Salivary flow analysis and oral injuries in homebound older persons care

Mussatto, Flávia; Wonsovicz, Fernanda Grisotti; Coelho, Bruno Bonacir; Figueiredo, Daniela de Rossi

doi:10.1590/1981-86372025000820240030

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Original • Rev Gaúch. Odontol. 73 • 2025 • https://doi.org/10.1590/1981-86372025000820240030 linkcopy

Salivary flow analysis and oral injuries in homebound older persons care

Análise do fluxo salivar e agravos bucais de idosos da atenção domiciliar

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: Test the association between salivary flow and oral conditions in homebound older persons in Palhoça, Santa Catarina.

Methods: This cross-sectional observational study included older persons aged >60 years, confined to their homes, and registered in the Better in Home program. Home visits were conducted with Community Health Agents between December 2019 and March 2020 and between December 2021 and March 2022. Were considered low flow when stimulated salivary flow rates <0.7 ml/min and unstimulated rates <0.1 ml/min. Socioeconomic variables, DMFS index, Visible Plaque Index, and mucosal alterations were included. Pearson’s Chi-squared and Student’s t-test were used (α=5%).

Results: The sample included 44 older persons. The prevalence of low-stimulated salivary flow was 65.9% (95% CI: 50.3-78.7), while low-unstimulated salivary flow was 27.3% (95% CI: 15.8-42.8). Two-thirds were aged 60–79 years, and 56.8% were female. Daily use of 5-10 medications was reported by 63.6%, with antihypertensives (88.6%), diuretics (36.4%), and antidiabetics (34.1%) being most common; 59.2% used at least one combination of these. Visible plaque was present in 96.0%, mean DMFS was 125.9, two-thirds exhibited mucosal lesions, and 52.3% required dental prostheses. Low-stimulated salivary flow was associated with older age (p=0.023), use of antidiabetics (p=0.037), and mucosal alterations (p=0.036). Low unstimulated salivary flow was associated with a higher mean of caries (p=0.036).

Conclusion: Low salivary flow, stimulated or unstimulated, was associated with oral ulcerations, gingivitis, caries, advanced age, and medication use, highlighting specific strategies for the oral health needs of homebound older persons.

Indexing terms
Aged; Homebound persons; Oral health

Variable	n	%	95% CI
Sex (n=44)
Male	19	43.2	(29.7-57.8)
Female	25	56.8	(42.2-70.3)
Age (n=44)
60-69 years	17	38.6	(25.7-53.4)
71-79 years	16	36.4	(23.8-51.1)
80-99 years	11	25.0	(14.6-39.4)
Reason for using Better in Home (n=44)
Difficulty in walking	30	68.2	(53.4-80.0)
Muscle atrophy	1	2.3	(0.4-11.8)
Accident	4	9.1	(3.6-21.2)
Home oxygen therapy	1	2.3	(0.4-11.8)
Stroke	4	9.1	(3.6-21.2)
Visual impairment	3	6.8	(2.3-18.2)
Post-surgery	1	2.3	(0.4-11.8)
Schooling (years) (n=44)
9-11	6	13.6	(6.4-26.7)
5-8	5	11.4	(5.0-24.0)
Up to 4	33	75.0	(60.6-85.4)
Family income in minimum Brazilian wages (n=44)
Less than 1	3	6.8	(2.3-18.2)
1-3	41	93.2	(81.8-97.7)
Stimulated salivary flow (n=44)
Normal	15	34.1	(21.9-28.9)
Low	29	65.9	(51.1-78.1)
Unstimulated salivary flow (n=44)
Normal	32	72.7	(58.2-83.7)
Low	12	27.3	(16.3-41.8)

Variable	n	%	95% CI
Number of medications used (n=44)
1-4	16	36.4	(23.8-51.1)
5-10	28	63.6	(48.9-76.2)
Use of anxiolytics drugs? (n=44)
No	40	90.9	(78.8-96.4)
Yes	4	9.1	(3.6-21.2)
Use of anti-hypertensives drugs? (n=44)
No	5	11.4	(5.0-24.0)
Yes	39	88.6	(76.0-95.0)
Use of anti-diabetics drugs? (n=44)
No	29	65.9	(51.1-78.1)
Yes	15	34.1	(21.9-48.9)
Use of diuretics drugs? (n=44)
No	28	63.6	(48.9-76.2)
Yes	16	36.4	(23.8-51.1.6)
Need for full denture (n=44)
No	21	47.7	(33.8-62.1)
Yes	32	52.3	(37.9-66.2)
Decayed teeth (n=44)
No	29	65.9	(51.1-78.1)
Yes	15	34.1	(21.9-48.9)
Tooth loss (n=44)
Partial edentulous	24	54.5	(40.1-68.3)
Total toothlessness	20	45.5	(31.7-59.9)
Filled teeth (n=44)
No	32	72.7	(58.2-83.7)
Yes	12	27.3	(16.3-41.8)
Visible plaque index (n=25)
Less than 10%	1	4.0	(0.7-19.5)
Between 10 and 25%	10	40.0	(23.4-59.3)
More than 25%	14	56.0	(37.7-73.3)
Presence of oral lesions (n=44)
No	18	40.9	(27.7-55.6)
Yes	26	59.1	(44.4-72.3)
Location of oral lesions (n=26)
Labial	1	3.8	(0.7-18.9)
Buccal mucosa	3	11.5	(4.0-29.0)
Tongue	6	15.4	(6.1-33.5)
Hard palate and/or soft palate	9	34.6	(19.4-53.8)
Alveolar/gingival ridge	9	34.6	(19.5-53.8)

Variable	Normal			Low-stimulated salivar flow			p-value^*
Variable	n	%	95% IC	n	%	95% CI	p-value^*
Age (n=44)							0.023
60-69 years	10	58.8	(33.9-79.9)	7	41.2	(20.0-66.0)
71-79 years	3	18.8	(5.73-46.6)	13	81.2	(53.3-94.2)
80-93 years	2	18.2	(0.4-53.7)	9	81.8	(46.2-95.9)
Use of antidiabetic drugs (n=44)							0.037
No	13	44.8	(27.4-63.6)	16	55.1	(36.3-72.5)
Yes	2	13.3	(0.3-42.8)	13	86.6	(57.1-96.9)
Presence of oral lesions (n=44)							0.036
No	9	52.9	(29.0-75.5)	8	47.1	(24.4-70.9)
Yes	6	22.2	(0.9-42.5)	21	77.8	(57.4-90.0)

Variable	Average DMFS
Variable	n	Mean	SD	p-value^*
Unstimulated salivary flow				0.0362
Normal	32	120.65	35.04
Low	12	139.92	13.33

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[1] Note: CI: Confiance Interval.