A longitudinal analysis of salivary flow in control subjects and older adults with type 2 diabetes.

OBJECTIVE: Many diabetics complain of xerostomia, a condition that can affect oral health, nutritional status, and diet selection. This study's purposes were (1) to investigate the effect on salivary flow of type 2 diabetes and change in glycemic control in a group of older adults over time and (2) to compare flow rates with subjective complaints of xerostomia. STUDY DESIGN: A total of 39 older adults, 24 with type 2 diabetes and 15 who were nondiabetic (controls), aged 54-90 years, participated in a 1-year follow-up study. Diabetic status was determined by means of glycosylated hemoglobin (HbA1c) levels and 2-hour glucose tolerance tests. Poor glycemic control was defined as HbA1c > 9%. Unstimulated whole, unstimulated parotid, and stimulated parotid saliva flow rates were measured for all subjects by a single examiner at baseline and 1 year later. Each subject completed a standardized xerostomia questionnaire at every visit. RESULTS: Age, sex, and duration of diabetes did not adversely affect salivary flow rates. Subjects with poorly controlled diabetes had significantly lower stimulated parotid saliva flow rates at both visits. There were no significant changes in flow rates over time on the basis of diabetic status or glycemic control. Subjects with diabetes reported significantly more complaints of thirst but not of xerostomia at 1 year. CONCLUSIONS: These results suggest that older adults with poorly controlled diabetes may have impaired salivary flow in comparison with subjects with better controlled diabetes and nondiabetic subjects, yet they may not have concomitant xerostomic complaints. There were no significant changes in salivary flow rates or glycemic control over the 1-year period.

Salivary function and glycemic control in older persons with diabetes.

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.

General anesthesia protocol for the dental patient: emphasis for older adults.

As the population ages, with increased retention of the natural dentition, there will be a greater responsibility for dental professionals to maintain the oral health of medically, behaviorally, cognitively, and physically impaired adults. Oral sedatives and nitrous oxide analgesia are frequently and successfully used for dental treatments in these patients. However, many compromised older adults cannot safely tolerate dental treatment with these sedative techniques in an outpatient setting. This paper describes the use of general anesthesia in a hospital environment, coordinated with medical and anesthesia specialists, that is a viable, safe, and effective treatment tool for providing comprehensive dental and oral surgical treatment for the older patient.

Recurrent aphthous stomatitis.

Etiology and Epidemiology: The Greek term aphthai was initially used in relation to disorders of the mouth and is credited to Hippocrates (460-370 BC). Today, recurrent aphthous ulceration, or recurrent aphthous stomatitis (RAS), is recognized as the most common oral mucosal disease known to human beings. Considerable research attention has been devoted to elucidating the causes of RAS; local and systemic conditions, and genetic, immunologic, and infectious microbial factors all have been identified as potential etiopathogenic agents (Table 1). However, to date, no principal etiology has been discovered. Epidemiologic studies indicate that the prevalence of RAS is between 2% and 50% in the general population; most estimates fall between 5% and 25%. In selected groups, such as medical and dental students, it has been observed with a frequency as high as 50% to 60%. The peak age of onset for RAS is between 10 and 19 years. After childhood and adolescence, it may continue throughout the entire human lifespan without geographic or age-, sex-, or race-related preference.

Management of systemic diseases and chronic impairments in older adults: oral health considerations.

This paper reviews the most common systemic diseases and chronic conditions among the elderly. It provides an overview of the adverse effects these conditions and their treatments have on oral health and function and summarizes some treatment methodologies to be employed in the dental office.

Sensory and motor deficits in the elderly: impact on oral health.

Hearing, vision, orthopedic, and speech disorders are the most common impairments in the elderly. Older adults experience other sensory impairments such as olfactory and gustatory dysfunction, as well as oral motor problems including difficulty with mastication, speech, and swallowing. These disorders can directly affect oral health and can impair dental treatment. Therefore, it is imperative that dental health practitioners be cognizant of these conditions and aware of the impact these conditions and their treatments can have on oral health and function. Dental professionals may need to use different communication techniques for patients with vision or hearing losses. Accommodations in the dental office and by dental professionals will help older patients who have sensory and/or motor impairments to preserve their oral health and function and receive dental treatments in a safe and efficacious manner. This paper reviews the most common causes of sensory and motor impairments and their implications for oral health care with treatment modification guidelines for the older patient.