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

Association between time from esophageal food impaction to endoscopy and adverse events

BACKGROUND AND AIMS

Guidelines recommend emergent or urgent EGD for esophageal food impaction (EFI), but data on how time to EGD impacts the risk of adverse events remain limited. We determined whether EFI-to-EGD time was associated with adverse events.

METHODS

In this retrospective cohort study of patients with endoscopically confirmed EFI, adverse events were classified as esophageal (mucosal tear, bleeding, perforation) or extraesophageal (aspiration, respiratory compromise, hypotension, arrhythmia). Esophageal perforation and extraesophageal adverse events requiring intensive care unit admission were classified as serious adverse events. Baseline characteristics, event details, and procedural details were compared between patients with and without adverse events. Multivariable logistic regression was performed to assess for an association between EFI-to-EGD time and adverse events.

RESULTS

Of 188 patients with EFI, 22 (12%) had any adverse event and 2 (1%) had a serious adverse event. Patients with adverse events were older and more likely to have an esophageal motility disorder, to tolerate secretions at presentation, and to have a higher American Society of Anesthesiologists score. EFI-to-EGD time was similar in those with and without adverse events. On multivariable analysis, EFI-to-EGD time was not associated with adverse events (odds ratio, 1.00 [95% confidence interval, .97-1.04] for 1-hour increments; odds ratio, 1.03 [95% confidence interval, .86-1.24] for 6-hour increments). Results were similar after stratifying by eosinophilic esophagitis status and after adjusting for possible confounders.

CONCLUSIONS

Because the time from EFI to EGD is not associated with adverse events, emergent EGD for EFI may be unnecessary, and other considerations may determine EGD timing.

PSMA PET/CT as a predictive tool for subregional importance estimates in the parotid gland

Objective. Xerostomia and radiation-induced salivary gland dysfunction remain a common side effect for head-and-neck radiotherapy patients, and attempts have been made to quantify the heterogeneity of the dose response within parotid glands. Prostate Specific Membrane Antigen (PSMA) ligands have demonstrated high uptake in salivary glands, which has been shown to correlate with gland functionality. Here we compare several models of parotid gland subregional relative importance with PSMA positron emission tomography (PET) uptake. We then develop a predictive model for Clarket al's relative importance estimates using PSMA PET and CT radiomic features, and demonstrate a methodology for predicting patient-specific importance deviations from the population.Approach. Intra-parotid gland uptake was compared with four regional importance models using 30 [18F]DCFPyL PSMA PET images. The correlation of uptake and importance was ascertained when numerous non-overlapping subregions were defined, while a paired t-test was used to compare binary region pairs. A radiomics-based predictive model of population importance was developed using a double cross-validation methodology. A model was then devised for supplementing population-level subregional importance estimates for each patient using patient-specific radiomic features.Main Results. Anticorrelative relationships were found to exist between PSMA PET uptake and four independent models of subregional parotid gland importance from the literature. Kernel Ridge Regression with principal component analysis feature selection performed best over test sets (Mean Absolute Error = 0.08), with gray level co-occurrence matrix (GLCM) features being particularly important. Deblurring PSMA PET images with neural blind deconvolution strengthened correlations and improved model performance.Significance. This study suggests that regions of relatively low PSMA PET uptake in parotid glands may exhibit relatively high dose-sensitivity. We've demonstrated the utility of PSMA PET radiomic features for predicting relative importance within subregions of parotid glands. PSMA PET appears to be a promising quantitative imaging modality for analyzing salivary gland functionality.

Brief Narrative Review on Commercial Dental Sealants-Comparison with Respect to Their Composition and Potential Modifications

The scope of this paper is to compare different dental sealants and flow materials indicated for sealing pits and fissures considering their chemical formula. The narrative review aims to address the following questions: What is the essence of different dental sealants' activity, how does their chemical formula affect their mechanisms of caries prevention, and what makes a dental sealant efficient mean of caries prevention? Another vital issue is whether the sealants that contain fluoride, or any other additions, have potentially increased antimicrobial properties. An electronic search of the PubMed, Cochrane, Web of Science, and Scopus databases was performed. The following keywords were used: (dental sealants) AND (chemical composition). Additionally, information about composition and indications for clinical use provided by manufacturers were utilized. All of the considered materials are indicated for use both in permanent and primary dentition for sealing fissures, pits, and foramina caeca. The selection of suitable material should be made individually and adjusted to conditions of the sealing procedure and patient's needs. Cariostatic mechanisms increasing sealants' effectiveness such as fluoride release are desired in modern dentistry appreciating preventive approach. The review aims are to find crucial elements of sealants' composition which affect their cariostatic mechanisms.

Immediate Loaded Full-Arch Mandibular Rehabilitations in Younger vs. Elderly Patients: A Comparative Retrospective Study with 7-Year Follow-Up

The aim of this comparative retrospective clinical study was to assess the effect of age on immediate loaded full-arch mandibular rehabilitation in younger vs. elderly patients. Patients with an age between 45 and 60 years (younger group, YG) or with an age more or equal to 75 years (older group, OG), requiring a mandibular full-arch rehabilitation were scheduled for the present study. Implant and prosthetic failure, biological and prosthetic complications, and peri-implant marginal bone level changes were recorded until a 7-year follow-up. Sixty-six patients were included in the study; a total of 264 implants were placed and, in total, 66 "all-on-four" rehabilitations were delivered. In total, 33 patients were scheduled in the YG and 33 patients in the OG. At the 7-year follow-up, an overall implant failure rate of 1.14% was reported. Moreover, at the 7-year radiographic evaluation, peri-implant crestal bone loss averaged 1.12 ± 0.91 mm for the YG and 1.04 ± 1.01 mm for the OG. No statistically significant differences were found between the YG and OG except for the rate of peri-implantitis, which was statistically higher in the YG. The present study reported that immediate fixed mandibular full-arch rehabilitation is a viable procedure in elderly people of equal or more than 75 years of age.

E-cigarette, cannabis and combustible tobacco use: associations with xerostomia among California adolescents

OBJECTIVE

Xerostomia (subjective experience of dry mouth), while less common in younger populations, can contribute to caries and oral discomfort. Use of e-cigarettes and cannabis among adolescents is increasing and may be a xerostomia risk factor. This study evaluates xerostomia prevalence in an adolescent population, overall and by e-cigarette, cannabis and combustible tobacco use.

METHODS

Cross-sectional analyses of 12-month follow-up data (N=976; collected 2020-2021) from a cohort of adolescents recruited from public high schools in Northern California (USA) compared self-reported past 30-day e-cigarette, cannabis and other tobacco use and dry mouth (overall dry mouth experience; shortened xerostomia inventory, SXI). Dry mouth experience (never, occasionally, frequently/always) was modelled using ordered logistic regression with school-level clustering and adjustment for gender, race/ethnicity, alcohol use, asthma, physical activity and mutually for e-cigarette, cannabis and tobacco use.

RESULTS

Past 30-day use prevalence was 12% for e-cigarettes, 16% for cannabis and 3% for combustible tobacco. Occasional dry mouth experience (54%) was more common than frequent/always experience (5%). Frequent/always dry mouth was more prevalent among frequent (>5 days/month) e-cigarette (14%) and cannabis (19%) users and combustible tobacco users (19%) than non-users of those respective products (all comparisons p < 0.001). In covariable-adjusted models, frequent e-cigarette use was no longer significantly associated with dry mouth experience (OR: 1.40; 95% CI: 0.69, 2.84), while frequent cannabis use (OR: 3.17; 95% CI: 1.47, 6.82) and combustible tobacco use (OR: 1.92; 95% CI: 1.38, 2.68) were associated with greater odds of reporting more frequent dry mouth. Findings were qualitatively similar using the SXI.

CONCLUSIONS

In this study, xerostomia was not independently associated with e-cigarette use but was one potential health concern of adolescent cannabis and combustible tobacco use.

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.

Xerostomia, the perception of general and oral health and health risk behaviours in people over 65 years of age

BACKGROUND

This study investigated the association between xerostomia and health risk behaviours, general and oral health and quality of life.

METHODS

A cross-sectional study involving 800 adults over 65 years of age residing in Spain using a computer-assisted telephone questionnaire. The severity of xerostomia was assessed through the Xerostomia Inventory (XI). Both univariate and adjusted multinomial logistic regression were used to determine the risk (OR) of xerostomia.

RESULTS

The sample comprised of 492 females (61.5%) and 308 males, with a mean age of 73.7 ± 5.8 years. Some, 30.7% had xerostomia: 25.6% mild, 4.8% moderate and 0.3% severe, the majority being female (34.8% vs 24%; p = 0.003). The mean XI was 24.6 ± 6.3 (95% CI 19.2-24.8) for those with poor health, whereas it was 17.4 ± 6.3 (95%CI 16.1-18.6) in those reporting very good health (p < 0.001). This difference was also observed in terms of oral health, with the XI mean recorded as 14.7 ± 10.7 for very poor oral health and 6.4 ± 5.4 for those with very good health (p = 0.002). Logistic regression showed that the highest OR for xerostomia was observed among adults with poor general health (2.81; 95%CI 1.8-4.3; p < 0.001) and for adjusted model the OR was still significant (2.18; 95%CI 1.4-3.4; p = 0.001). Those who needed help with household chores had 2.16 higher OR (95%CI 1.4-3.4; p = 0.001) and 1.69 (95%CI 1.1-2.7; p = 0.03) in the adjusted model. Females had a higher risk of suffering from xerostomia than males.

CONCLUSION

The strong association between xerostomia and the general and oral health status of older adults justifies the need for early assessment and regular follow-up.

Oral manifestations in young adults infected with COVID-19 and impact of smoking: a multi-country cross-sectional study

Background

Oral manifestations and lesions could adversely impact the quality of people's lives. COVID-19 infection may interact with smoking and the impact on oral manifestations is yet to be discovered.

Objectives

The aim of this study was to assess the self-reported presence of oral lesions by COVID-19-infected young adults and the differences in the association between oral lesions and COVID-19 infection in smokers and non-smokers.

Methods

This cross-sectional multi-country study recruited 18-to-23-year-old adults. A validated questionnaire was used to collect data on COVID-19-infection status, smoking and the presence of oral lesions (dry mouth, change in taste, and others) using an online platform. Multi-level logistic regression was used to assess the associations between the oral lesions and COVID-19 infection; the modifying effect of smoking on the associations.

Results

Data was available from 5,342 respondents from 43 countries. Of these, 8.1% reported COVID-19-infection, 42.7% had oral manifestations and 12.3% were smokers. A significantly greater percentage of participants with COVID-19-infection reported dry mouth and change in taste than non-infected participants. Dry mouth (AOR=, 9=xxx) and changed taste (AOR=, 9=xxx) were associated with COVID-19- infection. The association between COVID-19-infection and dry mouth was stronger among smokers than non-smokers (AOR = 1.26 and 1.03, p = 0.09) while the association with change in taste was stronger among non-smokers (AOR = 1.22 and 1.13, p = 0.86).

Conclusion

Dry mouth and changed taste may be used as an indicator for COVID-19 infection in low COVID-19-testing environments. Smoking may modify the association between some oral lesions and COVID-19-infection.

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.

Xerostomia, Salivary Flow, and Oral Health Status Among Saudi Diabetic Patients: A Comparative Cross-Sectional Study

Purpose

Diabetes mellitus (DM) is associated with numerous oral complications, including frequent oral infections, periodontal diseases, hyposalivation, and xerostomia. The present study aimed to investigate salivary flow rate, xerostomia, and oral health status among a group of Saudi diabetic patients as compared to healthy controls.

Patients and Methods

This comparative cross-sectional study involved 50 diabetic patients (aged between 15 and 70 years) and 53 age- and gender-matched healthy controls. Data collection was carried out using a structured questionnaire and clinical examination of oral health status, which included salivary flow rates, saliva pH, tooth loss, plaque accumulation, and gingival health. Independent t-tests, one-way analysis of variance (ANOVA), and chi-square tests were performed to compare between groups.

Results

The results revealed a statistically significant lower salivary flow (0.33 ± 0.16 vs 0.59 ± 0.54; p = 0.002) and lower saliva pH (6.36 ± 0.49 vs 6.58 ± 0.39; p = 0.014) in diabetic patients than in the control group. A higher proportion of diabetic subjects (60%) self-reported having xerostomia compared to controls (52%), but the findings were statistically non-significant. Additionally, the results revealed slightly poorer oral health and greater tooth loss among DM patients, although the results did not attain a significant difference (P > 0.05).

Conclusion

The findings of the present study demonstrate poor oral health and a high prevalence of xerostomia among Saudi diabetic patients. Oral health education should therefore be promoted in this group of patients.

The survival time of restorations is shortened in patients with dry mouth

OBJECTIVES

The aim of this retrospective data collection study was to determine the effect size of dry mouth on the survival of restorations and teeth.

METHODS

The data were collected from the electronic patient files of City of Oulu Public Dental Services (Finland). Study population consisted of 71 dry mouth patients and 142 control patients. The survival of 3208 restorations were analyzed using Kaplan-Meier survival curves and multivariate Cox regression analysis with shared frailty for patients. Separate analyses were performed for the survival of the teeth.

RESULTS

The hazard ratio of restorations in dry mouth patients was 2.08 (95% CI: 1.65-2.63) compared to the control patients. For the dry mouth patients, the fixed prosthetic crowns outlasted composite fillings of all sizes, but the difference increased concomitantly with the filling size. The dry mouth patients had hazard ratio of 1.98 (95% CI: 1.02-3.82) for tooth extractions compared to the control patients. The teeth with fixed prosthetic crowns outlasted the teeth with direct restorative materials.

CONCLUSIONS

The survival time of restorations and teeth are severely shortened in patients with dry mouth. Especially the survival time of the large composites is short in dry mouth patients whereas fixed prosthetic crowns have acceptable survival time also in dry mouth patients.

CLINICAL SIGNIFICANCE

When informing a dry mouth patient on the expected survival of a restoration or tooth, one should take into account that dry mouth patients´ restorations and teeth have severely shortened survival time.

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.

Incorporating parotid gland inhomogeneity into head-and-neck treatment optimization through the use of artificial base plans

Despite a great improvement in target volume dose conformality made possible in recent years by modulated therapies, xerostomia remains a common and severe side effect for head-and-neck radiotherapy patients. It is known that parotid glands exhibit a spatially varying dose response; however, the relative importance of subregions throughout the entire gland has yet to be incorporated into treatment plan optimization, with the current standard being to minimize the mean dose to whole parotid glands. The relative importance of regions within contralateral parotid glands has been recently quantified, creating an opportunity for the development of a method for including this data in plan optimization. We present a universal and straightforward approach for imposing varying sub-parotid gland dose constraints during inverse treatment planning by using patient-specific artificial base plans to penalize dose deposited in sensitive regions. In this work, the proposed method of optimization is demonstrated to reduce dose to regions of high relative importance throughout contralateral parotids and improve predictions for stimulated saliva output at 1-year post-radiotherapy. This method may also be applied to impose varying dose constraints to other organs-at-risk for which regional importance data exists.

The mechanism of submandibular gland dysfunction after menopause may be associated with the ferroptosis

Salivary gland dysfunction is a common symptom that occurs after menopause. This study was performed to investigate the mechanism of salivary gland dysfunction to confirm the relationship between ferroptosis and salivary gland dysfunction by ovariectomy. Forty-eight female rats were randomly divided into four groups (12 rats in each group). Histology, real time PCR, western blot, immunohistochemistry, electron microscopy, cytosolic iron assay, and salivary function were analyzed. Human salivary gland tissue analysis was also done. Lipogenesis and lipid deposition in the submandibular gland tissue occurred after ovariectomy. ROS generation, MDA+HAE was increased and GPX4 activity was decreased and in the OVX group compared to the CON group. Iron deposition in the submandibular gland tissue was increased in the OVX group. Submandibular gland fibrosis was increased and saliva secretion was decreased in the OVX group. In human submandibular gland analysis, lipid and iron deposition was also increased in the postmenopause group. This is the first in vivo study in which salivary gland dysfunction is associated with the ferroptosis in postmenopausal animal model. Increased lipid and iron deposition in normal submandibular gland tissues of postmenopausal women can suggest that the salivary gland dysfunction after menopause may be associated with the ferroptosis.

Nutrient intakes and medication use in elderly individuals with and without dry mouths

BACKGROUND/OBJECTIVES

The nutrition of the elderly depends on various factors. Oral health, especially oral dryness, can be an important risk factor. In this study, we attempted to determine whether dry mouth is associated with compromised nutrient intakes.

SUBJECTS/METHODS

A total of 120 participants aged 65–86 yrs (mean age: 69 ± 1 y) were included in this study. Demographic and health-related characteristics, living status, meals, number of medications, medical conditions, chewing ability, and quality of life, the Oral Health Impact Profile (the OHIP-14) were assessed. We performed one day 24-hr recall assessment for nutrient analyses. The differences of the means between the dry-mouth and non-dry-mouth groups were analyzed. Elderly subjects with xerostomia-induced dry mouth were classified as those who reported at least one dryness symptom on a questionnaire.

RESULTS

A significant difference in population distribution was observed among the elderly who took medications for hypertension, diabetes and osteoporosis and was significantly higher in the dry-mouth group (70.2%) than in the non-dry-mouth group (44.4%) (P = 0.005). Compared with the non-dry-mouth group (50.8%), a significantly higher proportion (73.7%) of participants in the dry-mouth group took multiple medicines (≥ 4 medications) (P = 0.019). The intakes of vegetable fat, vitamin E, folate and water in the dry-mouth group were lower than in the non-dry-mouth group. The intakes of fluoride and ω-3 fatty acids were significantly lower in the dry-mouth group than in the non-dry-mouth group.

CONCLUSION

The participants in the dry-mouth group exhibited low nutrient and water intakes. It is recommended that the elderly with dry mouth should drink sufficient water and receive targeted and specific nutritional guidance to prevent malnutrition.

Preparation and Characterization of Natural Bleaching Gels Used in Cosmetic Dentistry

The novelty of this study consists of the formulation and characterization of three experimental bleaching gels with hydroxylapatite oxides and fluorine (G28®, G29®, G30®) based on natural fruit extracts compared to the commercial Opalescence 15% (GC, Ultradent, South Jordan, UT, USA). Studies have been conducted on the effect that the experimental bleaching gels have on the color and morphology of different restorative materials (Nanofill®-Schulzer, P.L. Superior Dental Materials GmbH, Hamburg, Germany, and experimental nanocomposites (P11®, P31®, P61®)), immersed in coffee and artificial saliva (for 10 days and 30 days). The study also includes a cytotoxicity test on the gels and nanocomposites after bleaching, with ISO 109993-5 protocols on human dental follicle stem cells. UV-VIS spectroscopy, computerized measurement, and fluorescence spectrometry were used in order to observe the color changes, while the microstructure of the surface was investigated by Scanning Electron Microscopy (SEM). All of the samples immersed in coffee showed the highest color shift in comparison to the baseline. The color difference ΔE values obtained using the two methods (UV-Vis, computerized based on digital images) both after coloring and bleaching, respectively, were different for all four types of nanocomposites stored in the coffee, while no difference was observed in those stored in artificial saliva. The studied experimental gels and nanocomposites had a low cytotoxic effect on cell cultures after bleaching.

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.

Efficacy of regular professional brushing by a dental nurse for 3 months in nursing home residents-A randomized, controlled clinical trial

Objectives

The oral health of nursing home residents is poor for various reasons. Many require help for oral hygiene. Regular professional brushing by a dental nurse should improve oral hygiene. This study aimed to determine the efficacy of regular tooth brushing by a dental nurse on the oral health of nursing home residents.

Methods

This controlled trial randomized participants (n = 50; mean age 83 ± 8 years) to brushing by a dental nurse every 2 weeks for 3 months (n = 25; test group) or oral hygiene procedures performed/controlled by nursing home staff (n = 25; control group). Personal, general and oral health, as well as various oral hygiene parameters—plaque index (PI), gingivitis index (GI), papilla bleeding index (PBI), oral hygiene index (OHI) and Volpe‐Manhold Index (VMI)—were evaluated at baseline, after initial professional dental cleaning and before last brushing.

Results

At baseline, oral health was impaired according to investigated indices in both groups. After professional brushing for 3 months, there were improvements in PI, GI and PBI, with significant increases compared with the control group in OHI and VMI (P = 0.017 and P < 0.001, respectively). Among the control group, the number of teeth decreased while the root caries index increased (P = 0.002 between groups).

Conclusions

Regular professional brushing every 2 weeks by a dental nurse can be recommended for nursing homes residents to improve oral health parameters and to help reduce root caries incidence as a basis to preserve the number of teeth. Such oral hygiene procedures will maintain and improve the oral health of nursing home residents.

Pharmacological characterization of DA-8010, a novel muscarinic receptor antagonist selective for urinary bladder over salivary gland

Several antimuscarinics have been commonly used for overactive bladder patients, but dry mouth as a major anticholinergic side effect remains a shortcoming to limit long-term use. The aim of this study was to elucidate the pharmacological properties of DA-8010, a novel muscarinic receptor antagonist selective for urinary bladder over salivary gland. DA-8010 exhibited a high binding affinity for human muscarinic M₃ receptor with pK_i of 8.81 ± 0.05 and great potencies for human M₃ receptor and rat bladder preparation. The potency of DA-8010 for bladder smooth muscle cells was 3.6-fold higher than that for salivary gland cells isolated from mice. Intravenous administration of DA-8010 dose-dependently inhibited rhythmic urinary bladder contractions induced by distension in rats, indicating the most potent activity (ID₃₀ = 0.08 mg/kg) among the antimuscarinics tested. Taken together with the inhibitory effects of DA-8010 and other antimuscarinics on carbachol-induced salivary secretion in rats, the in vivo functional selectivity of DA-8010 for urinary bladder over salivary gland was 3.1-fold, 3.2-fold and 5.2-fold greater than those observed for solifenacin, oxybutynin and darifenacin, respectively. Furthermore, oral administration of DA-8010 in mice resulted in more selective and persistent binding for muscarinic receptors in the bladder rather than in the submaxillary gland, in comparison with other antimuscarinics. These findings suggest that DA-8010 is a potent muscarinic M₃ receptor antagonist to be highly selective for bladder over salivary gland, which might be a promising agent with greater efficacy and less dry mouth in the treatment of overactive bladder.

Medication-Induced Xerostomia and Hyposalivation in the Elderly: Culprits, Complications, and Management

Medication-induced xerostomia and hyposalivation will increasingly become oral health issues for older and geriatric patients because of the likely high prevalence of medication intake and polypharmacy, with a complex negative impact on other symptoms such as dysphagia, caries incidence, malnutrition, and quality of life. All healthcare professionals are encouraged to investigate dry mouth symptoms among their patients, since diagnosis can easily be performed within daily clinical practice. This practical article also provides a review of available treatment options, which include medication changes towards products with fewer xerogenic side effects or dose reductions, if possible, as well as multidisciplinary, preventive care-oriented approaches that consider all influencing factors and treatment of the oral symptoms. In addition, several topical agents and saliva substitutes are discussed that may provide symptomatic relief but need to be carefully adapted to each patient's situation in terms of usability and practicability and in the knowledge that therapeutic success varies with each individual. Innovative methods such as intraoral electrostimulation or topical application of anticholinesterase on the oral mucosa are also discussed. The most commonly prescribed pharmaceutical treatment options for dry mouth are pilocarpine (a parasympathomimetic agent with potent muscarinic, cholinergic salivation-stimulating properties) and cevimeline (a quinuclidine analogue with therapeutic and side effects similar to those of pilocarpine). These pharmaceutic treatment options are described in the context of older patients, where the highly prevalent cholinergic side effects, which include nausea, emesis, bronchoconstriction, among others, need to be thoroughly supervised by the healthcare professionals involved. Providing these therapeutic options to patients with medication-induced dry mouth will help improve their oral health and therefore maintain a better quality of life, general health, and well-being.

Effects of a Novel Formulation on Oral Biofilm, pH Buffering, and Gingival Health in Patients with Dry Mouth

Goal

To identify in patients with dry mouth the effects of a novel test agent (Oral Essentials Hydrating Formula Mouthwash, Beverly Hills, CA) versus a control agent (Biotène Dry Mouth Oral Rinse, GlaxoSmithKline Consumer Healthcare L.P., Moon Township, PA, USA) versus no treatment on dry mouth, plaque, salivary pH and buffering capacity, gingival health, and tooth sensitivity.

Materials and Methods

In this cross-over study, ten subjects with dry mouth used test and control dry mouth interventions, as well as no dry mouth intervention in randomized sequence. Plaque Index, Gingival Index, Sulcus Bleeding Index, Plaque staining, and photographs were recorded at baseline and end of each study arm. Salivary volume, pH, and buffering capacity were also recorded at these time points. Additionally, subjects completed a questionnaire for dry mouth and dentinal sensitivity at each visit.

Results

Reductions in plaque presence and clinical indices were similar after use of test or control products (p < 0.05). Saliva volume and pH buffering improved significantly after use of test and control products (p < 0.05).

Conclusions

The effects of a novel dry mouth intervention are similar to those of an existing OTC remedy and are significantly better than no intervention.

Compliance with Saliva Collection Protocol in Healthy Volunteers: Strategies for Managing Risk and Errors

Salivary bioscience technologies such as electrophoresis are widely applied for diagnosing systemic health status. Diagnosis using a saliva sample has emerged as a preferred technique since the sample is easy to collect and the method is inexpensive and non-invasive. Salivary diagnostics have even been identified as potential substitutes for serum protein biomarkers. However, the optimal protocol for collecting saliva has not yet been established. In many scientific settings, such as randomized controlled trials, sampling and statistical errors often occur when handling samples from healthy volunteers. These errors can be due to the psychological behavior of the volunteers, subject nonadherence, questionnaire characteristics, collection methods, and/or sample processing. The purpose of the review presented here is to outline the strategies for managing the risk factors and to minimize the sampling errors during saliva collection in healthy volunteers.

Astaxanthin affects oxidative stress and hyposalivation in aging mice

Oral dryness, a serious problem for the aging Japanese society, is induced by aging-related hyposalivation and causes dysphagia, dysgeusia, inadaptation of dentures, and growth of oral Candida albicans. Oxidative stress clearly plays a role in decreasing saliva secretion and treatment with antioxidants such astaxanthin supplements may be beneficial. Therefore, we evaluated the effects of astaxanthin on the oral saliva secretory function of aging mice. The saliva flow increased in astaxanthin-treated mice 72 weeks after administration while that of the control decreased by half. The plasma d-ROMs values of the control but not astaxanthin-treated group measured before and 72 weeks after treatment increased. The diacron-reactive oxygen metabolites (d-ROMs) value of astaxanthin-treated mice 72 weeks after treatment was significantly lower than that of the control group was. The plasma biological antioxidative potential (BAP) values of the control but not astaxanthin-treated mice before and 72 weeks after treatment decreased. Moreover, the BAP value of the astaxanthin-treated group 72 weeks after treatment was significantly higher than that of the control was. Furthermore, the submandibular glands of astaxanthin-treated mice had fewer inflammatory cells than the control did. Specifically, immunofluorescence revealed a significantly large aquaporin-5 positive cells in astaxanthin-treated mice. Our results suggest that astaxanthin treatment may prevent age-related decreased saliva secretion.

Xerostomia: current streams of investigation

Xerostomia is the subjective feeling of dry mouth, and it is often related to salivary hypofunction. Besides medication-related salivary hypofunction, Sjögren syndrome and head-and-neck radiation are two common etiologies that have garnered considerable attention. Approaches to treating and/or preventing salivary hypofunction in patients with these conditions will likely incorporate gene therapy, stem cell therapy, and tissue engineering. Advances in these disciplines are central to current research in the cure for xerostomia and will be key to eventual treatment.

A risk prediction model for xerostomia: a retrospective cohort study

OBJECTIVE

We investigated the prevalence of xerostomia in dental patients and built a xerostomia risk prediction model by incorporating a wide range of risk factors.

MATERIALS AND METHODS

Socio-demographic data, past medical history, self-reported dry mouth and related symptoms were collected retrospectively from January 2010 to September 2013 for all new dental patients. A logistic regression framework was used to build a risk prediction model for xerostomia. External validation was performed using an independent data set to test the prediction power.

RESULTS

A total of 12 682 patients were included in this analysis (54.3%, females). Xerostomia was reported by 12.2% of patients. The proportion of people reporting xerostomia was higher among those who were taking more medications (OR = 1.11, 95% CI = 1.08-1.13) or recreational drug users (OR = 1.4, 95% CI = 1.1-1.9). Rheumatic diseases (OR = 2.17, 95% CI = 1.88-2.51), psychiatric diseases (OR = 2.34, 95% CI = 2.05-2.68), eating disorders (OR = 2.28, 95% CI = 1.55-3.36) and radiotherapy (OR = 2.00, 95% CI = 1.43-2.80) were good predictors of xerostomia. For the test model performance, the ROC-AUC was 0.816 and in the external validation sample, the ROC-AUC was 0.799.

CONCLUSION

The xerostomia risk prediction model had high accuracy and discriminated between high- and low-risk individuals. Clinicians could use this model to identify the classes of medications and systemic diseases associated with xerostomia.

Xerostomia induced by radiotherapy: an overview of the physiopathology, clinical evidence, and management of the oral damage

BACKGROUND

The irradiation of head and neck cancer (HNC) often causes damage to the salivary glands. The resulting salivary gland hypofunction and xerostomia seriously reduce the patient's quality of life.

PURPOSE

To analyze the literature of actual management strategies for radiation-induced hypofunction and xerostomia in HNC patients.

METHODS

MEDLINE/PubMed and the Cochrane Library databases were electronically evaluated for articles published from January 1, 1970, to June 30, 2013. Two reviewers independently screened and included papers according to the predefined selection criteria.

RESULTS

Sixty-one articles met the inclusion criteria. The systematic review of the literature suggests that the most suitable methods for managing the clinical and pathophysiological consequences of HNC radiotherapy might be the pharmacological approach, for example, through the use of cholinergic agonists when residual secretory capacity is still present, and the use of salivary substitutes. In addition, a modified diet and the patient's motivation to enhance oral hygiene can lead to a significant improvement.

CONCLUSION

Radiation-induced xerostomia could be considered a multifactorial disease. It could depend on the type of cancer treatment and the cumulative radiation dose to the gland tissue. A preventive approach and the correct treatment of the particular radiotherapeutic patient can help to improve the condition of xerostomia.

Salivary Secretory Disorders, Inducing Drugs, and Clinical Management

BACKGROUND

Salivary secretory disorders can be the result of a wide range of factors. Their prevalence and negative effects on the patient's quality of life oblige the clinician to confront the issue.

AIM

To review the salivary secretory disorders, inducing drugs and their clinical management.

METHODS

In this article, a literature search of these dysfunctions was conducted with the assistance of a research librarian in the MEDLINE/PubMed Database.

RESULTS

Xerostomia, or dry mouth syndrome, can be caused by medication, systemic diseases such as Sjögren's Syndrome, glandular pathologies, and radiotherapy of the head and neck. Treatment of dry mouth is aimed at both minimizing its symptoms and preventing oral complications with the employment of sialogogues and topical acting substances. Sialorrhea and drooling, are mainly due to medication or neurological systemic disease. There are various therapeutic, pharmacologic, and surgical alternatives for its management. The pharmacology of most of the substances employed for the treatment of salivary disorders is well-known. Nevertheless, in some cases a significant improvement in salivary function has not been observed after their administration.

CONCLUSION

At present, there are numerous frequently prescribed drugs whose unwanted effects include some kind of salivary disorder. In addition, the differing pathologic mechanisms, and the great variety of existing treatments hinder the clinical management of these patients. The authors have designed an algorithm to facilitate the decision making process when physicians, oral surgeons, or dentists face these salivary dysfunctions.

Diagnosis and management of xerostomia and hyposalivation

Xerostomia, the subjective complaint of dry mouth, and hyposalivation remain a significant burden for many individuals. Diagnosis of xerostomia and salivary gland hypofunction is dependent upon a careful and detailed history and thorough oral examination. There exist many options for treatment and symptom management: salivary stimulants, topical agents, saliva substitutes, and systemic sialogogues. The aim of this review is to investigate the current state of knowledge on management and treatment of patients affected by xerostomia and/or hyposalivation.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL SIGNIFICANCE

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

Polypharmacy and food-drug interactions among older persons: a review

Polypharmacy is generally defined as the use of 5 or more prescription medications on a regular basis. The average number of prescribed and over-the-counter medications used by community-dwelling older adults per day in the United States is 6 medications, and the number used by institutionalized older persons is 9 medications. Almost all medications affect nutriture, either directly or indirectly, and nutriture affects drug disposition and effect. This review will highlight the issues surrounding polypharmacy, food-drug interactions, and the consequences of these interactions for the older adult.