Original Study| Volume 19, ISSUE 12, P1080-1085.e2, December 2018

The Effect of Xerostomic Medication on Oral Health in Persons With Dementia



      Medication-induced hyposalivation can increase the risk for oral complications, including dental caries and tooth loss. This problem is particularly important in people with dementia because of their declining ability to maintain oral care. The objective of this study was to describe the association between the number of xerostomic medications used and tooth loss and restorative and dental preventive treatment in a population of persons with dementia.


      A longitudinal population-based register study with a 3-year follow-up was conducted. Data were extracted from the Swedish Dementia Registry (SveDem), the Swedish Prescribed Drug Register (SPDR), the Swedish National Patient Register (SNPR), and the Dental Health Register (DHR).

      Setting and participants

      Participants were persons with dementia who were registered in the SveDem at the time of their dementia diagnosis.


      The exposure was continuous use of xerostomic medications over the 3 years prior to dementia diagnosis (baseline). The outcomes were the incidence of tooth extractions, tooth restorations, and dental preventive procedures. Poisson regression models were used to estimate incidence rate ratios (IRRs) for the association between the exposure and outcomes, adjusting for relevant confounders.


      A total of 34,037 persons were included in the analysis. A dose-response relationship between the exposure and tooth extractions was observed. Compared with nonusers of xerostomic medication, the rate of tooth extractions increased with increasing number of xerostomic medications used (IRR = 1.03, 1.11, and 1.40 for persons using an average >0-1, >1-3, and >3 xerostomic medications, respectively). However, the risk for having new dental restorations and receiving preventive procedures did not differ between groups.


      Continuous use of xerostomic medications can increase the risk for tooth extraction in people with dementia. This study highlights the importance of careful consideration when prescribing xerostomic medications to people with dementia, and the need for regular and ongoing dental care.


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        • Scully C.
        Drug effects on salivary glands: Dry mouth.
        Oral Dis. 2003; 9: 165-176
        • Desoutter A.
        • Soudain-Pineau M.
        • Munsch F.
        • et al.
        Xerostomia and medication: A cross-sectional study in long-term geriatric wards.
        J Nutr Health Aging. 2012; 16: 575-579
        • Villa A.
        • Wolff A.
        • Narayana N.
        • et al.
        World Workshop on Oral Medicine VI: A systematic review of medication-induced salivary gland dysfunction.
        Oral Dis. 2016; 22: 365-382
        • Wolff A.
        • Joshi R.K.
        • Ekstrom J.
        • et al.
        A guide to medications inducing salivary gland dysfunction, xerostomia, and subjective sialorrhea: A systematic review sponsored by the World Workshop on Oral Medicine VI.
        Drugs R D. 2017; 17: 1-28
        • Tan E.C.
        • Lexomboon D.
        • Sandborgh-Englund G.
        • et al.
        Medications that cause dry mouth as an adverse effect in older people: A systematic review and metaanalysis.
        J Am Geriatr Soc. 2018; 66: 76-84
        • Humphrey S.P.
        • Williamson R.T.
        A review of saliva: Normal composition, flow, and function.
        J Prosthet Dent. 2001; 85: 162-169
        • Barry H.E.
        • Cooper J.A.
        • Ryan C.
        • et al.
        Potentially inappropriate prescribing among people with dementia in primary care: A retrospective cross-sectional study using the enhanced prescribing database.
        J Alzheimers Dis. 2016; 52: 1503-1513
        • Lau D.T.
        • Mercaldo N.D.
        • Harris A.T.
        • et al.
        Polypharmacy and potentially inappropriate medication use among community-dwelling elders with dementia.
        Alzheimer Dis Assoc Disord. 2010; 24: 56-63
        • Parsons C.
        Polypharmacy and inappropriate medication use in patients with dementia: An underresearched problem.
        Ther Adv Drug Saf. 2017; 8: 31-46
        • Reeve E.
        • Trenaman S.C.
        • Rockwood K.
        • et al.
        Pharmacokinetic and pharmacodynamic alterations in older people with dementia.
        Expert Opin Drug Metab Toxicol. 2017; 13: 651-668
        • Foley N.C.
        • Affoo R.H.
        • Siqueira W.L.
        • et al.
        A systematic review examining the oral health status of persons with dementia.
        JDR Clin Trans Res. 2017; 2: 330-342
        • Zenthofer A.
        • Schroder J.
        • Cabrera T.
        • et al.
        Comparison of oral health among older people with and without dementia.
        Community Dent Health. 2014; 31: 27-31
        • Fereshtehnejad S.M.
        • Garcia-Ptacek S.
        • Religa D.
        • et al.
        Dental care utilization in patients with different types of dementia: A longitudinal nationwide study of 58,037 individuals.
        Alzheimers Dement. 2018; 14: 10-19
        • Religa D.
        • Fereshtehnejad S.M.
        • Cermakova P.
        • et al.
        SveDem, the Swedish Dementia Registry—A tool for improving the quality of diagnostics, treatment and care of dementia patients in clinical practice.
        PLoS One. 2015; 10: e0116538
        • Thomson W.M.
        Dental caries experience in older people over time: What can the large cohort studies tell us?.
        Br Dent J. 2004; 196: 89-92
        • Muller F.
        • Naharro M.
        • Carlsson G.E.
        What are the prevalence and incidence of tooth loss in the adult and elderly population in Europe?.
        Clin Oral Implants Res. 2007; 18: 2-14
        • Wettermark B.
        • Hammar N.
        • Fored C.M.
        • et al.
        The new Swedish Prescribed Drug Register—Opportunities for pharmacoepidemiological research and experience from the first six months.
        Pharmacoepidemiol Drug Saf. 2007; 16: 726-735
        • WHO Collaborating Centre for Drug Statistics Methodology
        Guidelines for ATC Classification and DDD Assignment 2016.
        WHO Collaborating Centre for Drug Statistics Methodology, Olso2016
        • The National Board of Health and Welfare
        Dental health registry.
        (Available at:)
        • McKeith I.G.
        • Dickson D.W.
        • Lowe J.
        • et al.
        Diagnosis and management of dementia with Lewy bodies: Third report of the DLB Consortium.
        Neurology. 2005; 65: 1863-1872
        • The Lund and Manchester Groups
        Clinical and neuropathological criteria for frontotemporal dementia.
        J Neurol Neurosurg Psychiatry. 1994; 57: 416-418
        • Emre M.
        • Aarsland D.
        • Brown R.
        • et al.
        Clinical diagnostic criteria for dementia associated with Parkinson's disease.
        Mov Disord. 2007; 22: 1689-1707
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • et al.
        A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • The National Board of Health and Welfare
        The Swedish National Patient Register.
        (Available at:)
        • Quan H.
        • Sundararajan V.
        • Halfon P.
        • et al.
        Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.
        Med Care. 2005; 43: 1130-1139
        • Fereshtehnejad S.M.
        • Johnell K.
        • Eriksdotter M.
        Anti-dementia drugs and co-medication among patients with Alzheimer's disease: Investigating real-world drug use in clinical practice using the Swedish Dementia Quality Registry (SveDem).
        Drugs Aging. 2014; 31: 215-224
        • Colovic M.B.
        • Krstic D.Z.
        • Lazarevic-Pasti T.D.
        • et al.
        Acetylcholinesterase inhibitors: Pharmacology and toxicology.
        Curr Neuropharmacol. 2013; 11: 315-335
        • Cermakova P.
        • Nelson M.
        • Secnik J.
        • et al.
        Living alone with Alzheimer's disease: Data from SveDem, the Swedish Dementia Registry.
        J Alzheimers Dis. 2017; 58: 1265-1272
        • Norlen P.
        • Ostberg H.
        • Bjorn A.L.
        Relationship between general health, social-factors and oral health in women at the age of retirement.
        Community Dent Oral Epidemiol. 1991; 19: 296-301
        • Tiisanoja A.
        • Syrjala A.M.
        • Komulainen K.
        • et al.
        Anticholinergic burden and dry mouth among Finnish, community-dwelling older adults.
        Gerodontology. 2018; 35: 3-10
        • Aliko A.
        • Wolff A.
        • Dawes C.
        • et al.
        World Workshop on Oral Medicine VI: clinical implications of medication-induced salivary gland dysfunction.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 120: 185-206
        • Nederfors T.
        Xerostomia and hyposalivation.
        Adv Dent Res. 2000; 14: 48-56
        • Rozas N.S.
        • Sadowsky J.M.
        • Jeter C.B.
        Strategies to improve dental health in elderly patients with cognitive impairment: A systematic review.
        J Am Dent Assoc. 2017; 148: 236-245
        • Ettinger R.L.
        Treatment planning concepts for the ageing patient.
        Aust Dent J. 2015; 60: 71-85
        • Iwasaki M.
        • Yoshihara A.
        • Ito K.
        • et al.
        Hyposalivation and dietary nutrient intake among community-based older Japanese.
        Geriatr Gerontol Int. 2016; 16: 500-507
        • Ikeda M.
        • Brown J.
        • Holland A.J.
        • et al.
        Changes in appetite, food preference, and eating habits in frontotemporal dementia and Alzheimer's disease.
        J Neurol Neurosurg Psychiatry. 2002; 73: 371-376
        • Volkert D.
        • Chourdakis M.
        • Faxen-Irving G.
        • et al.
        ESPEN guidelines on nutrition in dementia.
        Clin Nutr. 2015; 34: 1052-1073
        • Morin L.
        • Fastbom J.
        • Laroche M.L.
        • et al.
        Potentially inappropriate drug use in older people: A nationwide comparison of different explicit criteria for population-based estimates.
        Br J Clin Pharmacol. 2015; 80: 315-324
        • Johnell K.
        Inappropriate drug use in people with cognitive impairment and dementia: A systematic review.
        Curr Clin Pharmacol. 2015; 10: 178-184
        • Janssens B.
        • Petrovic M.
        • Jacquet W.
        • et al.
        Medication use and its potential impact on the oral health status of nursing home residents in Flanders (Belgium).
        J Am Med Dir Assoc. 2017; 18: 809.e1-809.e8
        • Janket S.J.
        • Jones J.A.
        • Rich S.
        • et al.
        Xerostomic medications and oral health: The Veterans Dental Study (part I).
        Gerodontology. 2003; 20: 41-49