Daily variation of oral malodour and related factors in community-dwelling elderly Thai

doi: 10.1111/j.1741‐2358.2011.00593.x Daily variation of oral malodour and related factors in community‐dwelling elderly Thai Objectives: The purposes of this study were (i) to estimate the prevalence of oral malodour, (ii) to evaluate the daily variation of oral malodour and (iii) to assess associations of volatile sulphur compound (VSC) concentrations with socio‐demographics, health behaviours and oral health status in community‐dwelling elderly Thai. Methods: The subjects were 428 dentate elderly people (67.6 ± 5.6 years) living in Phitsaulok, Thailand. Information on their socio‐demographics, general health and health behaviours was obtained by a questionnaire. Their dental condition, periodontal status and tongue coating were clinically examined. Their flow rates and the pH of unstimulated saliva were also assessed. Oral malodour was measured at four different times of day using an Oral Chroma?. Results: The proportions of subjects diagnosed with oral malodour using the thresholds of H₂S, CH₃SH and (CH₃)₂S were 60.5%, 62.9% and 80.7%, respectively. Concentrations of H₂S showed significant daily variation. Linear regression analysis demonstrated the following significant associations: (i) oral malodour from H₂S and thickness of the tongue coating, (ii) oral malodour from CH₃SH and periodontal pocket depth of 5 mm or more and the presence of gingival bleeding and (iii) oral malodour from (CH₃)₂S and systemic disease, medications and thickness of the tongue coating. Discussion: Oral malodour was shown to be prevalent among the elderly. Daily variation was observed in the concentration of H₂S. Tongue coating, periodontal disease, systemic diseases and medications were related to oral malodour. Therefore, these factors should be taken into consideration in oral malodour treatment and prevention programmes for the elderly.     

Effects of lactoferrin and lactoperoxidase‐containing food on the oral microbiota of older individuals

The oral microbiota influences health and disease states. Some gram‐negative anaerobic bacteria play important roles in tissue destruction associated with periodontal disease. Lactoferrin (LF) and lactoperoxidase (LPO) are antimicrobial proteins found in saliva; however, their influence on the whole oral microbiota currently remains unknown. In this randomized, double‐blinded, placebo‐controlled study, the effects of long‐term ingestion of LF and LPO‐containing tablets on the microbiota of supragingival plaque and tongue coating were assessed. Forty‐six older individuals ingested placebo or test tablets after every meal for 8 weeks. The relative abundance of bacterial species was assessed by 16S rRNA gene high‐throughput sequencing. Most of the bacterial species in supragingival plaque and tongue coating that exhibited significant decreases in the test group were gram‐negative bacteria, including periodontal pathogens. Decreases in the total relative abundance of gram‐negative organisms in supragingival plaque and tongue coating correlated with improvements in assessed variables related to oral health, such as oral malodor and plaque accumulation. Furthermore, there was significantly less microbiota diversity in supragingival plaque at 8 weeks in the test group than in the placebo group and low microbiota diversity correlated with improvements in assessed variables related to oral health. These results suggest that LF and LPO‐containing tablets promote a shift from a highly diverse and gram‐negative‐dominated to a gram‐positive‐dominated community in the microbiota of supragingival plaque and tongue coating. This microbial shift may contribute to improvements in oral health, including oral malodor and state of the gingiva.

     

Investigation of oral opportunistic pathogens in independent living elderly Japanese

doi: 10.1111/j.1741‐2358.2010.00449.x
Investigation of oral opportunistic pathogens in independent living elderly Japanese Objective: Pneumonia is reported to be associated with high morbidity in elderly and compromised individuals, with poor oral health demonstrated to be a significant risk factor for pneumonia. Several opportunistic pathogens, such as Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli and Staphylococcus aureus, have been detected in patients with pneumonia. We investigated the prevalence of opportunistic pathogens in the oral cavity of healthy independent living Japanese elderly subjects and analysed factors related to harbouring those pathogens. Materials and methods: We studied 265 subjects, each of whom received a dental examination, during which specimens were collected with a tongue swab and examined for the presence of 10 oral opportunistic pathogens using single or multiple selective media. Furthermore, the presence of occult blood in saliva was examined using test paper strips. Results: Oral opportunistic pathogens were detected in 13.6% of the subjects. Those positive for occult blood in saliva had a significantly higher rate of harbouring the pathogens (p < 0.05). In addition, age was a significant factor for the presence of pathogenic microbes in the oral cavity (p = 0.033). Conclusion: Positive findings of occult blood in saliva and older age are suggested to be significant factors for harbouring opportunistic pathogens in the oral cavity.     

Evaluation of an oral function promotion programme for the independent elderly in Japan

Objectives: The purpose of this study was to provide an oral function promotion programme for the independent elderly and evaluate the changes in oral health status and oral function. Background: Few studies have scientifically analysed and evaluated the effectiveness of oral function promotion programmes provided for the independent elderly. Materials and methods: The subjects were independent elderly females (mean age: 74.6 ± 6.3) recruited from senior citizens’ centres in Tokyo. The intervention group (n = 79) received a 3‐month oral function promotion programme, which included facial muscle and tongue exercises and salivary gland massages. The control group (n = 62) did not receive this programme. Results: In the intervention group, the tongue coating scores decreased and the organoleptic score of oral malodour fell. The amount of food debris in the oral cavity decreased and the tongue dryness improved. Furthermore, the salivary flow rate increased. The length of time for maintaining the tongue in the forward position increased from 11.2 s to 18.7 s, and the number of times for moving the tip of the tongue in a clockwise circular motion, counter‐clockwise circular motion and side‐to‐side motion within 30 s, increased from 14.5 to 20.6, 14.5 to 20.2, and 17.2 to 23.3 respectively. The number of times for movement of the lips significantly improved from 23.0 to 28.8 and the pronunciation of words was observed to be clearer. Conclusion: An oral function promotion programme was effective in improving the oral health status and oral function of an independent 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.     

Effects of functional training of dysphagia to prevent pneumonia for patients on tube feeding

Objective: The purpose of this study was to evaluate the effects of functional training on outbreak frequency of pneumonia for the elderly dysphagia patients who were being tube fed. Methods: Subjects were divided into two groups; one group (n = 10) received oral care (i.e. non‐training group) and the other group (n = 11) received functional training of dysphagia in addition to oral care (i.e. training group). The dental health team treated subjects once a week for 3 years (1999–2001). The frequency of pneumonia outbreaks and changes in activities of daily living scale (ADL) were evaluated for each year. Result: It was recognised that the frequency of pneumonia in the training group decreased year by year (p < 0.05). Cognitive items in ADL improved in two subjects of the training group. No statistical differences were recognised in the non‐training group. Conclusion: It was suggested that once‐a‐week functional training of dysphagia with professional oral care might be effective in preventing pneumonia for elderly people who were being tube fed.     

The role of anti‐PAc (361–386) peptide SIgA antibody in professional oral hygiene of the elderly

Objective: Measurement of salivary IgA antibody (PAc‐peptide antibody, PPA) to amino acid residues 361–386 of Streptococcus mutans PAc, which possess a multiple binding motif to various HLA‐DR molecules and a B‐cell epitope that recognises the inhibiting antibody to S. mutans, is an indicator for the population numbers of mutans streptococci (MS) in human saliva. The purpose of this study was to clarify the role of PPA in infection control of MS after professional oral hygiene care. Materials and methods: Thirty‐nine dependently living institutionalised elderly subjects (75.9 ± 7.5 years; 10 males, 29 females) participated in the study. The measurements of PPA, MS, total streptococci (TS) and lactobacilli (LB) were performed by ELISA and culture techniques from saliva, plaque and tongue samples from the elderly. Results: After treatment using professional oral care, the numbers of MS decreased significantly at 6 months in saliva and tongue samples from the group not having PPA in comparison with the primary data; whereas in the PPA‐detected group, a significant decrease in MS number was shown immediately following professional care at 1–12 months in all samples. There was little difference in the numbers of LB at any of the time points. The numbers of TS decreased rapidly in PPA‐not detected group in comparison with the PPA‐detected group. Conclusion: PPA may be more effective for controlling MS number in the oral cavity after professional treatment. The measurement of PPA may be used for preventive instruction to dental caries at the chair side in the clinical setting.     

Exploring the oral microflora of preschool children

The oral cavity is one of the most important and complicated habitats in our body and supports diverse microbial communities. In this study, we aimed to determine the bacterial diversity and composition of various oral micro-niches. Samples were collected from supragingival plaque, saliva, and tongue coating from 10 preschool children (30 samples total). 16S rRNA gene pyrosequencing dataset generated 314,639 clean reads with an average of 10,488 ± 2,787 reads per sample. The phyla Firmicutes, Proteobacteria, Actinobacteria, Bacteroidetes, and Fusobacteria were predominant, accounting for more than 90% of the total sequences. We found the highest α diversity, microbial richness, and evenness in plaque, compared with saliva and tongue coating. Plaque was also distinguished from saliva and tongue coating by phylogenetic distances (weighted UniFrac). Taxa with different relative abundances were further identified, confirming the existence of microbial differences across the three niches. Core microbiomes were defined of each niche; however, only a small proportion of operational taxonomic units (8.07%) were shared by the three niches. Coaggregation between Actinomyces spp. and Streptococcus spp. and other correlations among periodontal pathogens, such as Prevotella, Fusobacteria, Capnocytophaga, and Tannerella, were shown by a co-occurrence network. In summary, our study provides a framework of oral microbial communities in the population of preschool children as a baseline for further studies of oral diseases related to microbes.     

Potential factors responsible for dryness of the dorsum of the tongue in elderly requiring care

Objective: This study explored potential factors in elderly requiring care that cause dryness of the dorsum of the tongue despite moisture retention in the sublingual mucosa. Materials and methods: Subjects were 224 elderly (mean age: 83.6 ± 7.4 years) living in a nursing home and requiring individual care. Measurement of moisture of the dorsum of the tongue and sublingual mucosa was performed using a wetness tester (L‐SALIVO) with a measurement time of 10 s. Results: A significant difference in drying only of the dorsum of the tongue was noted depending on the degree of incapacity, level of consciousness, eating (oral ingestion or tube‐feeding), and conversation. Multiple logistic regression identified the degree of incapacity in terms of eating (oral ingestion or tube‐feeding) as a significant factor for dryness. The odds ratio for the degree of incapacity was 3.2 while that for eating was 11.226. Conclusion: Dry mouth of the dorsum of the tongue in elderly requiring care was associated with the degree of incapacity, tube feeding, and level of conversation.     

The presence of black-pigmented Gram-negative anaerobes in the oral cavity of edentolous subjects

Abstract The aim of this study was to investigate whether black-pigmented Gram-negative anaerobes are part of the indigenous oral flora of edentulous subjects with or without dentures. Group I consisted of 11 subjects with dentures (mean age 63.6 years, range 52–75) and Group II consisted of 39 subjects with complete dentures in both jaws (mean age 59.3 years, range 37–80). Two microbial samples for microbiological examination were taken from each subject. One of them was from the dorsum of the tongue and the other was from saliva. Black-pigmented Gram-negative anaerobes > 10⁷ cfu/ml were found in both samples. In 50 edentulous subjects, they were found more commonly from tongue (40%) than from saliva (26%). None of the subjects had Porphyromonas gingivalis . There was no statistically significant difference ( P > 0.05) between the presence of black-pigmented Gram-negative anaerobes on tongue and in saliva in the two groups. Our results suggested that high levels of black-pigmented Gram-negative anaerobes may belong to the indigenous oral flora in edentulous mouths with or without dentures.     

Decreased hippocampal brain‐derived neurotrophic factor and impaired cognitive function by hypoglossal nerve transection in rats

The hypoglossal nerve controls tongue movements, and damages of it result in difficulty in mastication and food intake. Mastication has been reported to maintain hippocampus‐dependent cognitive function. This study was conducted to examine the effect of tongue motor loss on the hippocampus‐dependent cognitive function and its underlying mechanism. Male Sprague Dawley rats were subjected to the initial training of Morris water maze task before or after the bilateral transection of hypoglossal nerves (Hx). When the initial training was given before the surgery, the target quadrant dwelling time during the probe test performed at a week after the surgery was significantly reduced in Hx rats relative to sham‐operated controls. When the initial training was given after the surgery, Hx affected the initial and reversal trainings and probe tests. Brain‐derived neurotrophic factor (BDNF) expression, cell numbers and long‐term potentiation (LTP) were examined in the hippocampus on the 10^th day, and BrdU and doublecortin staining on the 14^th day, after the surgery. Hx decreased the hippocampal BDNF and cells in the CA1/CA3 regions and impaired LTP. BrdU and doublecortin staining was decreased in the dentate gyrus of Hx rats. Results suggest that tongue motor loss impairs hippocampus‐dependent cognitive function, and decreased BDNF expression in the hippocampus may be implicated in its underlying molecular mechanism in relation with decreased neurogenesis/proliferation and impaired LTP.     

Prevalence of periodontopathic bacteria on the tongue dorsum of elderly people

Objectives: The aim of this study was to analyse the prevalence of oral bacteria on the dorsum of the tongue. In addition, the relationship between the number of teeth and the microflora present on the coating of the tongue in a population of 85‐year‐old people was assessed. Subjects and methods: Two hundred and five individuals (89 males, 116 females) from the same geographical area who were 85 years of age were examined. Five periodontopathic bacteria (Porphyromonas gingivalis, Tannerella forsythia, Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum, and Treponema denticola) and one cariogenic bacterium (Streptococcus mutans) were analysed using a polymerase chain reaction assay of tongue samples from the population. Results: Periodontal bacteria‐positive individuals have more teeth than that of periodontal bacteria‐negative people. Between the periodontal bacteria‐positive and ‐negative individuals, there were significant differences in the mean number of teeth for P. gingivalis (p < 0.0001), T. denticola (p < 0.001), F. nucleatum (p = 0.002), and T. forsythia (p = 0.005), while there were no significant differences for A. actinomycetemcomitans (p = 0.998) or S. mutans (p = 0.147). Conclusions: A wide range of species, including anaerobes, was detected in 85‐year‐old subjects. It was found that the detection of periodontal bacteria on the tongue coating increased with the number of teeth. There was a positive relationship between the tooth number and periodontopathic bacteria, except for A. actinomycetemcomitans.These results suggest that tongue care is essential for preventing oral disease and needs to be part of any oral care programme in elderly people.     

Thyroid hormone regulation of adrenergic receptors and beta-adrenergic responsiveness in the rat submandibular gland

The effects of altered thyroid function on the sensitivity of isoproterenol induced secretion of saliva and in the characteristics of adrenergic receptors from the rat submandibular gland were examined. Hyperthyroidism produced an increased sensitivity to beta-adrenergic stimulation of the gland, and this phenomenon was associated with an increase in the number of beta and alpha 1-adrenoceptors. On the other hand, surgical thyroidectomy produced a decrease sensitivity to isoproterenol stimulation of the submandibular gland and a diminished density of beta-adrenoceptors. In this case, no changes in alpha-adrenoceptors were observed. These results are discussed emphasizing the correlation between the functional control of saliva secretion and the adrenergic receptors in different thyroid states.     

Implant‐supported overdenture in an elderly patient with Huntington’s disease

doi:10.1111/j.1741‐2358.2009.00343.x
Implant‐supported overdenture in an elderly patient with Huntington’s disease Huntington’s disease is a hereditary, progressive, neuro‐degenerative disorder characterised by increasingly severe motor impairment, cognitive decline and behavioural manifestations leading to functional disability. Dyskinesia and hyperkinesia of the tongue and the peri‐oral musculature make it impossible for the patient to wear a conventional complete denture, despite an adequate alveolar ridge. The present paper reports on a patient with Huntington’s disease who was rehabilitated with a mandibular overdenture supported by two endosteal implants. One year follow‐up examination showed that the prosthesis was stable and there was considerable improvement in the patient’s masticatory function.     

Oral Physiology and the Baltimore Longitudinal Study of Aging1

Since initiation of the oral physiology component of the Baltimore Longitudinal Study of Aging in 1978 almost 500 individuals have been examined. Participants are generally healthy males and females ranging in age from 25 to 93. The goal of this study is to determine oral health status during the “normal” process of aging. A dental/medical history and subjective reports of oral motor, oral sensory and salivary function are elicited. The current objective test battery includes an oral exam, salivary flow rate determination, and assessment of taste, temperature, texture and pressure differentiation, as well as olfaction, and oral motor function. Results indicate no age-related changes occur in stimulated parotid or unstimutated or citrate-stimulated submandibular salivary flow rates. In addition, oral motor and oral sensory skill deficits were found to be generally independent of age. However, olfactory ability, as measured by an olfactory recognition test, declined after age 65 for both sexes, as did the ability of older subjects to judge pressure differences applied to the tongue.     

Effects of oral functional training for nutritional improvement in Japanese older people requiring long-term care

Objectives: The aim of this study was to evaluate the effect of oral functional training and nutrient supplements to improve the nutrition of malnourished elderly people in a nursing home. Background: Malnutrition is a frequent problem in the elderly requiring long‐tem care; however, it is not clear whether oral functional training can be effective to improve nutrition. Subjects and methods: Fourteen subjects of 82 residents (mean age 85.7 ± 6.2 years) in a nursing home, who had a serum albumin level of ≤3.8 g/dl and understood the purpose of this study, were randomly divided into two groups of seven: one group served as the supplement group (mean age 87.0 ± 4.9 years) to which a high‐calorie and high‐protein diet was provided, and the other as the oral training plus supplement group (mean age 84.6 ± 10.1 years) to which oral functional training was given by a dental hygienist once a week as well as the above diet. Nutritional status was evaluated using serum biochemical values as indices at 4 months after the start of the intervention. Results: In the supplement group, serum albumin was 3.44 ± 0.36 g/dl at the start of the study (before intervention) and 3.24 ± 0.45 g/dl at 4 months after intervention. In the oral training plus supplement group, it was 3.56 ± 0.22 g/dl before intervention and significantly increased to 3.70 ± 0.33 g/dl after intervention (p < 0.05: Wilcoxon signed‐rank test). Conclusion: Nutritional supplements alone were not adequate, but with oral functional training to maintain and improve feeding function, nutritional improvement in the elderly could be observed.     

Effect of saliva viscosity on the co-aggregation between oral streptococci and Actinomyces naeslundii

doi: 10.1111/j.1741‐2358.2011.00595.x Effect of saliva viscosity on the co‐aggregation between oral streptococci and Actinomyces naeslundii Background: The co‐aggregation of oral bacteria leads to their clearance from the oral cavity. Poor oral hygiene and high saliva viscosity are common amongst the elderly; thus, they frequently suffer from pneumonia caused by the aspiration of oral microorganisms. Objectives: To examine the direct effect of saliva viscosity on the co‐aggregation of oral streptococci with actinomyces. Materials and methods: Fifteen oral streptococcal and a single actinomyces strain were used. Co‐aggregation was assessed by a visual assay in phosphate buffer and a spectrophotometric assay in the same buffer containing 0–60% glycerol or whole saliva. Results: Nine oral streptococci co‐aggregated with Actinomyces naeslundii ATCC12104 in the visual assay and were subsequently used for the spectrophotometric analysis. All tested strains displayed a decrease in co‐aggregation with increasing amounts of glycerol in the buffer. The co‐aggregation of Streptococcus oralis with A. naeslundii recovered to baseline level following the removal of glycerol. The per cent co‐aggregation of S. oralis with A. naeslundii was significantly correlated with the viscosity in unstimulated and stimulated whole saliva samples (correlation coefficients: ?0.52 and ?0.48, respectively). Conclusion: This study suggests that saliva viscosity affects the co‐aggregation of oral streptococci with actinomyces and that bacterial co‐aggregation decreases with increasing saliva viscosity.     

Oral glucose clearance in nonagenarians in relation to functional capacity,medication and oral variables

Objectives: To study oral sugar (glucose) clearance and to examine some factors which were believed to either influence or be dependent upon oral glucose clearance. Design: Cross-sectional, clinical study with analysis of records. Setting: Göteborg gerontological and geriatric population studies, Göteborg University, Sweden. Subjects: 71 community-dwelling individuals, 27 men and 44 women, of a representative sample of 260 92-year-old persons. Intervention and Main outcome measures : Glucose concentration was measured in saliva after chewing of a glucose tablet and the clearance was assessed by three different variables: (i) the initial salivary glucose concentration, (ii) the area under the curve (AUC) and (iii) the clearance time. Results: The glucose clearance showed a wide inter-individual variation, which could be explained partly by differences in oral state, chewing time, stimulated salivary secretion rate and medication use. A positive correlation was found between the clearance variables and the number of lactobacilli and mutans streptococci in saliva and the percentage of untreated root caries lesions of the total number of exposed root surfaces. Conclusions : A slow oral sugar clearance is more common among 92-year-olds than younger adults earlier reported in other studies, particularly in those who have uncompensated functional impairments and a high medication history. A decreased oral glucose clearance was associated with high counts of salivary lactobacilli and mutans streptococci and a high proportion of untreated root caries lesions.     

The effect of different types of cortisol secretion on the prognosis of lumbar discectomy

Background

The purpose of this study was to investigate saliva cortisol levels of Chinese patients with discogenic sciatica and to clarify the relationship between psychosocial factors and saliva cortisol levels. We also intended to elucidate the effect of different types of cortisol secretion on the prognosis of lumbar discectomy.

Methodology

37 patients with discogenic sciatica, 18 patients with chronic somatic pain and 20 healthy pain-free subjects were included in this analysis. The Japanese Orthopedic Association (JOA) score was used to evaluate functional ability. The diurnal patterns of cortisol secretion of the three groups were assessed. The correlation between cortisol secretion level and preoperative psychosocial surveys was assessed.

Results

The patients with chronic somatic pain showed a significantly low level of cortisol secretion during the declining period and an obvious decline from the peak. The change in JOA score after surgery was positively correlated with saliva cortisol concentration during the peak period and the declining period, and negatively correlated with the magnitude of cortisol change throughout the day. Psychosocial factors were correlated with improved JOA scores. These factors are also interrelated to the cortisol secretion level.

Conclusions

Cortisol secretion level is a correlative physiological mechanism for the effect of psychosocial factors on the prognosis of lumbar discectomy.     

Oral mucous membrane flora in patients using saliva substitutes

Salivary substitutes are sometimes valuable for elderly people and radiotherapy patients, and may be used indefinitely. It is possible that this change in the ecology may effect the oral flora. Objective: To analyse the presence of micro‐organisms on oral mucous membranes during use of saliva substitutes. Design: Cross‐over single‐blind study. Setting: Clinic for Maxillofacial Surgery, Malmö University Hospital and Department of Oral Microbiology, Malmö University. Subjects: 19 patients with low salivary secretion who had been radiated for cancer in the head and neck region. Intervention Two saliva substitutes: linseed extract and a carboxymethyl cellulose preparation (Salinum and MAS‐84) were used for 3 week periods. Measurements: Microbial samples taken, processed and analysed. Results: No differences were observed when comparing baseline values with the results after the saliva substitutes and no significant differences between the use of different agents. Conclusion: The study suggests that use of linseed extract and carboxymethyl cellulose preparation during periods of weeks does not influence flora commonly related to caries, periodontitis or infections in the oral mucous membranes.