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| Title |
Chewing discs demonstrate significant diagnostic potential for xerostomia. |
| Clinical Question |
For healthy and patients with systemic conditions associated with dry mouth, is chewing time of specifically designed discs a viable screening modality for diagnosing xerostomia compared to sialometry? |
| Clinical Bottom Line |
In healthy and indisposed adult patients, chewing or dissolution time of specifically designed discs demonstrate significant diagnostic potential in primitive studies. The cross-sectional studies reviewed find positive correlations between disc dissolution times and salivary flow rates (sialometry gold standard). Both studies observed sensitivity and specificity values approaching 90%. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 11961167 | Sanchez-Guerrero/2002 | Healthy, n=153 pts Sjogren’s Syn, n=30 Conn Tiss Dis, n=60 | Comparison with Gold Standard | | Key results | This cross-sectional study measured passive dissolution time for wheat-based wafers compared to the non-stimulated whole salivary flow gold standard. Success was indicated with a diagnostic ability to identify xerostomia. Wafers were placed on subject’s tongues; the time for saliva to dissolve the wafer was recorded. A Wafer dissolution time of 2.8 +/- 2.1 mins was found in the healthy cohort (n=152); 3.3 +/- 1.5 mins in the connective tissue disease cohort (n=60); and 9.2 +/- 3.9 mins in the Sjogren’s syndrome cohort (n=30). A correlation coefficient between the Wafer test and non-stimulated whole salivary flow was found to be -0.60 (95% CI -0.47, -0.71). The ROC curve-derived time providing optimal sensitivity and specificity was 4 minutes with a 92.9% sensitivity, 71.7% specificity, 31.7% positive predictive value, 98.6% negative predictive value and a likelihood ratio of 3.3 (95% CI 2.3, 4.6) to predict xerostomia. After “controlling for age, gender, temperature and relative humidity,” Sanchez-Guerrero et al determined a 4-minute dissolution time cutoff as the diagnostic threshold for patients experiencing salivary flow rates indicative of xerostomia. | | #2) 19392963 | Madinier/2009 | Trial I: n=30 adults Trial II: n=30 elderly | Comparison with Gold Standard | | Key results | This cross sectional study compared time required to chew flour-based discs with stimulated salivary flow rate (SSFR, mL/min) in the diagnostic ability to identify hyposalivation (SSFR <1 mL/min). By utilizing a receiver operating characteristic (ROC) curve, a 40-second chewing time threshold enabled diagnosis of hyposalivation with a specificity of 1.00 and a specificity of 0.72. Accuracy of the tool was found to diagnose hyposalivation and mild hyposalivation (SSFR <1.5mL/min) with a sensitivity (95% CI) of 0.93 (0.77-0.99), a specificity (95% CI) of 0.88 (0.70-0.98), a positive predictive value (95% CI) of 0.90 (0.73-0.98), and a negative predictive value (95% CI) of 0.92 (0.74-0.99). A negative correlation was found between chewing times and sialometry with a Spearman coefficient of R=0.77 (P<.001). | |
| Evidence Search |
1.("xerostomia"[MeSH Terms] OR "xerostomia"[All Fields]) AND disc[All Fields] AND ("research design"[MeSH Terms] OR ("research"[All Fields] AND "design"[All Fields]) OR "research design"[All Fields] OR "test"[All Fields])
2.wafer[All Fields] AND ("research design"[MeSH Terms] OR ("research"[All Fields] AND "design"[All Fields]) OR "research design"[All Fields] OR "test"[All Fields]) AND ("xerostomia"[MeSH Terms] OR "xerostomia"[All Fields] OR "hyposalivation"[All Fields])
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Comments on
The Evidence |
Validity: Results of the Wafer test confirm a significantly low positive predictive value of 31.7%; however, the test’s strength is noted in its strong negative predictive value (98.6%), enabling a provider to confidently discount xerostomia when chewing time exceeds 40 seconds.
Perspective: Subjectivity is introduced into the methodology in both studies. Subjects were instructed to self-report chewing times before an observer evaluated physical confirmation. Further studies are suggested before a definite protocol is proposed, to include integration of a subjective component required to diagnose xerostomia. A diagnosis for xerostomia includes both quantatitive and qualitative factors.
|
| Applicability |
The studies include a wide spectrum of diseases and demographics in design. Diagnostic discs are significantly affordable and easily implemented without compromise of time and complication. Natural ingredients offer minimal harm while serving as a pragmatic screening modality where a positive result would warrant subsequent gold standard investigation. |
| Specialty/Discipline |
(Oral Medicine/Pathology/Radiology) (General Dentistry) (Periodontics) (Restorative Dentistry) (Dental Hygiene) |
| Keywords |
xerostomia, diagnosis, hyposalivation, wafer, disc, specificity, sensitivity
|
| ID# |
2518 |
| Date of submission: |
08/06/2013 |
| E-mail |
passb@livemail.uthscsa.edu |
| Author |
Benjamin Pass |
| Co-author(s) |
Andrew Nguyen |
| Co-author(s) e-mail |
NguyenA9@livemail.uthscsa.edu |
| Faculty mentor/Co-author |
James Piper, DDS |
| Faculty mentor/Co-author e-mail |
james.piper@us.af.mil |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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