Dental state, prosthodontic treatment and chewing ability ? a study of five cohorts of 70-year-old subjects

The aim was to study the relationship between dental state, prosthetic rehabilitation and chewing ability in 70-year-old subjects examined between 1971 and 2001. Five birth cohorts born in 1901/1902 (I), 1906/1907 (II), 1911/1912(III), 1922 (V), and 1930 (VI) were examined at 70 years of age. The number of participants in the odontological cohorts varied between 386 and 583. The prevalence of total edentulism changed from 51% in cohort I to 7% in cohort VI. The proportion of subjects using removable dentures decreased from 76% to 17%, whereas those with >or=20 teeth increased from 13% to 65%. The prevalence of subjects with fixed partial dentures increased from 26% to 58%. Of the 70-year-old subjects examined in 2001, 5% had implant-supported restorations. The self-assessed chewing ability showed only weak associations with dental state, and there was no significant cohort trend. When all cohorts were pooled together, 80% considered their chewing ability good, 16% less good and 4% poor. Among the edentulous subjects, more individuals complained about poor chewing ability in the last two cohorts than in the first three. It was concluded that there were great differences in dental state between the five cohorts of 70-year-old subjects examined from 1971 to 2001. Edentulism and wearing of removable dentures decreased substantially, whereas the proportion of subjects with fixed partial dentures showed a marked increase. In spite of the improved dental state, the self-assessed chewing ability exhibited only minor variation over time.

Patterns of carbohydrate intake--a study of typology, associations and changes over time in an elderly Swedish population

BACKGROUND

Patterns may explain part of the dietary variation between subjects.

OBJECTIVE

To create a typology of carbohydrate intake among the elderly and to analyse whether it seems valuable or not.

DESIGN

Factor and cluster-analyses of dietary interviews from two elderly cohorts of free-living elderly people in Göteborg, Sweden.

SUBJECTS AND METHODS

Three hundred and thirty seven women and three hundred and twenty three men aged 70-79 was studied cross-sectionally and longitudinally. The altogether 917 dietary interviews were based on the dietary history method. Cluster analysis, based on factor scores, was used to create the typology.

RESULTS

Seven clusters were identified: 1) Small eaters (high relative intake of starch and a low energy intake), 2) Lean and green eaters (high intake of dietary fibre), 3) Fruit eaters (high intake of monosaccharides), 4) Sweet tooth eaters (high intake of sucrose), 5) Gourmands (high absolute intake of starch, dietary fibre and energy), 6) Milk drinkers (high intake of lactose) and 7) Fat eaters (high intake of fat and low intake of carbohydrates). The different patterns were associated with different food consumption, different intake of micronutrients and different social and physiological factors. There were also changes over time of the proportion of subject within the clusters.

CONCLUSIONS

The typology found by using cluster analysis, seems to be valid and was related to all analysed dimensions. Therefore, the methods may be valuable for describing and analysing the dietary intake among elderly.

In vitro models for the blood-brain barrier

The aim of the present study was to identify a model for the blood-brain barrier based on the use of a continuous cell line, and to investigate the specificity of this model. A set of test compounds, reflecting different transport mechanisms and different degrees of permeability, as well as different physiochemical properties was selected. In vivo data for transport across the blood-brain barrier of this set of test compounds was generated as part of the study using two different in vivo models. A computational prediction model was also developed, based on 74 proprietary Pharmacia compounds, previously tested in one of the in vivo models. Molsurf descriptors were calculated and 21 descriptors were correlated with log(Brain(conc.)/Plasma(conc.)) using partial least squares projection to latent structures (PLS). However, the correlation between predicted and measured values was found to be rather low and differed between one and two log units for several of the compounds. The test compounds were analyzed in vitro using primary bovine and human brain endothelial cells co-cultured with astrocytes, and also using two different immortalized brain endothelial cell lines, one originating from rat and one from mouse. Cell models using cells not derived from the blood-brain barrier, ECV/C6, MDCK and Caco-2 cell lines, were also used. No linear correlation between in vivo and in vitro permeability was found for any of the in vitro models when all compounds were included in the analysis. The highest r2 values were seen in the bovine brain endothelial cells (r2=0.43) and MDCKwt (r2=0.46) cell models. Higher correlations were seen when only passively transported compounds were included in the analysis, bovine brain endothelial cells (r2=0.74), MDCKwt (r2=0.65) and Caco-2 (r2=0.86). By plotting in vivo Papp values against logDpH7.4 it was possible to classify compounds into four different classes: (1) compounds crossing the blood-brain barrier by passive diffusion, (2) compounds crossing the blood-brain barrier by blood-flow limited passive diffusion, (3) compounds crossing the blood-brain barrier by carrier mediated influx, and (4) compounds being actively excreted from the brain by active efflux. Papp and Pe values obtained using the different in vitro models were also plotted against logDpH7.4 and compared to the plot obtained when in vivo Papp values were used. Several of the in vitro models could distinguish between passively distributed compounds and efflux substrates. Of the cell lines included in the present study, the MDCKmdr-1 cell line gave the best separation of passively and effluxed compounds. Ratios between AUC in brain and AUC in blood were also calculated for six of the compounds and compared to ratios between Pe or Papp for transport in the apical to basolateral and basolateral to apical direction. Again the MDCKmdr-1 cell line gave the best correlation with only one compound (AZT) giving large discrepancy between in vitro and in vivo data. None of the in vitro models could identify compounds known to be substrates for carrier mediated influxed as such, and the results indicate that a tighter in vitro blood-brain barrier model probably is needed in order to facilitate studies on carrier mediated influx. The findings presented also indicate that identification of "batteries" of in vitro tests are likely to be necessary in order to improve in vitro-in vivo correlations and to make it possible to perform acceptable predictions of in vivo brain distributions from in vitro data.

Masticatory ability in 80-year-old subjects and its relation to intake of energy, nutrients and food items

OBJECTIVE

The aim of the present study was to analyse the relationship between masticatory ability (self-assessed masticatory ability and bite force) and intake of energy, nutrients and food items in a population sample of elderly subjects.

DESIGN AND SUBJECTS

From a population sample of 80-year-old people, 160 individuals (74 men and 86 women) took part in an odontological study.

MAIN OUTCOME MEASURES

A dental examination including bite force recording, a questionnaire focusing on self-assessed masticatory ability, and a dietary interview.

SETTING

Department of Geriatric Medicine, Göteborg University, Sweden.

RESULTS

The dental status among the participants varied much (from edentulous in both jaws--22%--to more than 20 natural teeth--30%). The mean maximum bite force was higher in men (165 N) than in women (105 N). Bite force was significantly correlated to the Eichner index and to the number of teeth. One third of the subjects reported no masticatory problem, whereas 18% identified > or = 3 such problems. The intake of energy and nutrients varied much but the means were well above recommended values. The correlations between dental status and bite force on one side and dietary intake on the other side were in general weak and most often statistically non-significant. Impaired general health and reduced dentition were both associated with more masticatory problems.

CONCLUSION

The examined sample of 80-year-old subjects had a great variation in dental status, bite force and self-assessed masticatory ability, but these factors had only a minor influence on dietary selection and intake, which on average were well above recommended values.

In vitro intestinal permeability of factor Xa inhibitors: influence of chemical structure on passive transport and susceptibility to efflux

PURPOSE

To study the in vitro intestinal permeability of a number of newly synthesised factor Xa inhibitors to better understand the poor oral absorption of these compounds.

METHODS

The bidirectional transport of the fXa inhibitors was studied in the Caco-2 cell model and isolated rat ileal tissue. An attempt was made to characterize efflux mechanisms with the help of commonly used substrates and inhibitors of various transport proteins. In addition, the transport of the fXa inhibitors was studied in MDCK cells transfected with the human MDR1 gene and expressing large amounts of P-glycoprotein (Pgp).

RESULTS

The in vitro absorptive permeability was low for all but one of the fXa inhibitors. For compounds with non-substituted amidine, a charge (due to ionisation at neutral pH) may have resulted in poor membrane partitioning. Neutral compounds with substituted amidines were effluxed from the epithelial cells. The significance of the secretion process was illustrated by the results obtained for a neutral analogue showing high absorptive Caco-2 cell permeability that was not obviated by efflux. Transport inhibition studies in Caco-2 and permeability studies in the MDR1-transfected MDCK cells consistently showed that Pgp is not involved in the secretion of fXa inhibitors. Besides efflux, metabolic liability limited the permeation of the neutral lipophilic analogues with a carbamate ester.

CONCLUSIONS

Poor intestinal permeability may be an important factor in the incomplete oral absorption of the bisbenzimidazole-type fXa inhibitors. Poor permeability may be related to poor membrane partitioning for hydrophilic analogues, whereas susceptibility to efflux transports and gastro-intestinal enzymatic degradation may limit the permeability of some of the neutral less hydrophilic derivatives.

Theoretical calculation and prediction of drug transport processes using simple parameters and partial least squares projections to latent structures (PLS) statistics. The use of electrotopological state indices

A method of modeling and predicting drug transport processes using simple, theoretically computed molecular descriptors and multivariate statistics has been investigated in four data sets related to Caco-2 cell permeability, human intestinal absorption, brain-blood partitioning, and immobilized artificial membrane (IAM) chromatography. The program Molconn-Z was used to compute theoretical molecular descriptors related to electrotopological state indices. Additional parameters related to size and lipophilicity [i.e., calculated molar refraction (CMR) and octanol-water partition coefficient (CLOGP)] were also used in the statistical modeling. Good statistical models were derived (r(2) and Q(2) values ranged from 0.75 to 0.93 and 0.70 to 0.89, respectively) that permit fast computational (electronic) screening and prioritization of virtual libraries.

B-domain deleted recombinant factor VIII formulation and stability

B-domain deleted recombinant factor VIII (BDDrFVIII) is a deletion form of human coagulation factor VIII. A lyophilized formulation of highly purified BDDrFVIII has been developed that does not require the use of blood-derived products such as human serum albumin (HSA). By avoiding the use of blood-derived products, the BDDrFVIII formulation minimizes the risk of transmitting blood-borne pathogens that may be present in plasma-derived factor VIII or in other recombinant factor VIII products that contain HSA in their formulation. Upon reconstitution with saline (4 mL), the composition of the reconstituted product (62.5 to 250 IU/mL BDDrFVIII) is 18 mg/mL sodium chloride, 3.0 mg/mL sucrose, 1.5 mg/mL L-histidine, 0.25 mg/mL calcium chloride dihydrate, and 0.1 mg/mL polysorbate 80. The optimal combination of these excipients in the lyophilized BDDrFVIII formulation provides long-term stability, as measured by a variety of analytical methods. The formulation preserves factor VIII activity of lyophilized BDDrFVIII during storage for at least 24 months at 8 degrees C, and for up to 6 months at room temperature (25 degrees C). The reconstituted product retains its factor VIII potency for at least 100 hours at 25 degrees C, which would allow it to be continuously administered via an infusion pump, assuming the product is handled under aseptic conditions.

Chromatographic retention of drug molecules on immobilised liposomes prepared from egg phospholipids and from chemically pure phospholipids

The partitioning of a chemically diverse set of drugs into liposomes was studied by immobilised liposome chromatography (ILC). For this purpose liposomes composed of (i) purified egg phospholipids (EPL), (ii) synthetic phosphatidylcholine (PC), (iii) PC--synthetic phosphatidylethanolamine (PE) 80:20 (mol/mol) and (iv) PC--synthetic phosphatidylserine (PS) 80:20 (mol/mol) were immobilised in gel beads by freeze-thawing. The drug partitioning was assessed from the retention volume, which was expressed as a capacity factor, K(s), normalised with respect to the amount of immobilised phospholipid. The drug retention on EPL, PC and PC--PE liposomes was very similar, whereas the negatively charged PC--PS liposomes increased the retention of positively charged and decreased retention of negatively charged drugs. The partitioning of drugs on liposome columns (log K(s)) versus their octanol--water partitioning (log P(oct)) showed three separate rectilinear relationships, depending on the charge of the compound (neutral, positive, or negative). Statistical analysis (ANCOVA) proved that the lines had similar slopes. Repeated analysis of four reference compounds showed a low variation (<0.12 log units) over time (about 250 days). A close relationship was observed between the drug retention in short EPL columns with a low content of phospholipids and the retention in longer standard EPL columns. The short 'quick screen bilayer columns' permit analysis of highly lipophilic compounds within 30 min and are thus applicable for medium-throughput screening in drug discovery settings. A very strong rectilinear relationship (r(2)=0.95, n=13) between log K(s) (EPL) and published liposome partitioning data (log D(mem)) confirmed that the ILC drug retention reflects the drug partitioning into the lipid bilayers. A moderate to fair rectilinear relationship was observed between the normalised retention on PC, PC-PE and EPL liposomes (r(2)=0.79, 0.86 and 0.85, respectively, n=24) and corresponding published log k'(IAM) data obtained on immobilised artificial membrane (IAM) columns. Transport across Caco-2 cell monolayers (log P(c)) showed curvilinear relationships with log K(s), log k'(IAM), log P(oct) and log D(oct). The drug fraction absorbed in humans showed a similar relationship to log K(s) values as to surface plasmon resonance signals representing drug-liposome interaction (Danelian et al., 2000 J Med Chem, 43, 2083--2086).

Prediction of drug transport processes using simple parameters and PLS statistics. The use of ACD/logP and ACD/ChemSketch descriptors

A method of modelling and predicting biopharmaceutical properties using simple theoretically computed molecular descriptors and multivariate statistics has been investigated for several data sets related to solubility, IAM chromatography, permeability across Caco-2 cell monolayers, human intestinal perfusion, brain-blood partitioning, and P-glycoprotein ATPase activity. The molecular descriptors (e.g. molar refractivity, molar volume, index of refraction, surface tension and density) and logP were computed with ACD/ChemSketch and ACD/logP, respectively. Good statistical models were derived that permit simple computational prediction of biopharmaceutical properties. All final models derived had R(2) values ranging from 0.73 to 0.95 and Q(2) values ranging from 0.69 to 0.86. The RMSEP values for the external test sets ranged from 0.24 to 0.85 (log scale).

Prediction of polar surface area and drug transport processes using simple parameters and PLS statistics

Modeling of the calculated polar surface area of drugs with rapidly derived descriptors (i.e., the number of hydrogen bonds accepting oxygen and nitrogen atoms and the number of hydrogen atoms bonded to these) using partial least squares projection to latent structures (PLS) analysis is described. The statistical analysis showed strong relationships between the hydrogen-bonding descriptors and the calculated polar surface area of five chemically diverse sets of drugs (R2>0.93 and Q2>0.69, n = 11, 20, 45, 70, and 74, respectively). The statistical models (using H-bonding descriptors and log P) of transport across Caco-2 cells (n = 11), brain-blood partitioning (two data sets, n = 45 and 70) and percent intestinal absorption (n = 20) showed R2 = 0.92, 0.72, 0.76, and 0.81 and Q2 = 0.74, 0.75, 0.71, and 0.73, respectively. The inclusion of log P improved two models, had no effect on one model, and had a slightly negative impact on one model. The combination of H-bonding descriptors with log P is similar to the Lipinski "rule-of-five" mnemonic. However, by using a multivariate statistical method (e.g., PLS), the prediction becomes quantitative instead of qualitative. Good statistical models were derived which permit fast computational screening and prioritization of virtual compound libraries.

Theoretical calculation and prediction of P-glycoprotein-interacting drugs using MolSurf parametrization and PLS statistics

A method for the modelling and prediction of P-glycoprotein-associated ATPase activity using theoretically computed molecular descriptors and multivariate statistics has been investigated using 22 diverse drug-like compounds. The program MolSurf was used to compute theoretical molecular descriptors related to physicochemical properties such as lipophilicity, polarity, polarizability and hydrogen bonding. The multivariate partial least squares projections to latent structures (PLS) method was used to delineate the relationship between the P-glycoprotein-associated ATPase activity and the theoretically computed molecular descriptors. The PLS analysis of the entire data set, with the exclusion of tamoxifen, resulted in one significant PLS component according to cross-validation with R(2)=0.718, Q(2)=0. 695, S.D.=0.475, F=48.37, RMSE(tr)=0.452, p<0.001. Properties associated with the size of the molecular surface, polarizability and hydrogen bonding had the largest impact on the P-glycoprotein-associated ATPase activity. All these properties should be high to promote high ATPase activity.

Root caries and some related factors in 88-year-old carriers and non-carriers of Streptococcus sobrinus in saliva

The prevalence of caries on exposed root surfaces in 88-year-old subjects with and without salivary levels of Streptococcus sobrinus was studied. Ninety-two individuals were examined with regard to root caries lesions and fillings. The root caries index (RCI) was calculated and related to salivary flow rate and buffer capacity, plaque score and salivary counts of Streptococcus mutans, S. sobrinus and lactobacilli. In 89 subjects with exposed root surfaces, all but 2 harbored mutans streptococci; 51 subjects carried S. mutans only, 35 both S. sobrinus and S. mutans, and 1 S. sobrinus only. The RCI was significantly higher in persons with than those without S. sobrinus (p < 0.05). Subjects with both S. sobrinus and S. mutans had higher counts of total mutans streptococci and lactobacilli than subjects with only S. mutans (p < 0.05). The RCI was significantly correlated to S. sobrinus and S. mutans (p < 0.05). The positive correlation between the RCI and S. sobrinus was still significant when the other tested variables were kept constant, whereas the correlation between the RCI and S. mutans was weaker when S. sobrinus and lactobacilli were kept constant. The D-component of the RCI (DSr%) was significantly correlated to S. sobrinus, S. mutans and lactobacilli, whereas the F-component of the RCI showed no significant correlation to any of the tested variables. A stepwise multiple correlation showed that the variance of DSr% was best explained in the S. sobrinus carriers by S. sobrinus and the salivary buffer effect, and in the non-carriers by S. mutans.

Trends and prognoses of dental status in the Swedish population: analysis based on interviews in 1975 to 1997 by Statistics Sweden

The aims of this study were to describe changes in dental status over the 22-year period from 1975 to 1997, and to make a prognosis of dental status based on these data for the years 2005 and 2015. The study is based on regular investigations of the living conditions performed by Statistics Sweden of samples varying between 11,582 and 14,964 participants and a response rate from 78% to 86%. The questions of the interview used in this study were focused on dental status and utilization of dental services. The prevalence of edentulism in the age group 25-74 years decreased from 19% in 1975 to 3% in 1996/97. The proportion of dentate persons increased from 75% in 1975 to 97% in 1996/97 in age group 45-64 years with similar trends in the other age groups. In 1996/97, 2.1% of the whole sample (16-84 years) reported that they had received implant-supported restorations. The rate was higher among the elderly and the edentulous subjects. The great regional differences in dental status found in the first part of the observation period remained only in the oldest age group in 1996/97. The prognosis predicts that 95% of the subjects in age group 65-74 years and 90% in age group 75-84 years will be dentate in the year 2015. The substantial increase of dentate subjects among the elderly that has occurred during the past few decades and its expected continuation in the coming years implies a great change in need and demand for dental care services.

Physical state of L-histidine after freeze-drying and long-term storage

Liquid samples of L-histidine of varying pH values and mixed with salt, metal ions, polysorbate 80 and sucrose have been analysed by differential scanning calorimetry to evaluate the influence of these additives on the glass transition temperature and crystallisation of L-histidine during freezing and thawing. L-Histidine solutions of varying pH were freeze-dried with and without a thermal cycle and the physical state of the freeze-dried cakes, following long-term storage, were studied by powder X-ray diffraction. Amorphous L-histidine crystallised when it was exposed to moisture, and the identity of the crystalline materials is reported. The crystallisation of L-histidine during freezing and thawing is dependent on the pH of the solution and is shown to be at a minimum at pH 6, which coincides with the pK(a) of the imidazoline function. Sucrose inhibited the crystallisation of L-histidine during thawing, while sodium chloride or polysorbate 80 did not. The addition of metal ions (Ca2+ and Mg2+) up to 10% (w/w) did not depress the glass transition temperature significantly, while the addition of Zn2+ increased it. The physical state of L-histidine after freeze-drying is shown to be dependent on both the pH of the solution and the freezing cycle. The risk of crystallisation of amorphous L-histidine is low if the freeze-dried material is protected from moisture.

Theoretical calculation and prediction of intestinal absorption of drugs in humans using MolSurf parametrization and PLS statistics

A method for modeling and prediction of the intestinal absorption of drugs in humans using theoretically computed molecular descriptors and multivariate statistics has been investigated using 20 diverse drug-like compounds. The program MolSurf was used to compute theoretical molecular descriptors related to physicochemical properties such as lipophilicity, polarity, polarizability and hydrogen bonding. The multivariate Partial Least Squares Projections to Latent Structures (PLS) method was used to delineate the relationship between the intestinal absorption of drugs in humans and the theoretically computed molecular descriptors.Good statistical models were derived. Properties associated with hydrogen bonding had the largest impact on absorption and should be kept to a minimum to promote high absorption. High charge-transfer properties and the presence of surface electrons, i.e. valence electrons, which are not tightly bonded to the molecule, were also found to promote high absorption.

Theoretical calculation and prediction of brain-blood partitioning of organic solutes using MolSurf parametrization and PLS statistics

Sixty-three structurally diverse compounds were investigated to statistically model the brain-blood partitioning of organic solutes using theoretically computed molecular descriptors and multivariate statistics. The program MolSurf was used to compute theoretical molecular descriptors related to physicochemical properties such as lipophilicity, polarity, polarizability, and hydrogen bonding. The multivariate Partial Least Squares Projections to Latent Structures (PLS) method was used to delineate the relationship between the brain-blood partitioning of organic solutes and the theoretically computed molecular descriptors. Good statistical models were derived. Properties associated with polarity and Lewis base strength had the largest impact on the blood-brain partitioning and should be kept to a minimum to promote high partitioning. The absence of atoms capable of hydrogen bonding interactions as well as high lipophilicity and the presence of polarizable surface electrons, i.e., valence electrons, were also found to promote high brain-blood partitioning. The results indicate that theoretically computed molecular MolSurf descriptors in conjunction with multivariate statistics of PLS type can be used to successfully model the brain-blood partitioning of organic solutes and hence differentiate drugs with poor partitioning from those with acceptable partitioning at an early stage of the preclinical drug-discovery process.

Self-assessed masticatory ability in relation to maximal bite force and dental state in 80-year-old subjects

By means of a questionnaire, clinical examination and force recordings, the relationships between self-assessed masticatory ability, dental state and bite force were studied in 160 80-year-old persons, 74 men and 86 women. The subjects were in general satisfied with their masticatory ability and 70% had no problems, while 6% reported three or more problems with mastication. Half of the subjects were dentate without removable prostheses and almost one-third had 20 or more natural teeth. The edentulous persons (about one-fifth of all) reported more problems related to mastication than the other dentition groups. The maximal bite force varied much and exhibited a significant correlation to the number of remaining teeth and dental state. The self-assessed masticatory ability was only weakly correlated with dental state and bite force. It was concluded that many subjects with few or no remaining teeth and/or removable dentures had only few complaints of impaired masticatory function and showed a good adaptation to an impaired dental status and small maximal bite force.

Utilization of dental services in relation to socioeconomic and health factors in the middle-aged and elderly Swedish population

The aims of this study were to describe the change in reported time since the latest visit to a dentist between the years 1980/81 and 1988/89 and the reported use of dental services in relation to age, dental state, and socioeconomic and health characteristics in a sample of the Swedish population in 1988/89. The studies are based on interviews by Statistics Sweden about the living conditions. In the investigations in 1980/81, 14,964 inhabitants between 16 and 84 years of age participated, and in 1988/89, 13,309 inhabitants. In all age groups there was a significantly higher frequency of reported visits to a dentist last year in 1988/89 than in 1980/81. In the age group 50-64 years old this figure increased from 54% to 75%, and in the age group 65-84 years old it increased from 26% to 39%. In the investigation in 1988/89 about 75% of the dentulous women in all age groups up to 75 years reported visiting a dentist last year. The relative risk for not visiting a dentist last year, adjusted for age, gender, and dental state, was higher in dentulous subjects with low income and education, not married, not native-born, living in rural areas, smoking, and low social and physical activity. The results of the logistic regression analysis showed that, among the elderly, functional ability and general health factors have lower significance for time since last visit to a dentist than socioeconomic, social support, and life-style factors.

Recombinant factor VIII SQ--inactivation kinetics in aqueous solution and the influence of disaccharides and sugar alcohols

PURPOSE

To investigate the influence of various nonreducing disaccharides and sugar alcohols on the inactivation kinetics of recombinant factor VIII SQ (r-VIII SQ) in aqueous solution not containing albumin as a stabiliser.

METHODS

The stability of r-VIII SQ was followed using measurement of activity (VIII:C) and HPLC gel filtration at different temperatures. The thermal stability was investigated using differential scanning calorimetry (DSC).

RESULTS

The decline in VIII:C followed pseudo-first order kinetics. However, the Arrhenius plot was not linear for formulations without carbohydrate, demonstrating a distinct, reproducible curvature. The reaction rate at 5 degrees C was faster than expected from the Arrhenius kinetics. The energy of activation (Ea) for formulations without added carbohydrates, derived from the linear part of the Arrhenius plot, varied between 77 and 86 kJ/mole in the temperature range 20-37 degrees C. The addition of 600 mg/ml sucrose increased the Ea to 104 kJ/mole. DSC measurements showed that Tm' was 64.2 +/- 0.2 degrees C for r-VIII SQ without stabiliser. This value increased linearly with increasing concentrations of carbohydrate. This stabilising effect is most probably explained by the theory of preferential hydration.

CONCLUSIONS

The inactivation kinetics of r-VIII SQ in aqueous solution without addition of carbohydrates followed pseudo-first order kinetics but the Arrhenius plot was nonlinear. Sucrose and sorbitol both had highly stabilising effects on r-VIII SQ at concentrations above 300 mg/ml. The preparation containing 600 mg/ml sucrose was stable for at least 12 months at 5 degrees C and 6 months at 25 degrees C.

Theoretical calculation and prediction of Caco-2 cell permeability using MolSurf parametrization and PLS statistics

PURPOSE

To statistically model the permeability across Caco-2 cell monolayers using theoretically computed molecular descriptors and multivariate statistics.

METHODS

Seventeen structurally diverse compounds were investigated. The program MolSurf was used to compute theoretical molecular descriptors related to physico-chemical properties such as lipophilicity, polarity, polarizability and hydrogen bonding. The multivariate Partial Least Squares Projections to Latent Structures (PLS) method was used to delineate the relationship between the permeability across Caco-2 cell monolayers and the theoretically computed molecular descriptors.

RESULTS

Excellent statistical models were derived. Properties associated with hydrogen bonding had the largest impact on diffusion through the monolayers and should be kept at a minimum to promote high permeability. High lipophilicity and the presence of surface electrons, i.e. valence electrons, which are not tightly bonded to the molecule, were also found to have a favorable influence to achieve high permeability.

CONCLUSIONS

The results indicate that theoretically computed molecular MolSurf descriptors in conjunction with multivariate statistics of PLS type can be used to successfully model permeability across Caco-2 cell monolayers and, thus, differentiate drugs with poor permeability from those with acceptable permeability at an early stage of the preclinical drug discovery process.

Dental caries and related factors in 88- and 92-year-olds. Cross-sectional and longitudinal comparisons

Our aim was to compare two groups of 88- and 92-year-olds (n = 92 and n = 40), respectively, with regard to teeth, caries, and salivary and microbial conditions. Oral variables were analyzed in relation to functional capacity and use of cardiovascular agents and psychoactive drugs. Untreated root caries, plaque score, and counts of lactobacilli increased between the ages of 88 and 92 years (P < 0.01). Nine of the 24 longitudinally followed up subjects had lost 1-5 teeth over 4 years, and 17 subjects had developed new caries (DFS). The mean caries increment over 4 years was 1.3 coronal and 3.6 root surfaces, and new DFS per 100 surfaces at risk was 4.3 coronal and 17.5 root surfaces. Plaque score and final pH of buffer capacity increased (P < 0.05 and 0.01, respectively), whereas saliva flow, independent of gender, was unchanged. Use of cardiovascular agents and psychoactive drugs was associated with a deteriorated dental status.

Development of freeze-dried albumin-free formulation of recombinant factor VIII SQ

PURPOSE

To develop a stable freeze-dried formulation of recombinant factor VIII-SQ (r-VIII SQ) without the addition of albumin.

METHODS

Different formulations were evaluated for their protective effect during sterile filtration, freeze-thawing, freeze-drying, reconstitution and long term storage. Factor VIII activity (VIII:C), visual inspection, clarity, solubility, moisture content and soluble aggregates and/ or fragments were assayed.

RESULTS

A combination of non-crystallising excipients (L-histidine and sucrose), a non-ionic surfactant (polysorbate 80) and a crystalline bulking agent (sodium chloride) was found to preserve the factor VIII activity during formulation, freeze-drying and storage. Calcium chloride was included to prevent dissociation of the heavy and light chains of r-VIII SQ. Sodium chloride was chosen as the primary bulking agent since the concentration of sodium chloride necessary for dissolution of r-VIII SQ in the buffer will inhibit the crystallization of many potential cake formers. It was found that L-histidine, besides functioning as a buffer, also protected r-VIII SQ during freeze-drying and storage. A pH close to 7 was found to be optimal. Some potential macromolecular stabilisers, PEG 4000, Haes-steril and Haemaccel, were evaluated but they did not improve the recovery of VIII:C. The freeze-dried formulation was stable for at least two years at 7 degrees C and for at least one year at 25 degrees C. The reconstituted solution was stable for at least 100 hours at 25 degrees C.

CONCLUSIONS

The albumin-free formulation resulted in consistently high recovery of VIII:C, very low aggregate formation and good storage stability. The stability of the reconstituted solution makes the formulation suitable for continuous administration via infusion pump. The formulation strategy described here may also be useful for other proteins which require a high ionic strength.

Oral glucose clearance in nonagenarians in relation to functional capacity, medication and oral variables

OBJECTIVES

To study oral sugar (glucose) clearance and to examine some factors which were believed to either influence or be dependent upon oral glucose clearance.

DESIGN

Cross-sectional, clinical study with analysis of records.

SETTING

Göteborg gerontological and geriatric population studies, Göteborg University, Sweden.

SUBJECTS

71 community-dwelling individuals, 27 men and 44 women, of a representative sample of 260 92-year-old persons.

INTERVENTION AND MAIN OUTCOME MEASURES

Glucose concentration was measured in saliva after chewing of a glucose tablet and the clearance was assessed by three different variables: (i) the initial salivary glucose concentration, (ii) the area under the curve (AUC) and (iii) the clearance time.

RESULTS

The glucose clearance showed a wide inter-individual variation, which could be explained partly by differences in oral state, chewing time, stimulated salivary secretion rate and medication use. A positive correlation was found between the clearance variables and the number of lactobacilli and mutans streptococci in saliva and the percentage of untreated root caries lesions of the total number of exposed root surfaces.

CONCLUSIONS

A slow oral sugar clearance is more common among 92-year-olds than younger adults earlier reported in other studies, particularly in those who have uncompensated functional impairments and a high medication history. A decreased oral glucose clearance was associated with high counts of salivary lactobacilli and mutans streptococci and a high proportion of untreated root caries lesions.

Associations between self-assessed masticatory ability and some general health factors in a Swedish population

OBJECTIVES

The aims of this study were 1) to describe changes in self-assessed masticatory ability over a 14 year period (1975-89); and 2) to describe associations between self-assessed masticatory ability and age, dental state and some other background factors in a sample of the Swedish population in 1988/89.

DESIGN

The Swedish National Central Bureau of Statistics investigates annually the living conditions of the Swedish population by means of interviews by trained persons. The data were analysed by means of stepwise logistic regression and calculation of adjusted relative risks.

SUBJECTS

In the investigation in 1988/89, 12,901 people above 16 years of age participated and the response rate was 80%.

RESULTS

In comparison between the investigations, the prevalence of reported impairment was lower in 1988/89 than in 1975 and 1980/81. Prevalence of reported impairment of chewing ability increased with ageing from 2% in young adults (16-34 years old) to 44% in older elderly (> 85 years old). In most age groups, edentulous people reported the highest prevalence, and dentate people the lowest. Relative risks for impaired masticatory ability, independent of age, gender and dental state, were higher for people in rural areas, with low income and living single, as well as for those with skeletal, gastrointestinal, psychiatric and tumour diseases. In the elderly, results from the logistic regression showed that some disability and psychosocial factors were also associated with masticatory ability.

CONCLUSIONS

The results indicated that there was a group of elderly people who reported several functional and health problems including impaired masticatory ability.

Association between radiographic findings in the mandibular condyle and temporomandibular dysfunction in an elderly population

Our aims were to study the prevalence of abnormal radiographic findings in mandibular condyles and the possible association between such findings and clinical signs and symptoms of temporomandibular dysfunction (TMD) and dental state. Two cohorts of 70-year-old people, 384 men and 484 women, living in Göteborg, Sweden, participated in the study. The first cohort was examined in 1972 and the other one in 1992. Besides a functional and clinical examination, a questionnaire on TMD and panoramic radiography were included. A deviation from the normal appearance of one or both condyles was found in 26% of the subjects (17% of the condyles). There was no significant difference in this respect between the two cohorts. There were in general only minor and no statistically significant differences between those with normal and deviating condylar findings with regard to various TMD signs and symptoms. The subjects in Eichner group A (with dental support in all zones) showed a slightly lower frequency of abnormal radiographic condylar findings (22%) than those in groups B (reduced dental support) and C (edentulous in one or both jaws; both B and C, 28%). It is concluded that abnormal radiographic condylar findings in these elderly people were not at all or only weakly correlated with signs and symptoms of TMD and dental status.

Caries prevalence and salivary and microbial conditions in 88-year-old Swedish dentate people

As part of a comprehensive investigation of 88-year-old people, caries prevalence, stimulated salivary secretion rate, buffer capacity, and the prevalence of lactobacilli and mutans streptococci were studied in a subsample of 92 dentate subjects. The mean number of remaining teeth was 14.1 +/- 7.3. The DMFT was 25.2 +/- 3.0, and DF surfaces 38.3 +/- 22.7. Root caries experience was found in 85% of the subjects, with a mean root caries index of 36.6 +/- 28.5%. The men had significantly higher mean values of salivary secretion rate (2.0 +/- 1.3 ml/min) than the women (1.1 +/- 0.6 ml/min) (p < 0.001). The mean final pH of buffer capacity was 6.3 +/- 1.3. High counts of lactobacilli (> 10(5)) and mutans streptococci (> 10(6)) were found in 49% and 55% of the subjects, respectively, of whom most were denture wearers. The mean number of total mutans streptococci was higher in persons harboring both Streptococcus mutans and S. sobrinus than in subjects with only S. mutans.

Oral complaints and utilization of dental services in relation to general health factors in a 88-year-old Swedish population

The aim of this study was to describe dental state, oral health problems, self-assessed ability to perform oral hygiene and utilization of oral health services in a sample of 88-year-old people (n = 374) and to relate these variables to functional ability, subjective health and drug consumption. The intention was also to identify barriers to utilization of dental care in non-institutionalized elderly people. The results of interviews showed that 46% of the subjects were dentate. Oral complaints were reported by 24% of the home living individuals. Poor health, medication and feelings of loneliness were factors associated with oral discomfort. Difficulties in performing oral hygiene activities were reported by 10% of the subjects and were correlated with functional impairments and feelings of loneliness. Utilization of dental services was correlated with dental state; 72% of the dentate and 8% of the edentulous subjects made regular dental visits. The main reason for not visiting a dentist was "no perceived need". Independent of dental state, some factors were significantly correlated to low demand for dental services; these included feelings of loneliness, functional impairments and low school education.

Utilization of dental care after the introduction of the Swedish dental health insurance

The dental care utilization rate in an urban Swedish population over an 11-year period was studied, starting at the time of the introduction of a national dental health insurance. The systematically selected samples comprised, for each calendar year of the period, approximately 11,000 inhabitants more than 20 years of age in the city of Göteborg. In 1976 and 1984 information on utilization was coupled to information about various demographic, socioeconomic, and disablement factors. In addition, a longitudinal study was performed of 8012 people who resided in Göteborg in 1976 and 1984, correlating dental attendance rates with the same factors. The results showed that dental care utilization increased among both men and women, mostly in age groups more than 65 years of age. Utilization rate in 1976 and in 1984 was independently associated with age, sex, income, marital status, disablement, and regions of the city, and it is concluded that the goal of the dental insurance act, which was, among other things, to contribute to a more equitable distribution of dental care, in many respects has not been achieved. Early identification of people with low utilization may provide a means to obtain the most pronounced improvement in dental health.

Prognosis of and factors associated with dental status in the adult Swedish population, 1975-1989

The aim was to describe changes in dental status in the Swedish population during the period 1975-89 and to make a prognosis based on these data for the year 2000. This study is based on investigations of the living conditions in 1975, 1977, 1980/81 and 1988/89 performed by The National Central Bureau of Statistics. The samples varied for each year from 11,500 to 15,000 participants and a response rate from 80 to 86%. The odontological questions of the interview were focused on dental status, utilization of dental services and chewing ability. The prevalence of edentulism in age group 16-74 yr decreased from 15% in 1975 to 6% in 1988/89. In 1988/89 19% of the 65-74-yr-old inhabitants of the big cities were edentulous and 45% in rural populations, indicating a 15-20-yr delay of the development in rural areas. The prognosis for the year 2000 indicates a further decrease of edentulism to 3-4% in age groups 45-64 yr and in age 75-84 yr more than 60% will be dentate. As a consequence of the reduction in edentulism and changes in populations the number of dentate inhabitants in age group 25-74 yr increased by about 800,000 from 1975 to 1989 and a further increase of 400,000 will occur up to the year 2000. The consequences of these changes for the dental care services are discussed.

Dental state and functional capacity in 75-year-olds in three Nordic localities

The aims of the study were to compare dental state in three Nordic 75-year-old populations and to evaluate dental state as a marker of functional ageing. The study is part of a Nordic comparative study of 75-year-olds in Glostrup, Göteborg and Jyväskylä. In the dental studies, 411 subjects in Denmark, 308 in Sweden and 310 in Finland participated. Odontological history was obtained from interviews. Other methods, which are described elsewhere, were used to measure various functional parameters. In Göteborg, 23% of the 75-year-olds reported they were edentulous and 27% that they had more than 20 of their own teeth. The corresponding figures in Glostrup were 45% and 15% and in Jyväskylä 58% and 9%, respectively. In all three localities, economic factors and lifestyle factors, such as tobacco smoking, low physical activity and low social activity, were significant predictors for impaired dental health. The number of teeth was significantly associated with, for example, spirometry parameters, reaction time, body extention and body flexion in males. In females, significant associations were obtained with spirometry parameters, reaction time, handgrip, body extension and body flexion. Internordic differences regarding dental state were obvious. Dental state was associated with functional capacities. We suggest that dental state is a marker of functional capacity in elderly populations.

The prevalence of Staphylococcus aureus, Enterobacteriaceae species, and Candida species and their relation to oral mucosal lesions in a group of 79-year-olds in Göteborg

A subject sample comprising 100 persons (47 men and 53 women) 79 years of age and selected on a statistical basis (representing all persons of that age living in Göteborg) was the object of a general medical, clinical, and microbiologic study of the prevalence of microorganisms in the oral cavity known to cause opportunistic infections. A high prevalence of diseases and frequent medications were recorded among the participants. Staphylococcus aureus was present in five patients and Enterobacteriaceae species in only one individual. Candida albicans was not found in any samples from the palatal mucosa of the 25 individuals without dentures. Of 36 healthy denture wearers C. albicans was found in 9 (25%). In 39 persons with denture stomatitis C. albicans was obtained in 11 (28%) of the samples from the mucosa, 29 (74%) from the dentures, and 10 (26%) from the angulus oris. The prevalence of S. aureus, enteric rods, and C. albicans was low in the elderly population and, when present, correlated with the presence of dentures. No association with the patients' general health or drug use was obtained.

A study of some masticatory functions in 90-year old subjects

A group of 35 90-year old subjects, randomly selected from the gerontologic population study in Göteborg (H-70), were examined with respect to function and dysfunction of the masticatory system. The methods included a questionnaire, clinical examination and recording of bite force endurance and maximal bite force, measured in the central incisor region. Forty percent were edentulous, 29% were partially edentulous and wore a removable denture, while the others were dentate without removable prostheses. Signs and symptoms of temporomandibular disorders were mostly mild and infrequent, except TMJ crepitation which was recorded in 69% of the subjects. Maximal bite force was in general low (mean 94 N) but showed a great individual variation (range 10 to 410 N). Bite force endurance was also very variable (mean 72 s, range 10 to 205 s). None of the 35 subjects reported poor masticatory ability, but 2 said they could not chew all kinds of food. In spite of a reduced bite force this group of 90-year olds considered their masticatory ability as good and most of them had no severe signs and symptoms of temporomandibular disorders.

Intake of energy, nutrients and food items in a ten-year cohort comparison and in a six-year longitudinal perspective: a population study of 70- and 76-year-old Swedish people

The aim of the investigation was to study cohort differences at age 70 in probands born in 1901/02 and 1911/12 and to study longitudinal changes of dietary habits and intake of energy and nutrients between ages 70 and 76. The study is part of the gerontological and geriatric population studies in Gothenburg, Sweden. The intake of both energy and nutrients was higher in the later cohort. One explanation for this lay in the choice of food items in that cohort. Intake of energy and almost all nutrients decreased in both men and women between ages 70 and 76. Energy intake reduced by 23% in men and 20% in women. The proportion of probands with nutrient intakes below RDA increased significantly at age 76. The study revealed both cohort and longitudinal age changes in dietary habits. There is no reason to believe that elderly people are more conservative regarding their food choices than the rest of the population--at least not at the relatively young ages studied.

Longitudinal study of stimulated whole saliva in an elderly population

The aim of this investigation, which is part of the longitudinal gerontologic population study in Gothenburg (H-70), was to examine the effect of aging on salivary flow. Three 70-yr-old cohorts, born in 1901/02, 1906/07, and 1911/12, were studied both cross-sectionally and longitudinally. Representative subsamples (n = 931) were followed up to 82 yr in the first and up to 75 yr in the second and third cohorts. Whole saliva secretion was stimulated by paraffin wax chewing for 5 min and all sampling was carried out in the morning after an overnight fast. The mean secretion rate was 1.24 for men and 0.94 ml/min for women at the age of 70 (all cohorts pooled). The percentage values for extremely low secretion rate (< 0.2 ml/min) were 2 and 6%, respectively. Neither the cross-sectional nor the longitudinal comparison showed any decrease in secretion rate on a group basis either in the age interval 70-82 yr in the first or between 70 and 75 yr in the other two cohorts. However, an increased prevalence of complaints of mouth dryness was found, especially among women. The main conclusion from this study is that there is no decline on a population basis in paraffin-wax-stimulated salivary flow with increasing age.

Influence of Parkinson's disease on oral health

Thirty patients with Parkinson's disease were investigated with regard to their oral health. They had significantly more teeth and less caries than a control group of corresponding age. However, the salivary secretion rate was significantly lower with advancing parkinsonian symptoms. It is concluded that not only motor impairment but also autonomic dysfunction, as an expression of a more advanced neuron degeneration, could be of importance when the possibility of maintaining a good oral health in parkinsonian patients is considered.

Coffee drinking: a minor risk factor for bone loss and fractures

The influence of coffee drinking as a possible risk factor for loss of bone mass was assessed in a cohort of 619 70-year-old men and women who were examined with dual photon absorptiometry of the right calcaneum. A high consumption of coffee was significantly associated with a lower bone mass, deteriorated dental state, lower socio-economic level and a higher consumption of tobacco. In non-smoking women a bivariate relationship was found between the daily consumption of three or more cups of coffee and a low bone mass (p less than 0.01). However, in a stepwise logistic regression model, only tobacco smoking, body mass index, body height, physical activity and a deteriorated dental state were found to be significant predictive factors for a low bone mineral content. Bone mass and tobacco smoking were the only significant predictive factors for fractures before the ages of 70 and 76 years. Coffee drinking was not a contributory independent risk factor for loss of bone mass and fractures in this population study.

Cohort comparisons of dental status in the adult Swedish population between 1975 and 1981

The aim was to describe and analyze changes in dental status in Sweden over a 6-yr period, and to establish a baseline for a subsequent investigation. Representative samples of the Swedish population in 1975, 1977, and 1981 were investigated by means of interviews. The participation rate varied between 81 and 86% and the number of participants between 11,582 and 14,964. Dental status, based on a question about natural teeth and/or removable denture(s), was analyzed in relation to demographic, socio-economic, social support and life style factors. The prevalence of edentulism in the age group 16-74 years decreased during the observation period from 12.7% to 9.9% in men and from 15.5% to 11.2 in women. Besides age, urbanization, occupation and tobacco smoking had the highest explanatory value for edentulism. The findings are discussed with respect to the increasing life expectancy and possible changes in the need and demand for dental care.

Dental health and functional ageing. A study of 70-year-old people

Functional ageing, including dental health, was studied in the gerontological population study in Gothenburg. This study was based on three 70-yr-old cohorts, born in 1901-2, 1906-7, and 1911-12 (n = 1380). The Eichner index was used as a measurement of deterioration in dental state and dental functional impairment. This impairment was significantly associated with a lower capacity in cognition, visual ability, hearing ability, lung volume, heart volume, muscle strength, and bone mineral content as well as a lower self-assessment of health. A multiple regression model showed that an index of seven functional capacities was the most predictive factor for dental status independent of confounding factors such as socioeconomic factors, tobacco smoking, and the most incapacitating diseases. These associations were more marked in men and the survival rate between 70 and 79 years of age was higher among men with a well preserved dental state of the age of 70. The co-variation between impairment in dental function and other functional variables and survival indicate a common functional ageing.

Smoking habits and tooth loss in Swedish women

A longitudinal population study of 1462 women, aged 38-60, was started in Gothenburg, Sweden, in 1968-69. In univariate analysis of the results from 1968-69, smokers were found to have a significantly lower number of remaining teeth than non-smokers had. The differences between smokers and non-smokers with respect to edentulousness and number of remaining teeth was further accentuated 12 yr later. The mean number of teeth lost during the 12-yr follow-up period was 3.5 among smokers and 2.1 among non-smokers, i.e. 67% higher among smokers than among non-smokers. The associations were independent of age, education, socio-economic group, marital status, frequency of toothbrushing, and frequency of visits to a dentist. It is concluded that smoking seems to play an important role as far as tooth loss is concerned.

Oral cancer after surgery for peptic ulcer

Oral cancer was studied in a population of 3435 which constituted all persons who were operated upon because of peptic ulcer in Gothenburg 1952-61. This population formed a data base which was coordinated with the National Cancer Register and the Register of Causes of Deaths in Sweden. The expected number of oral cancers was 7.7 and the observed number was 17 (P less than 0.01). In gerontologic population studies of the elderly in Gothenburg it was shown that 70-yr-old men with a history of peptic ulcer surgery more often were tobacco smokers, edentulous and more often had sideropenic and megaloblastic anemia and also had a lower bone mineral content.

Dental health and parity in three 70-year-old cohorts

In three cohorts of 70-yr-olds in Gothenburg, Sweden, born in 1901/02, 1906/07 and 1911/12, the relationship between oral health and parity was studied in 713 women and between oral health and the reported number of children in 660 men of the same cohorts. For women in all three cohorts, the number of teeth decreased in relation to increasing number of children that they had given birth to. Significantly more women with high parity were edentulous in one or both jaws compared to the other groups. Among parous compared to nulliparous women the age for becoming edentulous occurred earlier. The number of intact teeth was lower in parous compared to nulliparous women. Among the men no relation was found between oral health and the number of their children. When socioeconomic factors were taken into consideration the above described relations between declining dental health and increasing parity remained on about the same level of significance. Although pronounced cohort differences were found, a relationship between parity and dental health was found in all cohorts, indicating a general biological influence of repeated pregnancies.

Tobacco smoking: a major risk factor for loss of teeth in three 70-year-old cohorts

Oral health was examined in a random sample of 1377 people in three 70-year-old cohorts studied within 5-yr intervals. During the studied period 1971-1983 the prevalence of toothlessness decreased from 52 to 34%. Toothlessness in men was more common in smokers, 48%, and ex-smokers, 32%, than in non-smokers, 20%. Eichner's index was used as a measurement of dental invalidity. This index showed a worse dental state among smokers and ex-smokers compared to non-smokers. Multivariate analyses indicated that tobacco smoking was a major independent risk factor for tooth loss in elderly men.

Salivary flow, saliva, pH and buffering capacity in 70-year-old men and women. Correlation to dental health, dryness in the mouth, disease and drug treatment

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).