Use of the modified Schirmer test to measure salivary gland hypofunction/hyposalivation: Systematic review and meta-analysis.

Although dry mouth is a relatively common condition, salivary flow is not routinely measured in dental clinical practice. Moreover, existing data regarding the use of the modified Schirmer test (MST) for the screening of dry mouth has not been summarized. This systematic review and meta-analysis, conducted in accordance with the PRISMA guidelines, aimed to determine whether the modified Schirmer test can be used to identify dry mouth. The databases of PubMed, Scopus, ScienceDirect, and CENTRAL (CRD42023393843) were systematically searched to retrieve articles published until 9th November 2023. Among the 343 original articles retrieved, six met the inclusion criteria. A total of 1150 patients, comprising 710 (61.7%) women and 440 (38.3%) men (mean age, 47.1 ± 7.3 years), were included. The meta-analysis revealed a weak correlation coefficient of r ¯ $\bar{r}$  = 0.42 (95% Cl: 0.29-0.55) between MST and the unstimulated salivary flow rate. Therefore, while the MST might offer a simple and accessible alternative for initial screening in the future, especially in non-specialized settings, its variability in sensitivity and specificity, along with an actual lack of standardization, necessitates cautious interpretation. Further studies are necessary before recommending the test in clinical routine.

The tongue microbiome of young patients with chronic kidney disease and their healthy mothers.

OBJECTIVES: Oral microbiome plays a crucial role in the incidence and development of oral diseases. An altered intestinal microbiome has been reported in adults with chronic kidney disease (CKD). This study aimed to characterize the tongue microbiome of young patients with CKD compared to their healthy mothers to identify the influence of CKD-associated factors on resilient tongue ecosystem. MATERIAL AND METHODS: Thirty patients with CKD (mean age, 14.2 years; 16 males and 14 females) and generalized gingivitis were included in the study. Swabs of the posterior tongue were collected from the patients and 21 mothers (mean age 40.8 years). Next-generation sequencing of 16S rDNA genes was employed to quantitatively characterize microbial communities. RESULTS: The bacterial communities were similar in terms of richness and diversity between patients and mothers (p > 0.05). In patients with CKD, 5 core phyla, 20 core genera, and 12 core species were identified. CONCLUSIONS: The tongue microbiome of the study participants showed no relevant CKD-associated differences compared to their mothers and appears to be a highly preserved niche in the oral cavity. Differences observed in the abundance of individual species in this study could be attributed to the age rather than CKD, even after a mean disease duration of 11 years. CLINICAL RELEVANCE: CKD and its associated metabolic changes appear to have no detectable impact on the resilient tongue microbiome observed in young patients.

Comparison of facilitators and barriers to providing oral hygiene measures in dependent older people and young children: A systematic review.

OBJECTIVE: The objective of the study was to systematically compare barriers/facilitators providing oral hygiene to young children and dependent older people and to generate ideas to improve the implementation of oral hygiene measures. BACKGROUND: Many older people, like children, rely on third-party assistance for teeth cleaning. Barriers/facilitators in providing oral care services have been described in recent works. The aim of our study was to compare these results for both groups and to increase knowledge on analogies/differences in barriers/intermediaries. METHODS: We performed a systematic review. Studies reporting on knowledge, attitudes and beliefs acting as barriers/facilitators for provision of teeth cleaning were included. Thematic analysis was used and identified themes translated to domains and constructs of the theoretical domains framework and aligned to the behaviour change wheel. Based on three published reviews in children or older people, our search (PubMed via Medline), Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science, Google Scholar, last search (21 January 2023) encompassed both populations dated from their last publication (28 February 2018). The review was registered (Prospero, CRD42021278944). For quality assessment, the Newcastle-Ottawa Scale (NOS) was used. RESULTS: Seventeen articles were identified (older people (n = 8), children (n = 9)). Deficits exist for both in terms of "knowledge/skills" among caregivers, with special difficulties in children with challenging behaviour and older people. "Capability" as one of the main elements of behavioural factors that are the basis for behaviour to take place (COM-B, Capability, Opportunity, Motivation-Behaviour) is most often mentioned for children and "opportunity" for older people. CONCLUSIONS: Most of the facilitators and barriers affecting oral care provision in children are also relevant in older people. Approaches for the development of strategies for better implementation of oral hygiene measures in older people are presented.

Use of smartphone photos to document the oral care status of nursing home residents.

OBJECTIVE: Investigate whether clinically assessed oral care status by an external dentist can be replicated using smartphone photographs. BACKGROUND: Many people with care needs have poor oral hygiene. To help maintain oral health, caregivers require a simple way of communicating oral care status to the dental team. MATERIALS AND METHODS: Cross-sectional study in which smartphone photographs of the oral and prosthetic care situation of N = 50 nursing-home patients (mean age 85.6 [SD 6] years, 74% women) were assessed by two blinded, external examiners (D1/D2) and compared with clinical assessments made by the onsite dentist who also took the photographs (D0). Intraoral care status was clinically evaluated using the modified Plaque Index for Long-Term Care (PI-LTC) and Denture Hygiene Index (DHI). The intraclass correlation coefficient (ICC) determined correlations between clinical and photographic findings. RESULTS: The ICC was assessed for the PI-LTC (upper jaw, n = 41; lower jaw, n = 49) and DHI (upper jaw, n = 25; lower jaw, n = 18). The DHI showed excellent reliability between clinical assessment and smartphone evaluation for the determination of positive surfaces (ICC: upper 0.91 [95% confidence interval (CI) 0.83-0.96], P < 0.001; lower 0.95 [95% CI 0.89-0.98], P < 0.001). The PI-LTC showed good reliability between clinical assessment (D0) and D1/D2 for determination of vestibular plaque (ICC: upper 0.84 [95% CI 0.74-0.91], P < 0.001; lower 0.87 [95% CI 0.79-0.92], P < 0.001). CONCLUSIONS: Although limited, this pilot study demonstrated that standardised smartphone photographs can simply communicate the intraoral care status of patients who have difficulties accessing their dentist. This should be considered when planning improved communication between dentists, care recipients, and their support network.

Older people's preferences and expectations of preventive oral care in the home.

OBJECTIVE: The aim of the study was to assess older people's preferences and expectations for preventive oral care in their own home. BACKGROUND: With increasing age, the use of dental services declines and oral health becomes secondary, yet good oral health contributes to quality of life and has a positive impact on general health. Thus, the healthcare system should offer a care structure in which oral health can be maintained into old age. To provide patient-centred care, patient preferences in additional preventive oral care need to be explored. MATERIALS AND METHODS: In this qualitative study, semi-structured interviews were conducted with community-dwelling individuals aged ≥65 years to understand their preferences and expectations for oral care in a home-based setting. Interviews were recorded, transcribed verbatim and analysed thematically. RESULTS: Fourteen dental patients were included. Three overarching themes were identified. The desire for independence was predominant when addressing their future capability to perform oral hygiene. When addressing possible future oral health support, self-determination and independence were important to them. Concerns about dependency in inpatient care facilities and the associated reduction in oral care were evident. Frequency, costs and the practice environment played a decisive role when thinking about additional preventive measures for their future. CONCLUSION: The results of this study provide important information about older people's preferences and expectations for preventive oral care in the home environment and relate to three core themes of (1) changes in oral hygiene skills and perceptions, (2) support and (3) organisational factors. These must be considered when planning and implementing preventive oral care.

[Integrating risks for oral diseases into Structured Information Collection: A practice development project]. / Integration pflegerelevanter Risiken für Munderkrankungen in die Strukturierte Informationssammlung.

Integrating risks for oral diseases into Structured Information Collection: A practice development project Abstract. Background: Deficient oral hygiene and oral diseases are highly prevalent among nursing staff. Up to now, there is no assessment for nursing professionals integrated in the daily nursing routine, which depicts the complex risks for oral diseases. The Structured Information Collection (SIS) is a concept to guide the nursing process and enables individual action planning. Aim: The aim was to integrate oral diseases as a nursing-relevant risk into the SIS and to develop an assessment instrument for oral hygiene deficits/diseases integrated into the SIS topic areas. Methods: Based on a literature search, 21 systematic reviews describing SIS topic areas and oral health risks were analysed by a panel of experts. The caregiver-relevant oral health risks identified in this way were compared with existing oral health assessment instruments and with screening criteria recommended in the German national expert standard for the promotion of oral health in care. Since none of the oral health assessments covers all nursing-relevant oral health risks and the recommended screening criteria of the expert standard, the area of "oral diseases" was integrated into the SIS as an additional category, and an oral health assessment adapted to the SIS was developed. Results: This article presents the SIS expanded to include nursing-relevant oral disease risk and the newly developed Oral Risk Assessment Prevention (Mu-RAP) for use by nurses. Conclusions: The SIS expanded to include oral disease and the Mu-RAP for identifying oral hygiene deficits/diseases cover all nursing-relevant oral health risks. Further studies on the applicability, reliability, and validity of the instrument, as well as on care-effective and patient-relevant effects of its use are needed.

Characteristics of desirable ambulatory health and oral healthcare from the perspective of community-dwelling people aged 80 and over-a qualitative examination.

BACKGROUND: people aged 80 and over frequently have diverse and complex health trajectories, which has been well studied. But their oral health is seldom included in care models. To realise comprehensive healthcare, both general and oral ambulatory (i.e. outpatient) healthcare need to be explored and conceptualised equally. OBJECTIVE: to elicit what matters to very old people regarding ambulatory health and oral healthcare. METHODS: interviews were conducted with non-institutionalised people aged 80 and over living in the area of Cologne, Germany. They were interviewed regarding their experiences of and views on ambulatory healthcare and oral healthcare care, respectively. Thematic analysis was performed to understand their motives and elicit relevant characteristics of desirable health services. RESULTS: from the interviews with 22 participants, 16 characteristics of good healthcare were described. These were generally similar for both general and oral healthcare and had a particular focus on patient-provider interaction and the organisation of care. However, regarding oral healthcare, the participants focused more strongly on the technical-medical skills of professionals and the perceptible treatment results and were more concerned about costs. It was noticeable that older people had the urge to differentiate themselves from 'others unnecessarily using health services'. They were unaware of possible future oral health deterioration and the resulting future needs. CONCLUSIONS: characteristics of good health and oral healthcare from the perspective of older people should be incorporated to ensure patient-centredness in care models. Older patients, as well as healthcare providers, need to be sensitised to their oral health needs to realise comprehensive healthcare.

Using the modified Schirmer test for dry mouth assessment: A cross-sectional study.

This study aimed to establish whether the modified Schirmer test could serve as a diagnostic tool for dry mouth, that is, whether it could reliably measure salivary film at selected locations within the oral cavity, and to identify levels of sensitivity/specificity and determine reference values. Therefore, a cross-sectional study (N = 120, mean age 63.5 [SD 13.9] years) was performed. The test was used at five locations (hard palate; buccal mucosa in molar region at 4 mm above occlusal plane; anterior tongue; lower lip; mouth floor), and results were recorded after 1, 2 and 3 min. A statistically significant discriminatory ability of the Schirmer test for the unstimulated salivary flow rates could be shown for the palate (at 3 min), buccal mucosa (at 1 min), mouth floor (at 1 min), and tongue (at 2 and 3 min) (areas under the curve 0.64-0.68), with individual sensitivity/specificity values depending on test location/time points. Thus, the modified Schirmer test has potential to become a simple and reproducible instrument for the detection of dry mouth based on low unstimulated salivary flow rates in dentistry and especially outreach care. Care must be taken concerning intraoral test location and measurement time.

Oil pulling to relieve medication-induced xerostomia: A randomized, single-blind, crossover trial.

OBJECTIVES: To determine the subjective effectiveness of oilpulling on medication-induced xerostomia with regard to symptom relief, quality of life, taste, mucosal moisture and oral parameters. MATERIALS AND METHODS: In a randomized, single-blind, crossover trial in participants with medication-induced xerostomia (n = 26; mean age 64.71 (standard deviation (SD) 15.60) years), we investigated oilpulling efficacy (sunflower oil) versus mineral water after one-week use. Xerostomic burden (visual analogue scale, VAS), symptom relief and oral examinations (gingivitis index, plaque index, whole stimulated and unstimulated salivation rates) were investigated at baseline and the end of the follow-up. RESULTS: Oilpulling reduced the xerostomic burden (baseline value 6.46 (SD 1.80), decreasing to 4.93 (SD 2.97)) (p = .003), without difference between oil versus water (p = .067). Baseline values for water were 6.08 (SD 2.17) decreasing to 5.72 (SD 2.17) (p = .124). Compared to water, oil made swallowing easier (p = .031), caused a pleasant mouthfeel (p = .031) and caused less waking up at night (p = .031). Effectiveness (p = .002) and duration (p = .007) of symptom relief showed differences between products in favour of oil. CONCLUSIONS: Oil pulling alleviated the overall xerostomic burden. In the comparison between oil and water, no difference regarding symptom relief could be shown. Patients should be informed of possibilities and limitations of oilpulling as inexpensive and easy-to-obtain alternative to commercially available products for short-term symptom relief.

Third-party toothbrushing is associated with a positive patient experience: randomized, single-blind, patient-centered analysis.

BACKGROUND: As the need for care increases with higher age, so does the need for assistance with oral hygiene. A recent study analyzed the clinical effectiveness of oral hygiene assistance provided by caregivers. The current secondary analysis of this study aimed to assess pleasant and unpleasant perceptions of patients while being brushed and to investigate whether these perceptions depend on the qualification of the person brushing and the type of toothbrush used (manual vs. powered). METHODS: First, a qualitative study was conducted. This aimed at developing the questionnaire. Items were extracted on the basis of qualitative interviews with a sample of 6. A delphi process ensured the content validity of the final instrument. The main study comprised 39 periodontitis patients with reduced oral hygiene capability randomized to one of four groups: brushing carried out by trained laypeople or dental professionals, each using a manual or powered toothbrush at three different time points during anti-infective periodontal therapy. Patient perceptions of the third-party toothbrushing were assessed immediately after brushing. RESULTS: Patients reported mainly positive feelings regarding being brushed by a third person and the interaction with this person during brushing. Neither the professional background of the brushing person nor the type of brush had a significant influence on pleasant and unpleasant perceptions (all F < 3.30, all p > 0.07, all η2 < 0.10). CONCLUSIONS: Patient perceptions of third-party toothbrushing are mainly positive regarding wellbeing and interactions with the toothbrushing person, and do not depend on the qualification of the brushing person or the toothbrush used (manual versus powered). Trial registration https://www.germanctr.de , No. DRKS00018779 (04/11/2019).

Impact of an interdisciplinary curriculum for dental students (GeriDent-Cologne) on attitudes and awareness towards older people and geriatric conditions.

INTRODUCTION: Training of dental students in the treatment of older patients must also consider the multiple chronic medical conditions that may be present. We developed an interdisciplinary gerodontology training curriculum for dental students (GeriDent-Cologne) to investigate its influence on the attitudes and expectancies of dental students towards the treatment of older patients. MATERIALS AND METHODS: The curriculum (given to fourth-year students) comprised five clinical examination stations that simulated different medical conditions affecting older people. Students were able to experience related issues first hand, express their fears and problems concerning dental treatment in older people and, through discussion with the supervisor, develop strategies to overcome these difficulties and enhance treatment. An extended version of the Los Angeles Geriatric Attitudes Scale was given to fourth- and fifth-year students (who acted as controls) over one semester. RESULTS: Dental students had a positive attitude towards older people, and their attitude did not change after attending the curriculum. However, participating in GeriDent-Cologne had a significant beneficial impact on the feeling of being prepared to treat older people, led to a significantly greater understanding of the impact of medical issues and resulted in a considerably higher level of geriatric clinical knowledge over time. CONCLUSIONS: GeriDent-Cologne led to positive and semester-long changes in awareness and knowledge of specific geriatric problems that influence dental treatment. We recommend the curriculum as a blueprint for the module of senior dentistry implemented in the new German dental licencing regulations.

Impact of care level, setting and accommodation costs on a newly developed oral care nursing plan format for elderly patients with care needs - Results from a cross-sectional study.

OBJECTIVES: A new oral care nursing plan format for improved communication among dentists, nursing staff and caregivers has been developed in Germany. We aimed to (1) describe this plan, (2) investigate the prevalence of oral health problems among elderly patients with care needs documented by the plan, outline the recommendations in the plans and (3) investigate whether the accommodation costs or care needs of patients influenced oral care quality or the need for oral hygiene support documented within the plan. METHODS: In this cross-sectional trial, oral care nursing plans were collected from outpatient and inpatient care clinics. Items on the oral care nursing plan were divided into three areas (oral health, oral hygiene needs, and coordination needs and dental therapy) and were correlated with the care level and accommodation costs. RESULTS: Oral care nursing plans were collected from seven dentists (N = 747; 94.5% from inpatient and 5.5% from outpatient care). The plans enabled documentation of well-known oral health and hygiene problems among elderly patients. In their current form, the plans provided recommendations for obvious oral hygiene tasks such as toothbrushing or fluoridating, rather than specialized tasks such as nutritional advice or dry mouth asymptomatic therapeutic approaches. Although accommodation costs were associated with the need for oral hygiene support (not with oral care condition), the care level influenced both measures. CONCLUSIONS: The oral care nursing plan can facilitate documentation of oral health and hygiene among elderly individuals with care needs. Further clarification of the plan would help promote careful documentation by dentists.

Does a pretreatment with a dentine hypersensitivity mouth-rinse compensate the pain caused by professional mechanical plaque removal? A single-blind randomized controlled clinical trial.

OBJECTIVES: Pain is affecting acceptance of supportive periodontal therapy and primary periodontitis prevention. Our objective was to evaluate the efficacy of a 1-week pre-treatment use of dentinal-hypersensitivity-reducing mouth-rinses (DHM) in periodontal maintenance (SPT) or dental prophylaxis patients. MATERIAL AND METHODS: One hundred fifty-five participants attending for professional mechanical plaque removal (PMPR) were randomly assigned to use a mouth-rinse twice daily for 1 week prior to their next PMPR. Rinses were containing either potassium oxalate (n = 52), arginine (n = 52), or herbal extracts (n = 51). At baseline and reassessment, procedural pain was assessed by visual analogue scale (VAS) and verbal rating scale (VRS). Self-reported efficacy was documented. RESULTS: No inter-group differences were estimated between both test groups and the control for baseline and reassessment means (VAS, VRS). In the SPT group, VAS reduction and self-reported efficacy were found (p < 0.05). CONCLUSION: The 1-week use of DHM failed to show a predictable effect on discomfort during PMPR overall. Around 20% of the patients showed a quantifiable benefit from both test mouth-rinses, whereas more than 50% reported a subjective pain reduction. Focusing patients undergoing supportive periodontal therapy, quantifiable effects were found for both test groups. From a patient's point of view, DHM might be a suitable adjunct to enhance procedural comfort, especially in patients with a history of periodontitis. CLINICAL RELEVANCE: The 1-week use of the dentinal-hypersensitivity-reducing mouth-rinses prior to professional-mechanical-plaque-removal showed to be a suitable adjunct to enhance procedural comfort during instrumentation, especially in patients undergoing supportive periodontal therapy. Registration number: DRKS00010811.

Effectiveness of brushing teeth in patients with reduced oral hygiene by laypeople: a randomized, controlled study.

BACKGROUND: To evaluate the success of plaque reduction after external toothbrushing by instructed laypeople versus dental professionals using either a manual or powered toothbrush. Longitudinal, randomized, parallel-group intervention study in periodontitis patients with reduced oral hygiene quality undergoing anti-infective therapy. Patients were randomly and equally assigned to one of four groups: laypeople using a manual or powered toothbrush or dental professionals using a manual or powered toothbrush. Plaque reduction (Quigley-Hein-Index (QHI), Marginal Plaque Index (MPI)), gingivitis (papilla bleeding index), and cleaning time (seconds) were investigated. RESULTS: Thirty-nine patients participated in the study. Neither the choice of toothbrush (p = 0.399) nor the use of a dental professional (p = 0.790) had a significant influence on plaque levels achieved. However, multivariate modeling indicated statistically significant differences in the external cleaning time between brushing groups, with longer time required by laypeople (p = 0.002) and longer use of the powered toothbrush (p = 0.024). CONCLUSION: When the ability to carry out personal oral hygiene is reduced, external brushing by dental professionals or instructed laypeople who meet previously defined criteria such as sufficient personal oral hygiene at home could help to fill the emerging dental care gap. A combination of oral hygiene approaches adapted to the individual needs of the patients in need of external help is necessary for optimum oral hygiene. TRIAL REGISTRATION: German Clinical Trials register ( https://www.germanctr.de ; number DRKS00018779; date of registration 04/11/2019).

[Oral health assessment of seniors under outpatient care by family doctors : Development and validation of the geriatric outpatient oral health screening]. / Erfassung der Mundgesundheit von ambulant betreuten Senioren durch Hausärzte : Entwicklung und Validierung des geriatrischen ambulanten Mundgesundheits-Screenings.

BACKGROUND: Despite a high prevalence in the general practitioner (GP) and geriatric field, limitations of oral health of seniors under outpatient care in Germany are not routinely recorded. Since seniors with a high age visit GPs more often than dentists, the question arises whether an interdisciplinary screening instrument can be used to identify reduced oral health in routine practice. OBJECTIVE: The aim of the work was to develop a screening tool for reduced oral health for GPs and to validate this by dental examinations. MATERIAL AND METHODS: The geriatric outpatient oral health screening (GAMS) was developed as a subjective screening instrument to depict dental aspects relevant for geriatric patients, such as chewing problems, pain, periodontitis, bad breath or dry mouth in dichotomous questions. The urgency of a visit to the dentist is also assessed by the family doctor. A total of 75 patients were included and the GAMS and a dental examination were performed for validation. RESULTS: The subjective assessment of patients and dental findings showed reduced oral health especially with recognized risk factors for the development of systemic comorbidities, such as dysphagia and malnutrition, whereas oral health problems were underestimated by patients. Bites, chewing problems and dry mouth showed sufficient correspondence between dental findings and subjective assessment. CONCLUSION: The GAMS could help facilitate the consideration of oral health problems in geriatric patients in a GP setting and promote cooperation with dentists in the sense of European recommendations for action.

[Subjective oral health problems of geriatric outpatients and general medical geriatric findings-a pilot study]. / Subjektive Mundgesundheitsprobleme ambulant betreuter geriatrischer Patienten und allgemeinmedizinisch-geriatrische Befunde ­ eine Pilotstudie.

BACKGROUND: Oral health problems of the aged in Germany are not recorded in general practitioner's practices despite a high prevalence. For this purpose, a subjective geriatric outpatient oral health screening (GAMS) is available. AIM: The aim was to clarify whether subjective oral health problems reported by the GAMS can serve as risk indicators for medical findings in geriatric patients. MATERIAL AND METHODS: A total of 75 geriatric patients >75 years old in a family doctor's practice, GAMS, laboratory parameters, e.g. blood count with hemoglobin (g/dl), leukocytes (cells/nl), platelets (cells/nl), sodium (mmol/l), potassium (mmol/l), glucose in serum (mg/dl), HbA1c (HPLC)%, cholesterol (mg/dl) and glomerular filtration rate (GFR, ml/min), Barthel index and timed up and go test (TUG) were carried out. RESULTS: The most common oral health problems were chewing difficulties (19%) and xerostomia (40%). In the case of oral health problems, there were reduced everyday skills (p = 0.066), slower walking speed (0.049), higher serum glucose (p = 0.001) and long-term glucose values (p = 0.002). Bleeding gums are risk indicators for higher leukocyte concentration (p = 0.036). With xerostomia, the hemoglobin value drops by 1.13 g/dl (p = 0.001). DISCUSSION: The GAMS helps to identify oral problems as risk indicators of reduced geriatric health. Also, GAMS can be initiated in cases of the described geriatric pathologies in order to identify possible oral problems.

Objective masticatory efficiency and subjective quality of masticatory function among patients with periodontal disease.

AIMS: To examine patient-centred clinical outcomes for objective masticatory efficiency (OME) and subjective quality of masticatory function (QMF) among periodontitis patients using test methods easily applicable in daily practice. MATERIALS AND METHODS: Cross-sectional investigation of patients undergoing supportive periodontal therapy (n = 224). Outcomes included OME and QMF related to periodontitis characteristics. RESULTS: OME and QMF were associated (x2  = 0.252, p = 0.037) and showed highest values in stage 4 according to the new classification of periodontal disease. There were correlations particularly in stage 2 between OME and number of teeth (x2  = -0.317, p < 0.001), Quigley-Hein Index (x2  = 0.152, p = 0.031), attachment level (x2  = 0.268, p < 0.001), probing depths (x2  = 0.185, p = 0.006), tooth mobility (x2  = 0.147, p = 0.031) and functional occlusal units (x2  = -0.423, p < 0.001) but not bleeding on probing. A trend existed between QMF and number of teeth (x2  = -0.237, p = 0.050) and functional occlusal units (x2  = 0.238, p = 0.058), but not other periodontal findings. CONCLUSIONS: OME and QMF values represent each other and are highest in stage 4. Periodontitis findings influence masticatory efficiency particularly in stage 2, but gingival inflammation does not. Number of teeth and functional occlusal units are associated with QMF, while periodontitis findings have less impact. An assessment of mastication should be routinely included in the diagnosis of periodontitis patients in all stages.

Impact of regular professional toothbrushing on oral health, related quality of life, and nutritional and cognitive status in nursing home residents.

OBJECTIVES: The oral hygiene of nursing home residents is poor. We aimed to investigate the efficacy of professional brushing using a specialized brush every three weeks and its impact on geriatric outcomes. METHODS: Nursing home residents received professional brushing with a three-headed brush by a dental nurse every three weeks for three months. Controls comprised subjects from an earlier investigation. Their general clinical, geriatric and oral health (number of teeth, periodontitis, Gingivitis Index, Plaque Index, Root Caries Index, Volpe-Manhold Index [VMI]) were investigated, and Geriatric Oral Health Assessment Index (GOHAI) was obtained before and after three months. RESULTS: Forty nursing home residents were included. Seventy-six percent of participants suffered from periodontitis, while 48% had partial and 20% total dentures. After three months, VMI had decreased vs baseline (P < .001). An improvement in nutritional status (P = .012) was found in residents with dementia after the intervention, as well as an improvement in the GOHAI (P = .031) in all participants. Gingivitis and plaque indices did not improve. CONCLUSIONS: The oral health of nursing home residents is poor for various reasons, and nursing home staff cannot fully address the increased oral hygiene risk with increasing multimorbidity. Professional brushing performed regularly by a dental nurse is an efficient method to improve oral hygiene in nursing home residents and may contribute to better nutritional status and quality of life. However, brushing every three weeks with a three-headed brush was not effective at improving gingivitis or plaque and was inferior to the two-week brushing interval with a manual toothbrush.

Efficacy of a newly developed mouth gel for xerostomia relief-A randomized double-blind trial.

OBJECTIVES: To determine the efficacy of a new symptom-relieving mouth gel vs. a widely used control gel on xerostomic burden. MATERIALS AND METHODS: This randomized, double-blind, crossover trial investigated the efficacy of the test gel (Dr. Wolff Gel) vs. control (Biotene) in participants with xerostomia (n = 32; mean age 60 years). Oral examinations were taken at baseline, and xerostomic visual analogue scales (xVAS), after-use questionnaires and willingness to pay were investigated before and after use. RESULTS: Neither gel reduced xerostomic burden (xVAS) after 7-day application. There was some preference for the test gel regarding taste and healthy gum feeling. After 1-time application, there were differences favouring the test gel for symptom-relieving effects between test gel and water (p < 0.001), mucosal adhesion (p < 0.001) and taste persistence (p < 0.001). Overall symptomatic relief with the test gel lasted around 2 hr. CONCLUSIONS: No mouth gel alleviated the overall xerostomic burden. Nevertheless, the test gel led to short-term perceived symptomatic relief and improved patient-centred outcomes as taste and perceived gum health. The gel will probably mainly be effective at moments that patients mostly suffer from xerostomia. Selection of a product will be based on perceived subjective differences and their value in the context of the overall xerostomic burden.

Circadian rhythms and influencing factors of xerostomia among Parkinson's disease patients.

OBJECTIVES: Parkinson's disease (PD) patients suffer from xerostomia, but limited information exists regarding associations with dysphagia, drooling, daily habits, PD characteristics, or possible circadian rhythms. SUBJECTS AND METHODS: A questionnaire was administered, including (a) clinical characteristics (comorbidities, prescribed medications, levodopa equivalent daily dose [LEDD], disease duration); (b) self-assessment of dysphagia, xerostomia, drooling (10-cm visual analogue scale [VAS]); (c) 24-hr diary of motor impairment, dyskinesia, xerostomia, dysphagia, drooling, daily habits. RESULTS: Of 75 PD patients who completed the study, 67% reported dysphagia (mean ± standard deviation VAS 4 ± 2), 76% drooling (5 ± 2), 77% xerostomia (5 ± 2). Xerostomia was associated with comorbidities (p = 0.021) and smoking (p = 0.010) and affected by tremor (p = 0.003), dyskinesia (p = 0.010), dysphagia (p < 0.001), food intake (p = 0.005), sleep (p = 0.011), age (p = 0.018), medication intake (p = 0.063), LEDD (p = 0.052), daytime (p = 0.075), disease duration (p = 0.004). Xerostomia peaked at 9 a.m. and 9 p.m. CONCLUSIONS: PD patients suffer from xerostomia, dysphagia, and drooling. Subjective dysphagia is associated with drooling and xerostomia, but drooling prevalence or intensity does not influence xerostomia symptoms. Tremor, dyskinesia, and disease duration, which characterise PD, affect xerostomia. Additionally, food intake, sleep, age, LEDD, and daytime (peaks at 9 a.m. and 9 p.m.) increase xerostomia occurrence. This knowledge may improve dentists' advice to patients and aid development of patient-centred, symptom-relieving products.