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Type 1 diabetes mellitus, xerostomia, and salivary flow rates

      Abstract

      Objective: The Oral Health Science Institute at the University of Pittsburgh has completed a cross-sectional epidemiologic study of 406 subjects with type 1 diabetes and 268 control subjects without diabetes that assessed the associations between oral health and diabetes. This report describes the prevalence of dry-mouth symptoms (xerostomia), the prevalence of hyposalivation in this population, and the possible interrelationships between salivary dysfunction and diabetic complications. Study Design: The subjects with diabetes were participants in the Pittsburgh Epidemiology of Diabetes Complications study who were enrolled in an oral health substudy. Control subjects were spouses or best friends of participants or persons recruited from the community through advertisements in local newspapers. Assessments of salivary function included self-reported xerostomia measures and quantification of resting and stimulated whole saliva flow rates. Results: Subjects with diabetes reported symptoms of dry mouth more frequently than did control subjects. Salivary flow rates were also impaired in the subjects with diabetes. Regression models of potential predictor variables were created for the 3 self-reported xerostomia measures and 4 salivary flow rate variables. Of the medical diabetic complications studied (ie, retinopathy, peripheral and autonomic neuropathy, nephropathy, and peripheral vascular disease), only neuropathy was found to be associated with xerostomia and decreased salivary flow measures. A report of dry-mouth symptoms was associated with current use of cigarettes, dysgeusia (report of a bad taste), and more frequent snacking behavior. Xerogenic medications and elevated fasting blood glucose concentrations were significantly associated with decreased salivary flow. Resting salivary flow rates less than 0.01 mL/min were associated with a slightly higher prevalence of dental caries. Subjects who reported higher levels of alcohol consumption were less likely to have lower rates of stimulated salivary flow. Conclusions: Subjects with type 1 diabetes who had developed neuropathy more often reported symptoms of dry mouth as well as symptoms of decreased salivary flow rates. Because of the importance of saliva in the maintenance and the preservation of oral health, management of oral diseases in diabetic patients should include a comprehensive evaluation of salivary function. (ORAL Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:281-91)
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      References

        • Harris MI
        • Flegal KM
        • Cowie CC
        • Eberhardt MS
        • Goldstein DE
        • Little RR
        • et al.
        Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in US adults. The Third National Health and Nutrition Examination Survey, 1988-1994.
        Diabetes Care. 1988; 21: 518-524
        • Harris MI
        Summary.
        in: Diabetes in America. National Diabetes Data Group. NIH, 1995: 95-1468 (NIH Publication)
        • Expert Committee on the Diagnosis and Classification of Diabetes Mellitus
        Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus.
        Diabetes Care. 1997; 20: 1183-1197
        • Orchard TJ
        • Dorman JS
        • Maser RE
        • Becker DJ
        • Drash AL
        • Ellis D
        • et al.
        Prevalence of complications in IDDM by sex and duration: Pittsburgh Epidemiology of Diabetes Complications Study II.
        Diabetes. 1990; 39: 1116-1124
        • Chavez EM
        • Taylor GW
        • Borrell LN
        • Ship JA
        Salivary function and glycemic control in older persons with diabetes.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89: 305-311
        • Darnell JA
        • Saunders MJ
        Oral manifestations of the diabetic patient.
        Tex Dent J. 1990; 107: 23-27
        • Galili D
        • Findler M
        • Garfunkel AA
        Oral and dental complications associated with diabetes and their treatment.
        Compendium. 1994; 15 (498, 500): 496
        • Lamey PJ
        • Darwazeh AM
        • Frier BM
        Oral disorders associated with diabetes mellitus.
        Diabet Med. 1992; 9: 410-416
        • Loe H.
        Periodontal disease. The sixth complication of diabetes mellitus.
        Diabetes Care. 1993; 16: 329-334
        • Murrah VA
        Diabetes mellitus and associated oral manifestations: a review.
        J Oral Pathol. 1985; 14: 271-281
        • American Diabetes Association
        Screening for diabetes.
        Diabetes Care. 2001; 24: S21-S24
        • Mandel ID
        • Wotman S.
        The salivary secretions in health and disease.
        Oral Sci Rev. 1976; 8: 25-47
        • Von Knorring L
        • Mornstad H.
        Qualitative changes in saliva composition after short-term administration of imipramine and zimelidine in healthy volunteers.
        Scand J Dent Res. 1981; 89: 313-320
        • Sreebny LM
        • Broich G.
        Xerostomia (dry mouth).
        in: The salivary system. CRC Press, Boca Raton (FL)1987: 180
        • Fox PC
        • Busch KA
        • Baum BJ
        Subjective reports of xerostomia and objective measures of salivary gland performance.
        J Am Dent Assoc. 1987; 115: 581-584
        • Ben-Aryeh H
        • Miron D
        • Szargel R
        • Gutman D.
        Whole-saliva secretion rates in old and young healthy subjects.
        J Dent Res. 1984; 63: 1147-1158
        • Gutman D
        • Ben-Aryeh H.
        The influence of age on salivary content and rate of flow.
        Int J Oral Surg. 1974; 3: 314-317
        • Sreebny LM
        • Schwartz SS
        A reference guide to drugs and dry mouth—2nd edition.
        Gerodontology. 1997; 14: 33-47
        • Osterberg T
        • Landahl S
        • Hedegard B.
        Salivary flow, saliva pH and buffering capacity in 70-year-old men and women. Correlation to dental health, dryness in the mouth, disease and drug treatment.
        J Oral Rehab. 1984; 11: 157-170
        • Sreebny LM
        • Yu A
        • Green A
        • Valdini A.
        Xerostomia in diabetes mellitus.
        Diabetes Care. 1992; 15: 900-904
        • Ben-Aryeh H
        • Serouya R
        • Kanter Y
        • Szargel R
        • Laufer D.
        Oral health and salivary composition in diabetic patients.
        J Diabetes Complications. 1993; 7: 57-62
        • Al-Tikriti U
        • Martin MV
        • Bramley PA
        A pilot study of the clinical effects of irradiation on the oral tissues.
        Br J Oral Maxillofac Surg. 1984; 22: 77-86
        • Shannon IL
        • Trodahl JN
        • Starcke EN
        Radiosensitivity of the human parotid gland.
        Proc Soc Exp Biol Med. 1978; 157: 50-53
        • Dreizen S
        • Brown LR
        • Handler S
        • Levy BM
        Radiation-induced xerostomia in cancer patients. Effect on salivary and serum electrolytes.
        Cancer. 1976; 38: 273-278
        • Bloch KJ
        • Buchanan WW
        • Wohl MJ
        • Bunim JJ
        Sjögren’s syndrome: a clinical, pathological, and serological study of sixty-two cases.
        Medicine. 1965; 44: 187-194
        • Bergdahl M
        • Bergdahl J.
        Low unstimulated salivary flow and subjective oral dryness: association with medications, anxiety, depression, and stress.
        J Dent Res. 2000; 79: 1652-1658
        • Parvinen T
        • Parvinen I
        • Larmas M.
        Stimulated salivary flow rate, pH and lactobacillus and yeast concentrations in medicated persons.
        Scand J Dent Res. 1984; 92: 524-532
        • Moore PA
        • Weyant RJ
        • Mongelluzzo MB
        • Myers DE
        • Rossie K
        • Guggenheimer J
        • et al.
        Type 1 diabetes mellitus and oral health: assessment of tooth loss and edentulism.
        J Public Health Dent. 1998; 58: 135-142
        • Moore PA
        • Weyant RJ
        • Mongelluzzo MB
        • Myers D
        • Rossie K
        • Guggenheimer J
        • et al.
        Type 1 diabetes mellitus and oral health: assessment of periodontal disease.
        J Periodontol. 1999; 70: 409-417
        • Moore PA
        • Weyant RJ
        • Etzel KR
        • Guggenheimer J
        • Mongelluzzo MB
        • Myers D
        • et al.
        Type 1 diabetes mellitus and oral health: assessment of coronal and root caries.
        Community Dent Oral Epidemiol. 2001; 29: 183-194
        • Moore PA
        • Orchard T
        • Guggenheimer J
        • Weyant RJ
        Diabetes and oral health promotion: a survey of disease prevention behaviors.
        J Am Dent Assoc. 2000; 131: 1333-1341
        • Guggenheimer J
        • Moore PA
        • Rossie K
        • Myers D
        • Mongelluzzo MB
        • Block HM
        • et al.
        Insulin-dependent diabetes mellitus and oral soft tissue pathologies II. Prevalence and characteristics of Candida and Candidal lesions.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89: 570-576
        • Guggenheimer J
        • Orchard TJ
        • Moore PA
        • Myers DE
        • Rossie KM
        Reliability of self-reported heart murmur history: possible impact on antibiotic use in dentistry.
        J Am Dent Assoc. 1998; 129: 861-866
        • Wagener DK
        • Sacks JM
        • LaPorte RE
        • Macgregor JM
        The Pittsburgh study of insulin-dependent diabetes mellitus. Risk for diabetes among relatives of IDDM.
        Diabetes. 1982; 31: 136-144
        • Guggenheimer J
        • Moore PA
        • Rossie K
        • Myers D
        • Mongelluzzo MB
        • Block HM
        • et al.
        Insulin-dependent diabetes mellitus and oral soft tissue pathologies. I. Prevalence and characteristics of non-candidal lesions.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89: 563-569
        • Narhi TO
        • Meurman JH
        • Ainamo A
        • Nevalainen JM
        • Schmidt-Kaunisaho KG
        • Siukosaari P
        • et al.
        Association between salivary flow rate and the use of systemic medication among 76-, 81-, and 86-year old inhabitants of Helsinki, Finland.
        J Dent Res. 1992; 71: 1875-1880
        • Bryne BE
        Oral manifestations of systemic agents.
        in: ADA Guide to Dental Therapeutics. ADA Publishing Co, Chicago2000: 452-488
        • Corah NL
        • Gale EN
        • Illig SJ
        Assessment of a dental anxiety scale.
        J Am Dent Assoc. 1978; 97: 816-819
        • Krantzler NJ
        • Mullen BJ
        • Schutz HG
        • Grivetti LE
        • Holden CA
        • Meiselman HL
        Validity of telephoned diet recalls and records for assessment of individual food intake.
        Am J Clin Nutr. 1982; 36: 1234-1242
        • Kohler PF
        • Winter ME
        A quantitative test for xerostomia: the Saxon test, an oral equivalent of the Schirmer test.
        Arthritis Rheum. 1985; 28: 1128-1132
        • Hardy SL
        • Brennand CP
        • Wyse BW
        (1981) Taste thresholds of individuals with diabetes mellitus and of control subjects.
        J Am Diet Assoc. 1981; 79: 286-289
        • Orchard TJ
        • Dorman JS
        • Maser RE
        • Becker DJ
        • Ellis D
        • LaPorte RE
        • et al.
        Factors associated with avoidance of severe complications after 25 yr of IDDM. Pittsburgh Epidemiology of Diabetes Complications Study I.
        Diabetes Care. 1990; 13: 741-747
        • Ellis D
        • Coonrod BA
        • Dorman JS
        • Kelsey SF
        • Becker DJ
        • Avner ED
        • et al.
        Choice of urine sample predictive of microalbuminuria in patients with insulin-dependent diabetes mellitus.
        Am J Kidney Dis. 1989; 13: 321-328
        • DCCT Research Group
        Manual of operations for the Diabetes Control and Complications Trial. US Dept of Commerce, Washington, DC1987
        • Stella P
        • Ellis D
        • Maser RE
        • Orchard TJ
        Cardiovascular autonomic neuropathy (expiration and inspiration ratio) in type 1 diabetes. Incidence and predictors.
        J Diabetes Complications. 2000; 14: 1-6
        • Dawes C.
        Physiological factors affecting salivary flow rate, oral sugar clearance, and the sensation of dry mouth in man.
        J Dent Res. 1987; 66: 648-653
        • Ghezzi EM
        • Lange LA
        • Ship JA
        Determination of variation of stimulated salivary flow rates.
        J Dent Res. 2000; 79: 1874-1878
        • Albrecht M
        • Banoczy J
        • Tamas Jr, G
        Dental and oral symptoms of diabetes mellitus.
        Community Dent Oral Epidemiol. 1988; 16: 378-380
        • Bacic M
        • Cigar I
        • Granic M
        • Plancak D
        • Sutalo J.
        Dental status in a group of adult diabetic patients.
        Community Dent Oral Epidemiol. 1989; 17: 313-316
        • Bernick SM
        • Cohen DW
        • Baker L
        • Laster L.
        Dental disease in children with diabetes mellitus.
        J Periodontol. 1975; 46: 241-245
        • Faulconbridge AR
        • Bradshaw WC
        • Jenkins PA
        • Baum JD
        The dental status of a group of diabetic children.
        Br Dent J. 1981; 151: 253-255
        • Harrison RA
        • Bowen WH
        Periodontal health, dental caries and metabolic control in insulin-dependent diabetic children and adolescents.
        Pediatr Dent. 1987; 9: 283-286
        • Cherry-Peppers G
        • Sorkin J
        • Andres R
        • Baum BJ
        • Ship JA
        Salivary gland function and glucose metabolic status.
        J Gerontol. 1992; 47: M130-M134
        • Navazesh M
        • Brightman VJ
        • Pogoda JM
        Relationship of medical status, medications, and salivary flow rates in adults of different ages.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996; 81: 172-176
        • Sreebny LM
        • Valdini A
        • Yu A.
        Xerostomia. Part II: Relationship to nonoral symptoms, drugs, and diseases.
        Oral Surg Oral Med Oral Pathol. 1989; 68: 419-427
        • Lamey PJ
        • Fisher BM
        • Frier BM
        The effects of diabetes and autonomic neuropathy on parotid salivary flow in man.
        Diabet Med. 1984; 3: 537-540
        • Newrick PG
        • Bowman C
        • Green D
        • O’Brien IA
        • Porter SR
        • Scully C
        • et al.
        Parotid salivary secretion in diabetic autonomic neuropathy.
        HNO. 1991; 5: 35-37
        • Meurman JH
        • Collin HL
        • Niskanen L
        • Toyry J
        • Alakuijala P
        • Keinanen S
        • et al.
        Saliva in non–insulin-dependent diabetic patients and control subjects: the role of the autonomic nervous system.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1988; 86: 69-76
        • Ship JA
        • Fox PC
        • Baum BJ
        How much saliva is enough? “Normal” function defined.
        J Am Dent Assoc. 1991; 122: 63-69
        • Pohjamo L
        • Knuuttila M
        • Tervonen T
        • Haukipuro K.
        Caries prevalence related to the control of diabetes.
        Proc Finn Dent Soc. 1988; 84: 247-252
        • Twetman S
        • Nederfors T
        • Stahl B
        • Aronson S.
        Two-year longitudinal observations of salivary status and dental caries in children with insulin-dependent diabetes mellitus.
        Pediatr Dent. 1992; 14: 184-188
        • Thorstensson H
        • Falk H
        • Hugoson A
        • Olsson J.
        Some salivary factors in insulin-dependent diabetics.
        Acta Odontol Scand. 1989; 47: 175-183
        • Baum BJ
        Evaluation of stimulated parotid saliva flow rate in different age groups.
        J Dent Res. 1981; 60: 1292-1296
        • Ben-Aryeh H.
        • Serouya R.
        • Kanter Y.
        • Szargel R.
        • Laufer D.
        Autonomic neuropathy and salivary composition in diabetic patients.
        J Diabetes Complications. 1996; 10: 226-227