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The Edentulous Patient: I. Xerostomia and the Serum Cholesterol Level
Published in Journal of the American Geriatrics Society, Vol. 17, No. 10, October 1969.
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Abstract:
Sixty-seven edentulous patients with complete dentures were studied during 168 visits. Xerostomia was reported during only 38 of the 168 visits, and in most of these instances it was mild and intermittent; there were no severe cases, and only 5 patients reported that the condition was constant. The serum cholesterol level was definitely elevated (250 mg per 100 ml, or higher) during 42 per cent of the visits, and marginally elevated during another 45 per cent. Statistical analysis showed that the concentration of serum cholesterol was significantly higher in the patients with xerostomia.
The condition of the saliva plays an important role in the success or failure of dentures. This is the first in a series of reports on edentulous patients with full dentures. It deals with the relationship between xerostomia (dry mouth) and lipid metabolism. An attempt is made to answer the following three questions:
- What is the frequency and severity of xerostomia in patients with complete dentures?
- What is the state of lipid metabolism (as judged by serum cholesterol concentration) in this group?
- Is there any relationship between xerostomia and the serum cholesterol level?
Material and Methods
The study included 67 edentulous patients fitted with complete dentures. Their ages ranged from 15 to 83 years, with a mean and standard deviation of 52.4±12.2 years (Table 1). The 67 subjects were observed one to four times each over a six-week period, for a total of 168 visits (Table 2). The greatest number of patients (37.3 per cent) were observed three times. The frequency and severity of xerostomia were recorded at each examination (Table 3). A blood sample was obtained from the patients (not fasting) at each visit, and serum cholesterol concentration was determined by the method of Zak.1 The values are shown in Table 4.
Results
Frequency and severity of xerostomia
As shown in Table 3, there were no complaints of xerostomia during 130 of the 168 visits; of the 38 times (23 per cent) xerostomia was reported, it was predominantly mild and intermittent; only 5 cases were constant, and none was severe.
Serum cholesterol level
According to the serum cholesterol values shown in Table 4, 14.3 per cent indicated a normal concentration, 45.3 per cent a marginal elevation, and 42.2 per cent a definite elevation. There is increasing evidence2 that values below 200 mg per 100 ml are physiological, those between 200 and 250 mg per 100 ml marginally elevated, and those above 250 mg per 100 ml definitely hypercholesterolemic. Thus, in our series, only 1 in 6 or 7 values was normal. Definite hypercholesterolemia was observed during 42.2 per cent of the visits.
Xerostomia and the serum cholesterol level
Because of the relatively few patients who reported constant but moderate oral dryness (Table 3), a comparison was made of the serum cholesterol levels in patients without xerostomia versus those with xerostomia. Table 5 shows that the mean serum cholesterol level was significantly higher (statistically) in the patients with dry mouth. It would appear that patients with xerostomia are likely to have hypercholesterolemia.
Discussion
According to a recent review,3 a number of investigators have reported xerostomia in diabetic subjects. In a few reports,3 dry mouth in non-diabetic patients has been correlated with a disturbance in carbohydrate metabolism. As far as can be determined, there are no published reports on the relationship between lipid metabolism and xerostomia. The findings in our study suggest a significant correlation consistent with the concept that a disturbance in carbohydrate metabolism often parallels an imbalance in lipid metabolism.
References Cited:
- Zak, B.: “Simple rapid microtechnic for serum total cholesterol,” Am. J. Clin. Path. 27: 583 (May) 1957.
- Stamler, J.; Berkson, D. M.; Lindberg, H. A.; Hall, Y.; Miller, W.; Mojonnier, L.; Levinson, M.; Cohen, D. B., and Young, Q. D.: “Coronary risk factors: their impact, and their therapy in the prevention of coronary heart disease,” Med. Clin. N. America 50: 229 (Jan.) 1966.
- Setyaadmadja, A. T. S. H.: “Epidemiologic Study of the Interrelationships of Oral Pathosis, Cardiovascular Symptoms-Signs, and Carbohydrate Metabolism.” Thesis, University of Alabama, 1967.