Shihoko Sakuma

Relationships between the amount of saliva and medications in elderly individuals

OBJECTIVE To investigate medications that are related to volume of saliva in the elderly. BACKGROUND DATA In the elderly, many cases of mouth dryness may represent side effects of medication. MATERIALS AND METHODS The volume of unstimulated saliva was measured for 30 s (cotton roll test), and with stimulation for 3 min (gum test) in 368 subjects 79-80 years old (177 men, 191 women). Medications were investigated using subjects medication notebooks. RESULTS Mean volumes of unstimulated and stimulated saliva were 0.14±0.13 and 4.30±2.54 ml respectively. Significant differences were seen between gender and mean volume of saliva. The volume of unstimulated saliva was 0.16±0.15 ml for men and 0.11±0.10 ml for women. The volume of stimulated saliva was 4.99±2.67 ml for men and 3.67±2.25 ml for women. The percentage of subjects taking medication was 64.7% (238/368). Mean number of medications was 2.08±2.26, with no significant difference with gender (2.01±2.37 for men, 2.16±2.16 for women). In a stepwise multiple regression analysis with volume of saliva as the objective variable and number of drugs by category as explanatory variables, significant explanatory variables in addition to gender and number of medications were blood-coagulating agents, Ca antagonists and peptic ulcer drugs for volume of unstimulated saliva, and diabetes medications and peptic ulcer drugs for volume of stimulated saliva. CONCLUSION These findings suggest that differences exist between gender in volume of saliva for elderly individuals, and that the volume of saliva is affected by the number and type of medications.

Fluoride Intake from Food and Liquid in Japanese Children Living in Two Areas with Different Fluoride Concentrations in the Water Supply

The purpose of this study was to estimate the average daily amount of fluoride from the diet ingested by Japanese children of ages susceptible to dental fluorosis in two areas with different fluoride concentrations in the water supply. Thirty-eight children aged 2–8 years participated in a survey of fluoride intake. Twenty-one out of 38 children lived in an area in which the community water fluoride concentration was an average of 0.555 ppm (moderate fluoride area: MFA), and 17 lived in a low fluoride area (LFA), which ranged between 0.040 and 0.131 ppm. To measure the fluoride intake, diets were collected with a duplicate-diet technique. The fluoride concentrations in each sample were measured using the diffusion technique of Taves and the electrode technique. Meanwhile, after clinical examinations for dental caries and fluorosis, 228 subjects aged 13–15 years were selected for analysis from the same communities. The mean DMFT in the MFA was significantly lower than that in the LFA. The severest grade of dental fluorosis observed was ‘very mild’ according to Dean’s fluorosis index in both areas. The total daily fluoride intakes were 0.0252–0.0254 mg F/kg/day in the MFA and 0.0126–0.0144 mg F/kg/day in the LFA. Differences in the fluoride concentration of drinking water in this study were reflected in the fluoride intake from the diet in a typical Japanese diet.

Changes in Electrical Resistance of Sound Fissure Enamel in First Molars for 66 Months from Eruption

The purposes of this study were to investigate the enamel maturation process in the occlusal pit of sound first molars by measuring electrical resistance. Ninety-nine sound first molars in 34 children (mean age of 6.47 ± 0.51 years) were measured electrically once every 6 months and were monitored for a maximum of 66 months. Electrical resistance increased during the posteruptive period. However, the results suggest that posteruptive enamel maturation in the occlusal pits may not be completed even 66 months after tooth eruption.

Influence of a fluoride mouthrinse on mutans streptococci in schoolchildren.

This study aimed to determine whether the long-term use of a fluoride mouthrinse affects the salivary levels of mutans streptococci. Two hundred and fifteen schoolchildren (aged 9–10 years) participated. One hundred and forty-nine of these children had used a fluoride mouthrinse since 5 years of age at nursery school, and the remaining 66 children had not. DFT (decayed and filled teeth) was recorded, and the salivary levels of Streptococcus mutans and Streptococcus sobrinus were measured using mitis salivarius bacitracin agar. The group that had used a fluoride mouthrinse had a significantly lower prevalence of both S. mutans and S. sobrinus (p = 0.038) and a significantly lower DFT score (p < 0.001) than the other group. Using logistic regression analysis including caries experience at baseline as a dependent variable, the odds ratio of carrying S. mutans alone was 8.0 (p = 0.066) and that of carrying both S. mutans and S. sobrinus was 16.5 (p = 0.022) in the group that had not used the fluoride mouthrinse. Children carrying both S. mutans and S. sobrinus had a higher caries incidence in 1 year than the others, with odds ratios of 5.73 (p = 0.067) in the group with a fluoride mouthrinse and 3.47 (p = 0.035) in the group without it. These results show that the long-term use of a fluoride mouthrinse is associated with reduced salivary levels of mutans streptococci and this bacterial reduction may partly contribute to the suppression of dental caries in children using a long-term fluoride mouthrinse.

Economic Evaluation of a School-based Combined Program with a Targeted Pit and Fissure Sealant and Fluoride Mouth Rinse in Japan

Background: In Niigata prefecture, Japan, a system has been developed based on a school-based fluoride mouth rinse program as follows; students with caries susceptible teeth are screened in a school dental examination, and encouraged to receive sealant placement in local dental clinics. However, the cost-effectiveness of sealant application in the public health has been questioned. The aim of this study was to estimate of the cost-effectiveness and cost-benefit ratio for a school-based combined program with fluoride mouth rinse and targeted fissure sealant in children residing in non-fluoridated areas in Japan. Participants: The analysis was based on comparing an intervention group with two cohorts in the 8-year-old (n=66) and 11-year-old (n=58) participating in the combined program for four and seven years, respectively, with a control group of the same grades (n=43 and n=54 respectively). Methods: The study measured mean differences in number of decayed and filled teeth (DFT) between the study groups and a combined program cost per child during study periods. The cost-effectiveness ratio was expressed as an individual annual program cost per DFT averted. In the cost-benefit ratio the mean difference in treatment cost between groups (program benefit) was compared to program cost. Results: The mean reduced DFT differences between groups were 1.44 in 8-year-old and 3.17 in 11-year-old children. The cost-effectiveness ratio was ¥ 493 in the 8-year-old and ¥ 202 in the 11-year-old, respectively. The cost-benefit ratio was 1.84 in 8-year-old children and 2.42 in 11-year-old. Conclusion: This combined program indicated acceptable cost-effectiveness and cost –benefit ratio.