Occurrence and impact of xerostomia among dentate adult New Zealanders: findings from a national survey

Factors influencing xerostomia and oral health-related quality of life in polymedicated patients

OBJECTIVES

To evaluate whether the severity of xerostomia in older polymedicated patients impacts oral health-related quality of life (OHRQoL).

BACKGROUND

Medication-associated xerostomia is common in older people. Xerostomia may impair OHRQoL.

MATERIALS AND METHODS

This cross-sectional study included older hypertensive patients from two health centres. We assessed the severity of xerostomia and OHRQoL using the Xerostomia Inventory (XI) tool, and the Oral Health Impact Profile-14 (OHIP-14) instrument, respectively. We measured unstimulated (UWS) and stimulated (SWS) salivary flows. Univariate and multiple linear regression analyses evaluated the associations of XI and OHIP-14 and different explanatory variables.

RESULTS

Of the 218 patients enrolled, 51.8% had xerostomia, and 38.1% and 27.5% suffered from UWS and SWS hyposalivation, respectively. Patients with xerostomia, UWS, and SWS hyposalivation scored significantly higher on the XI. However, only those with xerostomia or UWS hyposalivation had significantly higher OHIP-14 scores. A moderate correlation was observed between XI and OHIP-14 scores. The multiple regression model showed that factors with the greatest impact on XI were the patient's complaint of xerostomia, UWS flow rate, age and sex. However, only the XI score was significantly associated with the OHIP-14 score.

CONCLUSION

Xerostomia has a negative impact on OHRQoL in older polymedicated patients, but this impact is less than in other types of xerostomia. Longitudinal studies are needed to determine whether changes in the detected explanatory variables influence XI and OHIP scores in these patients.

Clinically estimated signs of hyposalivation in older adult residents of long-term care

OBJECTIVE

To assess whether the estimation of clinical signs of hyposalivation is applicable in recognising long-term care facility (LTCF) residents with poor oral health, and which individual characteristics are important in that respect.

BACKGROUND

A common inconvenience among older adults, dry mouth, particularly hyposalivation, can cause many complications, such as greater susceptibility to root caries and oral infections, and it can lead to further deterioration of oral health. However, very little is known about the association of clinically assessed signs of hyposalivation with the oral health status of LTCF residents.

METHODS

The study sample comprised 362 individuals (dentate n = 266, edentate n = 96) aged 65 or older. The examinations included a questionnaire and clinical oral examination. Participants were categorised into three groups based on clinically assessed oral dryness: normal salivation (n = 83, 22.9%), lower salivation (n = 182, 50.3%) and dry mouth (n = 97, 26.8%). The association between signs of dry mouth with aspects to oral health was evaluated and further tested with logistic regression analysis.

RESULTS

The signs of oral dryness were observed among females, those with dementia, and those with longer stays in the current facility. Root caries (odds ratio, OR 1.3) and diagnosis of periodontitis (OR 4.1), together with several individual periodontal parameters, as well as having less than ten occluding pairs of natural teeth (OR 3.5) were associated with dry mouth. Edentate participants showed an increased likelihood of having dry mouth with advancing age, and lesions on the lips were associated with dry mouth with OR 3.0.

CONCLUSION

Clinical estimation of signs of oral dryness can be a useful adjunct in evaluating the oral health status of dentate LTCF residents. Poor oral health was a frequent finding, especially among dentate LTCF residents with signs of dry mouth.

Xerostomia in a Group of Turkish Patients Using an Online Survey During the COVID-19 Pandemic

Background Xerostomia is defined as the subjective feeling of dry mouth and affects millions of patients worldwide. Most studies are based on samples of the elderly in nursing homes. This study aimed to investigate the presence of xerostomia and the severity of self-reported xerostomia by sociodemographic variables and to evaluate xerostomia symptoms (self-reported halitosis, burning mouth, and mouth sores) in young adults. Methodology A questionnaire regarding sociodemographic data and the 11-item Xerostomia Inventory was delivered to patients aged 20-65 years who applied to the Ankara University Faculty of Dentistry for dental treatment before the COVID-19 pandemic. Statistical analyses were performed to determine the relationships between the presence of xerostomia and other variables such as age, gender, the presence of a systemic disease, medication use, smoking, alcohol consumption, and the use of removable prostheses. Results A total of 300 patients were included in the study. Xerostomia presence of 54.6% (164 patients) was identified. A significant relationship was found between age and xerostomia (p = 0.023; p = 0.001). The presence of xerostomia decreased as age increased. Xerostomia was more common in female patients (p = 0.028; p = 0.004). The presence of xerostomia was found to be high, not only in the elderly but also in younger adults. Conclusions This study sheds light on the current status, symptoms, and etiology of xerostomia presence in the young population in Turkey. Factors associated with xerostomia were age, female gender, and the number of cigarettes smoked per day. In this study, the high presence of xerostomia was due to smoking.

Evaluation and management of dry mouth and its complications in rheumatology practice

INTRODUCTION

The symptom of dry mouth has multiple potential etiologies and can be a diagnostic clue to the presence of common systemic diseases encountered in rheumatology practice. The presence of decreased saliva flow (i.e. salivary hypofunction) defines a subset of dry mouth patients in whom there may be reversible drug effects, an iatrogenic insult such as head and neck irradiation, or a disease that directly involves the salivary glands (e.g. Sjögren's disease). The assessment of salivary hypofunction includes sialometry, salivary gland imaging, salivary gland biopsy, and an assessment for relevant systemic diseases. Optimal management of dry mouth requires accurate definition of its cause, followed by general measures that serve to alleviate its symptoms and prevent its complications.

AREAS COVERED

Through a literature search on xerostomia and salivary hypofunction, we provide an overview of the causes of dry mouth, highlight the potential impact of salivary hypofunction on oral and systemic health, detail routine evaluation methods and treatment strategies, and emphasize the importance of collaboration with oral health care providers.

EXPERT OPINION

Our Expert Opinion is provided on unmet needs in the management of dry mouth and relevant research progress in the field.

Efficacy of new oral rinse containing sodium hyaluronate in xerostomia: A randomized crossover study

OBJECTIVES

To evaluate the efficacy of a new oral rinse containing sodium hyaluronate and other functional ingredients in reducing xerostomia-associated symptoms.

MATERIALS AND METHODS

In this 8-week, double-blind crossover study, xerostomia subjects used all three of GUM®HYDRAL™ Oral Rinse, placebo rinse, and Biotene® Oral Rinse as active control. Visual Analog Scale, a dry mouth questionnaire, Oral Health Impact Profile-14, unstimulated saliva flow rate (USFR), and Revised Oral Assessment Guide (ROAG) were assessed before and after 2 weeks of treatments.

RESULTS

Thirty-seven patients completed all three treatment modalities. Subjective measurements were significantly decreased by test product and active control; however, no significant difference was observed between the treatments. Test product and active control demonstrated a significant increase in USFR over 0.2 ml/min, a normal threshold of hyposalivation. Both test product and active control improved a total score of ROAG, whereas the effectiveness of the test product was significantly better than that of other two treatments.

CONCLUSIONS

The new oral rinse may be beneficial to improve the quality of life of xerostomia patients as dry mouth symptoms were reduced for both subjective and objective measurements. Test oral rinse was found to be more effective than placebo or active control for some of the objective measurements.

Influence of case definitions on epidemiological estimates of periodontitis prevalence and its associations with smoking and OHRQoL

OBJECTIVES

To compare periodontitis prevalence estimates obtained using the new classification system with those generated using other case definitions from the literature, examine the strength of the association between tobacco smoking and periodontitis (and that between periodontitis and its impact on oral-health-related quality of life; OHRQoL) using those definitions.

METHODS

We conducted a secondary analysis of data from the 2009 New Zealand Oral Health Survey, a cross-sectional dental examination survey of a representative sample of people aged 18 or over. We identified cases using 10 different periodontitis case definitions and then compared weighted prevalence estimates across those. The associations between smoking and periodontitis, and between periodontitis and short-form Oral Health Impact Profile (OHIP-14) scores, were then compared across the various case definitions.

RESULTS

There was considerable variation in periodontitis prevalence estimates (range 3% to 59%). All definitions (but one) showed a higher prevalence of periodontitis in smokers than in non-smokers. The new classification stage III definition showed the strongest association, with an adjusted prevalence ratio of 1.99 (95%CI: 1.35, 2.91). All case definitions (but one) had a higher mean OHIP-14 score among people with periodontitis.

CONCLUSIONS

Periodontitis prevalence estimates are greatly influenced by case definition choice. The new classification system may be more accurate than any other used to date, but questions remain about its utility for periodontal epidemiology.

Impact of xerostomia and the use of dental prosthesis on the quality of life of elderly

Aim: To evaluate the impact of xerostomia, edentulism, use of dental prosthesis, and presence of chronic diseases on quality of life in relation to oral health in institutionalized elderly individuals. Methods: This is a cross-sectional study. A questionnaire was administered containing the following instruments: Oral Health Impact Profile (OHIP-14), which measures the quality of life related to oral health; the Summated Xerostomia Inventory questionnaire (SXI-PL) for evaluation of xerostomia, sociodemographic data, clinical description, and patient-reported factors was assessed (edentulism, use of dental prostheses, and chronic diseases). Results: Most elderly individuals did not have any teeth in their mouths and used dental prosthesis. The impact on quality of life, considering the mean of the OHIP-14 scores, was positive in 58.3% of the elderly. Those who used a dental prosthesis were three times more likely to have their oral health negatively impacted (OR=3.09; 95%CI =1.17 8.11), compared to those who did not use, and individuals with xerostomia were more likely to have their oral health negatively impacted (OR=1.57; 95%CI=1.25-1.98) compared to those without xerostomia. There was no difference in the quality of life of individuals with and without chronic diseases. Conclusions: The feeling of dry mouth and use of dental prostheses negatively impacted the quality of life in relation to oral health of the elderly.

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

OBJECTIVE

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

STUDY DESIGN

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

RESULTS

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

CONCLUSION

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

Oral Health-Related Quality of Life from Young Adulthood to Mid-Life

Quality of life varies with time, often worsening, and is affected by circumstances, events, and exposures at different stages of life. Little is known about how oral health-related quality of life (OHRQoL) changes during middle age. We investigated OHRQoL changes from age 32 to 45 years among participants in a population-based birth cohort, along with clinical and socio-behavioural associations. Generalised estimating equation models were used to investigate the association between OHRQoL (assessed at ages 32, 38, and 45 years; n = 844), and the socioeconomic position in childhood (up to age 15 years) and adulthood (ages 26 through to 45 years), dental self-care (dental services utilisation and tooth brushing), oral conditions (such as tooth loss), and experiencing a dry mouth. The multivariable analyses were controlled for sex and personality traits. At each stage of life, those of a lower socioeconomic status were at greater risk of experiencing OHRQoL impacts. Those who engaged in favourable dental self-care habits (the regular use of dental services and at least twice daily tooth brushing) experienced fewer impacts. A social disadvantage at any stage of life has enduring deleterious effects on one's quality of life in middle age. Ensuring access to timely and appropriate dental health services in adulthood may reduce the impacts of oral conditions on one's quality of life.

Normal salivary production using a swab method in clinical settings

Objectives

The purpose of the study was to generate age‐ and gender‐based normative data for unstimulated salivary flow rate (uSFR) by means of a swab method, and to provide preliminary results of using the test in patients suspected of reduced salivary function.

Methods

The 130 healthy participants without subjective xerostomia or suspicion of reduced salivation were recruited. Measurements of uSFR were conducted three times per subject and mean uSFR was calculated for the entire population and stratified according to age and gender. The method was applied in a pilot population of 25 patients suffering from either Sjögren's syndrome or had underwent irradiation of the head and neck.

Results

Mean uSFR in the healthy group was 0.808 g/min (range: 0.165–2.442). Not significant trends towards declining uSFR with increasing age and higher uSFR in women were seen. Mean uSFR in the patients was 0.429 g/min (range: 0.111–1.448), which was significantly lower than normative values. Use of xerogenic drugs correlated to lower uSFR.

Conclusion

Age‐ and gender‐based normative data of uSFR was presented using a fast and readily implementable swab test. The test was able to objectively verify hyposalivation among patients suffering from Sjögren's syndrome or having been exposed to head and neck radiation.

Oral health and depressive symptoms among older adults: longitudinal study

OBJECTIVE

The aim of this study was to describe the prevalence of depressive symptoms and determine the association with oral health variables in older adults belonging to an oral health cohort.

METHOD

A prospective longitudinal study was conducted between 2009 and 2015. A standardized questionnaire was administered to collect demographic-socioeconomic variables and self-perceived oral health status. The clinical oral examinations were performed by examiners who had undergone training and calibration exercises. Depressive symptoms (outcome) were measured using the Geriatric Depression Scale (GDS-15), with a score of five points or higher considered indicative of the presence of depressive symptoms.

RESULTS

A total of 439 and 163 older adults (≥60 years of age) were evaluated in 2009 and 2015, respectively. The prevalence of depressive symptoms was 18.3% in 2009 and 28.5% in 2015. In the adjusted Poisson regression model, older adults who experienced tooth loss between 2009 and 2015 (PR = 1.86; 95% CI: 1.01-3.53) and those with a sensation of dry mouth in 2015 but not in 2009 (PR = 3.25 95% CI: 1.56-6.72) were at greater risk of exhibiting depressive symptoms.

CONCLUSION

In this study, the prevalence of depressive symptoms was considerable. Older adults with tooth loss between 2009 and 2015 and those with a perception of dry mouth were at greater risk of exhibiting depressive symptoms, which underscores the importance of including a dentist as part of the health team for the prevention and treatment of mental health problems.

Association between dry mouth and physical frailty among community-dwelling older adults in Japan: The Otassha Study

OBJECTIVE

To elucidate the relationship between physical frailty and dry mouth among community-dwelling older adults in Japan.

BACKGROUND

Oral hypofunction is associated with physical frailty in older adults. Dry mouth, subjectively evaluated as xerostomia and objectively measured as hyposalivation, is highly prevalent in older adults. However, few reports have used both measures of dry mouth and investigated their association with physical frailty.

MATERIALS AND METHODS

This cross-sectional study included 643 individuals (mean age, 73.9 years) from the Otassha Study in 2019. Xerostomia was assessed using the 5-item Summated Xerostomia Inventory (SXI). Hyposalivation was assessed by measuring the amount of resting saliva using the modified cotton roll method. Frailty phenotypes were defined by weakness, slowness, weight loss, low physical activity level and exhaustion components, and served as the outcome variable. Participants with three or more components were considered physically frail, and those with one or two components were considered pre-frail. Ordinal logistic regression analyses were performed to evaluate the associations between physical frailty and xerostomia and hyposalivation.

RESULTS

Among the participants, 4.5% and 49.8% had physical frailty and pre-frailty, respectively. In ordinal logistic regression analysis adjusted for demographic and health characteristics, the SXI score was associated with physical frailty status (adjusted odds ratio for a one-point increase in SXI, 1.12; 95% confidence interval, 1.06-1.19). However, no difference was observed between the amount of resting saliva and severity of physical frailty.

CONCLUSION

Xerostomia is associated with physical frailty among community-dwelling older adults in Japan.

CLINICAL TRIAL REGISTRATION

Not applicable.

The Challenge of Medication-Induced Dry Mouth in Residential Aged Care

With a reported prevalence between 20% and 30%, dry mouth is more common among older people than any other age group. The major risk factor for dry mouth is polypharmacy. Older people take more medications than any other age group, not only for symptomatic relief of various age-associated chronic diseases, but also to reduce the likelihood of the complications that may arise from those conditions. Most aged care residents take even more medications than older people who are living in their own homes. The greater the number of medications taken, the greater the associated anticholinergic burden, and the more likely it is that the individual will suffer from dry mouth. The condition not only affects the dentition and ability to wear dentures, but also the sufferers' quality of life. Treating dry mouth is a considerable challenge for clinicians. As medication use is by far the most important risk factor, there is a need for pharmacists, doctors and dentists to work together to prevent this from occurring. Medication review and deprescribing is a key strategy, but there have not yet been any randomised control trials of its efficacy in reducing the occurrence of dry mouth.

Novel Multidisciplinary Salivary Gland Society (MSGS) Questionnaire: An International Consensus

Objectives

First, establishment and validation of a novel questionnaire documenting the burden of xerostomia and sialadenitis symptoms, including quality of life. Second, to compare two versions regarding the answering scale (proposed developed answers Q3 vs. 0–10 visual analogue scale Q10) of our newly developed questionnaire, in order to evaluate their comprehension by patients and their reproducibility in time.

Study Design

The study is a systematic review regarding the evaluation of the existing questionnaire and a cohort study regarding the validation of our new MSGS questionnaire.

Materials and Methods

A Multidisciplinary Salivary Gland Society (MSGS) questionnaire consisting of 20 questions and two scoring systems was developed to quantify symptoms of dry mouth and sialadenitis. Validation of the questionnaire was carried out on 199 patients with salivary pathologies (digestive, nasal, or age‐related xerostomia, post radiation therapy, post radioiodine therapy, Sjögren's syndrome, IgG4 disease, recurrent juvenile parotitis, stones, and strictures) and a control group of 66 healthy volunteers. The coherence of the questionnaire's items, its reliability to distinguish patients from healthy volunteers, its comparison with unstimulated sialometry, and the time to fill both versions were assessed.

Results

The novel MSGS questionnaire showed good internal coherence of the items, indicating its pertinence: the scale reliability coefficients amounted to a Cronbach's alpha of 0.92 for Q10 and 0.90 for Q3. The time to complete Q3 and Q10 amounted, respectively, to 5.23 min (±2.3 min) and 5.65 min (±2.64 min) for patients and to 3.94 min (±3.94 min) and 3.75 min (±2.11 min) for healthy volunteers. The difference between Q3 and Q10 was not significant.

Conclusion

We present a novel self‐administered questionnaire quantifying xerostomia and non‐tumoral salivary gland pathologies. We recommend the use of the Q10 version, as its scale type is well known in the literature and it translation for international use will be more accurate. Laryngoscope, 132:322–331, 2022

Xerostomia and polypharmacy among dependent older New Zealanders: a national survey

BACKGROUND

Medication-induced xerostomia is common in older people. We investigated medication use and xerostomia in dependent older New Zealanders.

METHODS

Medication and xerostomia data analysed from a nationally representative survey of dependent older people. Automatic interaction detection analysis identified medications combinations most strongly associated with xerostomia, and then xerostomia was modelled.

RESULTS

Just over half were taking five to nine different medications; one in five was taking 10+. Xerostomia prevalence (29.4%; 95% confidence interval 26.5, 32.5) was higher among the latter and lowest in psychogeriatric patients. After controlling for age and sex, it was higher among people taking any antidepressant, and higher still with a tricyclic antidepressant and either a steroid or an anticholinergic, or among people taking a bronchodilator without prophylactic aspirin.

CONCLUSIONS

Health practitioners should work together to ensure that those with xerostomia are managed in a timely and appropriate manner. Medication review is an important component of that.

Determining the relationship among stress, xerostomia, salivary flow rate, and the quality of life of undergraduate dental students

Objective

Xerostomia may result in several oral conditions, which ultimately affect oral health-related quality of life (OHRQOL). This study aims to evaluate the relationship of stress, xerostomia, salivary flow rate, and OHRQOL among young adults.

Method

We invited 72 participants to complete three validated questionnaires including the Perceived Stress Scale-10 (PSS-10), a shortened version of the Xerostomia Inventory (SXI), and the shortened Oral Health Impact Profile (S–OHIP). Unstimulated saliva was collected, and flow rate was determined. Based on the SXI scores and hyposalivation, the participants were categorised into four groups: subjective xerostomia, subjective and objective xerostomia, objective xerostomia, and true non-xerostomia. Based on the median PSS score, participants were categorised into high stress and low stress groups. Data were analysed using the Mann–Whitney U test, Kruskal–Wallis H test, and Spearman's correlation coefficient. A p value of 0.05 was set for all tests.

Results

A significant difference was observed in the unstimulated salivary flow rate (χ²(3) = 26.677, p < 0.001) and PSS scores (X²(3) = 8.552, p = 0.036) between xerostomia groups, while OHIP scores were not statistically different (X²(3) = 5.488, p = 0.139). A significant correlation was observed between SXI and S–OHIP scores (r = 0.348, p = 0.003) and unstimulated salivary flow rate and PSS (r = −0.259, p = 0.028).

Conclusion

This study shows that perceived stress can influence salivary flow rate. Among the xerostomia groups, stress scores and salivary flow rates varied significantly. Additionally, subjective xerostomia has an impact on OHRQOL.

Clinical Oral Disorders in Adults Screening Protocol (CODA-SP) from the 2019 Vancouver IADR Consensus Symposium

BACKGROUND

The Clinical Oral Disorder in Elders (CODE) index was proposed in 1999 to assess the oral health status and treatment needs of older people who typically were edentate or had few natural teeth. Since then, more people are retaining natural teeth into old age and have oral disorders similar to younger adults. In addition, there has been further guidance on screening for disease that includes changes to the clinical indicators of several oral disorders and greater sensitivity to people's concerns about their oral health and care needs.

METHODS

Experts in dental geriatrics assembled at a satellite symposium of the International Association of Dental Research in June 2019 to revise the objectives and content of the CODE index. Before the symposium, 139 registrants were asked for comments on the CODE index, and 11 content experts summarised current evidence and assembled reference lists of relevant information on each indicator. The reference lists provided the base for a narrative review of relevant evidence supplemented by reference tracking and direct searches of selected literature for additional evidence.

RESULTS

Analysis of the evidence by consensus of the experts produced the Clinical Oral Disorders in Adults Screening Protocol (CODA-SP).

CONCLUSIONS

The CODA-SP encompasses multiple domains of physical and subjective indicators with weighted severity scores. Field tests are required now to validate its effectiveness and utility in oral healthcare services, outcomes and infrastructure.

Xerostomia: its prevalence and associations in the adult Australian population

BACKGROUND

Little is known of the occurrence of dry mouth among Australians.

AIM

To describe the prevalence and associations of xerostomia in a nationally representative sample of Australian adults.

METHODS

Dentate persons aged 15+ years were asked 'How often does your mouth feel dry?' (response options 'never', 'occasionally', 'frequently' or 'always'). Those responding 'frequently' or 'always' were classified as xerostomic.

RESULTS

The prevalence of xerostomia was 13.2% (95% CI 12.4, 14.0). It ranged from 9.3% (95% CI 7.9, 10.8) among 15-to-34-year-old to 26.5% (95% CI 23.3, 30.0) among those aged 75+ years. Prevalence was higher in the lowest income tertiles (24.5%, 95% CI 22.6, 26.5), lowest SEIFA tertiles (15.7%, 95% CI 14.2, 17.3), those who were dentally uninsured (16.6%, 95% CI 15.4, 17.8) and those with unfavourable dental visiting patterns (18.1%, 95% CI 16.2, 20.1).

CONCLUSIONS

More than one in ten Australians experience dry mouth. Among older Australians, this estimate is one in four. With an ageing, medicated population that is increasing in size, xerostomia is a condition that needs to be better understood, recognized and managed by both dental and general health practitioners.

Salivary and lacrimal dysfunction after radioactive iodine for differentiated thyroid cancer: American Head and Neck Society Endocrine Surgery Section and Salivary Gland Section joint multidisciplinary clinical consensus statement of otolaryngology, ophthalmology, nuclear medicine and endocrinology

BACKGROUND

Postoperative radioactive iodine (RAI) administration is widely utilized in patients with differentiated thyroid cancer. While beneficial in select patients, it is critical to recognize the potential negative sequelae of this treatment. The prevention, diagnosis, and management of the salivary and lacrimal complications of RAI exposure are addressed in this consensus statement.

METHODS

A multidisciplinary panel of experts was convened under the auspices of the American Head and Neck Society Endocrine Surgery and Salivary Gland Sections. Following a comprehensive literature review to assess the current best evidence, this group developed six relevant consensus recommendations.

RESULTS

Consensus recommendations on RAI were made in the areas of patient assessment, optimal utilization, complication prevention, and complication management.

CONCLUSION

Salivary and lacrimal complications secondary to RAI exposure are common and need to be weighed when considering its use. The recommendations included in this statement provide direction for approaches to minimize and manage these complications.

Self-reported oral and general health related to xerostomia, hyposalivation, and quality of life among caries active younger adults

Objective: The aim was to study prevalence of xerostomia, hyposalivation and quality of life among caries active younger adults.Materials and methods: A questionnaire regarding oral and general health, xerostomia and quality of life was mailed to 134 caries active (CA) and 40 caries inactive (CI) patients, 25-50 years of age (mean age 39.9 ± 6.2 years) treated at a Swedish Public Dental Service clinic, regarding oral and general health, xerostomia and quality of life. Caries data and unstimulated whole salivary flow rates were obtained from dental records.Results: The overall response rate was 69%. Dental records confirmed that CA patients had more decayed teeth over time than CI patients (p < .001). The CA group reported worse oral health (p < .001) and general health (p < .01), more xerostomia (p < .001) and lower salivary flow rate (p < .01) compared to CI patients. Xerostomia was inversely related to unstimulated whole salivary flow rates as well as to oral and general health (p < .01). There were no differences between groups in quality of life.Conclusion: Younger caries active adult patients reported significantly more xerostomia and hyposalivation compared to caries inactive patients. Xerostomia and hyposalivation were inversely related to perceptions of oral and general health, but not to quality of life.

Self-reported dry mouth in 50- to 80-year-old Swedes: Longitudinal and cross-sectional population studies

Xerostomia is a common condition among elderly. The objectives were to examine prevalence, persistence, progression, yearly incidence of xerostomia, associated background factors and its influence on oral impacts on daily performances (OIDP) in 50- to 80-year-old people. In 1992, a questionnaire was sent to all 50-year-old (n = 8888) and in 2007 to all 75-year-old persons (n = 5195) living in two Swedish counties. In 2012, the same questionnaire was sent to both age cohorts, now 70- and 80-year-old. Response rate was for the 50-, 70- 75- and 80-year-old groups 71.4%, 72.2%, 71.9% and 66.4%, respectively. In the 50- to 70-year-old sample, 40.3% of the participants answered all five examinations and in the 75-80 group 49.5% (intact samples). In all age groups, xerostomia was significantly more prevalent in women than in men. At age 80, "often mouth dryness at night" was reported by 24.3% and 16.2% of women and men, respectively. Prevalence increased with age and was more frequent at night-time. Persistence of xerostomia was reported by 61.4%-77.5%, progression by 11.5%-33.0% and remission by 5.7%-11.3%. Average yearly incidence was 0.99%-3.28%. Xerostomia was more prevalent in those who reported a negative impact on OIDP. Highest odd ratios for xerostomia were burning mouth (OR 12.0), not feeling healthy (OR 5.1) and medicine usage (OR 3.9). Xerostomia is common in older age, persistence is high and progression common. The comorbidity between xerostomia, oral health problems and impaired general health needs to be taken into consideration when providing dental care to elderly patients.

Evaluate five different diagnostic tests for dry mouth assessment in geriatric residents in long-term institutions in Taiwan

BACKGROUND

Residents in long-term care (LTC) institutions require care plans to effectively resolve dry mouth. Simple and easily comprehensible dry mouth indices must be developed to assist care professionals in determining dry mouth among residents. Therefore, this study aim of the study was to evaluate five different diagnostic tests for dry mouth assessment.

METHODS

A total of 568 residents were recruited from several LTC institutions in central Taiwan. The research instruments and tools comprised of the characteristics of the residents, state of oral health care, self-perceived ability to chew food, Taiwanese short-form of the Oral Health Impact Profile (OHIP-7 T), self-perceived levels of dry mouth, oral moisture checking, and a repetitive saliva swallowing test (RSST). The data collected were analyzed through demographic analysis, Correlation coefficient and chi-squared automatic interaction detection.

RESULTS

Results of the decision tree analysis indicated that RSST results, tooth brushing frequency, and age were the three indices that exerted the greatest influence on oral moisture levels. Specifically, in residents with relatively high RSST results, a daily tooth brushing frequency > 1, and an age < 68 years exhibited more favorable oral moisture levels. The results indicated that residents' self-perceived oral status was not associated with their oral moisture levels.

CONCLUSION

The three indices can be provided to LTC institutions for on-site assessment of dry mouth among residents to facilitate early detection of those with dry mouth.

How Common is Dry Mouth? Systematic Review and Meta-Regression Analysis of Prevalence Estimates

The aim of this paper is to systematically review the literature to estimate the overall prevalence of xerostomia/hyposalivation in epidemiological studies. An electronic search was carried out up to February 2018 with no language restrictions. A total of 5760 titles were screened and just twenty-nine papers were included in review and the meta-analysis after a two independently reviewers applied the selection criteria. Data were extracted from PubMed and Web of Science databases. Eligibility criteria included original investigations from observational population-based studies that reported the prevalence of xerostomia or data that allowed the calculation of prevalence of xerostomia and/or hyposalivation. Studies conducted in samples with specific health conditions, literature reviews, case reports and anthropological studies, as conferences or comments were excluded. Sample size, geographic location of the study, study design, age of the studied population, diagnosis methods, and evaluation criteria used to determine xerostomia e/or hyposalivation were extracted for meta-analysis and meta-regression. Multivariate meta-regression analysis was performed to explore heterogeneity among studies. The overall estimated prevalence of dry mouth was 22.0% (95%CI 17.0-26.0%). Higher prevalence of xerostomia was observed in studies conducted only with elderly people. Despite diverse approaches to the condition's measurement, just over one in four people suffer from xerostomia, with higher rates observed among older people. Moreover, the measurement methods used currently may over- or underestimate xerostomia. These findings highlight the need for further work on existing and new clinical measure and will be useful to determine which one is more reliable in clinical and epidemiological perspectives.

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.

A randomized controlled study to evaluate an experimental moisturizing mouthwash formulation in participants experiencing dry mouth symptoms

OBJECTIVE

The aim of this study was to evaluate the efficacy and tolerability of an experimental moisturizing mouthwash versus water only in participants experiencing dry mouth symptoms, including those with Sjögren syndrome (n = 28).

STUDY DESIGN

Participants were randomized to the experimental mouthwash group (n = 53) or the water-only group (n = 47). For 8 days, the mouthwash group used 1 to 2 doses/day at home; both groups could sip water, as needed. Supervised treatment occurred on days 1, 3, and 8, and during this treatment, before and after administration, participants completed the Product Performance and Attributes Questionnaire parts 1 through 4.

RESULTS

Significant between-treatment differences on all Product Performance and Attributes Questionnaire questions were shown at most time points. On day 8, at 120 minutes, there was a significant difference on Product Performance and Attributes Questionnaire 3-Question 1 ("Relieves the discomfort of dry mouth"; the predefined primary efficacy variable) in favor of mouthwash versus water (0.63 [95% confidence interval 0.17-1.10]; P = .0084). Subgroup analysis found a significant difference that favored mouthwash in participants without Sjögren syndrome (0.67 [0.11,1.23]; P = .0203) but not with Sjögren syndrome (0.52 [-0.35,1.38; P = .2272). Eight, non-serious, oral treatment-related adverse events were reported by the mouthwash group.

CONCLUSIONS

The findings of a subjective questionnaire showed that an experimental moisturizing mouthwash provided greater relief than water only from dry mouth symptoms over 8 days.

Prevalence of xerostomia in an adolescent inpatient psychiatric clinic: a preliminary study

OBJECTIVE

Adolescents with psychiatric conditions may be at risk for xerostomia. In this preliminary study, we estimated xerostomia prevalence in adolescents ages 9 to 17 years from an inpatient psychiatric clinic (N = 25) and examined whether: (1) gender and age were associated with xerostomia and (2) xerostomia was associated with self-reported cavities.

METHODS

We used a modified 11-item Xerostomia Index to identify xerostomia (no/yes) and asked if adolescents ever had or currently have cavities (no/yes).

RESULTS

The mean age was 14 years (SD = 2.3) and 72% were male. Sixty percent reported xerostomia (SD = 50). There were no significant associations between xerostomia and gender (p = 0.99) or age (p = 0.66), or between xerostomia and past (p = 0.26) or current cavities (p = 0.11). Larger proportions of adolescents with xerostomia reported previous and current cavities.

CONCLUSIONS

Sixty percent of adolescents from an inpatient psychiatric clinic reported having xerostomia, which may lead to increased caries risk over time. Additional research should examine the prevalence and consequences of xerostomia in high-risk adolescents.