University of Oulu

Tiisanoja, A., Syrjälä, A.-M. H., Kullaa, A., & Ylöstalo, P. (2020). Anticholinergic Burden and Dry Mouth in Middle-Aged People. JDR Clinical & Translational Research, 5(1), 62–70.

Anticholinergic burden and dry mouth in middle-aged people

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Author: Tiisanoja, Antti1; Syrjälä, Anna-Maija Hannele1,2,3; Kullaa, Arja3,4,5;
Organizations: 1Periodontology and Geriatric Dentistry, Unit of Oral Health Sciences Research, University of Oulu, Oulu, Finland
2Dental Training Clinic, Social and Health Services, Oulu, Finland
3Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
4Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
5Unit of Oral Health Sciences Research, University of Oulu, Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
Persistent link:
Language: English
Published: SAGE Publications, 2020
Publish Date: 2020-04-23


Introduction: Anticholinergic burden refers to the cumulative effect of taking 1 or more drugs with anticholinergic properties. At the moment, little is known about the association between the anticholinergic burden and dry mouth.

Objectives: The objective of this article was to study, whether an anticholinergic burden is associated with dry mouth among middle-aged people.

Methods: The study population included 1,345 people aged 46 y from the Northern Finland Birth Cohort 1966 (NFBC1966) study, who took part in a clinical medical and dental examination during 2012–2013. Medication data comprised both self-reported drug use and information obtained from the national register. Anticholinergic burden was measured using 10 different anticholinergic scales. Dry mouth was defined on the basis of having either a subjective feeling of dry mouth (xerostomia) or objectively measured low unstimulated or stimulated whole salivary flow rates (hyposalivation). Poisson regression models with robust error variance were used to estimate relative risk (RR). Regression models were adjusted for sex, smoking, diabetes, rheumatoid diseases, depressive symptoms, anxiety, total number of drugs, and antihypertensive drugs.

Results: Approximately 14% of the participants reported having xerostomia and about 2% had hyposalivation. The RRs of different anticholinergic scales for xerostomia varied from 1.05 to 1.68. The scales’ RRs were between 0.89 and 2.03 for low unstimulated whole salivary flow (<0.1 mL/min) and between 0.59 and 1.80 for low stimulated whole salivary flow (<0.7 mL/min). Seven of 10 studied anticholinergic scales associated statistically significantly with dry mouth, either with xerostomia or hyposalivation.

Conclusion: Most of the anticholinergic scales were associated with dry mouth, either with xerostomia or hyposalivation. There was considerable variation in the strength of the associations between anticholinergic scales and dry mouth.

Knowledge Transfer Statement: The findings of this study suggest that dentists should take notice of the use of drugs with anticholinergic properties and their harmful effects among middle-aged people. Dentists should provide these patients with necessary guidance on how to cope with dry mouth and give them prophylactic measures against oral diseases associated with dry mouth.

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Series: JDR clinical & translational research
ISSN: 2380-0844
ISSN-E: 2380-0852
ISSN-L: 2380-0844
Volume: 5
Issue: 1
Pages: 62 - 70
DOI: 10.1177/2380084419844511
Type of Publication: A1 Journal article – refereed
Field of Science: 313 Dentistry
Funding: NFBC1966 received financial support from the University of Oulu (No. 24000692), Oulu University Hospital (No. 24301140), and the ERDF European Regional Development Fund (No. 539/2010 A31592). This study was supported by a personal grant to A.T. from the Finnish Dental Association Apollonia. The authors alone are responsible for the content and writing of the article.
Copyright information: © International & American Associations for Dental Research 2019. Reprinted by permission of SAGE Publications. The Definitive Version of Record can be found at: