Anja Ainamo

Association Between Salivary Flow Rate and the Use of Systemic Medication Among 76-, 81-, and 86-year-old Inhabitants in Helsinki, Finland

The aim of this study was to examine salivary flow rate and its association with the use of medication in a representative sample of 76-, 81-, and 86-year-old subjects, totaling 368. In this study, 23% (n = 80) of the subjects were unmedicated. From one to three daily medications were used by 47% (n = 168) and more than four medications by 30% (n = 104). The most commonly used medications were nitrates, digitalis or anti-arrhythmic drugs (47.7%), analgesics and antipyretics (32.6%), and diuretics (29.5%). The mean number used daily was significantly higher in 86-year-olds than in the two younger age groups (p < 0.01). No significant differences in this respect were found between genders. Among the unmedicated subjects, 76-year-olds had significantly higher stimulated salivary flow rates than did the 81-year-olds (p < 0.05). Unmedicated women showed significantly lower unstimulated (p < 0.01) and stimulated flow rates than did men (p < 0.05). Stimulated salivary flow rate was also significantly higher in the 76-year-old medicated subjects than in the medicated 86-year-old subjects (p < 0.05). No statistically significant differences were found in unstimulated salivary flow rates among the three age groups. Medicated women showed significantly lower unstimulated salivary flow rates than men (p < 0.001), although the difference in stimulated saliva flow was not significant. A statistically significant difference in unstimulated and stimulated salivary flow rates was found between unmedicated persons and those who took from four to six, or more than seven, prescribed medications daily.

Xerostomia and hyposalivation: causes, consequences and treatment in the elderly.

Xerostomia and salivary gland hypofunction (SGH) are prevalent in elderly populations, causing much discomfort and even difficulties in eating. SGH also increases the occurrence and severity of oral diseases and makes the patient susceptible to candidiasis. The principal causes of SGH and xerostomia are systemic diseases and drugs used daily. The diagnosis of SGH and xerostomia is based on simple methods, of which measuring both unstimulated and stimulated salivary flow rate is the most important. Treatment calls for proper management of underlying disease, avoidance of all unnecessary medications, and topical remedies such as artificial saliva substitutes. However, good hydration is essential in the elderly with SGH and xerostomia, and water is the drink of choice. In extremely difficult cases, for instance in patients receiving radiotherapy for cancer of the head and neck regions, parasympathomimetic drugs may be administered if no contraindications exist.

Salivary Yeasts, Saliva, and Oral Mucosa in the Elderly

Yeasts are commensals in the oral cavity and may not cause disease unless there are predisposing host factors, such as other disease, or when medication is being taken. The elderly are at increased risk of yeast infection. In this paper, prevalence of salivary yeasts in a group of 368 inhabitants of Helsinki aged 76, 81, and 86 years is reported. Salivary yeasts were counted by the Oricult-N® dip-slide method, salivary secretion rate and buffering capacity were measured, type of dentition was noted, and signs of yeast infection and the occurrence of subjective symptoms were determined. There was no growth of yeasts in 25% of the subjects. From one to 20 colonies/slide were observed in 21%, 21-50 colonies in 21%, and over 50 colonies (a high count) in 33%. Subjects with low salivary flow rates and low buffering capacities had significantly higher yeast counts than did subjects with normal salivary flow rates and buffering capacities. High yeast counts were found in 19% of subjects with natural teeth. The corresponding percentages in those wearing partial or complete dentures were 32 and 41, respectively. High salivary yeast counts were associated with oral mucosal lesions but not with subjective complaints of oral symptoms.

Association of residual ridge resorption with systemic factors in home-living elderly subjects

Residual ridge resorption after loss of teeth is a multifactorial oral problem. To examine the association of residual ridge resorption with systemic factors, a cross-sectional study was made of 177 edentulous subjects (43 men and 134 women) aged 76, 81, and 86 years. Resorption in the mandibular and maxillary residual ridges was assessed from panoramic radiographs. The effects on residual ridge resorption of the age, gender, smoking, alcohol intake, body mass index, functioning in daily living, and certain systemic diseases of the subjects were investigated. After adjustment for age and duration of edentulousness, the elderly women had a greater amount of reduction in the mandibular residual ridge than the men (P < 0.001). When the resorption was classified into slight or moderate and severe resorptions, the elderly with asthma were at high risk of severe reduction in the edentulous mandible (odds ratio, 6.0; 95% confidence interval (CI), 1.3-28.2); the elderly women were at high risk of severe resorption in the edentulous mandible, with an odds ratio of 4.5 (95% CI, 1.2-17.1); an inverse association was found between alcohol intake and severe resorption in the edentulous maxilla (odds ratio, 0.4; 95% CI, 0.2-0.9). This study suggests that asthma due to corticosteroid treatment is to be considered a risk indicator for severe resorption of the edentulous mandible, alcohol intake in the elderly may be related to a lesser degree of resorption of the edentulous maxilla. Female gender is confirmed as a major factor resulting in mandibular atrophy.

Oral status and prosthetic factors related to residual ridge resorption in elderly subjects

Our earlier studies on edentulous elderly subjects have shown associations of severe resorption in the mandibular residual ridge with female gender and systemic diseases. The aim of this study was to examine whether other factors also were related to residual ridge resorption (RRR). Among 177 edentulous elderly subjects effects on RRR were investigated with regard to history of edentulousness and denture-wearing, the condition of the dentures and soft tissues, dental status of the opposing jaw, and oral hygiene habits. No significant association was found between degree of resorption and duration of edentulousness in either the mandible or the maxilla. RRR was related to denture quality (P < 0.05); however, severe resorption was not. In the maxilla previous use of removable partial dentures was a factor contributing to the resorption (odds ratio (OR), 2.4); flabby ridge was related to the severity of the resorption (OR, 2.4). This study showed local factors related to RRR more often in the maxilla than in the mandible, thus suggesting that severe resorption in the mandible is influenced more by systemic factors than by those investigated in this study.

Salivary Findings, Daily Medication and Root Caries in the Old Elderly

Root caries is one of the main dental problems among the dentate old elderly. The aim of our study was to evaluate the occurrence of root caries in 196 dentate elderly (mean age 79.3) in relation to their salivary flow rate, buffering capacity and salivary microbial counts. These subjects participated in the oral health component of the Helsinki Aging Study in 1990–1991. Clinical oral examinations included assessment of the state of root surfaces and salivary flow rates, both paraffin-wax-stimulated and unstimulated. Salivary buffering capacity and the growth of salivary mutans streptococci, lactobacilli and yeasts were determined by means of commercially available kits. Root caries occurred in 52% of men and in 35% of women (p < 0.05). Number of decayed (DRS) and decayed or filled (DFRS) root surfaces correlated (r = 0.16 to 0.26) with salivary microbial counts. No correlation appeared between DRS and subjects’ salivary flow rates. Basic estimates on the association between DRS and salivary findings showed that microbial counts only produced significant odds ratios, from 2.0 to 3.5. However, in a log-linear model high salivary mutans streptococci and yeast counts together with male gender were associated with greater occurrence of root caries.

Resorption of mandibular canal wall in the edentulous aged population

STATEMENT OF PROBLEM The mandibular canal wall may be affected by the progress of residual ridge resorption after tooth extraction. Little knowledge is available regarding the relationship of specific systemic factors and the resorption of the mandibular canal wall. PURPOSE The purpose of this study was to assess the status of the mandibular canal in the edentulous mandible and to determine whether there is any relationship between the resorption of the mandibular canal wall and selected health indices in the elderly. MATERIAL AND METHODS The status of the mandibular canal was assessed from panoramic radiographs of 128 edentulous elderly subjects (32 men and 96 women). RESULTS The superior border of the mandibular canal was more frequently resorbed in women (32.6%) than in men (9.8%). Resorption in the mandibular canal wall was significantly more prevalent in subjects with asthma (odds ratio: 6.0), with thyroid disease (odds ratio: 3.04), and with a cortical thickness at the mandibular angle less than 1 mm thick (odds ratio 2.74). CONCLUSION The findings suggest that gender, asthma, and thyroid disease play important roles in resorption of the mandibular canal wall.

Dental diseases and loss of teeth in a group of Finnish alcoholics: a radiological study

A total of 85 Finnish alcohol-dependent subjects and 53 controls were studied with panoramic radiography. The aim was to study the possible associations between prolonged alcohol consumption and dental health. The mean number of teeth, caries lesions, endodontic treatments, periapical lesions, marginal bone loss, and periodontal infrabony pockets was studied. The subjects met the diagnostic criteria of alcohol dependence as set out in DSM-IV and ICD-10. The control group comprised social drinking volunteers with an AUDIT score h 8. For the final results the subjects were divided into groups on the basis of sex and age. The social backgrounds of the subjects were similar, except for employment and smoking. The results show significantly fewer teeth and more caries in the alcoholic group. There was a tendency for the alcoholics <45 years of age to have more endodontically treated teeth than the controls, but no difference in the number of periapical lesions in endodontically treated teeth was found. Horizontal bone loss and the presence of calculus were more frequent in alcoholic men than in alcoholic women. Significantly more horizontal bone loss was observed in the group of alcoholic nonsmokers than in nonalcoholic nonsmokers. In the nonsmoking groups alcoholics had significantly more periodontal destruction than the nonsmoking controls. We conclude that radiological dental health among individuals dependent on alcohol is weakened by more caries, more horizontal bone loss, and more numerous vertical infrabony pockets than social drinkers.A total of 85 Finnish alcohol-dependent subjects and 53 controls were studied with panoramic radiography. The aim was to study the possible associations between prolonged alcohol consumption and dental health. The mean number of teeth, caries lesions, endodontic treatments, periapical lesions, marginal bone loss, and periodontal infrabony pockets was studied. The subjects met the diagnostic criteria of alcohol dependence as set out in DSM-IV and ICD-10. The control group comprised social drinking volunteers with an AUDIT score < or =8. For the final results the subjects were divided into groups on the basis of sex and age. The social backgrounds of the subjects were similar, except for employment and smoking. The results show significantly fewer teeth and more caries in the alcoholic group. There was a tendency for the alcoholics <45 years of age to have more endodontically treated teeth than the controls, but no difference in the number of periapical lesions in endodontically treated teeth was found. Horizontal bone loss and the presence of calculus were more frequent in alcoholic men than in alcoholic women. Significantly more horizontal bone loss was observed in the group of alcoholic nonsmokers than in nonalcoholic nonsmokers. In the nonsmoking groups alcoholics had significantly more periodontal destruction than the nonsmoking controls. We conclude that radiological dental health among individuals dependent on alcohol is weakened by more caries, more horizontal bone loss, and more numerous vertical infrabony pockets than social drinkers.

Quantitative Assessment of Vertical Heights of Maxillary and Mandibular Bones in Panoramic Radiographs of Elderly Dentate and Edentulous Subjects

The clinical applicability of vertical measurements of the mandible and maxilla in panoramic radiographs was studied by assessing the variety of vertical heights among 91 elderly dentate subjects. Measurements in each jaw and calculations of a maxillary ratio were made at five sites. Variations in measurements of the dentate subjects were small: 9-11% for vertical measurements in the mandible, 6-11% for vertical measurements in the maxilla, and 8-10% for the maxillary ratios. These findings suggest that it is possible quantitatively to assess heights of the mandibular and maxillary bones in panoramic radiographs. Reductions in the edentulous jaws were assessed by comparing the heights of jaws of elderly dentate subjects with those measured in 177 elderly edentulous subjects. Significant differences in heights of the mandibular body and maxilla were found between the dentate and the edentulous (P < 0.001). Edentulous women had greater values for percentage reduction in the mandibles than did the men (P < 0.01; P < 0.001 in various locations).

Radiographic maxillary sinus findings in the elderly

The prevalence of radiographic maxillary sinus findings in 293 elderly subjects (76, 81, and 86 years old) were investigated with the use of panoramic radiography: 124 subjects were edentulous in both jaws, 167 had an edentulous maxilla, and 169 had at least one natural tooth left. Mucous cysts or diffuse mucosal thickenings were found in 12% of the subjects. Of the mucosal thickenings, 70% were found in subjects with a dentate upper jaw (p < 0.05), suggesting an odontogenic origin for that proportion (40%) exceeding the prevalence in subjects edentulous in the maxilla. That the prevalence of mucous cysts was 5% both in subjects with a dentate upper jaw and in those with a edentulous upper jaw suggests nonodontogenic causes.