Medication in elderly people: its influence on salivary pattern,signs and symptoms of dry mouth

doi:10.1111/j.1741‐2358.2009.00293.x
Medication in elderly people: its influence on salivary pattern, signs and symptoms of dry mouth Objective: To compare stimulated and non‐stimulated salivary flow, pH, buffering capacity and presence of signs and symptoms of hyposialie and xerostomia in elderly patients, with senile dementia using medication and healthy elderly subjects not using medication. Methods: Forty individuals (mean age: 68.5 years) were divided into two groups, according to the use (G1) or non‐use (G2) of medication and the presence (G1) or absence (G2) of senile dementia. Data with reference to the general health condition, use of medication and the patient’s complaints were collected during anamnesis. Clinical examination identified signs associated with hyposialie and xerostomia. Stimulated and non‐stimulated saliva flow, pH and buffering capacity were verified. Results: The stimulated saliva flow in both groups was below normal parameters. The drugs used by individuals in G1 showed xerostomic potential. Individuals with a higher consumption of xerostomic medication presented with dry and cracked lips. A significant negative relationship was found between drugs consumption and the buffering capacity (p < 0.001), and the resting saliva flow rate (p = 0.002). Conclusion: The use of medication increases the chance that an elderly person may present signs related to xerostomia and alterations in stimulated saliva flow and buffering capacity.     

Relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth in menopausal women

doi: 10.1111/j.1741‐2358.2010.00403.x Relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth in menopausal women Objectives: To evaluate the relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth (DM) in menopausal women. Background: A feel of DM is a major complaint for many elderly individuals and strongly associated with the menopause. The exact mechanisms that mediate sensation of DM in menopausal women have not been firmly established. Methods: A case–control study was carried out on 104 selected menopausal women with/without a feeling of DM, conducted at the Clinic of Oral Medicine, Tehran University of Medical Sciences. Xerostomia Inventory (XI) score was used as an index of DM severity. Stimulated whole saliva cortisol concentration (stimulated by chewing standard‐sized paraffin for 60 s) was measured by ELISA. Statistical analysis by Student’s t‐test and Spearman correlation was used. Results: The mean cortisol concentration of saliva, but not saliva cortisol output, was significantly higher in the cases than in the controls. There was significant positive correlation between XI score and concentration (r = 0.357, p = 0.000) or output (r = 0.223, p = 0.017) of stimulated whole saliva cortisol. Conclusions: It appears that stimulated whole saliva cortisol is high in menopausal women with a feeling of DM.     

Salivary immunity in elderly individuals presented with Candida-related denture stomatitis

doi: 10.1111/j.1741‐2358.2011.00476.x
Salivary immunity in elderly individuals presented with Candida‐related denture stomatitis Objectives: Elderly individuals with Candida‐related denture stomatitis (DS) present with a reduced defence against Candida albicans. This study evaluated levels of antimicrobial mediators in the elderly DS saliva and salivary neutrophils’ activation characteristics compared with elderly and young without DS. Methods: Salivary peroxidases (SPO) and elastase activities (ELA), nitric oxide (NO), transforming growth factor beta (TGF‐β), IL‐6 and CCL3 production were determined in saliva from elderly with or without DS, and young control individuals. TLR4, CXCR1, CD11b, CD16 and CD32 expression on salivary neutrophils were evaluated. Correlations between number and apoptosis rate of salivary neutrophils, enzymatic activities and cytokine levels were determined. Results: Elderly DS individuals exhibited the lowest SPO and ELA activities. Also, the activity of both enzymes was low in elderly without DS. Although both elderly groups showed higher salivary NO and TGF‐β levels compared to young control groups, elderly DS presented the highest salivary NO, TGF‐β, IL‐6 and CCL3 levels. Decreased percentages of salivary TLR4⁺ and CD16⁺ neutrophils were detected in both elderly groups. Although these damages could influence the establishment and persistence of DS, the highest levels of salivary IL‐6 and CCL3 in elderly DS could be preventing more serious complications.     

The influence of medication on salivary flow of the elderly: preliminary study

doi:10.1111/j.1741‐2358.2009.00326.x
The influence of medication on salivary flow of the elderly: preliminary study Objective: This study was to evaluate the influence of medications on unstimulated and stimulated salivary flow in elderly men and women. Background: Several diseases and conditions are associated with decreasing salivary flow. Medications can be risk factors for hyposalivation due to the effect particular drug categories. Methods: Seventy‐five elderly of both gender (sixty years old or over) from the Geriatric Dental Clinic at the Federal Fluminense University Dental School, were interviewed about their health status and chronic use of medication. After the interview, unstimulated and stimulated saliva were collected from each subject. The collection time was five minutes, and the flow rate was calculated as ml/min. Results: The mean unstimulated salivary flow was 0.25 ml/min for women and 0.30 ml/min for men, while the mean for stimulated salivary flow was 1.23 ml/min for women and 1.31 ml/min for men, without both differences being non‐significant (p > 0.05). The difference between the mean production of unstimulated and stimulated salivary flow was statistically significant, regardless of gender (p < 0.01). A significant reduction of stimulated salivary flow was observed with the usage of cardiovascular agents (p < 0.05). Conclusion: Drugs used in cardiovascular disease influence the flow of stimulated saliva.     

Burning mouth syndrome (BMS): sialometric and sialochemical analysis and salivary protein profile

Objective: The aim of the present study was to analyse the characteristics of salivary production and its composition in individuals with burning mouth syndrome (BMS). Study Design: Salivary flow rate, concentrations of potassium, iron, chloride, thiocyanate, magnesium, calcium, phosphorus, glucose, total protein and urea, as well as the expression profile of salivary proteins were analysed by SDS‐PAGE. Results: The mean salivary flow rate among control patients was lower than that of BMS patients. Chloride, phosphorus and potassium levels were elevated in patients with BMS (p = 0.041, 0.001 and 0.034, respectively). Total salivary protein concentration was reduced in individuals with BMS (p = 0.223). Analysis of the expression of salivary proteins by Coomassie blue SDS‐PAGE revealed a lower expression of low molecular weight proteins in individuals with BMS compared to healthy controls. Conclusions: These results indicate that the identification and characterisation of low molecular weight salivary proteins in BMS may be important in understanding BMS pathogenesis, thus contributing to its diagnosis and treatment.     

Clinically acceptable restorations may be a hotbed for cariogenic microbes

doi: 10.1111/j.1741‐2358.2011.00571.x Clinically acceptable restorations may be a hotbed for cariogenic microbes Objective: The aim of this study was to investigate the cross‐sectional association of dental restorations with salivary cariogenic pathogens among the elderly to establish effective parameters of caries risk for this population. Materials and methods: Stimulated whole saliva was collected from 289 community‐dwelling older adults (66.2 ± 3.9 years old) who had 20 or more teeth. Salivary levels of three cariogenic bacteria (Streptococcus mutans, Streptococcus sobrinus and lactobacilli) were estimated using quantitative polymerase chain reaction (real‐time PCR) method. Results: The mean number of residual teeth was 26.4, and restored teeth with crowns, inlays and composite resin were 7.35, 3.88 and 0.68, respectively. The number of crowns correlated positively with salivary S. mutans, S. sobrinus and lactobacilli. Multiple linear regression analyses showed that the number of restored teeth with crowns was independently associated with salivary S. mutans, S. sobrinus and lactobacilli after controlling for age, gender, number of residual teeth and salivary flow rate. Salivary flow rate was independently associated with salivary S. mutans and lactobacilli. Conclusion: The number of crowns had an association with salivary levels of cariogenic bacteria, suggesting that this parameter may be a caries risk indicator for the elderly population.     

Enhancing the quality of life in elderly women through a programme to improve the condition of salivary hypofunction

doi: 10.1111/j.1741‐2358.2011.00594.x Enhancing the quality of life in elderly women through a programme to improve the condition of salivary hypofunction Objective: The purposes of this study were to examine the effects of oral exercise intended to improve the function of the oral cavity in the elderly and their quality of life to pave the way for the development of oral‐health promotion programmes geared towards the elderly. Methods: The subjects were 78 female Koreans who resided in Seoul and were aged 65 years and older. During a 3‐month period, an oral function promotion programme was conducted twice a week, between 10.00 am and 12.00 pm , applying oral exercise suggested by a Japanese public health centre. A survey was conducted by interviewing the selected women to determine the state of their subjective dry mouth, quality of life related to oral health and jaw functional limitation. Their opening, unstimulated whole saliva and pronunciation speed were measured before and after the oral function exercise programme. Results: The subjects showed a significant improvement in subjective dry mouth symptoms, relevant behaviour, the level of discomfort caused by dry mouth and subjective jaw functional limitation during mastication and swallowing and emotional expression after receiving the oral exercise. After the oral exercise, there was a significant increase in mouth opening, unstimulated whole saliva and speaking speed (‘patakala’ pronunciation) after oral exercise. There was also significant progress in their quality of life related to oral health. Overall improvement in subjective dry mouth symptoms and relevant behaviour over time after oral exercise had a positive correlation with the level of improvement in discomfort triggered by dry mouth and mastication. The level of improvement in OHIP‐14 had a positive correlation with the level of overall improvement in dry mouth symptoms and behaviour, the level of improvement in discomfort by dry mouth and that in mastication and swallowing. Conclusion: This study showed the effects of the oral function promotion programme and correlation of oral condition and oral health‐related quality of life. It is suggested that this oral function promotion programme has positive effects on both objective and subjective oral conditions. It is strongly recommended that this programme, along with other oral health promotion programmes, be implemented to improve oral function and oral health‐related quality of life for the elderly.     

Comparison of antioxidant enzymes in saliva of elderly smokers and non-smokers

Objectives: This study was designed to compare the levels of copper/zinc superoxide dismutase (Cu/Zn SOD), peroxidase (POx) and glutathione peroxidase (GSH‐Px) in saliva of smokers and those in saliva of non‐smokers. Methods: Unstimulated saliva samples were collected from 88 elderly males (65 years old or over) who visited a private dental clinic. Forty‐four subjects were current smokers (more than 20 cigarettes daily for at least 30 years) and 44 were non‐smokers. The levels of salivary thiocyanate, Cu/Zn SOD, GSH‐Px, and POx activity were measured using standard procedures. Results: The mean levels of salivary thiocyanate (SCN^?) and SOD were significantly higher (p < 0.01) in the smoking group than in the non‐smoking group, whereas the specific activity levels of POx and GSH‐Px were significantly higher (p < 0.05) in the non‐smoking group than in the smoking group. Significant correlation coefficients were found between the levels of SCN^? and SOD (r = 0.37, p < 0.001). In the non‐smoking group, a significant positive association was found between specific activity of POx and age (r = 0.33, p < 0.05). Conclusion: Measurement of SCN^? and Cu/Zn SOD in human saliva might be useful for estimating the level of oxidative stress caused by cigarette smoke. Despite increased H₂O₂ level as a defense system induced by SOD, detoxification of H₂O₂ might be deteriorated in the oral cavity of elderly smokers.     

Usefulness of new wetness tester for diagnosis of dry mouth in disabled patients

Objectives: The condition of dry mouth is an influential factor in the incidence of caries, periodontal disease, fungal infections, masticatory dysfunctions and denture function. Bedridden elderly and disabled persons often suffer from oral dryness and the aim of this study was to evaluate the usefulness of measuring the amount of moisture in the oral mucosa for clinical diagnosis of dry mouth in this group. Subjects and methods: The subjects were 20 elderly bedridden individuals, age range 65–89 years old, living in a nursing home and six healthy laboratory researchers, aged 20–46 years old, used as controls. Tongue dorsum moisture measurements were performed using a newly developed wetness tester (L‐SALIVO^®), in which the wet portion was measured after 10 s. Further, clinical diagnosis of dry mouth was carried out using a clinical classification scale of the tongue mucosa (grade range, 0–3). Results: It was possible to measure tongue dorsum moisture in all subjects with the wetness tester. The average moisture value was 0.1 ± 0.2 mm in elderly subjects with a dry mouth grade of 2 (n = 8) or 3 (n = 12), while the average moisture value in the control subjects was 3.67 ± 1.75 mm with a dry mouth grade of 0 (n = 4) or 1 (n = 2). Tester values and clinical classification showed a positive co‐relationship (r = 0.31, p < 0.05). Conclusions: Our results show that this new tester could be useful for evaluating oral dryness and diagnosing dry mouth.     

Prevalence of xerostomia and hyposalivation in the nursing home and the relation with number of prescribed medication

In nursing homes, the number of patients with their own dentition increases. Many of them, however, are unable to perform oral hygiene procedures. Medication is considered to be an important cause of hyposalivation, which may lead to oral alterations and loss of teeth. The aim of the present study was to investigate the prevalence of xerostomia and hyposalivation in a Dutch nursing home and to examine the possible relation with medication usage. Between January and March 2001, the salivary flow rates were measured in 50 patients residing in a nursing home in Amsterdam. Unstimulated saliva, parafilm-stimulated saliva and citric acid stimulated saliva were determined. Xerostomia was determined by the question "My mouth feels dry" and the medication used was examined. The data were analysed with (M)ANOVA. The average age of the patients was 78.1 +/- 9.7 years. Forty-eight % of the patients had an unstimulated flow rate of less then 0.20 ml/min and 24% had a flow rate even lower than 0.10 ml/min (reference values: 0.25-0.50 ml/min). The flow rate of women was significantly lower than that of men (p < 0.01), even after correction for age, smoking and the number of prescribed medications. Salivary flow rates decreased significantly with age (p < 0.05). The number of prescribed medication was significantly higher in patients over the age of 70 (p < 0.01, n = 42) and also in women (p < 0.01). The prevalence of xerostomia was 52% with no difference between men and women. In nursing homes, the prevalence of hyposalivation and xerostomia is high. The number of xerogenic medications used seems to be an important factor. Women and patients aged over the age of 70 years need special attention with respect to oral health.     

Influence of bite force and tongue pressure on oro-pharyngeal residue in the elderly

Objective: To investigate the influence of maximal bite force, maximal tongue pressure, number of mastications and swallowing on the oro‐pharyngeal residue in the elderly. Background: Oro‐pharyngeal residue in the elderly is an indication of dysphagia. Pharyngeal residue is especially critical as it may cause aspiration pneumonia, which is one of the major causes of death in elderly. Materials and methods: Videofluorographic recordings were performed on 14 elderly volunteers (six males, eight females, age range 65–93 years) without any history or symptoms of dysphagia. The subjects were instructed to consume 9 g of barium containing bread in two manners; free mastication and swallow (FMS: masticate and swallow freely), and limited mastication and swallow (LMS: swallow once after 30 chewing actions). The amount of oral and pharyngeal residue was evaluated using a 4‐point rating scale. Maximal occlusal force was measured by a pressure sensitive sheet, and maximal tongue pressure using a handy probe. Multiple regression analysis was performed to examine the influence of these items on the amount of oral and pharyngeal residue in FMS and LMS. Results: In FMS, age was found to be a factor which increased oral residue (p = 0.053), and the number of swallowing (p = 0.017) and the state of the prosthesis (p = 0.030) reduced the pharyngeal residue. In LMS, tongue pressure was a factor which reduced oral residue (p = 0.015) and increased pharyngeal residue (p = 0.008). Conclusion: It is suggested that in the elderly tongue pressure contributed to propulsion of the food bolus from oral cavity into the pharynx, and multiple swallowing contributed to the reduction in the amount of pharyngeal residue.     

Whole saliva and the diagnosis of Sjögren's syndrome: an evaluation of patients who complain of dry mouth and dry eyes. Part 1: Screening tests

Sjögren's Syndrome (SS) is a common autoimmune disorder characterised by generalised desiccation, exocrine hypofunction and serologic abnormalities, More than 90% of the patients are women. Objective : to determine if whole saliva could be used to diagnose this disease. Setting: The study was conducted at the School of Dental Medicine, SUNY, at Stony Brook. Patients : There were 49 subjects (48F; 1M), the mean age was 54 ± 13 years. In order to be admitted into the study, they had to complain of dry mouth and dry eyes. Tests : Whole saliva was collected by the spitting method. “Screening Tests'” were employed to measure the salivary flow rate, pH, buffer capacity; lactobacillus and yeast concentrations. Chemical tests were performed to determine protein, albumin, sodium and amylase activity. Lacrimal dryness was assessed by the Schirmer and Rose-Bengal methods. Results: Based on the sialometric findings, the patients were divided into 3 groups: Group 1: those with abnormally low resting (RFR) and stimulated (SFR) flow rates; Group 2: those with a low RFR but normal SFR; and Group 3: those with normal salivary flow rates. The group 1 patients were unique: their saliva demonstrated a low pH and buffer capacity, high lactobacillus and yeast concentrations, decreased protein output and amylase activity, and elevated albumin and sodium. Moreover, virtually all of them had abnormally low lacrimal flow rates. Conclusions : The findings suggested that whole saliva could be used to provisionally diagnose SS. Critical to this diagnosis was an abnormally low stimulated whole saliva flow rate. Other requisites included a low resting flow rate, the presence of dry mouth and dry eyes and evidence of lacrimal hypofunction. All of these attributes can easily be obtained by dentists in their clinics.     

Self-reported oral hygiene habits among institutionalised elderly and their relationship to the condition of oral tissues in Taubaté, Brazil

Objectives: To record self‐reported hygiene habits, examine the oral conditions of a sample group of institutionalised elderly, and examine possible relationships between these habits and conditions. Design: Cross‐sectional. Setting: All the institutions for the elderly in Taubaté, Brazil. Subjects: The entire population of these institutionalised elderly people (n = 553). Intervention: The subjects were interviewed and underwent an oral examination. Main outcome measures: Oral hygiene habits, oral conditions and statistical relationships between habits and oral conditions were recorded. Results: The average age of the subjects who knew their age (n = 364) was 74.9 years (±12.9), and 64.7% of the sample group were females. Denture‐related stomatitis was found in 19.5%, impaired manual dexterity in 40%, dry mouth sensation in 36.3%, difficulty in performing oral hygiene in 20%, no oral hygiene‐related orientation in 54.1%, no periodic oral examinations in 59.5%, and no tongue cleaning in 68.3% was declared. Among dentate subjects, 73.3% had periodontal disease, 54.7% had caries, 26% reported no toothbrushing, and 7.3% reported flossing. Of the denture wearers, 7% did not brush their dentures. Denture‐related stomatitis showed a statistical relationship with impaired manual dexterity (p = 0.012) and an inverse statistical relationship with denture brushing frequency (p = 0.006). Periodontal disease showed an inverse relationship to flossing (p < 0.001) and tongue cleaning (p = 0.0026). Caries showed an inverse relationship with tooth‐brushing (p = 0.043), flossing (0.022), proper oral hygiene orientation (p = 0.041) and periodical check‐ups (p = 0.007). Conclusion: Oral hygiene practices in this sample group were found to be inadequate, and statistically significant relationships were verified between the lack of good oral hygiene practices and the deleterious oral conditions.     

Factors which are associated with dental decay in the older individual

Objectives: To improve reliability of salivary bacterial cultures as a surrogate for plaque levels of cariogenic bacterial species by reporting the salivary CFUs of these organisms as a function of the number of teeth. Design: Cross-sectional collection of data in a convenience sample of adults over 60 years of age. Setting: Hospital Dental clinic, University bacteriology laboratory. Subjects: 523 older dentate subjects, average age 70, including 412 subjects who were in an independent living status and 111 in a dependent-living situation. Main outcome measures : Subjects were examined for decay and the presence of salivary factors including the levels of S. mutans, lactobacilli, yeast and other bacteria. The salivary levels of the bacteria were adjusted for the number of teeth in the mouth, and the resultant values were entered into multivariable logistic regression models along with clinical and other salivary parameters. Results: Mutans streptococci levels reported as CFUs/ml saliva per tooth were significantly associated with coronal surface decay, and lactobacilli, reported in a similar way, were significantly associated with root surface decay. Salivary levels of yeasts, which had previously been associated with decay in this population, were no longer significant using this construct. Conclusions : This construct of reporting salivary bacteriological data as a function of tooth number and per ml saliva could improve the reliability of bacteriological data obtained in epidemiological studies investigating the role of bacteria in dental decay in the elderly.     

Self-reported dry mouth in Swedish population samples aged 50, 65 and 75 years

doi: 10.1111/j.1741‐2358.2010.00420.x Self‐reported dry mouth in Swedish population samples aged 50, 65 and 75 years Background: Reduced salivary flow may have a negative impact on general well‐being, quality of life and oral health. Objectives: To examine xerostomia in 50‐, 65‐ and 75‐year‐olds, background factors and effect on Oral Impacts on Daily Performances (OIDP). Methods: In 1992, a questionnaire was sent to all 50‐year‐old persons (n = 8888) in two Swedish counties. In 2007, the same questionnaire was sent to all 65‐year‐olds (n = 8313) in the two counties and to all 75‐year‐olds (n = 5195). Response rate was for the 50, 65 and 75 year olds 71.4, 73.1 and 71.9%, respectively. Results: Xerostomia was higher in women than in men in all age groups. There was higher prevalence of xerostomia with increasing age in both sexes and it was more frequent at night than during daytime. ‘Often mouth dryness’ was 2.6–3.4 times more prevalent in those who reported an impact from OIDP. The highest odd ratios were for daytime xerostomia and for the variables burning mouth (17.1), not feeling healthy (4.5), daily smoking (4.4), and medication (4.1). Conclusions: The dramatic increase of xerostomia between age 50 and 75, especially amongst women, needs to be considered in the management of this age group.     

The investigation of genetic polymorphisms in the carbonic anhydrase VI gene exon 2 and salivary parameters in type 2 diabetic patients and healthy adults

The aim of this study was to investigate carbonic anhydrase (CA) VI Exon 2 single nucleotide polymorphism (SNP) and its possible association with salivary parameters in type 2 diabetic patients compared to healthy adults. Caries status was measured by using the DMFT (number of decayed, missing, and filled teeth) index. Unstimulated whole saliva and blood samples were taken. SNPs of CA gene exon 2 were determined by PCR and DNA sequencing. Salivary CA activity and buffering capacity were determined by the method of Verpoorte and Ericson, respectively. Furthermore, salivary pH was measured with pH paper and salivary flow rate was calculated. Salivary buffering capacity and pH were significantly lower in diabetic patients than those of healthy subjects (P < 0.05). Salivary flow rate, CA activity and DMFT levels did not differ between groups (P > 0.05). Four SNPs were detected; their pubmed database number are rs2274327 (C/T), rs2274328 (A/C), rs2274329 (G/C) and rs2274330. While first three of those were responsible for amino acid changes, the last one was not. The frequencies of SNPs were not significant between groups (P > 0.05). Positive significant correlation was found between CA activity and the frequency of SNPs. There was no correlation between the SNPs frequencies and pH or buffering capacity. SNPs found in this study may be related to salivary CA activity in diabetics.     

The effects of saliva collection,handling and storage on salivary testosterone measurement

Several endocrine parameters commonly measured in plasma, such as steroid hormones, can be measured in the oral fluid. However, there are several technical aspects of saliva sampling and processing that can potentially bias the validity of salivary testosterone measurement. The aim of this study was to evaluate the effects caused by repeated sampling; 5 min centrifugation (at 2000, 6000 or 10,000g); the stimulation of saliva flow by a cotton swab soaked in 2% citric acid touching the tongue; different storage times and conditions as well as the impact of blood contamination on salivary testosterone concentration measured using a commercially available ELISA kit. Fresh, unprocessed, unstimulated saliva samples served as a control. Salivary testosterone concentrations were influenced neither by repeated sampling nor by stimulation of salivary flow. Testosterone levels determined in samples stored in various laboratory conditions for time periods up to 1 month did not differ in comparison with controls. For both genders, salivary testosterone levels were substantially reduced after centrifugation (men F = 29.1; women F = 56.17, p < 0.0001). Blood contamination decreased salivary testosterone levels in a dose-dependent manner (men F = 6.54, p < 0.01, F = 5.01, p < 0.05). Salivary testosterone can be considered A robust and stable marker. However, saliva processing and blood leakage can introduce bias into measurements of salivary testoterone using ELISA. Our observations should be considered in studies focusing on salivary testosterone.     

Correlation of serum oestrogen with salivary calcium in post-menopausal women with and without oral dryness feeling

doi: 10.1111/j.1741‐2358.2011.00580.x
Correlation of serum oestrogen with salivary calcium in post‐menopausal women with and without oral dryness feeling Objective: The aim of this study was to verify the association between salivary calcium and serum oestrogen levels with oral dryness in post‐menopausal women. Also, the correlation between these variables was evaluated. Methods: A case‐control study was carried out on 60 selected menopausal women with and without oral dryness feeling (30 as case and 30 as control) conducted in the Department of Oral Medicine and Radiology, Maharishi Markandeshar University, Mullana, India. Paraffin‐stimulated saliva samples were obtained by expectoration. Salivary calcium concentrations were assessed colorimetrically using Arsenazo III reaction. The serum oestrogen concentration was measured using ELISA. Statistical analysis of Student’s t‐test and Pearson correlation was used. Results: There was significant difference in mean values of both salivary calcium concentration and serum oestrogen between case and control groups. The result obtained also showed that an inverse correlation was found between salivary calcium concentration and serum oestrogen levels in both the groups and in total sample size. Conclusion: Oral dryness in post‐menopausal women is associated with high levels of salivary calcium and low levels of serum oestrogen. The concentrations of salivary calcium and serum oestrogen are inversely correlated in post‐menopausal women, regardless of the presence or absence of oral dryness.     

Buffering effect of a prophylactic gel on dental plaque in institutionalised elderly

Objectives: The effect of multiple daily applications of a prophylactic gel, with buffering substances, on plaque acidogenicity in elderly institutionalised individuals was evaluated. Background: Many elderly suffer from reduced salivary flow, poor oral hygiene and increased levels of cariogenic bacteria and are considered to be at an increased risk for coronal and root caries. Reinforcing the buffering capacity of dental plaque by the addition of substances such as bicarbonate and phosphates may decrease their caries activity. Materials and methods: Fourteen elderly, with subjective dry mouth, were treated for 16‐day‐periods at random with: (i) Profylin fluoride gel with buffering components; (ii) Profylin fluoride gel without buffering components and (iii) rinsing with water. Applications were made four times a day and each period was followed by a 2‐week wash‐out period. The plaque pH was registered after a carbohydrate challenge and the following were recorded before and after each test period: stimulated salivary secretion rate, buffer capacity, number Colony Farming Units (CFU) mutans streptococci, lactobacilli and a sample of Candida albicans on oral mucosa. Results: Eleven participants (mean age 76.6 years) fulfilled the study. Changes in plaque pH measurements, when calculated as area under the curve (AUC_6.2 and AUC_5.7) values (pH × min), before and after each of the three treatments, showed no significant differences. A tendency to a higher plaque acidogenicity and amount of cariogenic microorganisms was found after the gel treatments. C. albicans was found in low levels. Conclusion: Frequent applications of the gel did not result in an improved neutralising effect in the elderly. This may be caused by a combination of several factors, such as the level of oral dryness of the individuals and low solubility, release and retention of the gel substances in plaque. Instead, an increased plaque acidogenicity was noted.