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Background: Periodontitis increases the risk of cardiovascular disease in the general population by triggering systemic inflammation., Aim: To investigate the relationship between systemic inflammation and periodontitis, and clarify any association between severe periodontitis and the medications used by patients receiving haemodialysis., Design: A cross-sectional study., Participants: The study was undertaken with 56 patients receiving haemodialysis., Measurements: Demographic and laboratory data and prescribed drugs regularly used by patients were recorded from hospital records. During the dialysis session, a validated Xerostomia Inventory score was completed. A complete dental/periodontal examination was also undertaken on all patients by the same periodontist., Results: In the study population, stage I periodontitis was determined in 41%, stage II periodontitis in 17%, stage III periodontitis in 21%, and stage IV periodontitis in 21%. Male gender, hypertension, coronary artery disease, β antagonists, calcium channel blockers, sodium polystyrene sulphonate, teeth brushing less than twice a day and high sensitive C-reactive protein > 8 mg/l were significantly associated with severe periodontitis., Conclusion: Drugs, including β antagonists, calcium channel blockers, polystyrene sulphonate, co-morbid conditions and poor or insufficient oral care could facilitate an increase in the severity of periodontitis in patients receiving haemodialysis. Severe periodontitis also seems to be associated with cardiovascular disease and inflammation in patients with chronic renal disease., (© 2019 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Purpose: The aim of this study was to generate normal tissue complication probability (NTCP) models in patients treated with either proton beam therapy (PBT) or intensity-modulated radiation therapy (IMRT) for oropharynx cancer and to use a model-based approach to investigate the added value of PBT in preventing treatment complications., Methods and Materials: For patients with advanced-stage oropharynx cancer treated with curative intent (PBT, n = 30; IMRT, n = 175), NTCP models were developed using multivariable logistic regression analysis with backward selection. For PBT-treated patients, an equivalent IMRT plan was generated to serve as a reference to determine the benefit of PBT in terms of NTCP. The models were then applied to the PBT-treated patients to compare predicted and observed clinical outcomes (calibration-in-the-large). Five binary endpoints were analyzed at 6 months after treatment: dysphagia ≥ grade 2, dysphagia ≥ grade 3, xerostomia ≥ grade 2, salivary duct inflammation ≥ grade 2, and feeding tube dependence. Corresponding toxicity grading was based on National Cancer Institute Common Terminology Criteria for Adverse Events version 4. Paired t tests and Wilcoxon rank tests were used to compare mean NTCP results for endpoints between PBT and IMRT., Results: NTCP models developed based on outcomes from all patients were applied to those receiving PBT. NTCP values were calculated for the equivalent IMRT plans for all PBT-treated patients, revealing significantly higher NTCP values with IMRT. PBT was associated with statistically significant reductions in the mean NTCP values for each endpoint at 6 months after treatment, with the largest absolute differences in rates of ≥grade 2 dysphagia and ≥grade 2 xerostomia., Conclusions: NTCP models predict significant improvements in the probability of short-term, treatment-related toxicity with PBT compared with IMRT for oropharyngeal cancer. This study demonstrates an NTCP model-based approach to compare predicted patient outcomes when randomized data are not available., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The purpose of this study was to explore the association of the clinical oral dryness score (CODS) with salivary flow rates, xerostomia inventory (XI), and bother index (BI). 147 patients were screened using CODS, which determined 10 features of oral dryness. Each feature contributed 1 point, and the total score varied from 0 to 10. Unstimulated (UWS), chewing-stimulated (CH-SWS) and acid-stimulated (A-SWS) whole salivary flows and the XI and BI were measured. Associations were explored with a bootstrapped Spearman rank correlation test (1000 × bootstrapping). Based on unstimulated salivary flow, 55 patients were classified as hyposalivators, 31 as low salivators, 48 as normosalivators and 13 as high salivators. Median CODS in the hyposalivation group was 5 (IQR 3-6) compared with 3 (IQR 2-5) in the low salivation group, 2 (IQR 1-4) in the normal salivation group and 2 (IQR 1-2.5) in the high salivation group. Significant associations between CODS and the other parameters were only found in the hyposalivation group between CODS and UWS (ρ(53) = - 0.513; p < 0.01), between CODS and CH-SWS (ρ(53) = - 0.453; p < 0.01), between CODS and A-SWS (ρ(53) = - 0.500; p < 0.01), CODS and XI (ρ(53) = 0.343; p < 0.001) and between CODS and BI (ρ(53) = 0.375; p = 0.01). In patients with hyposalivation, CODS is associated with unstimulated and stimulated salivary flow and XI and BI. CODS alone or a combination of CODS with a subjective measure, such as the XI or BI, could be recommended during routine clinical assessment to detect hyposalivation.

Objective: This paper describes the results of a bi-level intervention, using a cognitive-behavioral theoretical approach, to improve the oral hygiene of older adults and the disabled in community-based low income senior housing., Methods: The bi-level pilot intervention consisted of an on-site tailored adapted motivational interviewing (AMI) session and two oral health fairs, supported by a resident campaign committee, to change community norms. All materials were available in English and Spanish. Participants completed a survey consisting of 12 domains that provided the basis for tailoring the AMI and shaping the campaigns. The domains were activities of daily living (ADLs), access to oral health information, oral hygiene status, dental knowledge, hygiene behaviors, importance of oral hygiene, self-efficacy/locus of control, diet, intentions, self-management worries/fears, perceived risk and dry mouth., Main Outcome Measures: Each participant received clinical assessments consisting of full-mouth plaque score (PS) and gingival index (GI) before the intervention and at three months., Results: Twenty-seven residents with at least one tooth completed all phases of the study. The mean number of domains requiring attention was 4.5 (SD 1.6) with a range of one to seven. Mean baseline PS was 83% (SD 16%) which improved significantly to 58% (SD 31%); mean baseline GI was 1.15 (SD 0.61) and improved significantly to 0.49 (SD 0.46)., Conclusions: This pilot study supports the feasibility and acceptability of a tailored oral hygiene intervention among older and disabled adults living in low income senior housing. Although a small sample, the study demonstrated significant improvements in both plaque and gingival scores three months after the bi-level intervention.

Purpose: This multicenter, randomized, parallel group study analyzed the effectiveness of an experimental oral gel, a commercially available oral rinse and a commercially available mouth spray versus water alone at relieving self-reported symptoms of dry mouth over a 28-day home use treatment period. The effects of the study treatments on dry mouth-related quality of life (QoL) were also investigated., Methods: Eligible subjects were stratified by dry mouth severity (mild, moderate or severe) and randomized to receive one of the study treatments. Prior to first use they completed a questionnaire designed to assess their baseline dry mouth-related QoL. Following first use and on Day 8 (2 hours post-treatment only) and Day 29, subjects completed the modified Product Performance and Attributes Questionnaire (PPAQ) I at 0.5, 1, 2 and 4 hours post-treatment. Subjects further assessed treatment performance using the PPAQ II questionnaire on Days 8 and 29 and the dry mouth-related QoL questionnaire on Day 29., Results: In 396 randomized subjects almost all comparisons of responses to PPAQ I, including those for the primary endpoint (response to PPAQ I Question 1 'Relieving the discomfort of dry mouth' after 2 hours on Day 29), were statistically significant in favor of active treatment groups versus water (P < 0.05). All comparisons of responses to PPAQ II on Days 8 and 29 were statistically significant in favor of active treatments versus water (P < 0.05). Moreover, nearly all comparisons for dry mouth-related QoL scores on Day 29 were statistically significant in favor of the active treatments versus water. All the dry mouth management strategies in this trial were well tolerated.

Background and Objective: Various studies have reported the relationship between alcohol consumption and gingival condition. However, they focus on the direct effects of alcohol consumption or alcohol sensitivity on gingival condition, and it is unclear how oral health behaviors relate these relationships. The aims of this study were to assess the inter-relationships between gingival condition, tooth-brushing behavior after drinking alcohol and alcohol sensitivity in university students who drink more than once per week on average., Material and Methods: A total of 808 students (541 males, 267 females) that habitually consume alcohol were analyzed. The disease activity of gingival condition was assessed as the percentage of bleeding on probing (%BOP). Additional information regarding alcohol sensitivity and oral health behaviors, including tooth-brushing behavior after drinking, were also collected., Results: Thirteen percent of the current participants reported neglecting tooth-brushing after drinking, and their alcohol consumption was higher than those who did not neglect tooth-brushing. Logistic regression analysis showed that high %BOP (%BOP ≥ 20) was associated with male (OR = 1.53; 95% CI, 1.01-2.33), neglect of tooth-brushing after drinking (OR = 2.60; 95% CI, 1.20-5.61) and debris index (OR = 8.38; 95% CI, 4.24-16.60) in participants with low alcohol sensitivity. In participants with high alcohol sensitivity, high %BOP was associated with debris index (OR = 7.60; 95% CI, 3.12-18.51), but not with any oral health behaviors., Conclusions: The study revealed that alcohol consumption was indirectly related to gingival disease activity through the neglect of tooth-brushing after drinking alcohol in university students with low alcohol sensitivity., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: This study aimed to elucidate the association between masticatory ability and physical performance in community-dwelling edentulous older adults wearing complete dentures., Background: Physical performance parameters are significant predictors of decreased activities of daily living. Previous studies have shown the relationships between oral conditions and these parameters. Here, we focused on complete denture wearers., Methods: Two hundred and ten edentulous adults aged ≥65 years and wearing complete dentures were enrolled. The following oral conditions were examined: masticatory ability measured by colour-changing chewing gum, number of foods considered chewable, pain when using dentures and denture base fit. Handgrip strength (HG) and one-leg standing time with eyes open (OLST) were used to evaluate muscle strength and static balance. Spearman's rank correlation coefficients were calculated to examine the correlations between oral conditions and physical performance. Forward stepwise linear regression models were applied with each physical performance parameters as the dependent variable and oral conditions as the independent variable., Results: The women did not show significant correlations between oral conditions and the physical performance. In men, significant and positive correlations were found between the number of chewable foods and HG, and between the colour scores and OLST. The significant correlation between the colour scores and OLST was still noted in the stepwise liner regression analysis after adjusting for demographic, social and medical conditions, and other oral conditions., Conclusion: In Japanese elderly edentulous men wearing complete dentures, masticatory ability evaluated as the mixing ability may be associated with static balance., (© 2012 The Gerodontology Society and John Wiley & Sons A/S.)

Objective: The aim of this study was to evaluate the clinical efficacy of a topical sialogogue spray containing 1% malic acid for elderly people affected by xerostomia., Material and Methods: This research took the form of a double-blind, randomized clinical trial. Forty-one individuals (mean age: 78.7 years) with xerostomia were divided into two groups: for the first 'intervention group' (21 subjects) a topical sialogogue spray (1% malic acid) was applied, while for the second 'control group' (20 subjects), a placebo spray was applied; for both groups, the sprays were applied on demand during 2 weeks. The Xerostomia Inventory (XI) was used to evaluate xerostomia levels before and after product/placebo application. Unstimulated and stimulated salivary flows rates, before and after spray application, were measured., Results: XI scores decreased significantly (clinically meaningful) from 36.4 ± 7.3 points to 29.1 ± 7.1 (p < 0.05) with an XI difference of 7.2 ± 6.1, after the combination among 1% malic acid with xylitol and fluoride application. After 2 weeks of 1% malic acid application, unstimulated and stimulated salivary flows rates increased significantly (p < 0.05)., Conclusion: A topical sialogogue spray containing 1% malic acid improved xerostomia in an elderly population and increased unstimulated and stimulated salivary flows rates., (© 2013 The Gerodontology Society and John Wiley & Sons A/S.)

Background: An increasing number of studies have revealed that microRNA (miRNA) contributes to the pathogenesis of autoimmune diseases. The objective of this study is to investigate the miR-146a and miR-155 levels in peripheral mononuclear blood cells from patients with primary Sjögren's syndrome (pSS) who were not receiving medications and to examine the correlations between these miRNA levels and the clinical features of the disease., Method: Using real-time polymerase chain reaction analysis of miRNAs, the miR-146a and miR-155 expression levels were assessed in peripheral mononuclear blood cells from 27 patients with pSS and 22 healthy controls, and the relationships between these miRNA levels and the visual analog scale (VAS) scores for dry mouth, dry eyes, and parotid gland swelling were investigated., Results: Compared with the healthy controls, the miR-146a expression level was significantly increased in the patients with pSS (P = 0.0182) and was positively correlated with the VAS scores for parotid swelling (r = 0.4475, P = 0.0192) and dry eyes (r = 0.4051, P = 0.0361). Although the miR-155 expression level was significantly decreased in the patients with pSS (P = 0.0131), the miR-155 expression positively correlated with the VAS score for dry eyes (r = 0.4894, P = 0.0096)., Conclusion: Our results demonstrated miR-146a overexpression and miR-155 underexpression in the peripheral mononuclear blood cells of the patients with pSS. Furthermore, the expression levels of these miRNAs correlated with the patients' clinical features. Our data suggest that miR-146a and miR-155 might play important roles in the pathogenesis of pSS and that their expression levels may be useful for diagnosing pSS and for predicting disease activity and therapeutic responses., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To develop a dental hygiene care programme based on the specific needs of patients with mental disorders and to suggest practical guidelines to improve the oral health care of these patients., Methods: A total of 73 patients with mental illness participated in the study. The patients were randomly classified into three groups and followed over 12 weeks at 4-week intervals. A newly designed dental hygiene care programme using flash-based video, brochures and a toothpick method was implemented by five dental hygienists. Plaque index, stimulated saliva, subjective oral dryness and dental caries activity were analysed as outcome variables., Results: Results showed that the dental plaque index significantly decreased after each session (P < 0.0001) in all three groups, and significant differences were found between groups (P = 0.036). Patients' oral dryness decreased significantly, but stimulated saliva and dental caries activity did not improve., Conclusion: The results of this study suggest that the dental hygiene care programme, which made use of a short, 10-min flash-based video and brochures every 4 weeks, was effective in reducing the dental plaque index of patients with mental disorders., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The effect of glycemic control on severity of periodontal inflammatory parameters in patients with prediabetes is unknown. The aim of the present study is to assess the effects of glycemic control on self-perceived oral health, periodontal parameters, and marginal bone loss (MBL) in patients with prediabetes., Methods: A total of 303 individuals were included. Hemoglobin A1c (HbA1c) and fasting blood glucose levels (FBGLs) were recorded. Participants were divided into three groups: 1) group A: 75 patients with prediabetes (FBGLs = 100 to 125 mg/dL [HbA1c ≥5%]); 2) group B: 78 individuals previously considered prediabetic but having FBGLs <100 mg/dL (HbA1c <5%) resulting from dietary control; and 3) control group: 150 medically healthy individuals. Self-perceived oral health, socioeconomic status, and education status were determined using a questionnaire. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), and clinical attachment loss (AL) were recorded. Premolar and molar MBLs were measured on panoramic radiographs., Results: Periodontal parameters (PI, BOP, PD, and AL) (P <0.01) and MBL (P <0.01) were worse among individuals in group A than those in group B. Self-perceived gingival bleeding (P <0.001), pain on chewing (P <0.001), dry mouth (P <0.001), and oral burning sensations (P <0.05) were worse among patients in group A than those in group B. There was no difference in periodontal parameters, MBL, and self-perceived oral symptoms among patients with prediabetes in group B and healthy controls., Conclusions: Self-perceived oral health, severity of periodontal parameters, and MBL are worse in patients with prediabetes than controls. Glycemic control significantly reduces the severity of these parameters as well as the state of prediabetes in affected individuals.

Objective: The objective of this study was to clarify differences in oral health status between patients who needed haemodialysis (HD) owing to diabetic nephropathy (DN) and chronic glomerulonephritis (CGN)., Materials and Methods: Ninety-eight HD patients who were 50-70 years old were selected as the study subjects [DN group (29 subjects) and CGN group (69 subjects)] to compare with 106 control subjects (control group) not undergoing HD. All HD subjects underwent oral- and systemic-related examination just before HD therapy., Results: The mean number of teeth present in the DN group was significantly less than in the CGN and control groups. The mean percentage of sites with bleeding on probing in the DN group was greater than in the CGN and control groups. The mean salivary flow rate in the DN and CGN groups was significantly lower compared with the control group., Conclusion: The patients undergoing HD for DN were found to have fewer teeth and worse periodontal health compared with those undergoing HD for CGN and with the control subjects not undergoing HD. Furthermore, the dental and periodontal health of the patients undergoing HD for CGN was comparable to that of the controls., Clinical Relevance: For effective measures of prevention and improvement of oral health in HD patients, clinicians should be aware of the differences in the characteristics of the oral health between patients undergoing HD for DN and CGN.

Root caries is prevalent in elderly disabled nursing home residents in Denmark. This study aimed to compare the effectiveness of tooth brushing with 5,000 versus 1,450 ppm of fluoridated toothpaste (F-toothpaste) for controlling root caries in nursing home residents. The duration of the study was 8 months. Elderly disabled residents (n = 176) in 6 nursing homes in the Copenhagen area consented to take part in the study. They were randomly assigned to use one of the two toothpastes. Both groups had their teeth brushed twice a day by the nursing staff. A total of 125 residents completed the study. Baseline and follow-up clinical examinations were performed by one calibrated examiner. Texture, contour, location and colour of root caries lesions were used to evaluate lesion activity. No differences (p values >0.16) were noted in the baseline examination with regards to age, mouth dryness, wearing of partial or full dentures in one of the jaws, occurrence of plaque and active (2.61 vs. 2.67; SD, 1.7 vs.1.8) or arrested lesions (0.62 vs. 0.63; SD, 1.7 vs. 1.7) between the 5,000 and the 1,450 ppm fluoride groups, respectively. Mean numbers of active root caries lesions at the follow-up examination were 1.05 (2.76) versus 2.55 (1.91) and mean numbers of arrested caries lesions were 2.13 (1.68) versus 0.61 (1.76) in the 5,000 and the 1,450 ppm fluoride groups, respectively (p < 0.001). To conclude, 5,000 ppm F-toothpaste is significantly more effective for controlling root caries lesion progression and promoting remineralization compared to 1,450 ppm F-toothpaste., (Copyright © 2013 S. Karger AG, Basel.)

Purpose: We report the results of a phase II study to determine the reproducibility of a submandibular salivary gland transfer (SGT) surgical technique for prevention of radiation (XRT)-induced xerostomia in a multi-institutional setting and to assess severity of xerostomia., Methods and Materials: Eligible patients had surgery for primary, neck dissection, and SGT, followed by XRT, during which the transferred salivary gland was shielded. Intensity modulated radiation therapy, amifostine, and pilocarpine were not allowed, but postoperative chemotherapy was allowed. Each operation was reviewed by 2 reviewers and radiation by 1 reviewer. If 13 or more (of 43) were "not per protocol," then the technique would be considered not reproducible as per study design. The secondary endpoint was the rate of acute xerostomia, grade 2 or higher, and a rate of ≤ 51% was acceptable., Results: Forty-four of the total 49 patients were analyzable: male (81.8%), oropharynx (63.6%), stage IV (61.4%), median age 56.5 years. SGT was "per protocol" or within acceptable variation in 34 patients (77.3%) and XRT in 79.5%. Nine patients (20.9%) developed grade 2 acute xerostomia; 2 had grade 0-1 xerostomia (4.7%) but started on amifostine/pilocarpine. Treatment for these 11 patients (25.6%) was considered a failure for the xerostomia endpoint. Thirteen patients died; median follow-up for 31 surviving patients was 2.9 years. Two-year overall and disease-free survival rates were 76.4% and 71.7%, respectively., Conclusions: The technique of submandibular SGT is reproducible in a multicenter setting. Seventy-four percent of patients were prevented from XRT-induced acute xerostomia., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Diagnostic and classification criteria for Sjögren's syndrome (SS) continue to evolve as more is learned about SS and about autoimmune diseases in general. Among diagnostic or classification criteria for SS that are in current use, most include various and variable combinations of results from questions about symptoms and objective tests, many of which are not specific to SS. Given the rapid increase of genetic knowledge about other autoimmune diseases and the potential of finding and testing new biological agents to treat SS, selection of patients who have as uniform a disease process as possible becomes an important goal to better understand and treat this prevalent autoimmune disease. Such is the goal and promise of the latest entry into the SS classification criteria field., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

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.

Hyposalivation is a long-term effect in patients receiving head and neck radiation. Radiotherapy can predispose oral colonization by Candida species of the mucosa. This study aims to evaluate the correlation between hyposalivation, measured by unstimulated saliva flow rates (SFR) and fungal colonization of the oral cavity, and also the resistance of isolated Candida strains to antimicrobial therapy. Fifty-three consecutive patients with radiotherapy were examined for late radiation damage on dental hard tissue and the salivary glands (SFR over a period of 5 min). The SFR were divided into three different values of hyposalivation: grade I (SFR 0.1-0.25 ml/min), grade II (SFR ≤0.1 ml/min), and grade III (SFR = 0.0 ml/min). Candidal colonization was defined using Sabouraud agar and identified using API 20C AUX (biomerieux) in the patients' rinsing water. Susceptibility was tested with Etest (amphotericin B, ketoconacole, voriconacole, and fluconacole). Hyposalivation grade I was detected in 23% (9.1 × 10(1) colony forming units (cfu); range, 200-5,900 cfu), hyposalivation grade II in 26% (4.3 × 10(1) cfu; range, 110-3,300 cfu), and hyposalivation grade III in 51% (2.0 × 10(3) cfu; range, 300-19,475 cfu) of patients. A significant correlation between the SFR and candidal colonization and clinical presentation (European Organization for Research and Treatment of Cancer (EORTC) score) was detected (Mann-Whitney test, p = 0.031). Twenty Candida albicans and 27 non-albicans species were identified. The resistance of C. albicans was higher than that of non-albicans strains against antimicrobial agents. By comparison, amphotericin B showed the greatest and fluconazole the least effect. A higher value of hyposalivation correlates with a higher risk of candidal colonization in patients who have received radiotherapy and also with a higher EORTC score. The spectrum of Candida is wide and susceptibility against antifungal therapy differs. In long-term examinations of patients with xerostomia after radiotherapy, the EORTC score can be used to measure hyposalivation. Reduced susceptibility of C. albicans might introduce complications to therapy. Findings of more non-albicans strains show a change in colonization which should be examined in further studies.

Background: Periodontal treatment is associated with lower hemoglobin A1c in individuals with diabetes, but the relationship between oral hygiene practices and A1c among youth with diabetes is understudied., Methods: This study evaluates the cross-sectional relationships among oral health habits, reported oral conditions, and A1c and control of diabetes among a subset of youth with diabetes enrolled in the SEARCH for Diabetes in Youth study in South Carolina. Oral hygiene practices were determined by questionnaire, and periodontal bone loss was defined as alveolar bone loss ≥3 mm on ≥1 permanent tooth site on preexisting bitewing radiographs. A1c was considered controlled if individuals were aged ≤6 years with A1c <8.5%; aged 7 to 11 years with A1c <8.0%; aged 12 to 18 years with A1c <7.5%; and aged ≥19 years with A1c <7.0%., Results: Among 155 participants, 68% brushed their teeth no less than once daily, 84% flossed, and 70% rinsed, respectively, less than once a week. Diabetes control was associated with toothbrushing (≥1 time daily [odds ratio (OR) = 3.10; 95% confidence interval (CI) = 1.26 to 7.62] and using mouthrinse at least once weekly (OR = 3.33; 95% CI = 1.30 to 8.54) after multivariate adjustment. Periodontal bone loss was three times more common among those with dry mouth (OR = 3.05; 95% CI = 1.07 to 8.70)., Conclusions: Clinicians should be aware that children with diabetes tend to have poor oral hygiene practices. Dry mouth may indicate periodontal bone loss in children with diabetes.

Objective: To study the associations of instrumental activities of daily living (IADL) and the handgrip strength with oral self-care among dentate home-dwelling elderly people in Finland., Materials and Methods: The study analysed data for 168 dentate participants (mean age 80.6 years) in the population-based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study. Each participant received a clinical oral examination and structured interview in 2004-2005. Functional status was assessed using the IADL scale and handgrip strength was measured using handheld dynamometry., Results: Study participants with high IADL (scores 7-8) had odds ratios (ORs) for brushing their teeth at least twice a day of 2.7 [95% confidence intervals (CI) 1.1-6.8], for using toothpaste at least twice a day of 2.0 (CI 0.8-5.2) and for having good oral hygiene of 2.8 (CI 1.0-8.3) when compared with participants with low IADL (scores ≤6). Participants in the upper tertiles of the handgrip strength had ORs for brushing the teeth at least twice a day of 0.9 (CI 0.4-1.9), for using the toothpaste at least twice a day of 0.9 (CI 0.4-1.8) and for good oral hygiene of 1.1 (CI 0.5-2.4) in comparison with the study subjects in the lowest tertile of handgrip strength., Conclusion: The results of this study suggest that the functional status, measured by means of the IADL scale, but not handgrip strength, is an important determinant of oral self-care among the home-dwelling elderly., (© 2012 The Gerodontology Society and John Wiley & Sons A/S.)

Using osseointegrated implants to replace teeth is a routine procedure today. This study investigated oral status, oral hygiene habits, and patient satisfaction in elderly with dental implants who were dependent on substantial support for daily living. Twenty-six persons over the age of 65 who were dependent on supportive care were examined. Data collected included the number of teeth and implants, plaque scores, bleeding on probing, and oral hygiene habits. Self-perceived knowledge about managing their implants and satisfaction with the implants was recorded. Subjects had a total of 148 natural teeth and 144 implants. Only a few signs of oral disease were found and the tissues around implants were healthier than around natural teeth. No correlations between oral hygiene habits and plaque scores or bleeding were found. A majority of the subjects were satisfied with their implants. Dental implants have satisfactory function even in individuals who are elderly and have substantial needs for supportive care., (© 2012 Special Care Dentistry Association and Wiley Periodicals, Inc.)

Background: Dry mouth is a frequent complaint of adults worldwide. In those who experience dry mouth, therapeutic options include the use of salivary substitutes and sialogogues., Methods: The authors compared the efficacy and safety of mucoadhesive disks (OraMoist, Axiomedic, Zurich; distributed by Quantum Health, Eugene, Ore.) applied three times daily with those of placebo mucoadhesive disks in a double-masked, randomized, controlled crossover study. The primary end point of interest was within-participant differences in subjective (visual analog scale) ratings of dry mouth according to the New York University Bluestone Mouthfeel Questionnaire. The secondary end point was within-participant differences in salivary flow rates., Results: Twenty-seven participants completed the single-site study. The results showed no significant difference between the two types of mucoadhesive disks, both of which were associated with a statistically significant improvement in the subjective experience of moistness across the 60-minute period after application and compared with baseline measures after two weeks of use. Furthermore, both disks were associated with a statistically significant improvement in salivary flow rates across the 60-minute period after application and compared with baseline measures after one and two weeks of use. The disks were well tolerated, and participants did not report any adverse events., Conclusions: The mucoadhesive disks used in this study were safe and provided symptomatic relief from dry mouth. Practice Implications. Patients with dry mouth may benefit from this novel delivery system.

Background: Older adults are susceptible to reduced saliva production related to certain medications, radiation and chronic conditions. Many of these people have many physical and oral health problems and limited access to dental care. The use of effective screening tools for xerostomia and hyposalivation would be helpful in identifying those at risk. The authors conducted a study to investigate the association between three measures of oral dryness: hyposalivation (low unstimulated salivary flow), self-reported xerostomia and clinically assessed dry mouth., Methods: The authors included a convenience sample of 252 nondemented and dentate West Virginia participants 70 years and older who were part of a larger study on oral health and cognition among older adults. Participants completed a self-reported xerostomia index, provided an unstipulated salivary sample and underwent an oral assessment for the study., Results: Twenty-eight participants (11.1 percent) had hyposalivation, eight of whom reported having xerostomia (sensitivity=28.6 percent). Of the 43 participants who reported having xerostomia, only eight had hyposalivation (positive predictive value=18.6 percent). Hyposalivation and self-reported xerostomia were not significantly related. Clinically assessed dry mouth correlated modestly, but significantly, with hyposalivation and self-reported xerostomia., Conclusions: Obtaining routine unstimulated salivary flow rates in addition to self-reported information and oral evaluations may increase early detection of oral dryness, which would assist in implementing early interventions to improve patients' quality of life., Clinical Implications: Visually inspecting oral tissues for dryness and asking a patient if his or her mouth is dry are insufficient measures for clinicians to use to determine if the patient has hyposalivation. The authors recommend that clinicians determine the patient's unstimulated salivary flow rate.

Objective: To assess the severity of xerostomia (subjective dry mouth) in haematopoietic stem cell transplantation (HSCT) patients and to investigate the association of xerostomia with other chronic oral complications., Design: Cross-sectional study.Study participants and methods Participants were 48 patients with a history of HSCT recruited among members of the Dutch Stem Cell Transplantation Contact Group, and a comparison group of 41 age- and sex-matched individuals. Data were collected using the Xerostomia Inventory (XI score) and a seven-item oral health questionnaire., Results: HSCT patients had a higher XI score than the comparison group, and a greater severity of several oral complaints: painful oral mucosa, altered taste, limited opening of the mouth and problems with tooth brushing. HSCT patients did not report greater pain during cold stimulation of teeth, chipped and cracked teeth or bleeding gums. In HSCT patients, the XI score correlated significantly with the severity of oral mucosal pain, altered taste, limited opening of the mouth, painful teeth following cold stimuli, chipped or cracked teeth, problems with tooth brushing and bleeding gums. In the comparison group, no correlations were observed between XI score and these oral problems., Conclusion: HSCT patients have more severe xerostomia, which is associated with other oral complaints. Dental professionals should monitor these patients post-transplant for oral complications. Symptoms of dry mouth should be relieved and secondary complications should be prevented.

Aim: Measurement of volatile sulphur compounds (VSC) by portable sulphur monitors (Halimeter, OralChroma) is a common practice for diagnosis of oral malodour. In this study, the clinical value of these devices was examined., Materials and Methods: Two hundred and eighty patients with bad breath complaints attending a halitosis consultation were enrolled. Organoleptic scores were given by a trained and calibrated judge, before measurement of the VSC levels (Halimeter, OralChroma), to avoid any bias., Results: Significant correlations were found between the organoleptic assessment, the Halimeter, and the OralChroma (R=0.74 for organoleptic versus Halimeter; 0.66 for organoleptic versus OralChroma; 0.63 for Halimeterversus OralChroma). The sensitivity and specificity (with regard to the organoleptic score) to detect patients with/without oral malodour for the Halimeter were 63% and 98%, respectively, and for the OralChroma 69% and 100% when using the cutoffs suggested by the manufacturer. By lowering these values, sensitivity could be improved without a significant decrease in specificity (both devices)., Conclusions: We concluded that the measurement of the VSC levels can be used as an adjunct to the organoleptic assessment. Thresholds should be revisited in order to improve their clinical utility. These devices can prove the absence of malodour in case of pseudo-halitosis.

Sjögren syndrome (SS) is a chronic inflammatory autoimmune disease of unknown cause whose main characteristic is severe dryness of the eyes and the mouth. The decreased functional capacity of the lacrimal and salivary glands which is the result of the inflammatory process and lymphocytic infiltration observed in SS is accountable for this complication. Twenty-nine patients with SS whose ages were ranging between 24-77, who were under treatment in Ege University Faculty of Medicine Department of Rheumatology, participated in the study, and their informed consents were obtained upon enrollment. Each patient recorded their subjective complaints on a separate questionnaire. The baseline and subsequent evaluation of the subjective findings on predetermined times (1 h after application of the material, at the end of the 1st, 7th, and 14th days) were also recorded on separate questionnaire sheets. Throughout the 14-day treatment period, no statistically significant differences were noted between the Xialine and placebo groups with regard to burning tongue, diminished taste, and waking up at night to sip water (p = 0.925, 0.527, and 0.066, respectively). However, patients' satisfaction with placebo decreased by 25.63% at the end of the test period, whereas it increased by 16.37% after Xialine administration. Overall, the patients preferred Xialine at the end of the study (p = 0.011). The main motive to administer saliva substitute is to improve lubrication and hydration of oral tissues. The results of this study indicated that Xialine is helpful in the management of xerostomia-related symptoms of SS patients. However, further investigations in larger scale group of patients are recommended to provide the effects of these agents on various complaints of xerostomia.

Objective: To examine the responsiveness to change of the Xerostomia Inventory (XI)., Background: The XI is an 11-item summated rating scale which results in a single continuous scale score representing the severity of chronic xerostomia. While the XI has been used as an outcome measure in clinical research, the magnitude of a clinically meaningful change score has yet to be determined., Methods: This study comprises a secondary analysis of data from a longitudinal study of changes in xerostomia symptoms in two groups whose symptom trajectories were likely to differ substantially: the normal group was a convenience sample of asymptomatic middle-aged and older individuals with otherwise stable perceptions of mouth dryness; and the onset group comprised patients who were about to undergo radiotherapy for head/neck cancer (and would therefore be expected to develop more severe xerostomia after the baseline measurements). Statistical analyses examined cross-sectional construct validity and internal consistency, test-retest reliability and the measure's responsiveness and longitudinal construct validity. The mean change scores of those for whom 'a little' improvement was reported were used to determine the minimally important difference for the XI., Results: Over two-thirds of the onset group members reported dry mouth 'frequently' or 'always' at follow-up (2 months) and there was a concomitant increase in their mean XI score. Test-retest reliability was acceptable. Examination of within-individual change among those who changed and those for whom stability was observed, showed that only those who worsened had significantly greater XI scores at follow-up. The minimally important difference to reflect deterioration in xerostomia symptoms was determined to be 6 scale points. Between baseline and 2 months, the XI scores of 32 participants (33.7%) deteriorated by the minimally important difference (7.1% and 54.7% respectively among the normal and onset groups; p < 0.0001)., Conclusion: The validity and responsiveness of the XI appear to be acceptable, and a change in XI score of 6 or more points is clinically meaningful.

Background: The aim of the study was to record the findings from intra-oral examination and the general health conditions encountered in a group of Greek individuals 65 years of age or older., Patients and Methods: The study subjects were derived from the elderly attending 12 randomly selected community centres located in Athens and neighbouring municipalities, consisting the non-institutionalized study group and from the elderly living in three ecclesiastical nursing homes, consisting the institutionalized study group. The research data comprised information from the subjects' interviews, self-defined health status, medical records and intra-oral examination on the following variables: sex, age, general health condition, dentate or not, use of dentures and oral conditions. Fisher's exact two-sided test was used for statistical analysis., Results: Overall, 316 patients were examined; 120 male (38%), 196 female (62%), mean age 78 years (range: 65-99). Of those, 150 were non-institutionalized (59 male, 91 female) and 166 institutionalized (61 male and 105 female). The vast majority (90%) of the patients had at least one general health problem, for which they were taking daily medication. Twenty-three different medical conditions were recorded. The most frequent medical problems were hypertension (56%), cardiovascular problems (41%), depression/anxiety (39%), arthritis (18.5%) and visual problems (16%). The vast majority of the study patients (79%) were edentulous, while 33% were not wearing or using their dentures. Almost half of them (47%) had at least one oral condition. Twenty-seven different oral conditions were recorded. The most frequent oral findings were denture-induced stomatitis (17.2%), dry mouth (14.6%), atrophy of tongue papillae (10.5%), fissured tongue (9.8%) and haemangioma (6.8%). No cases of malignant lesions were observed., Conclusions: The present study confirms that in this particular age group, general health problems are frequent, variable, coexistent, necessitating the daily administration of multiple medications, while oral examination by a specialist is an essential part of the multidisciplinary medical care in this group of individuals.

Objective: To compare the proposed criteria for the diagnosis of primary Sjögren's syndrome (pSS) in childhood to the validated American-European Consensus Group (AECG) classification criteria for pSS in adults., Methods: Charts of 7 children with pSS seen at British Columbia's Children's Hospital (BCCH) and data on 128 children identified through Medline in the English language literature between 1963 and 2003 were reviewed for pediatric and AECG criteria for pSS. The presence of > or = 4 criteria was required to satisfy the respective classification criteria. The expert clinical opinion of pediatric rheumatologists was considered the gold standard for diagnosis., Results: A total of 24/62 (39%) cases satisfied the AECG criteria; 47/62 (76%) satisfied the proposed pediatric criteria. Inclusion of recurrent parotitis increased the sensitivity of the pediatric clinical criteria. From the cases, 78/133 (59%) satisfied the pediatric oral symptom criteria; only 6/78 (8%) had xerostomia in the absence of recurrent parotitis. There was no reported case of recurrent conjunctivitis in the absence of keratoconjunctivitis sicca. We found 101/130 (78%) cases had at least one positive autoantibody test result [antinuclear antibodies (ANA), rheumatoid factor (RF), SSA, SSB]; 78/123 (63%) had autoantibodies to SSA or SSB., Conclusion: The AECG adult criteria for pSS should not be applied to children as the sensitivity is unacceptably low. The inclusion of recurrent parotitis increases the sensitivity of the pediatric criteria, and recurrent parotitis should alert the clinician to the possibility of pSS. The inclusion of recurrent conjunctivitis did not improve the sensitivity over the AECG ocular criteria. The addition of ANA and RF to the AECG criteria did not change the number of patients satisfying the criteria for pediatric pSS.

Purpose: To evaluate xerostomia following intensity-modulated radiation therapy (IMRT)., Materials and Methods: An institutional review board-approved study of xerostomia was conducted in 210 head and neck cancer patients who were beyond the acute recovery phase (> 1 year) after radiation therapy. Xerostomia was evaluated with the 8-question XQ developed and validated at the University of Michigan., Results: Median XQ scores (normalized so that no xerostomia = 0 and maximum xerostomia = 100) were larynx-only group, 4 points, ipsilateral radiotherapy, 34 points; bilateral radiotherapy, 64 points; IMRT with mean contralateral parotid dose more than 26 Gy, 44 points; and IMRT with mean contralateral parotid dose 26 Gy or less, 32 points (P < 0.05 for all major comparisons)., Conclusion: The XQ is an excellent tool for identifying important differences in xerostomia after radiation therapy for head and neck cancer. The authors' IMRT program decreases the severity of xerostomia symptoms compared with what is typically seen after conventional radiation therapy.

Anxiolytic drugs are widely used for premedication in oral surgery. Since anxiety is usually associated with the fear of pain, we tested the effects of the analgesic tramadol in premedication before operative extraction of the mandibular third molar under local anesthesia. In a double-blind crossover study, 20 patients were randomized to receive 100 mg oral tramadol or placebo 1 h before operation. Anxiety, nausea, dryness of the mouth, pain and discomfort were recorded before administration of the drug, immediately before and after operation, and 0.5, 1, and 2 h postoperatively using ungraded 0-100 mm VAS scales. Blood pressure and heart rate were measured at the same times; vigilance was tested using the Maddox Wing Test and sensorimotor performance using the Trieger Dot Test; hemoglobin oxygen saturation (SpO2) was measured using a pulse oximeter. In addition, SpO2 and heart rate were recorded continuously in nine patients using a pulse oximeter connected to a computer. The surgeon assessed the quality of operating conditions on the VAS scale. Tramadol delayed and decreased the need of analgesics on the day of operation (p < 0.05). The operating conditions were better in patients on tramadol premedication than in those on placebo during the first operation (p < 0.05), but no differences were seen in patient well-being between treatments. The second operation was less stressful than the first. Tramadol is recommended only with special indications for premedication of patients undergoing third molar extraction under local anesthesia.

The authors sent a questionnaire to a random sample of general dentists in Ontario, Canada, to assess the types of non-clinical information (NCI) dentists usually obtain during initial examinations of older patients. From a list of 11 NCI questions, dentists indicated which questions they usually asked during new patient examinations. The adjusted response rate was 34% (n = 672). Respondents most often asked about pain and satisfaction with the appearance of teeth and/or dentures. About half the respondents asked about oral dryness and whether problems with chewing had limited food choices. Respondents were least likely to ask about problems with speaking and avoidance of eating with others because of chewing problems. Traits of those who asked the least common NCI questions typically including continuing education courses in geriatric dentistry, self-perceived competence in treating elderly adults living in institutional settings, exposure to geriatric outreach settings during dental school and greater dentist involvement in patient history taking.

We evaluated the role of quantitative indices derived from dynamic 99mTc-pertechnetate salivary scintigraphy in the differentiation between a group of patients with Sjögren's syndrome (SS), a group of patients without xerostomia, but with underlying autoimmune disorders, and a group of controls. Seventeen patients with SS (group A), 18 patients with autoimmune disorders (group B) and 15 controls (group C) underwent dynamic salivary gland scintigraphy. Functional indices for the parotid and submandibular glands were calculated and comparisons were made between the groups. There were no significant differences between the three groups in terms of the maximum accumulation (MA), maximum secretion (MS) and pre-stimulatory oral index (PRI). The uptake ratios (URs) for both the right and left parotid glands and the left submandibular gland in group A were significantly lower than those in group C, but no different from those in group B. The URs for the parotid glands in group B were significantly less than those in group C. The percentage uptake by the right parotid gland at 4 min (U4) was significantly lower in group A than in groups B or C, and lower than the percentage uptake by the left parotid gland at 4 min in group A. The rest of the U4 values and all of the uptakes at 14 min (U14) were not significantly different between the three groups. The time taken for the right parotid gland to reach peak activity (Tmax) was significantly less in group A than in the other groups, but other glands showed no significant differences. It can be concluded that MA, MS and PRI cannot be used to differentiate between the three groups. The URs in groups A and B were no different, but were significantly lower than those in group C. However, the extensive overlap between xerostomic patients and normal controls for all the quantitative indices calculated imposes a severe limitation on their discriminatory power., (2003 Lippincott Williams & Wilkins)

Objective: To measure the oral health status of southern Chinese nasopharyngeal carcinoma (NPC) survivors 1-4 years after radiotherapy., Subjects and Methods: A total of 109 subjects participated in this cross-sectional study. Thirty-eight subjects were NPC survivors, 40 subjects were patients newly diagnosed with NPC and 31 were healthy subjects. Verified clinical examination techniques were used to assess limitation of jaw opening, the presence of mucositis, candidiasis, dental caries, periodontal disease [community periodontal index (CPI)] including attachment loss (ALoss) and prosthetic status/need. Differences among three groups were tested by chi-squared and Kruskal-Wallis tests. Relationships between selected clinical variables and radiation parameters were analysed using Spearman's rank correlation coefficients., Results: The NPC survivors attended for dental treatment more frequently than the other groups (P < 0.01). NPC survivors had significant xerostomia (92%, P < 0.01), trismus (29%, P < 0.01), a higher prevalence of clinical candidiasis (24%, P < 0.01), a greater DMFT (16.4 +/- 7.0, P < 0.01), more decay/filled roots (2.1 +/- 2.9, P = 0.01) compared with new NPC patients and controls. No difference was found in CPI, ALoss, prosthetic status and need between groups. Dry mouth and tooth hypersensitivity were the most common oral problems perceived by the NPC survivors., Conclusion: Despite having regular dental follow-ups, oral health was compromised in NPC survivors 1-4 years postradiotherapy.

Background: A validated measure to assess sicca-related symptoms in patients with primary Sjögren's syndrome (1 degrees SS) is required for clinical studies., Methods: A self-administered questionnaire was developed to assess sicca-related symptoms and dysfunction in 1 degrees SS. This was administered to three groups of 40 respondents to measure construct validity: 1 degrees SS patients, non-SS patients reporting xerostomia and a non-patient group. The frequency of scores and the mean score for each question were calculated for each group. Reliability was assessed by test/retest., Results: The measure consisted of 28 items divided into five domains. Scores for questions in domains were generally worse (higher) for 1 degrees SS patients than for patients with xerostomia. The non-patient group reported the best (lowest) scores for all questions. The Kappa statistic for all but four questions was greater than 0.6, suggesting good reliability., Conclusion: Questionnaire showed good construct validity and reliability. The Liverpool sicca index needs to be further validated in larger, multicentre studies.

Purpose: Sialadenitis is a well-recognized adverse effect of high-dose radioactive iodine treatment. This study was undertaken to determine whether Tc-99m pertechnetate salivary gland scintigraphy may be used for objective assessment of salivary gland function in patients with thyroid cancer treated with I-131., Patients and Methods: The study group consisted of 71 patients (16 men, 55 women) with a mean age of 44 years (range, 16 to 73 years). Twenty-six (37%) patients were not given any radioiodine, and 18, 16, and 11 patients received doses of 100, 150, or 200 mCi (or higher), respectively. Parotid and submandibular glands were evaluated based on a four-grade scoring system. Correlation between the type of surgery, administered dose, time since therapy, subjective symptoms, and findings of salivary gland scintigraphy were evaluated., Results: Subjective symptoms were questioned in 39 of the 45 patients who received radioactive iodine treatment. Fifty-four percent (21 of 39) of the patients reported xerostomia, of whom 86% (18 of 21) showed salivary gland dysfunction. Objective salivary gland dysfunction was observed in 69% (31 of 45) of patients. In 81% of the patients, the parotid glands were affected; in 13% of the patients, the submandibular glands were affected; and in 6%, both were affected ( < 0.000001). The frequency of salivary gland dysfunction showed a dose dependence to cumulative activity ( = 0.007). A greater complication rate was observed in patients with total thyroidectomy compared with subtotal surgery, although the correlation was not significant ( = 0.625)., Conclusions: Parenchymal damage to the salivary glands induced by radioactive iodine treatment can be evaluated by salivary gland scintigraphy. The impairment is worse in the parotid glands and increases with the total dose.

Objective: The purpose of this study was to determine whether systolic and diastolic blood pressures are associated with salivary flow, dry mouth, or dry eye symptoms in patients with primary Sjögren's syndrome as compared with xerostomic control subjects., Study Design: One hundred forty consecutive patients seen at the Sjögren's Syndrome Clinic were categorized retrospectively with various classification schemes: (1) subjective dry mouth; (2) subjective dry eye; (3) European criteria; and (4) international criteria. Data collection included age, gender, systolic blood pressure, diastolic blood pressure, salivary flow rate, focus score, Schirmer's test, and laboratory findings, including antinuclear antibodies, anti-SSA, anti-SSB, IgG, IgA, IgM, erythrocyte sedimentation rate, and rheumatoid factor., Results: No meaningful associations of salivary flow rates with systolic or diastolic blood pressures were found in patients with Sjögren's syndrome or in xerostomic control subjects. An inverse correlation was seen between salivary flow and elevated diastolic blood pressure in xerostomic control subjects only., Conclusion: Elevated blood pressure was not related to saliva flow in patients with Sjögren's syndrome.

Objective: To evaluate the characteristics of patients presenting with symptoms suggestive of Sjögren's syndrome (SS) but failing to satisfy diagnostic criteria., Methods: Clinical, serological and histological data were collected on 34 patients presenting with dry eyes and/or mouth who did not satisfy the Vitali criteria for the diagnosis of SS. They were compared with 136 patients with primary SS, 38 patients with secondary SS, and 13 patients without SS. Questionnaires on symptoms from each group were compared with 43 healthy controls., Results: The 34 patients who did not satisfy the diagnostic criteria for SS or any other connective tissue disease were designated dry eyes and mouth syndrome (DEMS). Their demography including age was similar to that of a primary SS group and there was no more atrophy seen on their biopsies compared with SS and non-SS controls. They scored highly on visual analogue scales of symptoms but had few objective signs. All were negative for anti-Ro and anti-La although the prevalence of antinuclear antibodies (19%) was increased compared with a normal population. There was no excess of SS-associated tissue types., Conclusion: There was no evidence that age, salivary gland atrophy or subclinical SS accounted for the symptoms in DEMS. Most of the patients fitted into a spectrum of disease which tended more towards fibromyalgia and/or chronic fatigue syndrome.

The sensation of dry mouth is a common problem, often neglected. The decrease of salivary flow causes chronic oral discomfort and functional problems and predisposes to rampant dental caries and oral candidiasis. Various methods are described to evaluate salivary gland hypofunction but no single test has sufficiently high specificity and sensitivity. Categorised questionnaires and unstimulated whole saliva flow are valuable. The causes of xerostomia are numerous, of which the principal are, drug or radiation induced xerostomia and primary an secondary Sjögren's syndrome. Treatment calls for good hydration, optimal oral hygiene and prophylaxis of candidosis. All unnecessary medications must be avoided. Oral pilocarpine is the only drug which had demonstrated beneficial effects if no contraindications exist.

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

Dry mouth must not be considered a trivial problem in the population, since it constitutes a phenomenon with many aspects relative to oral function as well as quality of life. Up until today, no global consensus has been reached with regard to the terminology of dry mouth, creating a substantial problem for research, education, diagnosis, and therapy. In this report, salivary gland hypofunction has been selected as the overarching term for subjective symptoms and objective signs of dry mouth. Its different aspects--xerostomia, hyposalivation, and altered saliva composition--are reviewed with respect to prevalence, diagnosis, and etiology. It is concluded that these aspects of salivary gland hypofunction are separate entities, which in many respects are interrelated, constituting not merely a dental but also a medical and social concern.

Objective: There is no consensus on the possible association between diabetes and salivary dysfunction in older persons with diabetes. This study's purpose was to investigate the effect of diabetes and glycemic control on salivary function in an older population., Study Design: Twenty nine persons with type 2 diabetes and 23 nondiabetic control subjects participated (age range, 54-90 years). Diabetic status was determined by a glycosylated hemoglobin (HbA(1c)) test and a 2-hour glucose tolerance test. Poor glycemic control was defined as HbA(1c) >9%. Unstimulated whole saliva, unstimulated parotid, and stimulated parotid flow rates were measured, and subjects completed a standardized xerostomia questionnaire., Results: Persons with poorly controlled diabetes had lower (P =.01) stimulated parotid flow rates than persons with well-controlled diabetes and nondiabetic control subjects. There were no significant differences in xerostomic complaints based on diabetic or glycemic control status or salivary flow rates., Conclusions: These results provide some evidence that poorly controlled diabetes may be associated with salivary dysfunction in older adults who have no concomitant complaints of xerostomia.

The symptom of dry mouth was correlated with unstimulated (UWSFR) and stimulated (SWSFR) whole-saliva flow rate on chewing medical paraffin in 62 patients with dry-mouth complaints (30 with Sjögren's syndrome, 32 with sialosis) and 23 controls. The symptom of dry mouth was classified into grades 0,1,2,3,4 according to a Treatment Emergent Symptom Scale (TESS). UWSFR and SWSFR were determined after fasting in the morning. UWSFR was 0.070 +/- 0.089 ml/min in Sjögren's syndrome, 0.175 +/- 0.115 ml/min in sialosis, 0.330 +/- 0.188 ml/min in controls. SWSFR was 0.709 +/- 0.720 ml/min in Sjögren's syndrome, 1.561 +/- 0.867 ml/min in sialosis, 1.894 +/- 0.661 ml/min in controls. A highly significant correlation was found between TESS score and UWSFR and between TESS score and SWSFR. Only UWSFR was decreased in the patients with a TESS score of 1 or 2, while both UWSFR and SWSFR were significantly decreased in the patients with TESS scores of 3, 4. It is concluded that UWSFR is more sensitive in relation to dry-mouth complaints than SWSFR, and that a mild dry mouth is mainly related to decreased UWSFR.

Bipolar disorder (manic depressive disease) affects 1% of the United States population. These persons suffer from episodes of extreme elation followed by long periods of depression. Dental screening examinations of 40 patients consecutively admitted to the medical center with this diagnosis were performed. Poor oral hygiene, accumulations of supragingival and subgingival calculus, extensive dental caries, and numerous missing teeth were commonly identified. The majority of patients with bipolar disorder are treated with lithium carbonate. The physiological effects of lithium, and its interaction with drugs used in dentistry are reviewed, and disease-specific modifications in dental treatment are recommended.

Personal experience with the sugar cube test for evaluating the degree of xerostomy induced by radiation therapy carried out by means of 60Co photons on volumes including the parotid glands is reported. The execution technique is described and the processing of data deriving from a series of 480 tests carried out in 60 patients suffering from head-neck cancers reported. On the basis of experience it is maintained that the test presents the following advantages: simple execution, maximum tolerance, easy evaluation, possibility of numerically quantifying and graphically evidencing the course of xerostomy; in conclusion, it is considered that this can be advantageously adopted for both research and practical clinico-therapeutic purposes.