Xerostomia, xerogenic medications and food avoidances in selected geriatric groups

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.

Recent advances in dosage form design for the elderly: a review

INTRODUCTION

With the increase in the elderly population and the prevalence of multiple medical conditions, medication adherence, and efficacy have become crucial for the effective management of their health. The aging population faces unique challenges that need to be addressed through advancements in drug delivery systems and formulation technologies.

AREAS COVERED

The current review highlights the recent advances in dosage form design for older individuals, with consideration of their specific physiological and cognitive changes. Various dosage forms, such as modified-release tablets/capsules, chewable tablets, and transdermal patches, can be tailored to meet the specific needs of elderly patients. Advancements in drug delivery systems, such as nanotherapeutics, additive manufacturing (three-dimensional printing), and drug-food combinations, improve drug delivery and efficacy and overcome challenges, such as dysphagia and medication adherence.

EXPERT OPINION

Regulatory guidelines and considerations are crucial in ensuring the safe utilization of medications among older adults. Important factors to consider include geriatric-specific guidelines, safety considerations, labeling requirements, clinical trial considerations, and adherence and accessibility considerations.

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.

Xerostomia and Its Cellular Targets

Xerostomia, the subjective feeling of a dry mouth associated with dysfunction of the salivary glands, is mainly caused by radiation and chemotherapy, various systemic and autoimmune diseases, and drugs. As saliva plays numerous essential roles in oral and systemic health, xerostomia significantly reduces quality of life, but its prevalence is increasing. Salivation mainly depends on parasympathetic and sympathetic nerves, and the salivary glands responsible for this secretion move fluid unidirectionally through structural features such as the polarity of acinar cells. Saliva secretion is initiated by the binding of released neurotransmitters from nerves to specific G-protein-coupled receptors (GPCRs) on acinar cells. This signal induces two intracellular calcium (Ca2+) pathways (Ca2+ release from the endoplasmic reticulum and Ca2+ influx across the plasma membrane), and this increased intracellular Ca2+ concentration ([Ca2+]i) causes the translocation of the water channel aquaporin 5 (AQP5) to the apical membrane. Consequently, the GPCR-mediated increased [Ca2+]i in acinar cells promotes saliva secretion, and this saliva moves into the oral cavity through the ducts. In this review, we seek to elucidate the potential of GPCRs, the inositol 1,4,5-trisphosphate receptor (IP3R), store-operated Ca2+ entry (SOCE), and AQP5, which are essential for salivation, as cellular targets in the etiology of xerostomia.

Using the modified Schirmer test for dry mouth assessment: A cross-sectional study

This study aimed to establish whether the modified Schirmer test could serve as a diagnostic tool for dry mouth, that is, whether it could reliably measure salivary film at selected locations within the oral cavity, and to identify levels of sensitivity/specificity and determine reference values. Therefore, a cross-sectional study (N = 120, mean age 63.5 [SD 13.9] years) was performed. The test was used at five locations (hard palate; buccal mucosa in molar region at 4 mm above occlusal plane; anterior tongue; lower lip; mouth floor), and results were recorded after 1, 2 and 3 min. A statistically significant discriminatory ability of the Schirmer test for the unstimulated salivary flow rates could be shown for the palate (at 3 min), buccal mucosa (at 1 min), mouth floor (at 1 min), and tongue (at 2 and 3 min) (areas under the curve 0.64-0.68), with individual sensitivity/specificity values depending on test location/time points. Thus, the modified Schirmer test has potential to become a simple and reproducible instrument for the detection of dry mouth based on low unstimulated salivary flow rates in dentistry and especially outreach care. Care must be taken concerning intraoral test location and measurement time.

Turkish translation and validation of the Xerostomia Inventory

Objectives

The Xerostomia Inventory (XI) was developed to assess the severity of dryness in patients with xerostomia. It has a long and a short form with three- and five-point Guttman-type response options. In this study, we aimed to translate the XI into Turkish, to assess the validity and reliability of both response options in patients with head & neck cancer (HNC) or Sjögren syndrome (SS), and to select the optimal version for Turkish patients.

Patients and methods

Between January 2019 and June 2019, the XI was translated into Turkish (XI-T) and applied to patients aged ≥18 years with HNC and SS. All patients were applied two tests including both the three- and five-point options. The internal consistency was assessed by Cronbach alpha and test-retest reliability by intraclass correlation coefficients (ICCs). Content validity was based on expert opinion and patient reviews.

Results

A total of 186 patients (109 males, 77 females; median age: 54 years; range, 19 to 78 years) answered the XI-T. The number of patients with HNC and SS was 143 (77%) and 43 (23%), respectively. Median XI-T score was 17 for the three-point, and 24 for the five-point option, respectively. Overall internal consistency was satisfactory for both options (α=0.81 and α=0.89, respectively). Overall test-retest reliability was satisfactory and ICCs ranged between 0.71 and 0.92 for the three-point, and 0.36 and 0.94 for the five-point option, respectively. Assessments based on expert opinions and patient reviews also favored the content validity of the scale.

Conclusion

The XI-T with both three- and five-point options is a valid and reliable tool to evaluate the presence and severity of dryness in patients with HNC and SS who experience xerostomia. The three-point option is more comprehensible and can be preferred over the five-point option in the Turkish population.

A Review on Xerostomia and Its Various Management Strategies: The Role of Advanced Polymeric Materials in the Treatment Approaches

The medical term xerostomia refers to the subjective sensation of oral dryness. The etiology seems to be multifactorial with the most frequently reported causes being the use of xerostomic medications, neck and head radiation, and systematic diseases (such as Sjögren’s syndrome). Xerostomia is associated with an increased incidence of dental caries, oral fungal infections, and difficulties in speaking and chewing/swallowing, which ultimately affect the oral health-related quality of life. The development of successful management schemes is regarded as a highly challenging project due to the complexity of saliva. This is why, in spite of the fact that there are therapeutic options aiming to improve salivary function, most management approaches are alleviation-oriented. In any case, polymers are an integral part of the various formulations used in every current treatment approach, especially in the saliva substitutes, due to their function as thickening and lubricating agents or, in the case of mucoadhesive polymers, their ability to prolong the treatment effect. In this context, the present review aims to scrutinize the literature and presents an overview of the role of various polymers (or copolymers) on either already commercially available formulations or novel drug delivery systems currently under research and development.

Effects of food particle loss on the evaluation of masticatory ability using image analysis

PURPOSE

To examine how particle loss affects the evaluation of masticatory ability using the image analysis method.

METHODS

The subjects were divided into two groups:Y-group (healthy young adults: 10 male, 10 female; mean age 27.6 ± 1.9 years), and D-group (denture wearing older adults: 13 male, 9 female; mean age, 75.1 ± 5.3 years). Raw carrots, peanuts, and a combined test food from 5 daily food materials (mixed foods) were selected as test foods. Images of the boluses were captured and processed after the subjects freely masticated the test foods until the point of swallowing or completed half strokes of total chewing cycles. The median particle size (X₅₀) was calculated from the data for each particle. We compared X₅₀ calculated from all particles obtained from the masticatory bolus (as X_50N) with the X₅₀ of only selectively larger particles (as X_50R).

RESULTS

Significant correlations were observed between X_50N and X_50R (p < 0.01) determined in almost all masticatory conditions. In particular, for particle sizes of 2 mm or more, the correlation coefficient between X_50N and X_50R was notably strong (r > 0.75).

CONCLUSION

The method of analyzing only larger particles makes it possible to evaluate masticatory ability without losing the characteristics of the original particle size distribution of the entire bolus. This finding can be applied for the evaluation of masticatory ability, especially among older adults who have difficulty retrieving the total amount of test food due to decreased activities of daily living.

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.

Anticholinergic medication: Related dry mouth and effects on the salivary glands

OBJECTIVE

Salivary glands are among the most sensitive target organs of medications with anticholinergic (AC) properties, interrupting the neural stimulation of saliva secretion and reducing saliva flow. Hyposalivation results in dry mouth, leading to dental caries, intraoral infection, orofacial pain, problems with speaking and swallowing, and diminished oral health--related quality of life. Current understanding of the pharmacokinetics of AC medications and their effect on muscarinic receptors in the salivary glands were reviewed to assist clinicians in predicting salivary damage in patients with AC medication-induced dry mouth.

STUDY DESIGN

We summarized the literature related to the mechanisms and properties of AC medications, anticholinergic adverse effects, and their effect on salivary function and management strategies to prevent oral health damage.

RESULTS

Although a large number of studies reported on the frequencies of medication-induced dry mouth, we found very limited data on predicting individual susceptibility to AC medication--caused hyposalivation and no prospective clinical studies addressing this issue.

CONCLUSION

Dry mouth is most frequently caused by medications with AC properties, which interrupt the neural stimulation of saliva secretion. Interdisciplinary care should guide pharmacotherapeutics and dental interventions should aim in preventing AC salivary adverse effects and reducing the oral health burden from AC medication-induced dry mouth.

Oral health-related quality of life and associated factors in patients with xerostomia

OBJECTIVE

This study aimed to investigate clinical and demographic factors associated with oral health-related quality of life (OHRQoL) in patients with xerostomia.

METHODS

Forty-one patients (55.2 ± 13.8 years) with xerostomia as a chief complaint participated in the study. Comprehensive information about clinical and demographic characteristics of the patients with xerostomia, xerostomia-related symptoms and behaviours, and xerostomia-associated complaints was investigated using a xerostomia questionnaire. Flow rates of unstimulated and stimulated whole saliva were measured. The Oral Health Impact Profile-14 (OHIP-14) score was used to assess the OHRQoL of patients. The relationships between various factors and the OHIP-14 score were assessed by simple and multiple linear regression analyses.

RESULTS

The OHIP-14 score of patients with xerostomia was high (44.3 ± 13.2). Characteristics of the patients with xerostomia associated with high OHIP-14 score were the intensity of xerostomia-related symptoms, frequency of xerostomia-related behaviours and the presence of speaking difficulty. Results from multiple linear regressions found that self-reported amount of saliva in usual, everyday life (β = 0.622, p = 0.012) and the presence of a speaking difficulty (β = 0.348, p = 0.014) had significant adversely affected the OHRQoL in patients with xerostomia.

CONCLUSIONS

Subjective perceptions of the amount of saliva in the mouth and the experience of speaking difficulty affected the OHRQoL in patients with xerostomia.

Taste Sensitivity of Elderly People Is Associated with Quality of Life and Inadequate Dietary Intake

Aging has been implicated in the alteration of taste acuity. Diet can affect taste sensitivity. We aimed to investigate the types of tastes altered in elderly Korean people and factors associated with taste alteration in relation to dietary intake and other factors. Elderly participants (≥65 years) and young adults were assessed to determine their recognition thresholds (RT) for sweet, salty, bitter, sour, and umami tastes. Elderly participants were further surveyed for dietary intake and non-nutritional factors. Five taste RTs were correlated with age, but only four taste RTs, except sweetness, differed between the elderly participants and young adults. Inadequate intake of iron, thiamin, folic acid, zinc, and phosphorus among the elderly participants was related to elevated taste RT levels, except for bitter taste. In both correlation and regression analyses, only salty and sour RTs were associated with energy, iron, thiamin, fiber, vitamin C, and riboflavin levels in the elderly participants. The elderly participants’ taste RTs exhibited strong associations with quality of life (QOL) but showed partial relationships with physical activity, number of medicine intakes, social gatherings, and education. Taste sensitivity may decrease with age, which is further influenced by insufficient dietary intake, especially iron and thiamin, and QOL.

The use of BokaFlo™ instrument to measure salivary flow

BACKGROUND

Dry mouth currently affects roughly 20% of the population and is a condition characterized by chronic hyposalivation and/or subjective reports of xerostomia. Low saliva flow can be indicative of other undiagnosed diseases, such as primary Sjogren's syndrome, and may contribute to difficulty chewing, increased caries susceptibility and infection. The passive drool test (PDT) is the primary method used to evaluate patients for hyposalivation but it is time-consuming and inconvenient. New methodology is needed to facilitate increased testing for hyposalivation in the dental clinic. The aim of this study was to evaluate an alternative method to measure salivary flow in dental offices.

METHODS

In this study, we tested a new biomedical device, the BokaFlo™, to measure salivary flow in subjects in comparison to the current PDT standard. Participants completed an oral health questionnaire and saliva flow was evaluated by the PDT and the BokaFlo™ system.

RESULTS

Saliva flow as measured by the BokaFlo™ positively correlated with the saliva flow measured by the PDT methodology (r = 0.22, p < 0.05). The device predicted low saliva flow in subjects with a sensitivity of 0.76 and specificity of 0.84 for subjects with hyposalivation, defined as a saliva flow rate of ≤ 0.1 ml/min. A significant negative correlation between the total oral health questionnaire score and the likelihood of participant exhibiting low salivary flow was observed (r = - 0.31, p < 0.006).

CONCLUSION

The BokaFlo™ was effectively able to measure low saliva flow correlating with the PDT methodology and may provide more efficient testing of saliva flow in the dental office.

Assessment of Salivary Flow Rate in Patients with Chronic Periodontitis

Background:

Chronic periodontitis (CP) is an infectious disease, primarily affecting the attachment apparatus of the dentition, and is categorized into mild, moderate, and severe periodontitis on the basis of its severity. It is a well-established and proven fact that an adequate level of saliva is essential for maintaining the integrity of oral tissues including the periodontium. Although various factors, such as stimulation, circadian rhythm, diet, age, and drugs, can affect the salivary flow rate, many recent studies have provided evidence that it can be altered by pathological inflammatory conditions such as periodontal diseases. Therefore, this study has been undertaken to assess the unstimulated and stimulated salivary flow rate in the different clinical stages of chronic periodontitis.

Materials and Methods:

This study comprised 60 study participants, who were divided into four groups depending on clinical attachment level (CAL). In all, both unstimulated and stimulated saliva were collected, and the flow rate was expressed in milliliter per minute.

Results:

Statistical analysis was accomplished with Statistical Package for the Social Sciences (SPSS) software. One-way analysis of variance (ANOVA) was used to analyze differences in salivary flow rate among the groups. Statistical significance was set at P < 0.05. The amount of unstimulated saliva in healthy subjects, in mild, moderate, and severe periodontitis was 0.766, 0.400, 0.270, and 0.146 mL/min, respectively. Likewise, the amount of stimulated saliva in healthy subjects, in mild, moderate, and severe periodontitis was 1.017, 0.494, 0.347, and 0.236 mL/min, respectively.

Conclusion:

The study identified a significant decrease in both unstimulated and stimulated salivary flow rate with the severity of progression of chronic periodontitis.

Oral health status of children with mouth breathing due to adenotonsillar hypertrophy

OBJECTIVES

Mouth breathing is an important health problem, commonly encountered in children. In children, adeno-tonsillar hypertrophy is the main reason causing partial or complete upper airway obstruction and reduction in airflow. This study aimed to determine the oral health status of children aged 3-15 years, with mouth breathing who were due to have surgery for adeno-tonsillar hypertrophy and referred to the Department of Otorhinolaryngology at Children's Hospital of a University in Ankara, Turkey between January-July 2015.

METHODS

The approval of the Non-Interventional Clinical Researches Ethics Board of Hacettepe University and written informed consents from the parents were obtained. The parents completed a questionnaire before the surgery. The children were examined using dental mirror and explorer under dental unit lighting. Oral health status was evaluated with DMFT/S, dmft/s, ICDAS II, dental plaque and gingival indices. The chi-square test, Kruskal Wallis and Mann Whitney U tests were used to statistically analyse the results, with statistical significance p<0.05.

RESULTS

Of the 170 children who had adenotonsillar hypertrophy with mouth breathing, 150 the parents agreed to participate the study. 77 of the children (51.3%) were male; the mean age was 5.9 ± 2.6. Mean dmft was 3.8 ± 3.6, dmfs 9.7 ± 1.1, DMFT 0.4 ± 1.0 and DMFS 0.6 ± 1.5 respectively. Among the children, 101 (67.3%) had cavitated dental caries, and according to ICDAS II, none had healthy teeth, 15 (10.0%) had initial, 42 (28.0%) had moderate and 93 (62.0%) had advanced caries. Of the children, 89.3% had gingivitis and the proportion of gingivitis in posterior region was found to be significantly higher than anterior region (p < 0,001).

CONCLUSIONS

The oral health status of mouth breathing in children with adeno-tonsillar hypertrophy was poor. To reduce the risk of dental caries and periodontal disease among these children, regular dental follow-up and preventive programmes for oral health are needed.

Salivary secretion in health and disease

Saliva is a complex fluid produced by 3 pairs of major salivary glands and by hundreds of minor salivary glands. It comprises a large variety of constituents and physicochemical properties, which are important for the maintenance of oral health. Saliva not only protects the teeth and the oropharyngeal mucosa, it also facilitates articulation of speech, and is imperative for mastication and swallowing. Furthermore, saliva plays an important role in maintaining a balanced microbiota. Thus, the multiple functions provided by saliva are essential for proper protection and functioning of the body as a whole and for the general health. A large number of diseases and medications can affect salivary secretion through different mechanisms, leading to salivary gland dysfunction and associated oral problems, including xerostomia, dental caries and fungal infections. The first part of this review article provides an updated insight into our understanding of salivary gland structure, the neural regulation of salivary gland secretion, the mechanisms underlying the formation of saliva, the various functions of saliva and factors that influence salivary secretion under normal physiological conditions. The second part focuses on how various diseases and medical treatment including commonly prescribed medications and cancer therapies can affect salivary gland structure and function. We also provide a brief insight into how to diagnose salivary gland dysfunction.

Salivary functions in mastication, taste and textural perception, swallowing and initial digestion

Saliva exerts multiple functions in relation to the initial digestive processes taking place in the upper parts of the gastrointestinal tract. Ingestion of food and beverages, in turn, is a strong stimulus for secretion of saliva with a differential composition depending on the neuronal stimulation pattern. This review paper provides insight into the mechanisms by which saliva acts in relation to taste, mastication, bolus formation, enzymatic digestion and swallowing. Also, the protective functions of saliva including maintenance of dental and mucosal integrity will be discussed as they indirectly influence the digestive process. The final part of this study focuses on the implications of xerostomia and salivary gland dysfunction on gastrointestinal functions.

Does reduced mastication influence cognitive and systemic health during aging?

There is a growing body of literature which suggests that oral health and mastication can influence cognitive and systemic health during aging. However, it is currently unclear whether oral health, masticatory efficiency, cognitive health and systemic health merely deteriorate independently with age, or whether mechanisms exist linking mastication to cognitive and systemic health directly. The aim of this paper is to review the extent to which reduced mastication influences cognitive and systemic health during aging because this knowledge may underpin future interventions that improve quality of life. Current evidence suggests that a deterioration in mastication and oral health during aging can have: 1) direct effects on systemic health through mechanisms such as the migration of the oral microbiota into the systemic environment, and 2) indirect effects on systemic health through changes nutrient intake. A loss of teeth and reduction in masticatory efficiency during aging can have: 1) direct effects on cognitive performance and potentially impact cognitive health through mechanisms such as enhanced adult hippocampal neurogenesis, and 2) indirect effects on cognitive health through changes in nutrient intake. It is concluded that oral health and masticatory efficiency are modifiable factors which influence the risk poor cognitive and systemic health during aging, although it is currently premature to propose chewing-based interventions to slow the rate of cognitive decline and improve cognitive health during aging. Future research should include large-scale longitudinal studies which control for the types of confounding factors which concurrently influence the association between mastication and cognitive and systemic health.

Hyposalivation and 10-year all-cause mortality in an elderly Japanese population

OBJECTIVE

To evaluate the association of salivary flow rate with all-cause mortality among older Japanese adults. We hypothesised that hyposalivation would be a marker for mortality.

BACKGROUND

Hyposalivation, which is an objectively measurable decrease in salivary flow, is highly prevalent among older adults. It is associated with malnutrition and poor general health.

METHODS

The study population comprised 600 community-dwelling Japanese adults (306 men and 294 women), who were 70 years old at baseline. They underwent stimulated salivary flow rate (SSFR) measurements and were followed up during a 10-year study period. After stratification by sex, the hazard ratios of all-cause mortality were estimated using Cox proportional hazards regression analysis comparing groups with and without hyposalivation (ie, SSFR < 0.7 mL/min).

RESULTS

The baseline prevalence of hyposalivation was 27.8% (85/306) among men and 47.3% (139/294) among women. During a mean (standard deviation) follow-up period of 104 (27) months, 80 deaths occurred: 60 (75.0%) deaths among men and 20 (25.0%) deaths among women. After adjusting for the number of remaining teeth, smoking status, exercise, hypoalbuminemia, diabetes and cardiovascular disease, hyposalivation at baseline was significantly associated with all-cause mortality among men (adjusted hazard ratio, 1.71; 95% confidence interval, 1.01-2.89). In contrast, no association between SSFR and all-cause mortality existed among women.

CONCLUSION

Hyposalivation could be a marker for all-cause mortality among older community-dwelling Japanese men. Future studies investigating the association between SSFR and cause-specific mortality are warranted.

A Pilot Study of Perceived Mouth Dryness, Perceived Swallowing Effort, and Saliva Substitute Effects in Healthy Adults Across the Age Range

Xerostomia, or perceived mouth dryness, increases with advancing age, but its influence on swallowing effort is unknown. This study: (1) quantified relationships among age, perceived sense of swallowing effort, and ratings of perceived mouth dryness, and (2) examined changes in swallowing effort following application of a gel-based saliva substitute in healthy participants. This was a cross-sectional observational study and data were collected from attendees of a community healthy aging fair. Forty-two healthy participants (mean age = 65 years; 20 female) were enrolled. Each participant rated perceived effort with swallowing and perceived mouth dryness on a 10-cm horizontal, undifferentiated line. After participants applied a gel-based saliva substitute (Biotene^® Oral Balance) to their tongue and oral mucosa, they rated perceived effort with swallowing again. Age was associated with greater perceived mouth dryness (r = 0.37, p < 0.03) but not with perceived swallowing effort (r = 0.16, p = 0.32). Perceived mouth dryness was associated with greater perceived swallowing effort (r = 0.62, p < 0.001). Perceived swallowing effort declined following application of the salivary substitute (mean difference = 9.39 mm, p < 0.002). Age was found to be a significant predictor of perceived mouth dryness (p < .02); and perceived mouth dryness was found to significantly predict perceived swallow effort (p < .001). Perceived mouth dryness increased with advancing age, but perceived swallowing effort did not. Regardless of age, participants with higher levels of perceived mouth dryness also reported more perceived effort with swallowing suggesting a role for adequate oral lubrication in this perception. Even in healthy participants, use of a gel-based saliva substitute lowered perceived swallowing effort.

TFOS DEWS II iatrogenic report

Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.

Salivary changes in oral mucosal diseases

Saliva is a unique biological fluid that can be easily collected and analyzed with low cost and low morbidity. Therefore, there is a growing attention for using salivary biomarkers in the diagnosis and monitoring of disease progress and response to treatment. Salivary changes have been described in relation to oral mucosal diseases. This article discusses the causes and consequences of salivary hypofunction and presents a review of the literature related to changes in salivary parameters in various oral mucosal diseases and in systemic diseases with possible oral mucosal involvement.

Adverse Drug Reactions in the Orofacial Region

A wide spectrum of drugs can sometimes give rise to numerous adverse orofacial manifestations, particularly dry mouth, taste disturbances, oral mucosal ulceration, and/or gingival swelling. There are few relevant randomized double-blind controlled studies in this field, and therefore this paper reviews the data from case reports, small series, and non-peer-reviewed reports of adverse drug reactions affecting the orofacial region (available from a MEDLINE search to April, 2003). The more common and significant adverse orofacial consequences of drug therapy are discussed.

Gastrointestinal Dysmotility in the Elderly

The number of persons 60 years and older has increased 3-fold between 1950 and 2000. Aging alone does not greatly impact the gastrointestinal (GI) tract. Digestive dysfunction, including esophageal reflux, achalasia, dysphagia, dyspepsia, delayed gastric emptying, constipation, fecal incontinence, and fecal impaction, is a result of the highly prevalent comorbid conditions and the medications with which those conditions are treated. A multidisciplinary approach with the expertise of a geriatrician, gastroenterologist, neurologist, speech pathologist, and physical therapist ensures a comprehensive functional and neurological assessment of the older patient. Radiographic and endoscopic evaluation may be warranted in the evaluation of the symptomatic older patient with consideration given to the risks and benefits of the test being used. Treatment of the digestive dysfunction is aimed at improving health-related quality of life if cure cannot be achieved. Promotion of healthy aging, treatment of comorbid conditions, and avoidance of polypharmacy may prevent some of these digestive disorders. The age-related changes in GI motility, clinical presentation of GI dysmotility, and therapeutic principles in the symptomatic older patient are reviewed here.

Evaluation of Xerostomia in Different Psychological Disorders: An Observational Study

INTRODUCTION

Psychiatric diseases like anxiety, depression, schizophrenia and bipolar disorders are increasing at an alarming rate. These diseases can affect the quantity and quality of saliva leading to multiple oral diseases. Although many researchers have evaluated xerostomia in general population, its prevalence is not been assessed in patients suffering from different psychological disorders.

AIM

To investigate the prevalence of xerostomia and to assess the correlation between xerostomia and dryness of lip and mucosa in different psychological disorders.

MATERIALS AND METHODS

A cross-sectional observational study was conducted over a period of six months in Department of Psychiatry and Department of Oral Medicine. Patients with anxiety, depression, schizophrenia and bipolar disorder, as diagnosed by an experienced psychiatrist, were given a questionnaire to evaluate the xerostomia. Patients with symptoms of xerostomia were subjected to oral examination by a skilled oral diagnostician to check for dryness of lips and mucosa. One hundred patients from each group of psychiatric diseases were included in the study using a consecutive sampling technique. An equal number of healthy individuals reporting to oral medicine department for routine oral screening were included as control group after initial psychiatric evaluation.

RESULTS

In this study statistically significant increase in the xerostomia in psychiatric patients was recorded when compared to the control group (p<0.01). Xerostomia was significantly higher in anxiety patients (51%) followed by depression (47%), bipolar disorder (41%), schizophrenia (39%) and control group (27%). The majority of the psychiatric patients had 'moderate' to 'severe' xerostomia whereas the control group had 'mild' xerostomia. Xerostomia was significantly higher in younger age group (18-49 years) than in older age group and females patients had higher xerostomia than male patients. Psychiatric patients had significantly more dryness of lip and mucosa than healthy controls. A moderate to strong spearman correlation (r=0.72) was observed between xerostomia and psychological alterations.

CONCLUSION

A positive association was established between psychological alterations and xerostomia and dryness of lip and mucosa. Emotional alterations may act as a precipitating factor that could influence the salivary secretion resulting in multiple oral diseases. Psychiatrists can screen for xerostomia and collaborate with dentists for comprehensive management of xerostomia in psychiatric patients.

Xerostomia among older home care clients

OBJECTIVES

The purpose of this study was to examine drug use and other factors associated with xerostomia in home care clients aged 75 years or older.

METHODS

The study sample included 270 home care clients aged ≥75 years living in Eastern and Central Finland. The home care clients underwent in-home interviews carried out by trained home care nurses, nutritionists, dental hygienists and pharmacists. The collected data contained information on sociodemographic factors, health and oral health status, drug use, depressive symptoms (GDS-15), cognitive functioning (MMSE), functional ability (Barthel Index, IADL) and nutrition (MNA). The primary outcome was xerostomia status (never, occasionally or continuously).

RESULTS

Among the home care clients, 56% (n = 150) suffered from xerostomia. Persons with continuous xerostomia used more drugs and had more depressive symptoms and a higher number of comorbidities than other home care clients. In multivariate analyses, excessive polypharmacy (OR = 1.83, 95% Cl 1.08-3.10) and depressive symptoms (OR = 1.12, 95% Cl 1.03-1.22) were associated with xerostomia.

CONCLUSIONS

Xerostomia is a common problem among old home care clients. Excessive polypharmacy, use of particular drug groups and depressive symptoms were associated with xerostomia. The findings support the importance of a multidisciplinary approach in the care of older home care clients.

Endodontics and the ageing patient

Patients are living longer and the rate of edentulism is decreasing. Endodontic treatment is an essential part of maintaining the health and well-being of the elderly. Retention of natural teeth improves the quality of life and the overall health and longevity of ageing patients. Also, teeth that might be otherwise extracted may be strategically valuable to retain a prosthesis, and elderly patients are more likely to have medical complications that may prevent dental extractions from being safely performed. The technical goals of endodontic treatment in the elderly are the same as those for younger patients. However, the pulpo-dentinal complex undergoes calcific changes over time, which may pose challenges for the clinician. The purposes of this review are to discuss age changes in the pulp and the challenges posed by diagnosing, treatment planning and treating the elderly endodontic patient.

Prevalence of xerostomia in patients attending Shorish dental speciality in Sulaimani city

Objectives: The aim of this study was to investigate the prevalence of xerostomia among dental patients and explore the possible risk factors and symptoms associated with this condition. Patient and Methods: The prevalence of xerostomia and its associations were investigated among patients (n=1132) who were visiting the department of oral medicine at shorish dental speciality in sulaimani city. The age range was between 10-79 years. 512 (45.2%) of participants were males and 620 (54.8%) were females. The data collected were age, sex, systemic diseases, medications and habit of smoking. Logistic regression models to estimate odds ratios and 95% confidence intervals were used to investigate the association of xerostomia with age, systemic diseases and medications and Chi Square test was also used to analyze the data. Results: Prevalence of xerostomia was 16.07%. Prevalence of xerostomia was significantly higher among females (19.51%) than males (11.91%) (P=0.001). The most common diseases with the highest prevalence of xerostomia were psychological disorders (57.14%) followed by diabetes mellitus (53.84%), neurological disorders (40%), thyroid disorders (37.5%) and hypertension (36.48%). The most common medication with the highest prevalence of xerostomia was antihistamine (66.66%) followed by psychotherapeutic medications (60%), pain medications (55.88%), endocrinologic agents (51.21%), antidyslipidic agents (50%) and antihypertensive medication (38.98%). Xerostomia was significantly associated with ageing (OR: 1.02, P=0.000), systemic diseases (OR: 2.80, P=0.000) and medications (OR: 5.17, P=0.000). There was a high prevalence of reported symptoms of xerostomia and these symptoms were more prevalent among females, Prevalence of xerostomia was higher in heavy smoker patients (19.48%) than non smoker patients but not significantly (16.14%) (p= 0.44). Conclusions: There was a high prevalence of xerostomia among dental patients; xerostomia was significantly more prevalent among females and significantly associated with age, systemic diseases and medications; xerostomia adversely affects oral functions; dentist must be familial with sign and symptoms of xerostomia and can have an active role in the management of xerostomia and preventing or treating complications.

Key words:Ageing, medications, xerostomia, prevalence.

Sjögren's syndrome in older patients: aetiology, diagnosis and management

Sjögren's syndrome (SS) is a systemic autoimmune disease, characterized by chronic inflammation of exocrine glands that results in development of xerostomia and keratoconjunctivitis sicca. The disease activity of SS is not restricted to exocrine glands, and many other organs and organ systems can be involved. Diagnosis of SS in the elderly population can be challenging because xerostomia, dry eyes, symptoms of fatigue, weight loss and muscle pain are also common features of old age. Delay between clinical onset and diagnosis of SS in the elderly may be due to the shared features of SS and old age. The 2002 revised American-European Consensus Group (AECG) classification criteria for SS are the preferred tool used to confirm diagnosis of SS, but recently alternative criteria have been put forward by the American College of Rheumatology (ACR). The AECG criteria set combines subjective symptoms of dry eyes and dry mouth with objective signs of keratoconjunctivitis sicca, salivary gland dysfunction and histopathological (salivary gland biopsy) and serological (autoantibodies against SSA/Ro and SSB/La antigens) features. Treatment of SS in the elderly does not differ from that in younger patients. The aims of the treatment of SS are to control glandular and extraglandular manifestations, to prevent damage to organ systems and loss of function, and to decrease morbidity and mortality. Treatment of the elderly can be complicated by co-morbidities, an increased rate of adverse events related to therapeutic agents, and polypharmacy. Therefore, careful follow-up of the treatment is required.

Clinical evaluation of BIOXTRA in relieving signs and symptoms of dry mouth after head and neck radiotherapy of cancer patients at Seyed-al-Shohada Hospital, Isfahan, Iran

Background:

Radiotherapy of head and neck cancers causes acute and chronic xerostomia and acute mucositis. Xerostomia increases risk of radiation caries and affects on oral comfort, fit of prostheses, speech, swallowing, and the growth of caries-producing organisms. Salivary flow rate can be measured by asking patients some questions. There are different types of commercial synthetic saliva such as BIOXTRA, but until now, no one can effectively relieve xerostomia. We tried to design a clinical research on BIOXTRA efficacy for treating xerostomia.

Materials and Methods:

In this research, 58 patients with head and neck cancer (except salivary gland cancers) treated in Seyed-al-Shohada Hospital. The patients received at least 40-50 GY; and after 2 months of compilation treatment, they were evaluated by asking about having xerostomia. Before and after treatment with the BIOXTRA, the PH of the oral cavity, candida albicans, and lactobacillus counts measured and documented in laboratory. We used BIOXTRA for 2 weeks, 3 times daily, and then re-evaluated patients with some questions.

Results:

The counts of candida albicans and lactobacilli statistically significant decreased.

Conclusion:

Xerostomia for most patients improved clinically during the day and night while PH of the oral cavity increased.

Xerostomia in complete denture wearers: prevalence, clinical findings and impact on oral functions

OBJECTIVES

To investigate the prevalence of dry mouth in a select sample of edentulous Jordanian older population wearing complete dentures and to evaluate its impact on oral functions.

BACKGROUND

The prevalence and impact of Xerostomia as a cofactor in causing denture problems in Jordanians have not been previously investigated.

MATERIALS AND METHODS

This study included 455 participants (253 men and 202 women). Perception of dry mouth was measured by a pilot-tested questionnaire. Xerostomic status was confirmed clinically. Complete denture function was also assessed.

RESULTS

One hundred and thirty six subjects (29.9%) had reported a subjective feeling of dry mouth with a prevalence of 24.9% in men (n = 63) and 36.1% in women (n = 73) (p < 0.01). 136 of the 145 subjects with satisfactory dentures showed one or more signs suggestive of Xerostomia. The majority of xerostomic participants with different sets of complete dentures were dissatisfied with oral functions (p < 0.05). There was a significant association between dry mouth and increasing age, female gender and smoking status (p < 0.05).

CONCLUSION

Among complete denture wearers, Xerostomia is significantly more prevalent in women and associated with increased age and smoking. Xerostomia adversely affects oral functions and overall satisfaction with dentures.

The role of medications in causing dry eye

The purpose of this paper is to review the possible role of polypharmacy in causing dry eye disease (DED), reflecting the complex interactions and complications associated with the use of multiple systemic and topical ocular medications. The pharmacological, physiological, anatomical, and histological mechanisms causing dry mouth differ little from those causing dry eye. Oral polypharmacy is the most common cause of dry mouth, but has not been investigated as a cause of dry eye. Topical ocular polypharmacy has been shown to cause DED. Information on drugs that likely cause or aggravate DED and the controversial role of preservatives in topical ocular medications are examined. Systemic or topical ocular medications and preservatives used in topical ocular drugs may cause dry eye through the drug's therapeutic action, ocular surface effects, or preservatives, and the effects probably are additive. Long-term use of topical ocular medications, especially those containing preservatives such as BAK, may play an important role in DED and the role of polypharmacy needs further study. We review possible ways to decrease the risk of medication-related dry eye.

A systematic review of methods to diagnose oral dryness and salivary gland function

Background

The most advocated clinical method for diagnosing salivary dysfunction is to quantitate unstimulated and stimulated whole saliva (sialometry). Since there is an expected and wide variation in salivary flow rates among individuals, the assessment of dysfunction can be difficult. The aim of this systematic review is to evaluate the quality of the evidence for the efficacy of diagnostic methods used to identify oral dryness.

Methods

A literature search, with specific indexing terms and a hand search, was conducted for publications that described a method to diagnose oral dryness. The electronic databases of PubMed, Cochrane Library, and Web of Science were used as data sources. Four reviewers selected publications on the basis of predetermined inclusion and exclusion criteria. Data were extracted from the selected publications using a protocol. Original studies were interpreted with the aid of Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool.

Results

The database searches resulted in 224 titles and abstracts. Of these abstracts, 80 publications were judged to meet the inclusion criteria and read in full. A total of 18 original studies were judged relevant and interpreted for this review. In all studies, the results of the test method were compared to those of a reference method.

Based on the interpretation (with the aid of the QUADAS tool) it can be reported that the patient selection criteria were not clearly described and the test or reference methods were not described in sufficient detail for it to be reproduced. None of the included studies reported information on uninterpretable/intermediate results nor data on observer or instrument variation. Seven of the studies presented their results as a percentage of correct diagnoses.

Conclusions

The evidence for the efficacy of clinical methods to assess oral dryness is sparse and it can be stated that improved standards for the reporting of diagnostic accuracy are needed in order to assure the methodological quality of studies. There is need for effective diagnostic criteria and functional tests in order to detect those individuals with oral dryness who may require oral treatment, such as alleviation of discomfort and/or prevention of diseases.

Xerostomia and salivary hypofunction in vulnerable elders: prevalence and etiology

OBJECTIVE

The goal of this article is to review existing research on the prevalence and etiology of dry mouth in the vulnerable elders and identify knowledge gaps.

STUDY DESIGN

Vulnerable elders (VE) are persons aged >65 years who have any or all of the following: limited mobility, limited resources, or complex health status. A systematic search was conducted of PubMed sources from 1989 to May 2010. Evidence was evaluated on the prevalence and etiology of xerostomia and salivary gland hypofunction (SGH) in VE.

RESULTS

The search identified 1,422 publications. The inclusion/exclusion criteria yielded 348 articles, 80 of which are cited herein.

CONCLUSIONS

Research has showed a high prevalence of xerostomia and SGH in VE. Common etiologies include medications, poor general health, female gender, and age. Gaps still exist in the evaluation of dry mouth in VE. Nonetheless, oral dryness will remain an important health issue as life expectancy increases.

Risk factors and symptoms associated with xerostomia: a cross-sectional study

BACKGROUND

The aim of this study was to examine the symptoms and risk factors associated with self-reported xerostomia.

METHODS

Data were collected from 601 self-administered questionnaires among dental clinic attendees. Logistic regression models to estimate odds ratios and 95% confidence intervals were used to investigate the association for exposures of interest, such as socio-demographic characteristics, self-reported symptoms, oral hygiene habits and xerostomia.

RESULTS

Participants reported having dry mouth in 19.6% of cases. Xerostomia was associated with a significant increase in the odds of having dry lips, throat, eye, skin and nose. Patients with self-reported xerostomia were three times more likely to drink water to swallow food than were patients without xerstomia. Older individuals were significantly more likely to report dry mouth, and the prevalence of xerostomia increased with advancing age. The prevalence of xerostomia in patients taking one or more drugs was significantly higher compared to medication-free patients, and increased with increasing numbers of medications used. Finally, individuals with a nervous or mental disorder, or who wore removable dentures were five times more likely to develop xerostomia than patients without disorder or dentures.

CONCLUSIONS

Dentists should be familiar with the symptoms of xerostomia and be prepared to take an active role in the diagnosis, management and treatment of the oral complications.

Xerostomia and medication: a cross-sectional study in long-term geriatric wards

OBJECTIVE

The purpose of this study was to determine the prevalence of xerostomia in old people living in long-term geriatric wards, and to measure the relationship between xerostomia and etiologic factors such as age and medication (total number of medications, xerogenic medications, anticholinergic medications and medications that induce hypersialorrhea).

DESIGN

An observational retrospective, comparative, multicentre epidemiological study.

SETTING

Long-term geriatric wards, in Reims, France.

PARTICIPANTS

769 old people living in long-term geriatric wards.

MEASUREMENTS

Prevalence of xerostomia assessed from age, total number of medications, xerogenic medications, anticholinergic medications and those that induce hypersialorrhea. Multivariable logistic regression was used to calculate Odds Ratios (OR) and their 95% Confidence Intervals (95% CI).

RESULTS

Among 769 old people (average age 84.6±8.4 years old), 287 residents suffered from xerostomia (37.3%). Significant predictors of xerostomia were: resident's age OR=1.56, 95% CI (1.30-1.88), p<0.0001 and anticholinergic medications OR=1.35, 95% CI (1.05-1.73), p=0.02. The only protective factor against xerostomia identified was medications that induce hypersialorrhea OR=0.81, 95% CI (0.67-0.98), p=0.03. The total number of medications and xerogenic medications did not play a significant role in xerostomia.

CONCLUSION

Increasing Age and anticholinergic medications induce a dry mouth. Conversely, the total number of medications and xerogenic medications do not influence xerostomia. Medications that induce hypersialorrhea protect against the occurrence of dry mouth.

Fatigue and depression predict physician visits and work disability in women with primary Sjögren's syndrome: results from a cohort study

OBJECTIVES

Patients with primary SS (pSS) are frequently suffering from multiple enduring disorders that raise the risk of work disability and require treatment by various health-care specialists. We aimed at determining predictors of physician visits and work disability in pSS patients.

METHODS

Physician visits within the past 6 months, employment status and sick leave were compared among 176 female pSS patients and 115 age-matched controls. Dryness, pain, fatigue and depression were assessed by rating scales of the EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), the Profile of Fatigue and Discomfort (PROFAD) and Patient Health Questionnaire depression measurements (PHQ-9). Factors associated with an increased number of physician visits and inability to work were determined by multivariate logistic regression analysis.

RESULTS

Patients and controls were comparable in age and education, but differed significantly in the prevalence of depression (38.1 vs 7.9%, P < 0.001), the number of physician visits [17.0 (10.0) vs 6.5 (4.5); P < 0.001] and gainful employment (≤64 years: 52.8 vs 77.1% P < 0.001). Multivariate regression analyses revealed that depression (PHQ-9) and/or fatigue, particularly lack of stamina, but not dryness, were significantly associated with physician visits and working status in pSS patients. Patients with high ratings for the statement 'I have had difficulties to keep going, was easily worn out or lacking in energy' had a highly increased risk of not being gainfully employed (adjusted OR 4.1; 95% CI 1.5, 11.2; P < 0.001).

CONCLUSION

In pSS, lack of stamina and/or depression cause a higher level of individual and societal burden than dry eyes and mouth. Fatigue and depression deserve more recognition as treatment targets in pSS.

Dry mouth and dietary quality in older adults in north Carolina

OBJECTIVES

To quantify prevalence of dry mouth, association between dry mouth and beverage intake and dietary quality, and association between dry mouth and self-reported dietary accommodations to oral health deficits.

DESIGN

Cross-sectional study; data from self-reports.

SETTING

Rural North Carolina counties with substantial African-American and American Indian populations.

PARTICIPANTS

Six hundred twenty-two participants aged 60 and older.

MEASUREMENTS

Data included the 11-item Xerostomia Inventory (higher scores connote greater effect from dry mouth), a food frequency questionnaire (converted into Health Eating Index-2005 scores), and survey items on foods modified before consumption or avoided because of oral health problems.

RESULTS

Dry mouth was associated with being female, lower education, and income below the poverty level. Although overall beverage consumption did not vary with dry mouth, consumption of certain sugar-sweetened beverages was positively associated with dry mouth. Overall dietary quality did not differ with dry mouth, but more-severe dry mouth was associated with lower intake of whole grains and higher intakes of fruits. Dry mouth was strongly associated with self-reported modification and avoidance of foods. Those in the highest tertile of dry mouth were more likely to modify several foods than those in the lowest tertile and were more likely to avoid three or more foods.

CONCLUSION

Older adults appear to modify foods or selectively avoid foods in response to perceived dry mouth. Despite these behaviors, dry mouth does not result in poorer dietary quality.