Evaluate Five Different Diagnostic Tests for Dry Mouth Assessment in Geriatric Residents in Long-term Institutions in Taiwan

Yao-Ming Cheng; Shao-Huan Lan; Yen-Ping Hsieh; Shou-Jen Lan; Shang-Wei Hsu


BMC Oral Health. 2019;19(106) 

In This Article


Residents of long-term care (LTC) institutions usually have poor oral health,[1] with dry mouth being one of the primary oral diseases. In addition to the effect of diseases, 20 to 86% of cases of dry mouth co-occur with salivary hypofunction status.[2–4] The symptomatic dry mouth that can have multivariate negative effects, including chewing difficulty, dysphagia, loss of appetite, malnutrition, oral discomfort, risk of tooth decay, burning-mouth sensation, halitosis, less social interaction, and lowered quality of life.[5–11] Numerous factors influence the occurrence of dry mouth in institutional elderly, and Japanese studies have reported factors such as body mass index (BMI), physical disability, age, mouth breathing, frequency of daily brushing, sex, medication, tube feeding, and level of conversation.[12–14]

In addition, an Australian study proposed mechanisms for the management of dry mouth among LTC residents,[15] and a Brazilian study reported that residents with dysphagia had dry mouth symptoms greater in number.[16]

Studies have suggested that older adults who received nonpharmacological interventions, such as participation in an oral function training program (e.g., massage on salivary gland and face, and tongue muscle training), showed improvement in dry mouth and overall oral status.[2,17,18] This demonstrated that older adults' regular participation in oral function training programs is a crucial preventative measure that ensures good oral health. However, improving the ability of caregivers in long-term care institutions to evaluate dry mouth symptoms in residents is a prerequisite for such programs. If caregivers can evaluate dry mouth symptoms in institution residents, implementing comprehensive oral health care strategies is possible (including oral medical care and treatment, daily oral cleaning, and oral functional training).

However, implementing oral care in LTC institutions in Taiwan is a challenge. First, oral treatment by dentists is mainly based in hospitals or private clinics, and conducting oral care in LTC institutions is still in the stage of policy encouragement. This is mainly because of the lack of vehicles for transporting residents, inadequate space or medical equipment for installing dental chairs at LTC institutions, and medical insurance benefits.[19–21] Second, in terms of caring for the oral conditions of LTC residents, dental hygienists have the functions of educating, preventing oral diseases, and promoting oral health and hygiene.[22] For example, in countries such as Japan, South Korea, Sweden, the United States, Australia, and Brazil, dental hygienists provide oral care and examinations as well as improve or assist in the oral knowledge and skills development of institutional caregivers.[23–26] However, Taiwan does not have such a system for oral hygienists.[27] Therefore, the task of promoting the oral health of LTC residents is mainly conducted by institution staff. Factors such as the inadequate knowledge and experience of caregivers in oral care[28,29] and oral care services are not top priorities,[30,31] which affects the willingness of staff to provide oral care to LTC residents.

Therefore, educating and training of knowledge and abilities regarding care for oral diseases among professionals is essential and thus helps improve the oral health of residents.[32,33] However, such training is difficult to implement in LTC institutions that lack oral health education measures and oral care professionals. Therefore, the formulation of a simple and convenient dry mouth indicator is necessary. Such an indicator can assist care professionals in accurately evaluating dry mouth among residents. Chalmers et al.(2005) reported that attention to saliva status is a crucial training component for caregivers to develop their ability to evaluate oral health[34] and is an objective indicators of dry mouth.[15]

This study aim of the study was to evaluate five different diagnostic tests for dry mouth assessment. These were evaluating the residents' characteristics, self-perceived ability to chew food, oral health impact profiles, and self-perceived levels of dry mouth, as well as a repetitive saliva swallowing test.