Type 1 diabetes mellitus, xerostomia, and salivary flow rates

Objective. The Oral Health Science Institute at the University of Pittsburg h has completed a cross-sectional epidemiologic study of 406 subjects with type I diabetes and 268 control subjects without diabetes that assessed the associations between oral health and diabetes. This report describes the p revalence of dry-mouth symptoms (xerostomia), the prevalence of hyposalivat ion in this population, and the possible interrelationships between salivar y dysfunction and diabetic complications. Study design. The subjects with diabetes were participants in the Pittsburg h Epidemiology of Diabetes Complications study who were enrolled in an oral health substudy. Control subjects were spouses or best friends of particip ants or persons recruited from the community through advertisements in loca l newspapers. Assessments of salivary function included self-reported xeros tomia measures and quantification of resting and stimulated whole saliva fl ow rates. Results. Subjects with diabetes reported symptoms of dry mouth more frequen tly than did control subjects. Salivary flow rates were also impaired in th e subjects with diabetes. Regression models of potential predictor variable s were created for the 3 self-reported xerostomia measures and 4 salivary f low rate variables. Of the medical diabetic complications studied (ie, reti nopathy, peripheral and autonomic neuropathy, nephropathy, and peripheral v ascular disease), only neuropathy was found to be associated with xerostomi a and decreased salivary flow measures. A report of dry-mouth symptoms was associated with current use of cigarettes, dysgeusia (report of a bad taste ), and more frequent snacking behavior. Xerogenic medications and elevated fasting blood glucose concentrations were significantly associated with dec reased salivary flow. Resting salivary flow rates less than 0.01 mL/min wer e associated with a slightly higher prevalence of dental caries. Subjects w ho reported higher levels of alcohol consumption were less likely to have l ower rates of stimulated salivary flow. Conclusions. Subjects with type I diabetes who had developed neuropathy mor e often reported symptoms of dry mouth as well as symptoms of decreased sal ivary flow rates. Because of the importance of saliva in the maintenance an d the preservation of oral health, management of oral diseases in diabetic patients should include a comprehensive evaluation of salivary function.