Factors associated with hyposalivation and xerostomia in older persons in South Brazil

The Impact of Xerostomia on Food Choices-A Review with Clinical Recommendations

Xerostomia and hyposalivation are highly prevalent conditions in old age, particularly among multimorbid elders, and are often attributed to the use of multiple medications. These conditions negatively affect oral functions, such as chewing, swallowing, speech, and taste. Additionally, the lack of lubrication of the oral mucosa frequently leads to super-infections with candida. Denture retention and comfort may also be compromised. The risk of dental caries and erosion of natural teeth increases since saliva, which is essential for repairing initial lesions in tooth structures, is insufficient. The dry sensation in the mouth also impacts the emotional and social well-being of elderly individuals. Patients experiencing xerostomia often avoid certain foods that are uncomfortable or difficult to consume. However, some foods may alleviate the symptoms or even stimulate salivation. This review discusses the limited available evidence on nutritional advice for patients with xerostomia and aims to provide insight into the patient's perspective while offering clinical recommendations. Future studies should focus on investigating the nutritional intake of individuals suffering from xerostomia or hyposalivation in order to ensure oral health comfort, prevent malnutrition, and minimize the impact on their quality of life.

From Drugs to Dry Mouth: A Systematic Review Exploring Oral and Psychological Health Conditions Associated with Dry Mouth in Older Adults with Polypharmacy

BACKGROUND

Approximately 60% of older adults complain of dry mouth, which may be associated with polypharmacy, common in this population. Existing studies have reported treatment approaches to dry mouth but do not address long-term preventative measures that would more positively benefit the health and well-being of older adults.

OBJECTIVE

We aimed to explore the consequences of dry mouth, associated with polypharmacy, on the physical and psychological health of older adults in order to establish the importance of preventing dry mouth.

METHODS

This systematic review was conducted of studies reporting health conditions of dry mouth, in relation to polypharmacy in older adults (aged ≥ 65 years). MEDLINE, EMBASE, PsycINFO and CINAHL databases were searched using keywords such as 'polypharmacy', 'dry mouth', 'oral health' and 'quality of life' (PROSPERO: CRD42021288945). Joanna Briggs Institute critical appraisal tools were used to assess study quality.

RESULTS

Of the 6852 citations screened, nine studies (cross-sectional, n = 8; longitudinal, n = 1) were included that comprised 37,459 participants (mean age range 68.5-85.0 years). Studies were published between 2005 and 2019. Because of the heterogeneity of reported study outcomes, a narrative synthesis was undertaken. The health conditions identified in this review were categorised as 'physical' or 'psychological'. The main physical health conditions reported in the studies related to dental health, such as tooth loss, and functional impairments, such as swallowing difficulties. An increase in the number of medicines taken, from 0 to 5, decreased the number of natural teeth remaining from 16 (standard deviation [SD] ± 9) to 12 (SD ± 8), respectively. Additionally, the number of dental complications increased from 1 (SD ± 2) to 2 (SD ± 2) as the number of medicines increased from 1 to ≥ 3. There was a paucity of studies (n = 2) that investigated psychological health conditions of dry mouth among older adults, with depression identified as a significant issue among older adults with dry mouth (where the reported prevalence was as high as 64%). An additional six psychological health conditions were identified: self-consciousness, feeling tense, difficulty relaxing, irritability, difficulty completing tasks and feeling less satisfied in life.

CONCLUSIONS

High levels of physical health conditions of dry mouth are observed in older adults and, to a lesser extent, psychological health conditions. These conditions can negatively affect quality of life. There remains a need to prevent dry mouth and the adverse health conditions associated with it in older adults. The modifiable nature of polypharmacy could be targeted to minimise, and potentially prevent, dry mouth. The optimisation of medication regimes to effectively treat chronic conditions, but also limit the likelihood of dry mouth, is a practical approach. Dry mouth prevention should be a priority and polypharmacy can pave the way for prevention strategies, avoiding the need to treat dry mouth.

Detection of xerostomia, Sicca, and Sjogren's syndromes in a national sample of adults

Objectives

To assess the prevalence and determinants of xerostomia among adults and identify how many of the ones experiencing xerostomia have Sicca and Sjogren's syndromes.

Materials and methods

This cross-sectional study included 1405 35–74-year-old Lithuanians (51.7% response rate) from the five largest Lithuanian cities and 10 peri-urban and rural areas that were randomly selected from each of the 10 Lithuanian counties. Xerostomia was determined by the self-reported experience of dry mouth as "often" or "always". A dentist diagnosed Sicca syndrome by unstimulated whole sialometry and the Schirmer's test, and all cases were referred to a rheumatologist to confirm Sjogren's syndrome. Self-reported questionnaires collected data about the determinants.

Results

The prevalence of xerostomia was 8.0% (n = 112), Sicca syndrome was diagnosed for 8 participants (0.60%), and Sjogren's syndrome for 2 participants (0.14%), with this being the first time it was diagnosed. Experiencing xerostomia was associated with older age (OR 1.7, 95% CI 1.1–2.6), urban residence (OR 3.3, 95% CI 1.6–5.0), presence of systemic diseases (OR 2.5, 95% CI 1.4–3.3), and the use of alcohol (OR 0.6, 95% CI 0.4–0.9). The higher proportion of participants with Sicca syndrome involved females, of older age, having systemic diseases, and using medications.

Conclusions

The prevalence of xerostomia was 8.0% and the determinants of xerostomia were older age, urban residence, systemic diseases, and absence of using alcohol. In total, 0.6% of participants had Sicca syndrome, which was more prevalent among females, older subjects, those with systematic diseases, and those using medications. Sjogren's syndrome was diagnosed in 0.14% of participants.

Clinical relevance

Dental clinicians need to be trained to identify potential Sjogren's syndrome cases.

The effect of demographic characteristics on the relationship between smoking and dry mouth in Iran: a cross-sectional, case-control study

OBJECTIVES

The effect of age, sex, and other demographic factors on the relationship between smoking and dry mouth remains unknown. The aim of this study was to investigate the effects of demographic characteristics on the relationship between dry mouth, also known as xerostomia, and smoking.

METHODS

This case-control study included 5,640 randomly-selected subjects from the second phase of the Kerman Coronary Artery Disease Risk Factors Study, which observed 10,000 participants from 2014 to 2018. A checklist was used to record the participants’ demographic characteristics and smoking frequency. Each participant completed a six-item Fox questionnaire to measure dry mouth as a dependent variable. The interaction terms of daily cigarette smoking with sex, age, educational level, and marital status were entered into the model. Non-significant terms were removed using hierarchical model selection.

RESULTS

Of the sample, 3,429 (60.8%) did not have dry mouth and were analyzed as controls, whereas 2,211 (39.2%) had xerostomia and were deemed to be cases. Smokers were more likely to have dry mouth in all ages and both sexes (p<0.001). As male became older, the chance of having dry mouth increased more rapidly than among female smokers (p<0.001). In addition, female smokers were more likely to have dry mouth than male smokers (p<0.001).

CONCLUSIONS

The likelihood of dry mouth among daily smokers depended on age and sex. Female smokers were more likely to have dry mouth, and its likelihood increased with age in daily smokers of both sexes, though more rapidly in males.

Relationship between Subjective Oral Discomfort and Health-Related Quality of Life in the South Korean Elderly Population

This study examined the relationship between oral discomfort and health-related quality of life (HRQOL) in the Korean elderly, using the datasets provided by the Korea National Health and Nutrition Examination Survey (KHNANES) over 6 consecutive years (2010-2015). A total of 13,618 participants aged 65 years and over were included in the final analysis. A complex sample logistic regression was performed to determine the impact of oral discomfort on HRQOL. The results revealed that toothache, masticatory discomfort, and pronunciation problems caused by oral health conditions were all risk factors for decreased HRQOL. In particular, masticatory discomfort (adjusted odds ratio (AOR) 1.63, Model III (adjusted for all covariates)) and pronunciation problems (AOR 1.64, Model III) negatively impacted the HRQOL of the elderly to a great extent. Masticatory discomfort had a stronger negative impact on HRQOL in the domains of "self-care" (AOR 1.83) and "usual activities" (AOR 1.66), while pronunciation problems had a similar impact on all five domains of the EuroQol 5-Dimension (EQ-5D). These findings could serve as baseline data for setting up early intervention programs for the timely prevention of oral health-related discomfort problems that greatly affect the QOL of the elderly population, and for the development of comprehensive and efficient dental insurance policies.

Nutritional challenges in older adults during the COVID-19 pandemic

ABSTRACT It has been documented that the older adults of the population are at the greatest risk of mortality due to the coronavirus disease; consequently, they could be the population most affected by the measures of social isolation and reduction of virus contagion implemented worldwide. Social isolation can expose older adults to an increased nutritional risk due to factors such as socioeconomic insecurity, which could affect food acquisition and the need for support in daily tasks and meals. The institutionalized older adults often depend on food donations, which may have reduced due the economic crisis caused by the pandemic, and the aging process itself causes changes in nutritional necessitie and eating habits. In the coronavirus pandemic, nutritionists and dietitians can offer remote nutritional follow-up. Moreover, the government actions, such as the implementation of educational and social service programs, should be applied to support healthy aging and minimize exposure to nutritional risks and coronavirus disease.