Studies on the prevalence of reduced salivary flow rate in relation to general health and dental caries, and effect of iron supplementation

Abstract

Background: Reduced salivary flow is a condition that affects oral health. Its prevalence is unknown in young and middle-aged adults and there is no known treatment that permanently increases the salivary flow rate. Reduced salivary flow is related to dental caries, the most common oral disease. Reduced salivary flow is often found in individuals with insufficient food intake and thereby insufficient nutrition to the salivary glands. One nutrition related factor that has been proposed to effect salivary flow rate is iron deficiency.

Aims: The aims of the thesis were to investigate i) the prevalence of reduced salivary flow rate in different age groups of adults, ii) the relationship between reduced salivary flow rate, general health and dental caries, iii) the influence of time of measurement on reduced salivary flow rate, and iv) if reduced salivary flow rates could be increased by iron supplementation.

Material and methods: In Study I saliva was collected from 1427 individuals aged 20-69 years. A questionnaire was answered regarding subjective oral dryness, general diseases, use of drugs, BMI (Body Mass Index) and use of tobacco. In Study II saliva was collected from 48 patients with active caries and 48 caries-inactive patients. A blood sample was analysed for serum ferritin. In Study III the unstimulated salivary flow rate was tested at 7:30 and 11:30 a.m. in 108 individuals, age 15-46 years. The participants were allocated to one of three groups (very low <0.1 mL/min, low 0.1-0.2 mL/min and normal >0.2 mL/min) based on the the unstimulated salivary flow rate at 7:30 a.m. Different aspects of the perception of oral dryness were rated using Visual Analogue Scales. In Study IV a double-blind, randomized controlled trial was carried out on 50 individuals with a low unstimulated whole salivary flow rate and low serum ferritin. Half the individuals received 60 mg of iron orally twice a day for 3 months, while the other half received placebo.

Results: In Study I it was found that the prevalence of very low (<0.1 mL/min) and low (0.10-0.19 mL/min) unstimulated salivary flow rate were similar for different age groups up to 50 years, ranging between 10.9-17.8% and 17.3- 22.7%, respectively. Multiple logistic regression revealed that above age 50, female gender, ‘having fewer than 20 teeth’, and taking xerogenic drugs significantly increased the risk of very low unstimulated salivary flow rate. In Study II 32 individuals (67%) in the caries active group had low unstimulated salivary flow rate compared with 13 individuals (27%) in the caries inactive group. There was no difference in serum ferritin levels between the two groups. Study III showed for all groups a statistically significant increase in unstimulated salivary flow rate at 11:30 a.m. compared with 7:30 a.m., all of similar magnitude (0.08-0.09 mL/min). In the group with very low salivary flow rate, 70% at 11:30 a.m. exceeded the 0.1 mL/min limit. There were significant difference in perception of oral dryness between the normal group and both the low and the very low groups. In Study IV no statistically significant difference was found between the groups after treatment for the unstimulated flow rate and in the subjective assessments of oral dryness.

Conclusions: The prevalence of reduced salivary flow rates is consistent and prevalent in younger and middle-aged adults (<50 years). Very low salivary flow rates are related to high Body Mass Index (BMI) and diagnosed diseases in younger adults, but to medication in older adults. Reduced salivary flow rate in young adult women is related to caries. The time of measurement of salivary flow rates influences diagnosis of hyposalivation. Iron supplementation does not enhance salivary flow.