse, a model for human SS, oral administration of green tea extract reduced the serum total autoantibody levels and the autoimmune-induced lymphocytic infiltration of the submandibular glands. Further, we show that EGCG protected normal human salivary acinar cells from TNF-alpha-induced cytotoxicity. This protection was associated with specific phosphorylation of p38 MAPK, and inhibitors of the p38 MAPK pathway blocked the protective effect. In conclusion, GTPs may provide a degree of protection against autoimmune-induced tissue damage in SS, mediated in part through activation of MAPK elements.

Oral health conditions of community-dwelling cognitively intact elderly persons with disabilities

OBJECTIVES

To present descriptive information on oral health and health care of community-dwelling elderly persons with disabilities who are living at home.

BACKGROUND

Most previous studies have focused on specific subpopulations, namely, persons who are essentially healthy and independent, are homebound, or are nursing home residents. Little information appears to be available on community-residing elderly persons with disabilities.

MATERIALS AND METHODS

A total of 641 participants aged 65 years and over in a Medicare Demonstration who were cognitively intact, completed an oral health questionnaire within 1 year of Demonstration entry. Demonstration participants were required to be living in the community, need or receive help with 2+ activities of daily living (ADLs) or 3+ instrumental ADLs (IADLs), and have recently experienced significant health services utilisation.

RESULTS

Subject mean age was 79.1 years, 73.8% were female, and 4% were minority. They were dependent in a mean of 1.8 ADLs and 2.9 IADLs. 43.1% reported that they had no natural teeth, 77.4% had dentures, 58.8% frequently felt their mouth was dry, 5.2% had jaw pain now and 6.1% had at some time experienced burning sensations in their mouth or tongue. 40.4% reported that they were currently in need of dental treatment, although 56.2% indicated they now had a dentist, and 42.1% identified having a dental visit within the past 12 months. 19.7% indicated some dental insurance coverage.

CONCLUSION

This is one of the first studies to focus on community-dwelling elderly people with disabilities. Substantial oral health morbidity was reported.

Impact of dry mouth and hyposalivation on oral health-related quality of life of elderly Japanese

OBJECTIVE

To determine the association of hyposalivation and the perception of dry mouth with oral health-related quality of life for independently living elderly.

STUDY DESIGN

The study sample consisted of 287 participants (mean age, 66.1 years) at a Senior Citizen educational system. Stimulated salivary flow rates during chewing were measured. The OHIP-14 to measure the impact of oral conditions on health-related quality of life was used, and summary OHIP-14 scores combining the response codes for the 14 items were analyzed.

RESULTS

A logistic regression analysis showed that a higher OHIP-14 score indicating a poorer quality of life was related to fewer residual teeth, perception of dry mouth on eating (OR: 4.01, P = .012) and hyposalivation (OR: 2.71, P = .006).

CONCLUSION

It is suggested that both dry mouth and hyposalivation are important problems influencing the quality of life in independently living, relatively healthy elderly Japanese.

Prevalence of xerostomia in population-based samples: a systematic review

The consequences of xerostomia on oral health have been studied for decades; however, the actual prevalence of this disorder on the general population remains controversial. The purpose of this systematic review was to determine the prevalence of xerostomia in population-based samples. Electronic databases were screened for relevant articles and reference lists of pertinent articles were also hand-searched. Thirteen articles meeting the final inclusion criteria were identified. Based on the definition of xerostomia used in this review, only publications including a subjective diagnosis of the disorder were included. All of the self-reported diagnoses were achieved through a questionnaire either by mail, telephone, interview or self-administered by the patient. There was a variation across papers regarding number and content of the questions as well as guidelines for the diagnosis of xerostomia (i.e. answer yes to one or more than one question). The prevalence of xerostomia in the selected articles ranged from 0.9% to 64.8%. The majority of these studies were performed in Scandinavia. In 9 of the articles, the studied samples were 50 years and older. None of the studies evaluated the prevalence xerostomia among individuals younger than 18 years. Based on these observations, it can be concluded that there is a need for population-based studies on prevalence of xerostomia in regions other than Scandinavia. A standardized protocol to diagnose xerostomia needs to be developed. Patient-perceived treatment needs and impact on quality of life should be included to have a complete picture of public health implications of the disease.

A New Approach to Managing Oral Manifestations of Sjogren's Syndrome and Skin Manifestations of Lupus

Sjogren's syndrome (SS) is an autoimmune disorder that affects the salivary glands, leading to xerostomia, and the lacrimal glands, resulting in xerophthalmia. Secondary SS is associated with other autoimmune disorders such as systemic rheumatic diseases and systemic lupus erythematosis (SLE), which can affect multiple organs, including the epidermis. Recent studies have demonstrated that green tea polyphenols (GTPs) possess both anti-inflammatory and anti-apoptotic properties in normal human cells. Epidemiological evidence has indicated that, in comparison to the United States, the incidence of SS, clinical xerostomia and lupus is considerably lower in China and Japan, the two leading green tea-consuming countries.Thus, GTPs might be responsible, in part, for geographical differences in the incidence of xerostomia by reducing the initiation or severity of SS and lupus. Consistent with this, molecular, cellular and animal studies indicate that GTPs could provide protective effects against autoimmune reactions in salivary glands and skin. Therefore, salivary tissues and epidermal keratinocytes could be primary targets for novel therapies using GTPs. This review article evaluates the currently available research data on GTPs, focusing on their potential application in the treatment of the oral manifestations of SS and skin manifestations of SLE.

Mundgesundheit, Zahnstatus und Ernährung im Alter

The loss of natural teeth impairs essentially the chewing function and can only partly be restored by the insertion of dental prostheses. Equally, xerostomia and dysphagia may aggravate the nutritional intake in older adults. Often denture wearers do subjectively not notice the adjustment of their food choice and the employment of special preparation techniques. Finally the dental state influences the nutritional intake. A reduced number of teeth correlates with the intake of less calories, proteins, fat, non-starch polysaccharides and vitamins. Often missing calories are compensated by an increased consumption of sugar and fat. Especially edentulous persons with a low level of education choose a diet which is rich in fat and sugar. Further the daily intake of fruit and vegetables diminishes along with fewer occlusal contacts in posterior teeth. The restoration of the chewing function by dental intervention does not lead to an improvement of the nutritional intake by itself and should therefore always be complemented by nutritional advice.

Oral dryness, nocturia and the menopause

OBJECTIVE

To analyse the relationship between oral dryness (OD), nocturia, the menopausal transition and some medical conditions and medications in women.

METHODS

A questionnaire study was carried out in 3669 randomly selected women (out of 6000 invited) in the County of Jämtland, Sweden. Questions were asked about occurrence of somatic diseases and symptoms, nocturia, nocturnal thirst and drinking, and the use of drugs.

RESULTS

The occurrence of oral dryness was 17.8% in women before the menopause, 23.3% during the first 5 years after, 29.2% 5-9 years after and 34.5% 10 or more years after the menopause (P < 0.0001). In a multiple logistic regression analysis independent correlates for oral dryness were: nocturnal micturition, one episode versus none 1.7 (1.4-2.1); two versus none 2.4 (1.7-3.2); > or = 3 versus none 3.3 (2.1-5.2); menopausal state: <5 years after the menopause versus before 1.2 (0.9-1.6); 5-9 years after the menopause versus before 1.6 (1.2-2.1); > or = 10 years after the menopause versus before 1.7 (1.3-2.2); musculo-skeletal pain 1.6 (1.3-2.1) being on one or more prescribed drugs 1.8 (1.5-2.1).

CONCLUSION

The present data show that OR is a common and disregarded symptom in women with nocturia independent of menopausal state, musculo-skeletal symptoms and medication with analgesics, diuretics, hypnotics and hormonal replacement therapy (HRT).

Xerostomia: clinical aspects and treatment

Xerostomia or dry mouth is a condition that is frequently encountered in dental practice. The most common cause is the use of certain systemic medications, which make the elderly at greater risk because they are usually more medicated. Other causes include high doses of radiation and certain diseases such as Sjogren's syndrome. Xerostomia is associated with difficulties in chewing, swallowing, tasting or speaking. This results in poor diet, malnutrition and decreased social interaction. Xerostomia can cause oral discomfort, especially for denture wearers. Patients are at increased risk of developing dental caries. A thorough intraoral and extra-oral clinical examination is important for diagnosis. Treatment may include the use of salivary substitutes (Biotene), salivary stimulants such as pilocarpine, ongoing dental care, caries prevention, a review of the current prescription drug regimen and possible elimination of drugs having anticholinergic effects. Because of the ageing population, and the concomitant increase in medicated individuals, dentists can expect to be presented with xerostomia in an increasing number of patients in the coming years and therefore should be familiar with its diagnosis and treatment. Therefore, the purpose of this review is to outline for clinicians the common aetiologies, clinical identification, and routine therapeutic modalities available for individuals with xerostomia.

Factors influencing eating ability of old in-patients in a rehabilitation hospital in Japan

OBJECTIVES

This study was designed to determine the factors influencing eating ability of old in-patients in a rehabilitation hospital.

DESIGN

Cross-sectional investigation.

SETTING

Forty-six in-patients in the rehabilitation ward of Hashimoto Hospital in Kagawa Prefecture in Japan were investigated using a multidisciplinary approach.

MAIN OUTCOME MEASURES

Age, gender, state of dentition, muscle activity of lip, cheek and tongue, biting force, salivary flow rate per a minute (SFR), masticatory ability for gummy jelly, swallowing ability, texture of meal, independency of walking (Functional Independence Measure = FIM) and ability to communicate.

RESULTS

Bivariate analysis for the relationship between surveyed items and masticatory ability (chi-square test) identified that better masticatory ability for gummy jelly was associated with age (< 85years), gender (male),state of dentition (dentate), SFR (high), activity of lip (good), biting force (high), swallowing ability (good) and activity of communication (high). Among these items, SFR (p = 0.001), gender (p = 0.004), ability to communicate (p = 0.005) and age (p = 0.012) were found having an influence on the masticatory ability (logistic regression analysis). On the other hand, age (< 85years), gender (male), SFR (high), activity of lip (good), activity of cheek (good), biting force (high), masticatory ability (good) and swallowing ability (good) had a relationship with normal texture of meal. In regression analysis, only two items, activity of lip (p = 0.003) and swallowing ability (p = 0.024) emerged as factors on texture of meal.

CONCLUSIONS

Masticatory ability for gummy jelly was influenced by cognitive function and was excluded from the factors on the state of meal. These results suggested the limitation of evaluation using test food, so dentists should observe eating behaviour of in-patients. In addition, dentists should pay attention to the activity of the lip and swallowing ability as well as dentition and prostheses in the rehabilitation of eating ability. As SFR was the most significant factor on masticatory ability, this emphasizes the necessity of care for dry mouth caused by side effects of multi-medication.