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

BackgroundMost 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.MethodsThe 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.ResultsThe 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.ConclusionThe authors found that medication use and age were highly significant risk factors for dental patients reporting xerostomia.Clinical ImplicationsClinicians should interview their patients carefully regarding their use of medications and provide proper oral health care to improve xerostomia resulting from medication use.     

Sleep quality in patients with xerostomia: a prospective and randomized case-control study

Objectives To investigate sleep quality, anxiety/depression and quality-of-life in patients with xerostomia. Materials and methods This prospective, observational, cross-sectional study was conducted among a group of xerostomia patients (n?=?30) compared with 30 matched control subjects. The following evaluation scales were used to assess the psychological profile of each patient: the Hospital Anxiety and Depression Scale, the Oral Health Impact Profile-14 (OHIP-14), the Xerostomia Inventory, the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Results The PSQI obtained 5.3 3?±?1.78 for patients with xerostomia compared with 4.26?±?1.01 for control subjects (p?=?0.006); ESS obtained 5.7?±?2.1 for test patients vs 4.4 0?±?1 for control subjects (p?=?0.010). Statistical regression analysis showed that xerostomia was significantly associated with depression (p?=?0.027). Conclusions Patients with xerostomia exhibited significant decreases in sleep quality compared with control subjects.     

Clinical and antimicrobial evaluation of a mouthwash and toothpaste for xerostomia: a randomized, double-blind, crossover study

Objectives

Specific toothpaste and mouthwash for xerostomia based on triclosan, fluoride, and mineral salts were studied in order to evaluate their efficacy in improving the quality of life as well as their in vitro antimicrobial action.

Materials and methods

30 patients with dry mouth and hyposalivation confirmed by sialometry were included in a randomized, double-blind, crossover study, during two weeks for each experimental phase. Dryness and oral comfort, difficulty in speaking, chewing, swallowing and using dental prostheses, as well as taste and sleep disorders were evaluated. Values of minimal biocidal and minimal inhibitory concentrations of both products against microorganisms that often cause oral disorders in these patients were determined and compared.

Results

The use of the mouthwash and toothpaste studied improved the dry mouth symptoms, whilst no significant differences when compared with the salivary enzyme substitutes were observed. The test products showed, in general, a higher biocidal and inhibitory action than the control products, with particularly noteworthy action against cariogenic bacteria.

Conclusions

The use of a toothpaste and mouthwash based on triclosan, fluoride, gingival revitalizers and mineral salts, improves the quality of life of patients suffering xerostomia.     

Risk factors of oral candidosis: a twofold approach of study by fuzzy logic and traditional statistic

OBJECTIVE: To assess a panel of risk factors associated to oral candidosis (OC) onset and its chronic maintenance by means of fuzzy logic (FL) approach and statistical traditional methodology (STM); to investigate their casual relationship within a multifactorial framework. DESIGN: Case-control study. SETTING: One hospital-based clinic. PATIENTS: Eighty-nine patients with OC infection microbiologically diagnosed and 98 healthy subjects were consecutively recruited. OUTCOME MEASUREMENTS: Anamnestic and clinical evaluations for OC, microbiological assessment (i.e. culture, CFU/mL counting and identification) were performed. The commonest predisposing factors for OC onset and its chronic status were analysed by FL and STM. RESULTS: By means of a twofold analysis (FL and STM) significant associations between OC onset and its chronic maintenance were found with respect to denture wearing and hyposalivation/xerostomia, as local risk factors, and to age and female gender, as socio-demographical variables. Tobacco smoking was found not to be a risk factor. CONCLUSIONS: The twofold (FL and STM) statistical approach for the identification of OC risk factors has been found useful and accurate in individuating a more selected target population for OC onset and chronic maintenance. The target patient appears to be an elderly person with multiple disease inducing, directly or by medications, hyposalivation/xerostomia. This data could provide to general and dental practitioners a decision-making model finalised to their preventative strategies for the geriatric population.     

Hyposalivation, xerostomia and the complete denture: a systematic review

BACKGROUND: To determine the treatment effects of hyposalivation on denture retention, the authors conducted a systematic review of the literature. TYPES OF STUDIES REVIEWED: The authors reviewed clinical investigations that assessed the treatment effects of hyposalivation on denture retention. They searched six electronic databases for works from 1950 to the second week of September 2007 by using the key words "denture," "hyposalivation," "xerostomia," "dry mouth," "elderly" and "aged." They limited the citation search to articles written in English and describing studies that involved human subjects. RESULTS: The authors identified 11 articles in the search; none was a report of a randomized controlled clinical trial. CLINICAL IMPLICATIONS: The few clinical research studies published on the topic of hyposalivation and denture retention represent a low level of evidence for establishing clinical practice guidelines. The authors found that they could make no conclusions regarding the treatment effects of hyposalivation on denture retention. The article provides a literature review regarding the etiologies and clinical presentation of salivary disorders and xerostomia in elderly people, the role of saliva in denture retention, the effect of dry mouth on denture use and the treatment of dry mouth problems in denture wearers. Prospective clinical trials are needed to establish a framework for evidence-based treatment of denture-wearing patients experiencing dry mouth.     

Salese to Buffer Saliva in Elderly Patients with Xerostomia: a Pilot Study

Purpose: The objective of this study was to compare the pH of saliva from xerostomic patients before and after the use of Salese lozenges (Nuvora Inc., Santa Clara, CA). Materials and Methods: After IRB approval, ten subjects were selected to participate in this pilot study to evaluate the efficacy of Salese. The inclusion criteria were patients on multiple medications who demonstrated xerostomia and acidic salivary pH. Saliva was collected from the patients at baseline and after the use of Salese at selected intervals up to 120 minutes. The pH of the collected saliva was measured, and the data were analyzed using an ANOVA. Results: Use of Salese lozenges showed a shift toward a more neutral pH in the first half hour. The pH remained at the same level after the primary shift for at least 2 hours. Conclusions: This pilot study indicates that patients suffering with xerostomia can use Salese lozenges for at least 10‐30 minutes to induce a salivary pH shift to a more neutral level. More research should be performed to investigate the buffering capacity of Salese lozenges.     

Prevalence of xerostomia and hyposalivation and their association with quality of life in elderly patients in dependence on dental status and prosthetic rehabilitation: A pilot study

Objectives

The aims of this pilot study were to investigate the prevalence of xerostomia and hyposalivation and their impact on quality of life in a cohort of elderly patients including dental status and the character of potential prosthetic restorations as independent variables.

Methods

Patients aged 60 years or older without any objective or subjective need for prosthodontic treatment taking part in a regular recall programme were included in the trial. Quality of life was assessed using the German version of the GOHAI; prevalence and severity of xerostomia was investigated using the shortened version of the Xerostomia Inventory (XI). Stimulated salivary flow rate was determined using a sialometric approach. Dental status and the character of prosthetic restorations (no/fixed restorations and removable but tooth-supported dentures vs. gum-supported dentures) were assessed in a clinical examination by experienced dentists specialized in prosthodontic treatment.

Results

A total of 68 patients were included in the trial; a prevalence of xerostomia of 16% and a prevalence of hyposalivation of 31% were identified. The quality of life in the study cohort decreased significantly as a function of xerostomia severity but not salivary flow; moreover, a significant impact of the number of teeth/implants in the upper jaw and the presence of gum-supported dentures in both jaws on GOHAI scores could be identified.

Conclusions

Within the limitations of a pilot study, the results support the assumption that the quality of life in elderly patients is particularly related to their subjective perception of xerostomia. A decline in salivary flow, the dental status and the character of prosthetic restorations appear to play a subordinate role for the quality of life in elderly patients.

Clinical significance

The quality of life in elderly patients may be severely diminished due to an increased subjective perception of dry mouth. Dental treatment should focus on alleviating xerostomia, whereas the impact of dental status and prosthetic restoration appear to be subordinate.     

Diagnosis and treatment of xerostomia (dry mouth)

Xerostomia (dry mouth) is a common complaint with widespread implications such as impaired quality of life, oral pain, and numerous oral complications. There are a variety of salivary and nonsalivary causes of xerostomia, the most frequent being medication side effects and systemic disorders. A systematic approach should be employed to determine the etiology of this condition, with distinctions made between patients with subjective complaints of xerostomia alone and those with measurable salivary gland dysfunction. Management is multidisciplinary and multimodal. This review summarizes the current literature on the etiology, diagnosis, and complications of xerostomia, and on the management of patients with xerostomia.     

Temporomandibular disorders and associated factors in Brazilian teenagers: a cross-sectional study

PURPOSE: This study aimed to assess the prevalence of temporomandibular disorders (TMD) and associated variables among adolescents from 16 to 18 years of age in their senior year of high school in the city of Recife, Pernambuco, Brazil, in 2005. MATERIALS AND METHODS: The studied variables were gender, self-esteem and nervous behavior, type of occlusion, and use of orthodontic appliances. In this cross-sectional study, the nonpatient population comprised 410 adolescents attending private and state schools. The data collection was conducted using 2 questionnaires, the first of which was used to evaluate the prevalence of TMD and the second to assess self-esteem. A clinical examination was conducted for the occlusion aspect of the evaluation. RESULTS: The prevalence of TMD was 16.3% in the study group and there was no statistical difference between occlusions judged as normal or as malocclusions (P = .1148). There was a statistically significant association between students who had previously undergone orthodontic treatment and TMD (P = .0033, odds ratio: 3.08). The students classified in the low self-esteem group showed a significant increase in TMD (P= .0140). The group that classified themselves as nervous also showed an increase (P = .0034), with a higher prevalence also found in females (P = .0021). CONCLUSIONS: This study suggests that low self-esteem and gender may be more frequently related than dental factors to TMD in adolescents.     

Risk factors associated with tongue lesions: a propensity score-matched case-control study

Background to analyse the potential risk factors of tongue lesions, comparing the results with a control group.Material and Methods An observational, case-control study was designed. The study included a case group comprising 336 patients with tongue lesions and 336 sex and age-matched controls. We recorded tobacco/alcohol habits, presence of dentures, allergies, medical conditions, and medications. Statistical analysis was performed via logistic regression models to estimate the odds ratio (OR) adjusted for gender, age, tobacco, and alcohol using propensity score-matching analysis (PSM).Results According to the final PSM model, patients with tongue lesions were more likely to suffer from allergies (OR 2.13; 1.27-3.66) or medical conditions (OR 2.14; 1.19-3.85), and more likely to take medication (OR 1.99; 1.11-3.57). Elderly individuals were more prone to hairy tongue (OR 3.82; 1.53-10.47). Smoking was associated with coated tongue (OR 2.05; 1.12-3.63), hairy tongue (OR 3.77; 1.52-9.22) and median rhomboid glossitis (OR 40.49; 5.84-860.43). Allergic individuals were more likely to exhibit sublingual varices (OR 1.73; 1.02-2.88). Medical conditions increased the chances of having coated tongue (OR 2.44; 1.36-4.64) or crenated tongue (OR 2.70; 1.42-5.30). Arterial hypertension was associated with median rhomboid glossitis (OR 5.85; 1.08-34.18). Individuals on medication showed a higher risk of fissured tongue (OR 1.87; 1.20-2.94) and varices (OR 2.42; 1.58-3.80). Agents acting on the alimentary tract and metabolism increased the probability of fissured tongue (OR 2.31; 1.42-3.79).Conclusions As far as we are aware, this is the first study on lingual pathology to include a PSM analysis. The results suggest that a history of allergies, the presence of medical conditions, and the use of medication are associated with increased probability of tongue lesions. The analysis of diseases and medications by subgroups requires studies matched by habits with larger sample sizes, in order to corroborate our observations. Key words:Tongue lesions, fissured tongue, allergies, medications, risk factors, systemic diseases.     

Personality,xerostomia and OHRQoL among 35–54-year-olds

Objective: Personality characteristics mean that people may interpret similar symptoms differently, complicating the measurement of self-reported oral health, and so we tested the hypothesis that controlling for aspects of personality makes a difference to the association between xerostomia and oral-health-related quality of life.

Material and methods: A cross-sectional study was conducted of a representative adult population sample in Dunedin (New Zealand). Data were collected on xerostomia, OHRQoL and personality characteristics, using (respectively) the 5-item Shortened Xerostomia Inventory (SXI), the OHIP-14 and the Positive and Negative Affect Schedule (PANAS). Negative binomial regression was used to model the association between the SXI and the OHIP-14 scores, and models with and without the PANAS score were compared.

Results: The participation rate was 51.3%, with complete OHIP-14 data available for 250 individuals (56.5% female). The SXI score (mean 6.9, sd 1.8) was strongly and positively associated with the OHIP-14 score (in both models), as was the PANAS negative affect score in the second model, which also explained slightly more of the observed variance than the first model. However, the difference in model deviance fell short of the amount required to reject the hypothesis that adding the PANAS variables to the model made a significant difference.

Conclusions: Considering aspects of personality in investigating OHRQoL remains a theoretically important undertaking, but adjusting for it in analyses of associations between xerostomia and OHRQoL is unlikely to be necessary.     

Salivary gland function and xerostomia in southern Chinese following radiotherapy for nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is rare among Caucasians but very common among southern Chinese. No information is presently available on the relationship between salivary gland function and xerostomia in irradiated southern Chinese. Salivary gland function and xerostomia were measured in irradiated NPC patients, recently diagnosed NPC patients, and a matched control group. Stimulated whole saliva was collected from each participant and flow rate, pH and buffer capacity measured. All participants completed a multi-item dry mouth questionnaire. Comparisons were made using Chi-square and Mann-Whitney tests and correlations assessed using Spearman's rank correlation coefficients. The mean saliva flow rate and pH were significantly lower and the buffer capacity impaired in irradiated NPC patients compared with the other groups (P<0.01). Significantly more irradiated NPC patients had negative impacts associated with dry mouth generally, sticky saliva, and hoarse voice (P<0.01). Subjective dry mouth symptoms and associated reduced saliva flow were also relatively common in non-irradiated participants. Salivary gland hypofunction and xerostomia were major complications in irradiated NPC patients. In irradiated and non-irradiated southern Chinese, subjective dry mouth symptoms appeared to be correlated with actual salivary gland function.     

Prevalence of dentine hypersensitivity and study of associated factors: A European population-based cross-sectional study

Objectives

Dentine hypersensitivity (DH) manifests as a transient but arresting oral pain. The incidence is thought to be rising, particularly in young adults, due to increases in consumption of healthy, yet erosive, diets. This study aimed to assess the prevalence of DH and relative importance of risk factors, in 18–35 year old Europeans.

Methods

In 2011, 3187 adults were enrolled from general dental practices in France, Spain, Italy, United Kingdom, Finland, Latvia and Estonia. DH was clinically evaluated by cold air tooth stimulation, patient pain rating (yes/no), accompanied by investigator pain rating (Schiff 0–3). Erosive toothwear (BEWE index 0–3) and gingival recession (mm) were recorded. Patients completed a questionnaire regarding the nature of their DH, erosive dietary intake and toothbrushing habits.

Results

41.9% of patients reported pain on tooth stimulation and 56.8% scored ≥1 on Schiff scale for at least one tooth. Clinical elicited sensitivity was closely related to Schiff score and to a lesser degree, questionnaire reported sensitivity (26.8%), possibly reflecting the transient nature of the pain, alongside good coping mechanisms. Significant associations were found between clinically elicited DH and erosive toothwear and gingival recession. The questionnaire showed marked associations between DH and risk factors including heartburn/acid reflux, vomiting, sleeping medications, energy drinks, smoking and acid dietary intake.

Conclusion

Overall, the prevalence of DH was high compared to many published findings, with a strong, progressive relationship between DH and erosive toothwear, which is important to recognise for patient preventive therapies and clinical management of DH pain.     

Gingival recession and associated factors in a homogeneous Mexican adult male population: A cross-sectional study

Background: Diverse variables are implicated in the pathogenesis of gingival recession; more detailed knowledge about the relationship between the clinical presentation of gingival recession and assorted risk indicators may lead to improved patient monitoring, early intervention, and subsequent prevention. The objective was to evaluate clinically gingival recession in a homogeneous Mexican adult male population and to determine the strength of association with related factors. Method: A cross-sectional study was carried out in a largely homogeneous group in terms of ethnic background, socioeconomic status, gender, occupation, and medical/dental insurance, in Campeche, Mexico. Periodontal examinations were undertaken to determine diverse clinical dental variables. All periodontal clinical examinations were assessed using the Florida Probe System, a dental chair and one examiner. Questionnaires were used to collect diverse risk indicators. Statistical analyses were undertaken with negative binomial regression models. Results: The mean number of sites with gingival recession per subject was 6.73±5.81; the prevalence was 87.6%. In the negative binomial regression model we observed that for (i) each year of age, and (ii) each percentage unit of increase in sites with plaque, and (iii) with suppuration, mean sites with gingival recession increased 2.9%, 1.0% and 13.0%, respectively. Having a spouse was associated with gingival recession. Conclusions: We observed association between gingival recession, and sociodemographic and clinical parameters. Patients need be educated about risk indicators for gingival recession as well as the preventive maneuvers that may be implemented to minimize its occurrence. The potential of improved oral self-care to prevent a largely benign condition such as gingival recession is important, given the associated disorders that may ensue root exposure, such as root caries and root hypersensitivity.     

Prevalence of clinical signs and pain symptoms of temporomandibular disorders and associated factors in adult Finns

Abstract

Objective: To assess the prevalence of clinical signs and pain symptoms of temporomandibular disorders (TMD) and associated factors in the Finnish adult population, as well as the association between self-reported TMD pain symptoms and clinical signs.

Material and methods: The sample consisted of 1577 Finnish adults who participated in the Health 2011 Survey (BRIF8901). Signs of TMD were assessed using clinical examination, and TMD pain symptoms were inquired using validated questions.

Results: Of the study subjects, 35% showed at least one sign of TMD, 8% reported weekly facial pain and 6% weekly pain when biting or jaw opening. According to logistic regression, female gender, poor general health and low level of education increased the risk for most TMD signs and TMD pain symptoms. Muscle or TMJ pain on palpation associated significantly with self-reported weekly facial pain or pain when biting or jaw opening.

Conclusion: Over a third of the population showed clinical signs of TMD and less than one-tenth reported TMD pain symptoms. An assessment of a patient’s general health needs to be a part of TMD diagnosis and treatment. The Finnish versions of the validated questions are applicable for screening of TMD pain.