Hyposalivation and its effect on oral health in elders

Panayiota Siskos ’23

Figure 1: Decreased salivary flow (hyposalivation) is a common problem in elders.

The co-existence of systemic diseases and multiple medications causes elders to be more vulnerable to oral issues. Lower salivary flow (hyposalivation) is a common issue and may be due to xerostomia (when there is the feeling of having a dry mouth). Even though saliva production and composition are mostly age-dependent, medications can also influence salivary flow. Decrease of salivary flow may disrupt oral functions, including cleansing and lubricating oral tissues, preparing food for digestion, forming the bolus, modulating taste perception, facilitating mastication and phonation, maintaining oral pH, promoting remineralizing early curious lesions, and maintaining oral microbial ecosystem equilibrium through immune components. When saliva flow lowers, the oral microbiome alters causing microbial dysbiosis and increased oral disease risk. Candida is a microorganism in the oral cavity, but when the immune system is compromised or local predisposing conditions exist there is risk for candidiasis infection. Non-albicans Candida species cause infections that are harder to treat and can be resistant to antifungal drugs. This study aimed to analyze associations between oral health status including gingival, tongue-coating, root caries indices, and oral Candida species colonization, with hyposalivation in dentate elders with either no or well-controlled systemic conditions. Factors associated with salivary flow rates, Candida colonization, and oral health indices were evaluated.

There were 53 subjects, and dry mouth symptoms were obtained with a questionnaire and a dentist determined information regarding dry mouth signs. Unstimulated and stimulated saliva was collected. Stimulated saliva was cultured using Sabouraud-dextrose agar for Candida counts which were identified by chromogenic Candida agar and polymerase chain reaction.

Candida colonization had a higher number of participants with dry mouth signs and hyposalivation, while gender, xerostomic drug use, subjective dry mouth symptoms, brushing, denture use, and systemic conditions had no difference. Denture use was associated with greater prevalence with non-albicans Candida colonization. This suggests low unstimulated and stimulated salivary flow rates correlate with higher Candida colonization. This study is important because Candida colonized in oral cavity accumulates oral and systemic infections when hoist immunity is compromised, making the presence of oral Candida, especially non‐albicans Candida species, in the elderly a topic of concern. Changes in salivary secretion affects the salivary proteome, especially proteins relating to innate immunity. Therefore, in the future studies will focus on further examining changes in the salivary proteome and the effect Candida species colonization has onelders that have hyposalivation, as well as examining relationships in larger longitudinal studies and identifying interventions to mitigate adverse effects of hyposalivation.

Works Cited: 

[1] N. Buranarom, O. Komin, and O. Matangkasombut, Hyposalivation, oral health, and Candida colonization in independent dentate elders. PLoS ONE 15 (2020). doi: https://doi.org/10.1371/journal.pone.0242832

[2] Image retrieved from: https://www.pexels.com/photo/woman-standing-near-yellow-petaled-flower-2050994/

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