Prevalence of subjective dry mouth and burning mouth in hospitalized elderly patients and outpatients in relation to saliva, medication, and systemic diseases.

OBJECTIVE: The purpose of this study was to investigate the prevalence of self-reported symptoms of dry mouth and burning mouth in the frail elderly. We expected to find the studied symptoms more frequently in the frail elderly than in those who were healthier. STUDY DESIGN: We examined 175 home-living elderly patients (mean age with SD, 82 +/- 5.7 years) hospitalized because of sudden worsening of their general health. For comparison, 252 elderly outpatients (mean age with SD, 77 +/- 5.7 years) from the same community were studied. The subjects' medical diagnoses and prescribed drugs used daily were recorded, their oral health examined, and saliva samples taken for analyses of flow rates, yeasts, and a variety of biochemical factors. RESULTS: The results showed that 63% of the hospitalized patients and 57% of the outpatients complained of dry mouth. The respective percentages of burning mouth were 13% in the hospitalized and 18% in the outpatients. The dentate status affected the feeling of dry mouth and burning mouth, but there were no consequent differences in concentrations of salivary biochemical constituents, yeast counts, and buffering capacity between patients with or without the symptoms except that hospitalized patients complaining of dry mouth more often had low salivary buffering than those without the symptom. Dry mouth was also more prevalent among the hospitalized patients who used several drugs daily, whereas no such association was found with the burning-mouth symptom. Use of analgesics appeared to safeguard against both the symptoms. Dry mouth and burning mouth were seldom reported simultaneously, although low salivary flow rate was a common finding in patients with burning mouth. The strongest explanatory factors for burning mouth were psychiatric disease among the outpatients (OR 8.7, CI 1.4-54.1, P <.05) and use of psychiatric drugs among the hospitalized (OR 4.2, CI 0.9-20.0, P =.07). For dry mouth, the strongest explanatory factors were respiratory disease in the outpatients (OR 2.0, CI 1.0-3.8, P <.05) and low salivary flow rate in the hospitalized elderly (OR 3.7, CI 1.4-10, P <.05). In all patients (n = 427), use of psychiatric drugs was the strongest explanatory factor for dry mouth (OR 2.1, CI 1.2-3.5, P <.01), whereas analgesic medication was found to protect against burning mouth (OR 0.5, CI 0.3-0.9, P <.05). CONCLUSION: The subjective feelings of dry mouth and burning mouth appeared to be a complex issue among the elderly population studied. The 2 symptoms were seldom reported at the same time. The appearance of symptoms did not directly correlate with general health, except in the case of psychiatric diseases and medications, which should be taken into account.

Oral health in hospitalized and nonhospitalized community-dwelling elderly patients.

OBJECTIVE: The purpose of this study was to compare hospitalized and nonhospitalized home-dwelling elderly patients in a single community with respect to oral health and general health and to study risk factors for edentulousness in these patients. The study hypothesis was that hospitalized elderly patients would have poorer oral health than nonhospitalized elderly patients. STUDY DESIGN: Oral health status was examined according to the World Health Organization's guidelines for 181 hospitalized patients (mean age, 81.9 +/- 5.8 years) in a geriatric ward and for 254 home-living patients (mean age, 76.9 +/- 5.6 years). Data regarding the patients diseases and medications came from hospital records and doctors prescriptions and were categorized on the basis of the International Classification of Diseases. Differences between the hospitalized and nonhospitalized patients, between genders, between age groups, and between the various disease and medication groups were analyzed. Logistic regression was used to analyze the effects of study variables on edentulousness. RESULTS: The mean number of teeth was 10. 3 +/- 7.6 in the hospitalized patients and 16.3 +/- 7.4 in the nonhospitalized patients (P <.001). The mean number of decayed teeth was 1.3 +/- 2.2 in the hospitalized patients and 0.6 +/- 0.9 in the nonhospitalized patients (P <.01). All dentate patients had poor periodontal health. Community Periodontal Index scores were between 2 and 4 in 94.8% of the hospitalized patients and 98.6% of the nonhospitalized patients. Edentulousness was observed in 66.3% of the hospitalized patients and 42.1% of the nonhospitalized patients (P <.001). In both groups, female gender (odds ratio, 2.0; CI, 1.3-3. 1) and age between 80 and 89 years (odds ratio, 2.5; CI, 1.5-4.4) were the strongest risk factors for edentulousness. The number of drugs used daily also correlated significantly with the loss of teeth (P <.05). In the nonhospitalized patients, edentulousness correlated significantly with cardiovascular diseases and drugs taken daily (P <.01), whereas in the hospitalized patients such an association was not found. CONCLUSIONS: The results of this study confirmed our hypothesis that hospitalized elderly patients who had many concomitant diseases and used many drugs daily had worse dental health than nonhospitalized home-dwelling elderly patients. The nature of a patient's illness was not a significant factor in this respect. Female gender and age between 80 and 89 years were the strongest factors for edentulousness in both patient groups.

Salivary flow and composition in elderly patients referred to an acute care geriatric ward.

OBJECTIVE: The purpose of this investigation was to study oral health and salivary aspects of the frail elderly. The study hypothesis was that elderly patients with many concomitant diseases and drugs would have different salivary secretion rates and biochemical constituents than healthier patients. STUDY DESIGN: The stimulated flow, pH buffering capacity, and biochemical constituents were analyzed from salivas of 169 elderly subjects (51 men and 118 women, mean age 81.2 years, range 69 to 96 years) admitted to an acute geriatric ward because of sudden worsening of their health. Common statistical methods were used to analyze the differences among patient groups. The patients were grouped according to the number of concomitant diseases and daily used drugs and on the basis of salivary flow rate values. RESULTS: Reduced salivary flow (< 0.7 ml/min) was found in 48% of the men and 62.5% of the women, and a low buffering capacity was found in 31.9% of the men and 36.7% of the women. Age did not significantly affect the salivary flow rate. The factors that showed the strongest influence on salivary flow were endocrinologic diseases, ophthalmologic and respiratory drugs, and potassium chloride. Salivary immunoglobulin A and immunoglobulin M concentrations were significantly higher in older patients. Immunoglobulin A, lysozyme, and amylase concentrations were significantly higher in older patients taking many drugs. Patients with many concomitant diseases had significantly higher salivary urea concentrations than healthier patients. Edentulous patients had significantly higher salivary immunoglobulin A, immunoglobulin M, lysozyme, and amylase concentrations. CONCLUSIONS: In this study, hyposalivation was a frequent observation, and the elderly who took many drugs and had several systemic diseases had higher concentrations of most of the analyzed biochemical constituents.

Oral infections in home-living elderly patients admitted to an acute geriatric ward.

Little is known about the oral health of the frail and home-living elderly. The effects of dentogenic infections on the general condition of the elderly are also unknown. We therefore set out to investigate 191 elderly patients referred to an acute geriatric hospital due to sudden worsening of their general health. The patients' mean age was 81.2 +/- 6.4 years (range, 67 to 96 years), and they had lived at home before hospitalization. The patients were examined and their diagnoses set by a team of physicians. The dentist's examination was also made bedside. Panoramic x-rays were taken for those who were able to stand (n = 148). Particular attention was paid to the occurrence of dental infection foci and systemic infection parameters of blood. Only patients free from other than dental infections were included in the statistical analyses (n = 184). Panoramic x-rays revealed dentogenic infection foci in 71.1% of the dentate patients. Periodontal condition was poor in 96.2% of the patients (CPI score, 2 to 4). All infection parameters were high in patients with high periodontal treatment need, but the differences were not statistically significant. Neither were there statistically significant correlations between the number of dentogenic infection foci recorded from the radiographs and infection parameters of blood. More of the edentulous patients had positive salivary yeast counts than did the dentate patients (84.4% vs. 66.1%; P < 0.05). No correlation was found between the main systemic diagnoses and dental infections. Since the prevalence of dentogenic infection foci in our subjects was high, and they did not cause marked increase in the hematological infection parameters investigated, it seems clear that geriatricians should refer their patients for dental examinations. Although our patients represent the home-living elderly population in a Nordic country with a high standard of living and good medical care, dental care had been neglected regardless of the patients' systemic disease.