The institutionalized elderly receive multiple drugs for the treatment of disease, alleviation of symptoms, and mood control. One side effect of many of these drugs is hyposalivation or xerostomia. Although hyposalivation attributed to drugs has been cited as a factor in dental caries, the prevalence of the use of these drugs for the institutionalized elderly and effect on dental caries has not been documented. In order to address this problem, this one-year project has the following aims: 1) to determine the prevalence of use of drugs in an institutionalized geriatric population; 2) to identify matched subsets of dentate persons receiving drugs which inhibit salivary flow and persons who have no history of using these drugs; 3) to conduct clinical examinations of both groups for root caries and coronal (including recurrent) caries prevalence, salivary flow, and plaque accumulation; 4) to obtain subjective evaluations of mouth dryness and dental sensitivity to hot, cold, and sweet foods for both groups; 5) to determine to what extent differences exist in the clinical and subjective parameters between the two groups. A data collection form has been developed and pre-tested which would allow efficient gathering of demographic information and data concerning types and amounts of drugs being used for approximately 750 residents in two nursing homes. Approximately 80-100 subjects who have been institutionalized for at least one year will be identified. Subjects will be divided into two groups. One cohort will consist of persons who are taking drugs which are reported to produce hyposalivation. The hyposalivation drug cohort will be further subdivided into subgroups based on prevalence of drug usage either singly or in combination with other drugs causing hyposalivation. The second cohort will consist of paired subjects who have not been on hyposalivatory-producing drugs for at least one year. All subjects will be examined for coronal caries (including recurrent) and for root caries, whole stimulated salivary flow and dental plaque. In addition, a structured interview will obtain responses related to mouth dryness and symptoms related to dental caries. The primary statistical method for comparing the salivary flows of the two paired cohorts will be analysis of covariance. Once the losses in saliva flow are determined, analysis of covariance will again be used to relate these to the prevalence of caries. If differences are found between cohorts, additional studies will be planned to determine the chemical and microbiological changes in plaque and saliva, and to develop methods to control the decay process.
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