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

J Am Med Dir Assoc. 2018 Dec;19(12):1080-1085.e2. doi: 10.1016/j.jamda.2018.05.014. Epub 2018 Jul 5.


Objectives: 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.

Design: 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.

Measures: 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.

Results: 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.

Conclusion: 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.

Keywords: Dementia; aged; dental care; longitudinal studies; medication; national register; polypharmacy; tooth loss; xerostomia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Dementia / complications*
  • Dose-Response Relationship, Drug
  • Drug-Related Side Effects and Adverse Reactions
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Polypharmacy
  • Risk
  • Salivation / drug effects*
  • Sweden / epidemiology
  • Tooth Diseases / epidemiology*
  • Tooth Diseases / etiology*
  • Xerostomia / chemically induced*
  • Xerostomia / complications*