Mouth Dryness
New Zealand xerostomia
Background.—Xerostomia can be composed of the
subjective feeling of dryness and/or salivary gland hypo-
function. Generally it has been estimated that 20% of adults
have xerostomia, with a belief that it is more common
among older adults than younger persons. Findings of
younger adults suggest that the clinical course of dry mouth
may begin at a relatively young age, however. The preva-
lence, associations, and impacts of xerostomia were investi-
gated in a nationally representative sample of dentate adult
community-dwelling New Zealanders age 18 years and
older.
Methods.—Data were gathered from a representative
sample of 2209 adults who were included in the 2009 New
Zealand Oral Health Survey (NZOHS). The collection was
done through personal interviews, dental examinations,
and the short-form Oral Health Impact Profile (OHIP-14).
Results.—Over half of the sample were female and a
tenth were Maori. Xerostomia was reported in 13.1% of
the individuals, occurring more often in female subjects
than in males. Those age 25 to 34 years and those 75 years
or older were the groups with the highest proportion of xe-
rostomia sufferers. The highest percentage of persons with
xerostomia was found among the second most deprived
group of individuals.
Mean OHIP-14 score was higher among the xerostomic
persons than those without xerostomia. Those with xero-
stomia were also more likely to have one or more OHIP-
15 impacts than those without xerostomia, with an inci-
dence of 1 in 4 for xerostomia sufferers and 1 in 7 for
non-sufferers.
Multivariate analysis indicated xerostomia was asso-
ciated with being female, living in the most deprived
Pediatric Dentistry
Atraumatic Restorative Treatment for kids
Background.—The Atraumatic Restorative Treatment
(ART) approach is a minimum intervention dentistry tech-
nique developed to provide dental care delivery in under-
served communities that may not have access to
areas, and having decayed missing teeth. The negative
binomial regression model showed xerostomia was
most strongly associated with mean OHIP-14 score,
being female, being a Pacific Islander or Maori, or hav-
ing missing teeth, periodontitis, or untreated dental
caries.
Discussion.—Using a nationally representative sample
of adult New Zealanders it was shown that xerostomia was
found in 1 in 8 adults and was more common in female
subjects and specific age groups. The day-to-day quality
of life of those with this condition was markedly
diminished.
Clinical Significance.—Xerostomia is a com-
mon condition, with the symptoms occurring
in 13.1% of the nationally representative sam-
ple. It is most common among those age 75
years or older and those age 25 to 34 years.
Mean OHIP-14 score in those with xerostomia
was 50% higher than those who do not have
the condition. Xerostomia causes persons to
suffer an altered quality of life.
Benn AML, Broadbent JM, Thomson WM: Occurrence and impact of
xerostomia among dentate adult New Zealanders: Findings from a
national survey. Austral Dent J 60:362-367, 2015
Reprints available from WM Thomson, Sir John Walsh Research Inst,
Faculty of Dentistry, The Univ of Otago, PO Box 647 Dunedin, New
Zealand; e-mail: murray.thomson@otago.ac.nz
electricity or running water. Increasingly it is seen as rele-
vant to groups in developing as well as developed nations.
In the ARTapproach, caries lesions are removed using hand
instruments only with no local anesthetic. Restoration of
Volume 61
Issue 3
2016 145
the prepared cavity is done with glass-ionomer cement.
Clinically this approach has proved itself to be successful
and well-accepted by patients. The management of early
childhood caries (ECC) requires considerable clinician
time and skill. ECC treatment may have to be done in a hos-
pital setting under general anesthesia, a costly and risk-
filled option. The use of the ART approach to restorative
care of children has been reported to be well-received,
with children experiencing less dental anxiety and pain
than with standard approaches. General dental practi-
tioners often choose a minimum intervention approach
to ECC treatment, whereas pediatric specialists prefer
more comprehensive rehabilitative interventions. A study
was undertaken to determine if ECC care delivered by
dental therapists using a hybrid ART approach could be as
successful as ECC delivered through standard care proto-
cols by a dentist. Successful management was defined as
providing the needed dental treatment for the child
without referring for specialist pedodontic care.
Methods.—A test group of 127 children (age range 1 to
5.5 years) received the modified ART treatment delivered
by school dental therapists. Hand instruments were used
in most cases to remove caries without a local anesthetic.
Rotary instruments were used if the dental therapist
believed they were needed and the child’s capacity to
cope was appropriate. Minimum intervention dentistry
was done, achieving caries-free status at the dentino-
enamel junction while leaving softened caries on the pulpal
floor if its removal would expose dental pulp. The cavity
was restored with glass-ionomer cement, at-risk pits and fis-
sures were sealed, and fluoride varnish was applied to ap-
proximal surfaces and noncavitated enamel lesions.
Recalls were scheduled for 3- to 6-month intervals when re-
pairs to restorations and fluoride varnish applications were
done, along with counseling on preventive measures. No
dental radiographs were obtained routinely.
A control group of 127 children (age range 1.1 to 5.2
years) received care from clinicians in dental clinics, who
were dentists in most cases. Dental therapists provided
the children’s hygiene services. The care was provided in
the usual way and used standard care approaches for chil-
dren this age. Standard treatment was the use of a local
anesthetic, rotary instruments, and restoration of the cavity
with adhesive restorations. Behavioral management was
used to manage the patients. Pharmacological approaches
were used as the dentist deemed necessary and had the
skills to do it.
Results.—More children in the control group were
referred for specialist pedodontic care than in the test
group. The risk ratio for children being referred for
specialist care was 10.1 for the control group, a risk differ-
ence of 0.44 from the test group.
146 Dental Abstracts
The children in the test group had significantly fewer
tooth surfaces and teeth suffering decay and more tooth
surfaces and teeth that had been filled when they were
compared with the control group. A trend toward lower
caries increment was also noted in the test group, but it
was not statistically significant.
Children’s fear level as self-reported did not change
from baseline to follow-up in either group. However, the
proportion of children reporting more severe dental fear
was significantly higher in the control group. The parents
reported their children’s oral health-related quality of life
(HRQoL) was significant better at follow-up than at baseline
in both groups. Seventy-three percent of the test group par-
ents and 42% of the control group parents reported
improved oral health for their children.
Age, caries experience, and group assignment had a sig-
nificant effect on the risk of referral for specialist care. Older
children were less likely to be referred than younger chil-
dren. An increase of 1 decayed-missing-filled-surface (dmfs)
increased the odds of referral by 10%. Children allocated to
the control group had the highest odds of being referred.
Discussion.—The modified ART intervention per-
formed by dental therapists reduced the referral rate to
specialist pedodontists by 45% compared to the conven-
tional treatment provided by dentists. The children in the
test group had restorative care more often and had a lower
caries increment than the control group children. Test
group children received comprehensive preventive care,
at least one application of fluoride varnish, at-risk pit and
fissure sealing, and oral health counseling. This approach
may explain the difference in caries increment.
Clinical Significance.—Hospital admissions
for dental care of ECC in preschool children
may be reduced by providing ART treatments.
This approach is well-accepted by both parents
and children and has the potential to improve
children’s oral health and reduce their dental
anxiety compared to conventional approaches.
Arrow P, Klobas E: Minimum intervention dentistry approach to
managing early childhood caries: A randomized control trial. Com-
munity Dent Oral Epidemiol 43:511-520, 2015
Reprints available from P Arrow, Dental Health Services, Bentley
Delivery Ctr, Locked Bag 15, Perth, WA 6983, Australia; fax: þ61 8
93134141; e-mail: parrow@ozemail.com.au, peter.arrow@
adelaide.edu.au