Associations between xerostomia and health status indicators in the elderly.

AIMS: This study investigated the associations between xerostomia (dry mouth) (low, moderate and high) with other categorical variables (e.g. demographic and health status indicators). This paper aims to report on the severity of xerostomia in the elderly population and investigate the relationship with other aspects of perceived health. METHOD: Data were obtained from a cross-sectional survey of 225 elderly people from a large multilevel geriatric care centre. The centre consists of three levels of care: an apartment building in which residents live more or less independently, a home for the aged, and a chronic care hospital. Participants in the study were recruited when they attended the dental care facility. Data were collected by means of a personal interview conducted either at the dental care facility or the participant's residence. RESULTS: The mean age was 83 years. Most were females (72%) and almost all (99%) reported one or more chronic medical conditions; 88% had physical disabilities. Xerostomia was recorded on a seven-point scale. Scores were categorised as low, medium or high and the proportions were 49.3%, 30.3% and 20.4% respectively Bivariate analysis showed no association between dry mouth and sex, age, general health change or life satisfaction. However, when the high xerostomia group was separated out and odds ratios calculated they were 2.3 to 4.9 times more likely to experience a negative impact on health than the low group. Xerostomia did not have a significant impact on chewing capacity, morale or stress, although it contributed to the variability of the oral health-related quality of life measures. It was the only variable with a significant effect (OR 2.55) for the Oral Health Impact Profile-14 and displayed a higher odds ratio (2.76) for the Geriatric Oral Health Assessment Index. Self-reported xerostomia in the elderly population can be categorised into a severity scale. Those suffering most from xerostomia are more likely to experience a negative impact on general health. CONCLUSION: The key finding in this study is that xerostomia has a significant and negative impact on the quality of life of elderly individuals, though oral function may be less affected.

Effectiveness of saliva substitute products in the treatment of dry mouth in the elderly: a pilot study.

The aging population is susceptible to developing dry mouth (xerostomia). Elderly patients present all of the major risk factors to acquiring dry mouth which include systemic diseases and disorders, such as diabetes and depression, and the use of numerous medications, including anti-hypertensives and anti-depressants. The consequences of untreated dry mouth are severe limitations of masticatory function and speech, and increased risk of developing caries, periodontal diseases and fungal infections. Assessment of xerostomia, which includes a set of signs and symptoms that impact on the individual, can only be fully explored through a thorough medical history, intra-oral examination and recording the subjective views of patients. This study suggests a methodology for the assessment of xerostomia through a xerostomia questionnaire, which was used to evaluate the effectiveness and acceptability of a saliva substitute product (Biotène) in the treatment of xerostomia in 20 elderly patients exhibiting both severe and moderate symptoms. Wilcoxon signed-ranked tests revealed significant improvements in the number and severity of symptoms between the pre-test and the post-test groups. Biotène products were also found to be effective in the treatment of both severe and moderate symptoms of xerostomia. Biotène saliva substitutes are an acceptable and effective method of treatment for elderly people suffering from dry mouth.

Salivary sIgA and cortisol: markers for functional dependence in older adults.

Elderly persons with health problems and physical limitations have reduced independence. Since poor functional ability is a known risk factor for disease among older populations, including oral disease, this study was undertaken to assess whether salivary defense factors and the stress hormone cortisol are significant markers for functional dependence. Oral examinations; salivary and microbial analyses; and interviews using the Activities of Daily Living (ADD index, the Mini Nutritional Assessment (MNA) and the Perceived Life Stress Questionnaire (PLSQ) were conducted for 123 dentate subjects. Of the subjects, 80 lived independently in the community or in apartments at the Baycrest Centre for Geriatric Care in Toronto, Canada, and 43 resided in the Baycrest nursing home or the Baycrest Hospital. Whole saliva samples were assayed for total secretory immunoglobulin A (sIgA), sIgA1, sIgA2, total protein and cortisol using ELISA. Dependent residents in the nursing home/hospital scored significantly lower in the nutritional assessment, had higher mean PLSQ scores, increased total protein and cortisol concentrations, and reduced salivary flow rates in comparison to ambulatory residents in the community/apartments. In multivariable logistic regression, factors associated with functional dependence were: being male, perceiving income as inadequate, having low salivary flow rate and drinking less than 5 cups of water per day. These results indicate that salivary flow and cortisol may be useful markers of functional dependence; however, the ability of these markers to predict functional decline cannot be confirmed until longitudinal studies are conducted.

Implementing evidence-based practice in undergraduate teaching clinics: a systematic review and recommendations.

The objective of this project was to identify an effective methodology of approaching and implementing evidence-based principles in undergraduate teaching clinics to promote evidence-based dentistry in future clinical practice. A systematic review was undertaken to examine evidence-based clinical teaching and faculty continuing education. Research published from 1996 to 2002 was retrieved by searching several databases and the Internet, along with conducting hand searches and reviewing bibliographies maintained by faculty experts. Qualitative checklists for different types of studies were created to evaluate the literature. Relevant studies were selected if they met all four predetermined essential criteria and a minimum of two out of three desirable criteria. Systematic reviews were chosen if they met all five essential criteria. Data from selected articles were extracted, and study quality was assessed. We found that three systematic reviews and nine original research articles were deemed methodologically acceptable. Problem-based learning and evidence-based health care interventions increased student knowledge of medical topics and their ability to search, evaluate, and appraise medical literature. Dental students in a problem-based learning curriculum, emphasizing evidence-based practices, scored higher on the NDB I (National Dentistry Boards, Part I) than students in traditional curricula. While effective modules in implementing theoretical evidence-based principles exist, very few high-quality studies are available that examine these principles in dental undergraduate teaching clinics. No methodologically appropriate studies on the education of faculty in the implementation of evidence-based principles are available. Some studies promote promising theories and methodologies of teaching evidence-based care; based on these theories, a comprehensive model is proposed in this article. Considering the strength of evidence in the reviewed literature, we concluded that an evidence-based approach to clinical care is effective.

The effectiveness of computer-aided, self-instructional programs in dental education: a systematic review of the literature.

Computer-aided learning (CAL), self-instructional programs provide an accessible, interactive, and flexible way of presenting curriculum material. In order to assess the effectiveness of CAL programs in dental education, a systematic review of the published literature comparing CAL with other teaching methods was performed. A systematic search of the published literature was performed. Articles formally assessed for inclusion had to meet the following criteria: randomized controlled trials comparing CAL with any other method of instruction, and the use of academically homogeneous dental students or dental professionals with objective, predefined outcome criteria measuring performance, time spent, and attitudes. The searches located a total of 1,042 articles; of these, only twenty-seven articles met the inclusion criteria. Further quality assessment identified twelve studies that were included in the final review. Five of the studies documented statistically significant differences in outcome measures (scores on multiple choice, written or oral tests, and clinical performance) favoring CAL over comparison group(s), while six revealed no statistically significant differences. One study documented a greater improvement in test scores in the seminar group over the CAL group. Participants' attitudes towards CAL in the included studies are also discussed. Our study concluded that CAL is as effective as other methods of teaching and can be used as an adjunct to traditional education or as a means of self-instruction.

Perceptions of caregivers regarding the importance of dental care for institutionalised seniors: a pilot study.

The type of dental treatment that institutionalised elderly receive often depends on the decisions made by various stakeholders. These decisions may be based on a perceived need for treatment. This study was designed to investigate the perception of primary caregivers as to the relative importance of dental care for institutionalised seniors. Seniors who lived in a long-term care institution, with a dental facility available to them on a daily basis, volunteered information regarding their primary caregivers. A total of 25 primary caregivers participated in a structured telephone interview. All (100%) of the caregivers considered emergency dental services and treatment to relieve pain as essential/important services which should be available to institutionalised seniors. The following were most commonly ranked in the top three by the primary caregivers: emergency dental services (57%); dental services to relieve pain (48%); cleanings to prevent mouth disease (45%); check-ups including X-rays (45%); dentures to replace missing teeth (33%); and fillings (24%). The findings of this study suggest that more effort should be directed at investigating the perceived need of value of dental services for institutionalised seniors within the various stakeholders.