Eating disorders and oral health: a matched case-control study

The aim was to compare the oral health status of patients with eating disorders (EDs), with sex- and age-matched controls, with a view to identify self-reported and clinical parameters that might alert the dental healthcare professional to the possibility of EDs. All patients who entered outpatient treatment in an ED clinic during a 12-month period were invited to participate. Of 65 ED patients who started psychiatric/medical treatment, 54 agreed to participate. Eating disorder patients and controls answered a questionnaire and underwent dental clinical examinations. Multivariate analysis identified significantly higher ORs for ED patients to present dental problems (OR = 4.1), burning tongue (OR = 14.2), dry/cracked lips (OR = 9.6), dental erosion (OR = 8.5), and less gingival bleeding (OR = 1.1) compared with healthy controls. Sensitivity and specificity for the correct classification of ED patients and controls using the five variables was 83% and 79%, respectively. The ED patients with vomiting/binge eating behaviors reported worse perceived oral health (OR = 6.0) and had more dental erosion (OR = 5.5) than those without such behavior. In ED patients with longer duration of the disease, dental erosion was significantly more common. In conclusion, oral health problems frequently affect ED patients, and this needs to be considered in patient assessment and treatment decisions.     

Xerostomia in geriatric patients: a burgeoning global concern

Saliva plays a key role in maintaining oral homeostasis, function, and health. The prevalence of xerostomia and its consequences are rising due to the increasing aging population, the effects of some systemic diseases, medical management, and commonly‐prescribed medications that reduce saliva production. When salivary function is diminished, patients are at a greater risk of developing caries, discomfort in wearing dentures, and opportunistic diseases, such as candidiasis. The psychosocial aspects of xerostomia can range from a mild effect on self‐rated oral health to frustration, embarrassment, unhappiness, or substantial disruptions in quality of life. This article reviews the clinical features, diagnosis, and prevalence of dry mouth, as well as its treatment strategies.     

Comparison between new saliva stimulants in patients with dry mouth: a placebo-controlled double-blind crossover study

Two new saliva stimulants: V6 and a mucin containing chewing gum were tested in this placebo-controlled double-blind crossover study. Forty-three patients (mean age 63 yr) complaining of dry mouth participated. The products were administered in a randomized order, and used for 2 wk each. The effect was evaluated by interviews and by determining changes in stimulated and unstimulated saliva flow rates. A positive effect was reported by 64%, 44%, and 26% of the patients using the mucin chewing gum, V6, and the placebo, respectively. More than 2/3 of the patients found the mucin chewing gum efficient at various times and situations. Sixty-one percent of the patients preferred the mucin chewing gum, 21% V6, and 5% the placebo product. Fifty percent of the patients had an increase in unstimulated salivary secretion rate from all products after 14 days regular use indicating a long-term effect.     

Prevalence of hyposalivation in relation to general health, body mass index and remaining teeth in different age groups of adults

Abstract – Objectives: Several studies have been conducted on the prevalence of hyposalivation in older adults but no population‐based studies in younger adults. Therefore, our aims were to determine the prevalence of very low and low unstimulated (UWSFR) and stimulated (SWSFR) whole salivary flow rates in different age groups between 20 and 69 years, and to analyse the relationship between hyposalivation, subjective oral dryness and predictors of reduced flow rate. Methods: A randomized and stratified cross‐sectional study including 1427 dental patients was conducted. UWSFR and SWSFR were measured, numbers of remaining teeth recorded and a questionnaire answered regarding subjective oral dryness, general diseases, use of drugs, body mass index (BMI) and use of tobacco. Results: The prevalence of very low (<0.1 ml/min) and low (0.10–0.19 ml/min) UWSFR was similar for different age groups up to 50 years, ranging between 10.9–17.8% and 17.3–22.7%, respectively. The prevalence of very low UWSFR was significantly higher for women aged 50–69 years than for younger women. For men, prevalence of very low UWSFR was higher at 60–69 years. The prevalence of very low (<0.7 ml/min) and low (0.70 – 0.99 ml/min) SWSFR was between 0–5.5% and 0.8–8.2%, respectively, for the different age groups 20–69 years. Multiple logistic regression revealed that age above 50 years, female gender, having fewer than 20 teeth, and taking xerogenic drugs significantly increased the risk of very low UWSFR. For very low SWSFR, only having fewer than 20 teeth and taking more than two drugs were significant. In the younger individuals (<50 years) only BMI > 25 for very low UWSFR and diagnosed disease for very low SWSFR were found significant. In this younger subset, female gender combined with having fewer than 27 teeth was significant for low UWSFR. Conclusions: Hyposalivation is prevalent in younger adults, among whom it is associated with diagnosed disease and high BMI, while after age 50 years it is associated with medication. It is also associated with gender and with fewer remaining teeth.     

Stimulating the discussion on saliva substitutes: a clinical perspective

Xerostomia is a significant problem commonly faced by patients and oral health practitioners. There is no cure for this condition, which commonly manifests as a side effect of medications, head and neck irradiation and other systemic conditions, such as Sjögren's syndrome and type 2 diabetes. It may also arise idiopathically. Therefore, treatment is palliative and takes the form of oral lubricants and saliva substitutes which aim to reduce symptoms associated with xerostomia as well as prevent oral disease secondary to it. Recently there has been an expansion of the number and range of products available in Australia for the palliative management of xerostomia. It is imperative then that oral health professionals have a sound understanding of the advantages and disadvantages of using such products as patients tend to be well informed about new products which are commercially available. This article discusses some of the most commonly available products used for the symptomatic relief and preventive management of xerostomia. Amongst the plethora of products available to the patient suffering from xerostomia, no single product or product range adequately reproduces the properties of natural saliva and therefore consideration of patients' concerns, needs and oral health state should be taken into account when formulating a home care regime. With Australia's ageing population and its heavier reliance on medications and treatments which may induce xerostomia, oral health professionals are likely to encounter this condition more than ever before and therefore an understanding of xerostomia and its management is essential to patient care.     

Newer saliva collection methods and saliva composition: a study of two Salivette® kits

Saliva is frequently used as a diagnostic fluid and several collection devices have been developed.
OBJECTIVE: The aim of the present study was to investigate the validity and reliability of two types of Salivette^® collection kits (non-covered cotton roll and polypropylene covered polyether roll) relative to conventional collection of saliva using paraffin wax chewing stimulation.
MATERIALS AND METHODS: Whole saliva samples were collected from 16 healthy volunteers. Following a cross-over design saliva was collected in a standardized way. The flow rate was determined and saliva samples were analyzed for pH, buffer capacity, electrolytes and protein/glycoprotein content.
RESULTS: We find that Salivette® methods do not allow evaluation of flow rate. pH was unaffected but buffer capacity was lower in Salivette® collected than in paraffin wax-stimulated saliva. The non-covered cotton rolls reduced the content of Na⁺ K⁺ CI^- as well as glycoprotein markers (hexosamines, fucose, sialic acid), lysozyme, lactoferrin, salivary- and myeloperoxidase but increased the concentrations of Ca²⁺ PO^3–₄ and SCN-. Polypropylene covered polyether rolls affected saliva composition less than the non-covered cotton rolls. Thus, SCN- and slgA concentrations were higher and lysozyme activity lower in the former (covered roll) saliva than in paraffin wax saliva. The reliability of the Salivette® kits was good.
CONCLUSION: We conclude that the Salivette® method generates data significantly different from conventional paraffin wax-stimulated saliva such as buffer capacity and several electrolytes and organic components. Care should be taken in interpreting the results when such methods are employed.     

Medication and dry mouth: findings from a cohort study of older people

OBJECTIVES: The aim of this study was to examine the association between medication exposure and (1) unstimulated whole-salivary flow rate and (2) the severity of xerostomia among older people while adjusting for multiple medication use. METHODS: Data were obtained from participants remaining at the five-year follow-up phase of a cohort study of community-dwelling older South Australians. Medication exposure information was available at baseline and at five years, enabling examination of the effects on dry mouth of long-term exposure to medications. At the five-year follow-up, unstimulated salivary flow was estimated using the spit method, and xerostomia severity was estimated using the 11-item Xerostomia Inventory. Because of the potential difficulties posed by polypharmacy, a two-stage analytical approach was employed: (1) Classification and Regression Tree (CART) analysis was used as an exploratory device to elucidate the relationships among the dependent and independent variables, and (2) linear regression analysis was used as a complementary procedure. RESULTS: Unstimulated flow rate was lower among individuals who were female or taking antidepressants at both baseline and five years, and higher among smokers or people who were taking hypolipidemic drugs. Xerostomia severity was higher among females, or individuals taking: (1) an anginal at baseline and five years, (2) an anginal without a concomitant betablocker at five years, (3) thyroxine and a diuretic at five years, or (4) antidepressants or antiasthma drugs at both baseline and at five years. CONCLUSIONS: These results suggest that polypharmacy can be accounted for to a certain extent by using CART analysis in conjunction with more conventional approaches; and that the relationship between medications and dry mouth is a complex one, and differs according to which aspect of dry mouth is being examined.     

An investigation into the use of pilocarpine as a sialagogue in patients with radiation induced xerostomia

BACKGROUND: Radiation therapy to the head and neck region can be an effective form of treatment for malignancies. Unfortunately damage to salivary glands may occur. Treatment of resultant dry mouth is at present very poor. The purpose of this pilot study was to investigate whether pilocarpine dissolved in artificial saliva and administered in a mouth spray would be effective in relieving such symptoms. METHODS: Twenty-three patients with radiation induced hyposalivation were recruited for this randomized, double-blind investigation. Subjects were randomly allocated to placebo or control medicaments used for eight weeks. All subjects were evaluated for the severity of their xerostomia associated symptoms prior to administration of the spray and again eight weeks later. RESULTS: The questionnaire and the visual analogue scale did not reveal any improvements in the dry mouth symptoms between cases and controls. Side-effects were reported among cases, mostly mild and tolerable. All patients taking pilocarpine (with base salivary flow rates > 0ml/min) demonstrated improvement in stimulated and unstimulated salivary flow rates. Candida counts decreased among the cases and controls although decrease among the cases was much greater. CONCLUSIONS: The results obtained indicate that provided residual functioning salivary tissue exists, pilocarpine used as formulated is effective and warrants further investigation.     

Objective and subjective efficacy of saliva substitutes containing mucin and carboxymethylcellulose

Abstract— The lubrication properties of mucin and carboxymethylcellulose (CMC)-containing saliva substitutes and water were evaluated in a double-blind trial. After mouthrinsing with the substitutes, the patients answered a questionnaire (subjective effect) and the change of oral mucosal friction was measured with a probe (objective effect). Mucin and CMC-containing saliva substitutes showed almost the same objective effects, with changed friction values of about 15 min, which was more than twice as long as for water. Both water and the two saliva substitutes relieved the symptoms of dry mouth to some extent but they did not have a sufficiently long-lasting effect.     

Eating disorders and signs and symptoms of temporomandibular disorders: a matched case-control study

The aim of the study was to examine signs and symptoms related to temporomandibular disorders (TMD) in patients with eating disorders (ED) and to compare the prevalence with that in sex- and age-matched controls. During a 12-month period, all patients (n = 65) who accepted and initiated psychiatric/medical outpatient treatment in an Eating Disorder Clinic/Erikbergsg?rden, Orebro, Sweden were invited to participate in the study. Of the ED patients, 54 (83%) accepted participation. ED patients and controls underwent a comprehensive TMD questionnaire and clinical examination. Reported symptoms such as headache, facial pain,jaw tiredness, tongue thrusting, and lump feeling in the throat as well as dizziness, concentration difficulties and sleep disturbances were all significantly more prevalent among ED patients compared to controls. There was also a significantly higher prevalence of clinical TMD signs in the ED patients. Analyses within the ED group showed that those who reported self-induced vomiting reported significantly more heavy feeling in the head, nausea and snoring. Those with binge eating reported significantly more heavy feeling in the head, facial pain, dizzy feeling and concentration difficulties. No significant differences regarding subjective symptoms and clinical signs of TMD were found within the ED group with respect to duration of ED. In conclusion, orofacial pain and TMD related signs and symptoms are significantly more common in ED patients than in matched control subjects. Special emphasis should be made to those who reports vomiting and/or binge eating behaviors.     

Evaluation of in vitro properties of films of saliva substitutes in contact with different surfaces A comparative study with instruments for measurements of friction and rheologic properties

An instrument based on friction measurement has been developed to evaluate oral mucosal dryness objectively. The purpose of this study was to compare the friction instrument with instruments measuring in vitro rheologic properties. Measurements were performed against steel and irreversible hydrocolloid after application of different concentrations of aqueous solutions of carboxymethylcellulose and chitosan lactate. The results of the measurements were logical, with inversely proportional values for the friction instrument as compared with values obtained using the instrument measuring rheologic properties; that is, increased viscosity led to decreased friction values.     

Speech,eating and saliva control in rare diseases – a database study

The aim was to study the background to and the manifestations of affected intelligibility of speech and reported difficulty with eating and saliva control in rare diseases. In Sweden, a disease or disorder is defined as rare when it affects no more than 100 individuals per million population and leads to a marked degree of disability. In 1996–2008, 1703 individuals with 169 rare diseases (3–67 years) answered a questionnaire about oral health and oro‐facial function and 1614 participated in a clinical examination. A control group of 135 healthy children was included. Oromotor impairment was a frequent finding (43%) and was absent among the controls. Half the children in the youngest age group (3–6 years) had moderate/severely affected intelligibility or no speech compared with one‐third in the other age groups. The most frequent eating difficulties were related to chewing and were found in approximately 20% of the individuals in the study group. Artificial nutrition was most common in children aged 3–6 years (9·2%), followed by children aged 7–12 years (4·9%), adolescents aged 13–19 years (3·3%) and adults (1·4%). Impaired saliva control was common (31·2%) and strongly and significantly correlated with oromotor dysfunction, intellectual disability, open mouth at rest and epilepsy. In conclusion, oromotor impairment and oro‐facial dysfunctions, such as affected intelligibility, eating difficulties and impaired saliva control, are frequent in individuals with rare diseases. There is a strong correlation between oromotor impairment and affected intelligibility, eating difficulties and impaired saliva control in individuals with rare diseases.