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Analysis of incidence of xerostomia in patients of advanced years
Marek Nahajowski, Sylwia Hnitecka, Patrycja Gorzel, Anna Majchrzak, Katarzyna Skośkiewicz-Malinowska, Barbara Malicka
Streszczenie
Wstęp. Osoby w podeszłym wieku często się skarżą na uczucie suchości w jamie ustnej, które może być spowodowane hipofunkcją gruczołów ślinowych (kserostomia pierwotna, prawdziwa) lub może przebiegać przy zachowanej prawidłowej czynności ślinianek i charakteryzować się brakiem objawów obiektywnych (kserostomia rzekoma).
Cel pracy. Celem pracy była analiza częstości występowania kserostomii u pacjentów w podeszłym wieku, diagnozowanej na podstawie wywiadu i badania klinicznego z uwzględnieniem czynników predysponujących.
Materiał i metody. Badaniu poddano 50 mieszkańców Wrocławia powyżej 60. roku życia. Do oceny suchości jamy ustnej zastosowano badanie kwestionariuszowe (test Foxa), badanie kliniczne (test Challacombe’a) oraz badanie ankietowe (wywiad chorobowy, pytanie o subiektywne odczucie suchości). Na przeprowadzenie badania uzyskano zgodę komisji bioetycznej Uniwersytetu Medycznego we Wrocławiu. Wyniki poddano analizie statystycznej z użyciem testu Levene’a, testu t-Studenta, testu niezależności χ2 oraz obliczono współczynnik korelacji Pearsona dla p > 0,05.
Średni wynik w teście Foxa wyniósł 3,8 ± 2,58. W grupie kobiet wartość ta była wyższa niż u mężczyzn (4,27 ± 2,54 vs. 2,88 ± 2,49; p = 0,42). W teście Challacombe’a średni wynik dla całej grupy wyniósł 2,12 ± 1,84. W grupie kobiet wartość ta była wyższa niż w grupie mężczyzn (2,33 ± 1,99 vs. 1,71 ± 1,49; p = 0,13). Na pytanie o subiektywne odczucie suchości odpowiedzi twierdzącej udzieliło 34% badanych, wśród nich 15 kobiet i 2 mężczyzn (p = 0,01).
Do wystąpienia kserostomii predysponują podeszły wiek, a także choroby ogólnoustrojowe, szczególnie choroby serca i nadciśnienie tętnicze. Ponadto problem suchości jamy ustnej częściej dotyczy kobiet niż mężczyzn. Równocześnie potwierdzono, że testy Foxa i Challacombe’a to odpowiednie narzędzia do oceny kserostomii u osób w wieku starszym.
Średni wynik w teście Foxa wyniósł 3,8 ± 2,58. W grupie kobiet wartość ta była wyższa niż u mężczyzn (4,27 ± 2,54 vs. 2,88 ± 2,49; p = 0,42). W teście Challacombe’a średni wynik dla całej grupy wyniósł 2,12 ± 1,84. W grupie kobiet wartość ta była wyższa niż w grupie mężczyzn (2,33 ± 1,99 vs. 1,71 ± 1,49; p = 0,13). Na pytanie o subiektywne odczucie suchości odpowiedzi twierdzącej udzieliło 34% badanych, wśród nich 15 kobiet i 2 mężczyzn (p = 0,01).
Do wystąpienia kserostomii predysponują podeszły wiek, a także choroby ogólnoustrojowe, szczególnie choroby serca i nadciśnienie tętnicze. Ponadto problem suchości jamy ustnej częściej dotyczy kobiet niż mężczyzn. Równocześnie potwierdzono, że testy Foxa i Challacombe’a to odpowiednie narzędzia do oceny kserostomii u osób w wieku starszym.
Abstract
Introduction. Older patients often complain of a feeling of dryness in the oral cavity, that may be caused by hypofunction of the salivary glands (primary xerostomia) or may take a course that has the characteristic features of normal salivary function without the objective characteristics with absence of objective symptoms (supposed xerostomia).
Introduction. Older patients often complain of a feeling of dryness in the oral cavity, that may be caused by hypofunction of the salivary glands (primary xerostomia) or may take a course that has the characteristic features of normal salivary function without the objective characteristics with absence of objective symptoms (supposed xerostomia).
Aim of study. The aim of the study was to analyse the incidence of xerostomia in patients of advanced years and diagnosed on the basis of history and clinical examination, taking into account predisposing factors.
Materials and methods. Examinations were carried out on 50 inhabitants of Wrocław over the age of sixty years. In order to evaluate dryness of the oral cavity use was made of a questionnaire (Fox), clinical examination (Challacombe) and a survey questionnaire (history of condition, questions about the subjective feeling of dryness). In order to carry out the study, permission was obtained of the Bioethical Commission of the Medical University of Wrocław. The results were subjected to statistical analysis using the tests: Levene, Student t-test, χ2 test and measurement was made of Pearson’s correlation for p > 0.05.
The mean value for the Fox test was 3.8 ± 2.58. In the group of women this value was higher than for the men (4.27 ± 2.54 vs. 2.88 ± 2.49; p = 0.42). In the Challacombe test the mean value for the whole group was 2.12 ± 1.84. In the women group this value was higher than in the men (2.33 ± 1.99 vs. 1.71 ± 1.49; p = 0.13). For the question about the subjective feeling about dryness, an affirmative answer was given by 34% of those examined, among whom there were 25 women and 2 men (p = 0.01).
Incidence to xerostomia is predisposed by old age, also by systemic disease, especially heart disease and aortic hypertension. In addition, the problem of dryness of the oral cavity more frequently affects women than men. At the same time it was confirmed that the tests of Fox and Challacombe are the proper tools for evaluating xerostomia in persons of advance years.
The mean value for the Fox test was 3.8 ± 2.58. In the group of women this value was higher than for the men (4.27 ± 2.54 vs. 2.88 ± 2.49; p = 0.42). In the Challacombe test the mean value for the whole group was 2.12 ± 1.84. In the women group this value was higher than in the men (2.33 ± 1.99 vs. 1.71 ± 1.49; p = 0.13). For the question about the subjective feeling about dryness, an affirmative answer was given by 34% of those examined, among whom there were 25 women and 2 men (p = 0.01).
Incidence to xerostomia is predisposed by old age, also by systemic disease, especially heart disease and aortic hypertension. In addition, the problem of dryness of the oral cavity more frequently affects women than men. At the same time it was confirmed that the tests of Fox and Challacombe are the proper tools for evaluating xerostomia in persons of advance years.
Hasła indeksowe: kserostomia, suchość jamy ustnej, niedobór śliny, hipofunkcja ślinianek
Key words: xerostomia, mouth dryness, saliva deficiency, salivary glands hypofunction
PIŚMIENNICTWO
1. Llena-Puy C.: The role of saliva in maintaining oral health and as an aid to diagnosis. Med. Oral Patol. Oral Cir. Bucal.,2006,11, 5, 449-455.
2. Han P., Suarez- Durall P., Mulligan R.: Dry mouth: A critical topic for older adult patients. J. Prosthodont. Res., 2015, 59, 6-19.
3. Villa A., Connell L.C., Abati S.: Diagnosis and management of xerostomia and hyposalivation. Ther. Clin Risk Manag., 2015, 11, 45-51.
4. Ouanounou A.: Xerostomia in the geriatric patient: causes, oral manifestations, and treatment. Compend. Contin. Educ. Dent., 2016, 37, 5, 306-311.
5. Fox P.C., Busch K.A., Baum B.J.: Subjective reports of xerostomia and objective measures of salivary gland performance. J Am. Dent. Assoc., 1987, 115, 4, 581-584.
6. Osailan S. i wsp.: Investigating the relationship between hyposalivation and mucosal wetness. Oral Dis., 2011,17, 1), 109-114.
7. Agha-Hosseini F., Shirzad N., Moosavi M-S.: Evaluation of xerostomia and salivary flow rate in Hashimoto’s thyroiditis. Med. Oral Patol. Oral Cir. Bucal, 2016, 21, 1, 1-5.
8. Mavragani C.P. Fragoulis G.E., Rontogianni D. i wsp.: Elevated IgG4 serum levels among primary Sjögren’s syndrome patients: do they unmask underlying IgG4-related disease? Arthritis Care Res. (Hoboken), 2014, 66, 5, 773-777.
9. Rzymska-Grala I., Stopa Z., Grala B. i wsp.: Salivary gland calculi – contemporary methods of imaging. Pol. J. Radiol., 2010, 75, 3, 25-37.
10. Kaczmarek U.: Suchość jamy ustnej – etiologia, częstość występowania i rozpoznanie – na podstawie piśmiennictwa. Czas. Stomatol., 2007, 60, 1, 20-31.
11. Chen A., Wai Y., Lee L. i wsp.: Using the modified Schirmer test to measure mouth dryness: a preliminary study. J. Am. Dent. Assoc., 2005, 136, 2, 164-170.
12. Sánchez-Guerrero J., Aguirre-García E., Pérez-Dosal M.R. i wsp.: The wafer test: a semi-quantitative test to screen for xerostomia. Rheumatology , 2002, 41, 4, 381-389.
13. Närhi T.O.: Prevalence of subjective feelings of dry mouth in the elderly. J. Dent. Res., 1994, 73, 1, 20-25.
14. Pescio J.J.: Clinical epidemiological study of xerostomia in elderly totally edentulous. Rev. Fac. Cien. Med. Univ. Nac. Cordoba. 2006, 63, 2, 6-12.
15. da Silva L., Kupek E., Peres G.K.: General health influences episodes of xerostomia: a prospective population-based study. Community Dent. Oral Epidemiol., 2016, 44, 6, 1-7.
16. Bossola M., Di Stasio E., Giungi S. i wsp.: Xerostomia is associated with old age and poor appetite in patients on chronic hemodialysis. J. Ren. Nutr., 2013, 23, 6, 432-437.
17. Tanasiewicz M., Hildebrandt T., Obersztyn I.: Xerostomia of various etiologies: a review of the literature. Adv. Clin. Exp. Med., 2016, 25, 1, 199-206.
18.Villa A., Polimeni A., Strohmenger L. i wsp.: Dental patients’ self-reports of xerostomia and associated risk factors. J. Am. Dent. Assoc., 2011, 142, 7, 811-816.
19. Field E.A., Fear S., Higham S.M. i wsp.: Age and medication are significant risk factors for xerostomia in an English population, attending general dental practice. Gerodontology, 2001, 18, 1, 21-24.
20. Locker D.: Xerostomia in older adults: a longitudinal study. Gerodontology, 1995, 12, 1, 18-25.
21. Johansson A.K., Johansson A., Unell L. i wsp.: Self-reported dry mouth in Swedish population samples aged 50, 65 and 75 years., Gerodontology, 2012, 29, 2, 107-115.
22. Kaur M., Himadi E., Chi D.L.: Prevalence of xerostomia in an adolescent inpatient psychiatric clinic: a preliminary study. Spec. Care Dentist. 2016, 36, 2, 60-65.
23. Bergdahl M.: Salivary flow and oral complaints in adult dental patients. Community Dent. Oral Epidemiol., 2000, 28, 1, 59-66.
24. Ohara Y., Hirano H., Yoshida H. i wsp.: Ratio and associated factors of dry mouth among community-dwelling elderly Japanese women. Geriatr. Gerontol. Int., 2011, 11, 1, 83-89.
25. Ikebe K., Nokubi T., Sajima H. i wsp.: Perception of dry mouth in a sample of community-dwelling older adults in Japan. Spec. Care Dentist., 2001, 21, 2, 52-59.
26. Al-Dwairi Z., Lynch E.: Xerostomia in complete denture wearers: prevalence, clinical findings and impact on oral functions. Gerodontology, 2014, 31, 1, 49-55.
27.Turner M., Jahangiri L., Ship J.A.: Hyposalivation, xerostomia and the complete denture. A systematic review. J. Am. Dent. Assoc., 2008, 139, 146-150.
28. Anil S., Vellappally S., Hashem M. i wsp.: Xerostomia in geriatric patients: a burgeoning global concern. J. Investig. Clin. Dent., 2016, 7, 1, 5-12.
29. Edgerton M., Tabak L.A., Levine M.J.: Saliva: a significant factor in removable prosthodontic treatment. J. Prosthet. Dent., 1987, 57, 57-66.
30. Hahnel S., Schwarz S., Zeman F. i wsp.: Prevalence of xerostomia and hyposalivation and their association with quality of life in elderly patients in dependence on dental status and prosthetic rehabilitation: a pilot study. J. Dent., 2014, 42, 6, 664-670.
31. Mortazavi H., Baharvand M., Movahhedian A. i wsp.: Xerostomia due to systemic disease: a review of 20 conditions and mechanisms. Ann. Med. Health Sci. Res., 2014, 4, 4, 503-510.
32. Kumar P., Mastan K.M.K., Chowdhary R. i wsp.:Oral manifestations in hypertensive patients: a clinical study. J. Oral Maxillofac. Pathol., 2012, 16, 2, 215-221.
33. Guggenheimer J., Moore P.A.: Xerostomia: etiology, recognition and treatment. J. Am. Dent. Assoc., 2003,134, 1, 61-69.
34. Anttila S.S., Knuuttila M.L., Sakki T.K.: Depressive symptoms as an underlying factor of the sensation of dry mouth. Psychosom. Med., 1998, 60, 2, 215-218.
35. Astor F.C., Hanft K.L., Ciocon J.O.: Xerostomia: a prevalent condition in the elderly. Ear Nose Throat J., 1999, 78, 7, 476-479.
PIŚMIENNICTWO
1. Llena-Puy C.: The role of saliva in maintaining oral health and as an aid to diagnosis. Med. Oral Patol. Oral Cir. Bucal.,2006,11, 5, 449-455.
2. Han P., Suarez- Durall P., Mulligan R.: Dry mouth: A critical topic for older adult patients. J. Prosthodont. Res., 2015, 59, 6-19.
3. Villa A., Connell L.C., Abati S.: Diagnosis and management of xerostomia and hyposalivation. Ther. Clin Risk Manag., 2015, 11, 45-51.
4. Ouanounou A.: Xerostomia in the geriatric patient: causes, oral manifestations, and treatment. Compend. Contin. Educ. Dent., 2016, 37, 5, 306-311.
5. Fox P.C., Busch K.A., Baum B.J.: Subjective reports of xerostomia and objective measures of salivary gland performance. J Am. Dent. Assoc., 1987, 115, 4, 581-584.
6. Osailan S. i wsp.: Investigating the relationship between hyposalivation and mucosal wetness. Oral Dis., 2011,17, 1), 109-114.
7. Agha-Hosseini F., Shirzad N., Moosavi M-S.: Evaluation of xerostomia and salivary flow rate in Hashimoto’s thyroiditis. Med. Oral Patol. Oral Cir. Bucal, 2016, 21, 1, 1-5.
8. Mavragani C.P. Fragoulis G.E., Rontogianni D. i wsp.: Elevated IgG4 serum levels among primary Sjögren’s syndrome patients: do they unmask underlying IgG4-related disease? Arthritis Care Res. (Hoboken), 2014, 66, 5, 773-777.
9. Rzymska-Grala I., Stopa Z., Grala B. i wsp.: Salivary gland calculi – contemporary methods of imaging. Pol. J. Radiol., 2010, 75, 3, 25-37.
10. Kaczmarek U.: Suchość jamy ustnej – etiologia, częstość występowania i rozpoznanie – na podstawie piśmiennictwa. Czas. Stomatol., 2007, 60, 1, 20-31.
11. Chen A., Wai Y., Lee L. i wsp.: Using the modified Schirmer test to measure mouth dryness: a preliminary study. J. Am. Dent. Assoc., 2005, 136, 2, 164-170.
12. Sánchez-Guerrero J., Aguirre-García E., Pérez-Dosal M.R. i wsp.: The wafer test: a semi-quantitative test to screen for xerostomia. Rheumatology , 2002, 41, 4, 381-389.
13. Närhi T.O.: Prevalence of subjective feelings of dry mouth in the elderly. J. Dent. Res., 1994, 73, 1, 20-25.
14. Pescio J.J.: Clinical epidemiological study of xerostomia in elderly totally edentulous. Rev. Fac. Cien. Med. Univ. Nac. Cordoba. 2006, 63, 2, 6-12.
15. da Silva L., Kupek E., Peres G.K.: General health influences episodes of xerostomia: a prospective population-based study. Community Dent. Oral Epidemiol., 2016, 44, 6, 1-7.
16. Bossola M., Di Stasio E., Giungi S. i wsp.: Xerostomia is associated with old age and poor appetite in patients on chronic hemodialysis. J. Ren. Nutr., 2013, 23, 6, 432-437.
17. Tanasiewicz M., Hildebrandt T., Obersztyn I.: Xerostomia of various etiologies: a review of the literature. Adv. Clin. Exp. Med., 2016, 25, 1, 199-206.
18.Villa A., Polimeni A., Strohmenger L. i wsp.: Dental patients’ self-reports of xerostomia and associated risk factors. J. Am. Dent. Assoc., 2011, 142, 7, 811-816.
19. Field E.A., Fear S., Higham S.M. i wsp.: Age and medication are significant risk factors for xerostomia in an English population, attending general dental practice. Gerodontology, 2001, 18, 1, 21-24.
20. Locker D.: Xerostomia in older adults: a longitudinal study. Gerodontology, 1995, 12, 1, 18-25.
21. Johansson A.K., Johansson A., Unell L. i wsp.: Self-reported dry mouth in Swedish population samples aged 50, 65 and 75 years., Gerodontology, 2012, 29, 2, 107-115.
22. Kaur M., Himadi E., Chi D.L.: Prevalence of xerostomia in an adolescent inpatient psychiatric clinic: a preliminary study. Spec. Care Dentist. 2016, 36, 2, 60-65.
23. Bergdahl M.: Salivary flow and oral complaints in adult dental patients. Community Dent. Oral Epidemiol., 2000, 28, 1, 59-66.
24. Ohara Y., Hirano H., Yoshida H. i wsp.: Ratio and associated factors of dry mouth among community-dwelling elderly Japanese women. Geriatr. Gerontol. Int., 2011, 11, 1, 83-89.
25. Ikebe K., Nokubi T., Sajima H. i wsp.: Perception of dry mouth in a sample of community-dwelling older adults in Japan. Spec. Care Dentist., 2001, 21, 2, 52-59.
26. Al-Dwairi Z., Lynch E.: Xerostomia in complete denture wearers: prevalence, clinical findings and impact on oral functions. Gerodontology, 2014, 31, 1, 49-55.
27.Turner M., Jahangiri L., Ship J.A.: Hyposalivation, xerostomia and the complete denture. A systematic review. J. Am. Dent. Assoc., 2008, 139, 146-150.
28. Anil S., Vellappally S., Hashem M. i wsp.: Xerostomia in geriatric patients: a burgeoning global concern. J. Investig. Clin. Dent., 2016, 7, 1, 5-12.
29. Edgerton M., Tabak L.A., Levine M.J.: Saliva: a significant factor in removable prosthodontic treatment. J. Prosthet. Dent., 1987, 57, 57-66.
30. Hahnel S., Schwarz S., Zeman F. i wsp.: Prevalence of xerostomia and hyposalivation and their association with quality of life in elderly patients in dependence on dental status and prosthetic rehabilitation: a pilot study. J. Dent., 2014, 42, 6, 664-670.
31. Mortazavi H., Baharvand M., Movahhedian A. i wsp.: Xerostomia due to systemic disease: a review of 20 conditions and mechanisms. Ann. Med. Health Sci. Res., 2014, 4, 4, 503-510.
32. Kumar P., Mastan K.M.K., Chowdhary R. i wsp.:Oral manifestations in hypertensive patients: a clinical study. J. Oral Maxillofac. Pathol., 2012, 16, 2, 215-221.
33. Guggenheimer J., Moore P.A.: Xerostomia: etiology, recognition and treatment. J. Am. Dent. Assoc., 2003,134, 1, 61-69.
34. Anttila S.S., Knuuttila M.L., Sakki T.K.: Depressive symptoms as an underlying factor of the sensation of dry mouth. Psychosom. Med., 1998, 60, 2, 215-218.
35. Astor F.C., Hanft K.L., Ciocon J.O.: Xerostomia: a prevalent condition in the elderly. Ear Nose Throat J., 1999, 78, 7, 476-479.
