Acute effects of hemodialysis on salivary flow rate and composition.

AIMS: To evaluate acute effects of hemodialysis (HD) on the salivary flow rate, pH and biochemical composition before, during and after completion of a dialysis session. MATERIAL AND METHODS: Unstimulated whole saliva (UWS) and chewing-stimulated whole saliva (CH-SWS) were collected in 94 HD patients. Salivary flow rate, pH, concentrations of total protein, albumin, cystatin C, secretory immunoglobulin A (S-IgA) and of sodium, potassium and urea were measured. RESULTS: HD had an acute stimulating effect on the salivary flow rate (UWSbefore = 0.30+/-0.22 ml/min, UWSduring = 0.39+/-0.25 ml/min, p < 0.005). The mean pH of UWS showed a small but significant increase during HD mainly due to an increased watery secretion from the salivary glands. The salivary biochemical constituents changed markedly, but no significant difference in output was found. The electrolyte concentration did not change significantly during dialysis. The level of urea in CH-SWS declined to 40% (Ureabefore = 25.+/-6.4 mmol/l, Ureaduring = 15.3+/-4.5 mmol/1). CONCLUSIONS: This study shows that HD has significant acute effects on both salivary secretion rate and protein concentrations in saliva. We conclude that the observed changes in salivary concentrations and proteins are mainly due to an increased watery secretion from the salivary glands.

Oral and salivary changes in patients with end stage renal disease (ESRD): a two year follow-up study.

OBJECTIVES: To compare oral health, salivary flow rate, xerostomia and thirst in end stage renal disease (ESRD) patients remaining on dialysis treatment and after renal transplantation. DESIGN: Longitudinal observation. SETTING: ESRD patients recruited from dialysis centres in Amsterdam, The Hague and Utrecht, The Netherlands. METHOD: At baseline and after two years, salivary flow rates, xerostomia and thirst were determined in 43 ESRD patients. The number of decayed missing filled teeth/surfaces (DMFT/DMFS) was recorded, and periodontal status assessed. RESULTS: After renal transplantation (n = 20), the salivary flow rate increased significantly from UWS = 0.30 +/- 0.21 ml/min to 0.44 +/- 0.29 ml/min (p <0.001) and the level of xerostomia and thirst decreased. After two years, the percentage of bleeding on probing in dialysis patients (n = 23) decreased from 29.5 +/- 25.4% to 10.3 +/- 12.3%, (p <0.05). No differences in DMFT and DMFS were observed between dialysis and renal transplant patients. CONCLUSIONS: DMFT, dental plaque, gingival bleeding and periodontal indices did not change remarkably after two years, comparing dialysis and renal transplant patients. Renal transplantation enhances salivary flow and decreases symptoms of xerostomia and thirst, and hence enhances the potential to improve the quality of life of affected individuals.

The oral health status of dentate patients with chronic renal failure undergoing dialysis therapy.

OBJECTIVE: The aim of this study was to compare the oral health status of chronic renal failure (CRF) patients on renal replacement therapy with a matched reference population. DESIGN: Cross-sectional study. SUBJECTS: Forty-two dentate CRF patients--aged 25-52 years old--were matched with a reference group of 808 dentate subjects. METHODS: The oral health was assessed using decayed missing filled (DMF) indices, simplified oral hygiene index and periodontal status. An oral health questionnaire was used to assess self-reported dental problems. Student t-tests and chi-square tests were performed to compare the CRF patients with the controls. RESULTS: All index-scores in the CRF patients were comparable with the controls except for number of teeth covered with calculus that was significantly higher (P < 0.05) in CRF patients (4.1 +/- 2.6) than in controls (3.0 +/- 2.9). The self-reported oral health questionnaire revealed a trend for increased temporomandibular complaints in CRF patients (16.7%vs 5.7% in controls; P = 0.06) as well as bad taste (31.0%vs 6.8% in controls, P = 0.08). CONCLUSIONS: For most dental aspects, the oral health of CRF patients is comparable with controls.

Preferences and saliva stimulation of eight different chewing gums.

OBJECTIVES: Chewing gums have been studied for clinical use to stimulate the salivary flow rate in healthy and diseased individuals. However, differences in preferences of chewing gums may influence patient compliance during long-term use. Therefore, we compared the effect of several chewing gums on the flow rate of whole saliva and pH, and investigated the preferences of these gums. METHODS: 83 healthy subjects participated in the first part of the study. Both parafilm-stimulated and chewing gum-stimulated whole saliva from 8 different chewing gums was collected and salivary flow rate and pH were determined. In another group of 112 healthy subjects, we investigated the preferences for the chewing gums with a 10-item questionnaire. RESULTS: All gums had comparable effects on salivary flow rate and pH. The average increase in flow rate was 187% during the first minute of chewing compared with parafilm stimulation. After 10 minutes of gum chewing, the amount of saliva was equal to parafilm stimulation. The questionnaire showed differences in preferences for the chewing gums, which were related to taste and gum shape. Gender interactions were observed for sparkling taste (p = 0.019), total judgement (p = 0.047) and the willingness to use the gum for several weeks (p = 0.037). CONCLUSIONS: Although all chewing gums stimulated the salivary flow rate equally, the observed differences in preferences may influence long-term compliance. Therefore, we recommend that chewing gums are tested before the start of clinical studies, to identify the most accepted chewing gum for specific groups of patients.

[Salivary tests for caries and erosion risk factors]. / Speekselonderzoek naar cariës- en erosie-risicofactoren.

Apart from a health questionnaire and oral health examination with a clinical history, it is also important to inquire after oral and salivary complaints. Supplementary it is useful to assess dietary habits in patients at risk and to perform a number of simple salivary tests. Interpretation of all data obtained through these investigations, will enable the identification of a number of caries and erosion risk factors. On the basis of these risk factors a preventive treatment plan can be made for the patient. These data provide the possibility to evaluate the success of the preventive treatment plan after a few years and to make adjustments, if necessary.

The merit of the practice-profile-time study.

The practice-profile-time study is a method developed by Joint FDI/WHO Working Group 9 on the study of 'Economic factors related to the delivery of oral services and oral health' to record the time spent by general dental practitioners on different practice activities. The method was developed to support the policies of National Dental Associations, but can also be used by general dental practitioners themselves. This method was tested in nine countries. The method has proved to be reliable and valid, and produces a vast amount of useful information for Dental Associations and for individual practitioners.

Relative importance of eight oral conditions for a fit dentition according to Dutch general practitioners.

Almost 5 million Dutch National Health Service members visit the dentist half-yearly in order to keep their so-called "dental fitness certificate" valid. The methods of paired comparisons and direct ranking were used to study the relative importance of eight oral conditions for a fit dentition: plaque, calculus, gingivitis, a pocket, a cavity, a root/radicle, a fistula and an extraction diastema. The assessments were made by a sample of Dutch general practitioners under contract to the National Health Service (n = 49). Each dentist was consistent in his comparative pairwise choices. Although agreement between the dentists was statistically significant, the low coefficient indicated individual differences between the dentists. The average rank orders of the eight oral conditions obtained from the dentists as a group by means of the two methods were highly comparable. To obtain dental fitness the dentists judged the treatment of a fistula and gingivitis more important than the treatment of plaque, calculus and cavities, and least important, the three conditions: root/radicles, pockets and extraction diastema. This average rank order indicates a shift in the concept of "dentally fit" as stated in the requirements, dating back to 1960, for granting a dental fitness certificate.

The economics and evaluation of dental care and treatment.

This paper is concerned with economic evaluation in dentistry. The potential for such evaluation is great, but has not been fully realised to date. A number of issues which are common to the existing literature are discussed, and particular attention is paid to the question of measuring dental health in economic appraisal. Directions for future research are presented. The paper concludes that the future for economic evaluation in dentistry is favourable and that there is a need for greater collaboration between economic and dental researchers in this area.

Dental care expenditures in the Netherlands and the USA: a design for historical and international comparison.

Policymakers face the problem that virtually no standards are available to judge whether the amount of dental care provided is satisfactory or to weight the interests of dental care against other health and economic interests. It is suggested that international comparison of a number of standardized indicators and analyses of their development over time constitutes a practical approach to the partial solution of these problems. A specific set of basic data and seven indicators are suggested. Of the indicators, two serve as measures for the total volume of dental care available to the individual, two could help to assess the productivity of dental care workers, and three are intended to put the expenditures for dental care in the perspective of health care expenditures in general and the national economy at large. The practicality of the approach is subsequently demonstrated by the comparison of the basic data and the indicators for the Netherlands and the USA over the period 1972 through 1979.