Availability of Diagnosis of Yin-deficiency in Elderly People with Xerostomia and Factors Influencing Subjective Oral Dryness: A Prospective Cross-sectional Study

Article information

J Korean Med. 2013;34(3):13-24

Publication date (electronic) : 2013 September 30

doi : https://doi.org/10.13048/jkm.13009

Juyeon Kim ¹, Jinsung Kim ¹^,, Jaewoo Park ², Bongha Ryu ¹

¹3rd Department of Internal Medicine, Hospital of Korean Medicine, Kyung Hee University

²Department of Internal Medicine, Hospital of Korean Medicine at Gangdong, Kyung Hee University

Correspondence to: 김진성 (Jinsung Kim), 서울시 동대문구 회기동 1번지 경희대학교 한방병원, Tel: +82-2-958-8895, Fax: +82-2-958-9136, E-mail: oridoc@khu.ac.kr

Received 2013 February 20; Revised 2013 April 08; Accepted 2013 April 08.

Abstract

Objectives:

The aims of this study were to investigate the availability of diagnosis of Yin-deficiency in the elderly with xerostomia and factors influencing subjective oral dryness.

Methods:

We surveyed 50 patients recruited by the clinical trial, ‘Efficacy of Yukmijihwang-tang on Xerostomia in the Elderly: A Randomized, Double-blind, Placebo-controlled, Two-center Trial’. The subjects were assessed on their subjective oral dryness using the Dry Mouth Symptom Questionnaire (DMSQ). Their salivary functions were measured by Unstimulated Salivary Flow Rate (USFR) measurements. In addition, the subjects were evaluated on their Qi-stagnation and Yin-deficiency conditions using the Qi-stagnation questionnaire and Yin-deficiency questionnaire.

Results:

There were statistically significant correlations between three variables (USFR, DMSQ score and Qi-stagnation score) and Yin-deficiency score. In the multiple regression analysis, the regression model was statistically significant (F = 10.273, p < .001). The factor most strongly influencing the subjective oral dryness was USFR (ß = −0.386). Yin-deficiency had the next strongest impact on the subjective oral dryness (ß = 0.371). Qi-stagnation affected the subjective oral dryness weakly (ß = 0.075). In the simple regression analysis, Yin-deficiency had a statistically significant effect on each of six subscales of DMSQ (p < .01). Among the six subscales, DMSQ-1 (‘Oral dryness at night or on awakening’) was the most strongly influenced by Yin-deficiency.

Conclusions:

The results of this study show that the diagnosis of Yin-deficiency in the elderly with xerostomia was available and Yin-deficiency was an important factor influencing the subjective oral dryness. Therefore, the consideration of Yin-deficiency is significant for diagnosis and treatment in the elderly with xerostomia.

Keywords: Xerostomia; elderly; subjective oral dryness; Yin-deficiency; Dry Mouth Symptom Questionnaire (DMSQ); Unstimulated Salivary Flow Rate (USFR); Qi-stagnationg

Table 1.

Inclusion and Exclusion Criteria

Table 2.

USFR^†, DMSQ^‡ score, Yin-deficiency score and Qi-stagnation score Related to General Characteristics table

Table 3.

Correlation Between Three Variables (USFR^†, DMSQ^‡ score and Qi-stagnation score) and Yin-deficiency score

Table 4.

Multiple Regression Analysis for DMSQ^† score

Table 5.

Comparison of Simple Regession Models of Yin-deficiency Score on Each Subcale of DMSQ^†

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Article information Continued

Table 1.

Inclusion and Exclusion Criteria

Inclusion Criteria

1) Aged between 60 and 80years

2) VAS scores greater than 4

3) The unstimulated salivary flow rate should be under 0.3mL/min

4) Patients complaining of xerostomia within the previous 3 months

5) Patients able to read, write, hear, or see

6) Patients able to agree that they will not receive xerostomia-related treatments for 3 months after initiation of the study

7) Patients able to sign a written informed consent form

Exclusion Criteria

1) A history of treatments for autoimmune diseases like Sjögren’s syndrome, rheumatism, or lupus

2) A history of craniocervical radiation therapy, organ transplantation

3) A history of severe psychiatric illness, or major depression

4) The use of any other herbal prescriptions or nutritional supplements before 2 weeks form participation

5) The use of xerostomia-relieving medications (pilocarpine and cevimeline) or therapies for xerostomia (mouthwash, gum, and toothpaste for xerostomia)

Table 2.

USFR^†, DMSQ^‡ score, Yin-deficiency score and Qi-stagnation score Related to General Characteristics table

	Gender			Age

	Male	Female	p	60–69	70–79	p
N(%)	20(40)	30(60)		28(56)	22(44)
USFR^†	0.15 ± 0.10	0.14 ± 0.08	0.797	0.14 ± 0.09	0.15 ± 0.08	0.637
DMSQ^‡	333.50 ± 164.40	311.33 ± 140.42	0.612	334.36 ± 151.46	302.18 ± 147.86	0.455
Yin-deficiency score	400.35 ± 146.51	272.23 ± 153.96	0.005*	317.39 ± 177.50	331.23 ± 144.62	0.224
Qi-stagnation score	33.35 ± 15.78	31.50 ± 15.92	0.688	29.82 ± 17.08	35.32 ± 13.58	0.768

P-value is calculated by independent t-test.

Statistically significant difference (p < .05)

The values of USFR, DMSQ, Yin-deficiency score and Qi-stagnation score were expressed as Mean ± Standard Deviation.

N(%): Number of subjects

^†

USFR: Unstimulated salivary flow rater

^‡

DMSQ: Dry mouth symptom questionnaire

Table 3.

Correlation Between Three Variables (USFR^†, DMSQ^‡ score and Qi-stagnation score) and Yin-deficiency score

	Yin-deficiency score
	r	p
USFR^†	−0.278	0.043^*
DMSQ^‡ score	0.519	< .001^*
Qi-stagnation score	0.500	< .001^*

P-value is calculated by Pearson’s correlation.

r: Pearson’s correlation coefficient

Statistically significant correlation

^†

USFR: Unstimulated salivary flow rate

^‡

DMSQ: Dry mouth symptom questionnaire

Table 4.

Multiple Regression Analysis for DMSQ^† score

Independent Variables	B	S.E.	ß	t	p	VIF
USFR^‡	−668.762	210.163	−0.386	−3.182	0.003	1.133
Qi-stagnation score	0.710	1.275	0.075	0.557	0.580	1.386
Yin-deficiency score	0.340	0.129	0.371	2.642	0.011	1.511

R²			0.401
F-value			10.273
P-value			< .001^*

F-value and P-value are calculated by multiple regression analysis.

Statistically significant

^†

DMSQ: Dry mouth symptom questionnaire

^‡

USFR: Unstimulated salivary flow rate

B: Unstandardized coefficients

S.E.: Standard error

ß: Standardized coefficients

t: t-statistic

VIF: Variance inflation factor

Table 5.

Comparison of Simple Regession Models of Yin-deficiency Score on Each Subcale of DMSQ^†

Subcale of DMSQ^†	B	S.E.	ß	t	R²	P-value	F-value
DMSQ^†-1	0.079	0.019	0.509	4.094	0.259	< .001*	16.757
DMSQ^†-2	0.079	0.022	0.463	3.620	0.214	0.001*	13.103
DMSQ^†-3	0.076	0.027	0.382	2.867	0.146	0.006*	8.222
DMSQ^†-4	0.084	0.027	0.404	3.058	0.163	0.004*	9.352
DMSQ^†-5	0.076	0.025	0.406	3.082	0.165	0.003*	9.500
DMSQ^†-6	0.083	0.021	0.498	3.975	0.248	< .001*	15.801

P-value and F-value are calculated by simple regression analysis.

Statistically significant

^†

DMSQ: Dry mouth symptom questionnaire

B: Unstandardized coefficients

S.E.: Standard error

ß: Standardized coefficients

t: t-statistic