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
Introduction
Numerous people suffer from dry mouth, and previous epidemiological studies highlighted that its prevalence even increases with age.1, 2 In fact, in patients older than 60 years, it has been estimated that by far more than 30% suffer from dry mouth in dependence on the methodology applied for its estimation,1, 3, 4 whereas the overall prevalence ranges between 7% and 29%.5, 6 The correlation between the prevalence of dry mouth and age is – in many causes – caused by the consumption of xerogenic drugs affecting either perception or secretion of saliva; other causes of “dry mouth” in elderly patients include autoimmune diseases or radiation therapy of malignancies. A decreasing production of saliva by the salivary glands with increasing age is, however, still controversially discussed.
Although numerous studies investigated the prevalence of “dry mouth” in elderly patients, only very few of them employed a scientifically sound approach towards the epidemiological evaluation of dry mouth.7 The terms xerostomia and hyposalivation, which may be regarded as the scientifically correct definitions of the subjective (xerostomia)8 and objective (hyposalivation) component of dry mouth, are frequently employed as synonyms. Patients suffering from xerostomia do not necessarily have hyposalivation,9 which underlines that both the subjective and the objective implications of dry mouth need to be determined in a scientifically valid approach. For the determination of xerostomia as the subjective perception of dry mouth, a questionnaire labelled Xerostomia Inventory has been introduced in the recent years,9, 10 which was actually the first scientifically validated tool to investigate the prevalence of xerostomia. For the analysis of hyposalivation, however, the measurement of salivary flow rate is commonly accepted as a simple and reproducible means to determinate either unstimulated or stimulated salivary flow.
The conventional wisdom is that both xerostomia and hyposalivation may limit the quality of life of the affected individuals. In elderly patients, previous studies have identified problems with daily routine as the most frequent complaint associated with xerostomia, including problems with speaking, chewing and biting.4, 11 However, the character and quality of prosthetic restorations and their relation to the quality of life in patients suffering from xerostomia and/or hyposalivation have almost been ignored. Particularly removable denture prostheses cover the marginal and gingival areas of the toothless jaw areas and, in dependence of the number of residual abutment teeth or implants, require saliva as a lubricant and agent for denture retention. The latest national study on oral health issues in Germany revealed that complete dentures are worn by more than 22% of the persons older than 65 years,12 which indicates that prosthetic rehabilitation of patients with removable denture prostheses is still common. With regard to the diminished availability of saliva in patients with hyposalivation, it can be controversially discussed whether these patients have a reduced quality of life in comparison to patients with no or fixed dentures, and also whether it should be recommended to avoid supplying these patients with removable prostheses at all. Although the authors of a recent review on this topic could not identify sufficient scientific evidence for this assumption as a result of the lack of clinical studies,13 it is likely that particularly in patients suffering from either xerostomia or hyposalivation or both, the number of residual teeth and the character of a prosthetic restoration impacts their quality of life.
The primary aim of this clinical study was to elucidate the prevalence of xerostomia and hyposalivation in a cohort of elderly patients taking part in a regular recall programme and to investigate the impact of xerostomia severity and salivary flow on their oral health-related quality of life. The primary study hypothesis was that the quality of life diminishes with an increased perception of xerostomia and decreased salivary flow. In addition to that, dental status and character of potential prosthetic restorations were included as independent variables in regression analyses, as we hypothesized that the quality of life in patients wearing removable or gum-supported dentures is lower than in patients with no or fixed prosthetic restorations or tooth-supported removable restorations.
Section snippets
Study design
The study was performed at the Department of Prosthodontics of the University Medical Center Regensburg, Germany, between January and December 2012. Patients aged 60 years or older, who took part in a regular recall programme offered by the Department of Prosthodontics and had not received prosthodontic treatment for at least 6 months, were asked to participate in the study. Patients suffering from dementia or temporomandibular disorders were excluded, as were patients consuming drugs or saliva
Results
Table 1 shows patient data, GOHAI, and XI scores and stimulated salivary flow rates of the entire cohort and patients with xerostomia and hyposalivation, Table 2 depicts the analysis of the categorical data by displaying the percentage of study participants responding “occasionally”, “fairly often”, or “very often” to the various GOHAI items, and Table 3 shows effect sizes according to mean GOHAI scores for patients with and without xerostomia and hyposalivation.
A prevalence of xerostomia of
Discussion
The results of this clinical study suggest only partial acceptance of the primary research hypothesis, indicating that the quality of life in elderly patients decreases as a function of an increased subjective perception of dry mouth but not stimulated salivary flow.
The results of numerous of the vast amount of studies dealing with the prevalence of xerostomia in elderly patients have to be interpreted with caution, as until the publication of the Xerostomia Inventory questionnaire in its
Conclusions
The results of this pilot study underline the relevance of the subjective sensation of dry mouth on the quality of life of elderly patients and indicate that effective strategies need to be developed to alleviate xerostomia in elderly patients. Within the limitations of this pilot trial, the results indicate that the presence of removable dentures is not a priori correlated to lower quality of life in comparison to patients without removable prosthetic restorations or tooth-supported dentures.
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