Effect of different bonding agents on shear bond strengths of composite-bonded porcelain to enamel

Effect of different bonding agents on shear bond strengths of compositebonded porcelain to enamel Cenk Cura, DDS, PhD,a Ahmet Sarac¸ogˇlu, DDS, PhD,b and H. Serdar C¸o¨tert, DDS, PhDc Faculty of Dentistry, Ege University, Izmir, Turkey Statement of problem. The use of bonding agents in the luting procedure for porcelain laminate restorations to enamel is not clear. Purpose. This study evaluated the shear bond strength differences between an enamel-luting composite and a heat-pressed ceramic with 6 different bonding systems. Material and methods. Seventy standardized heat-pressed IPS Empress ceramic discs (4-mm diameter, 3-mm height) were prepared. A vertical planar enamel-bonding surface was prepared on the buccal or lingual enamel of 70 freshly extracted sound human molars and premolars. The teeth were oriented to maintain a parallel relationship between the bonding plane and the shear loading axis of a universal testing machine. Tooth specimens were divided into 7 groups (n⫽10) comprising equal numbers of molars and premolars. The enamel surfaces of specimens in groups 1 through 6 were prepared with 1 of 6 bonding agents (Scotchbond Multi Purpose Plus, Heliobond, PQ1, SE Bond, Prime&Bond NT, and Prompt L-Pop). Finally, the specimens were luted to the ceramic discs with the composite cement (Opal Luting Composite). Ceramic discs in the seventh group (Control) were luted to the etched enamel with the composite cement without using bonding material. Enamel-ceramic specimens were kept in distilled water at room temperature for 30 days after cementation. All specimens were shear loaded axially in a universal testing machine with a crosshead speed of 0.05 mm/min until fracture. Shear bond strength was measured and recorded for each group in MPa. To determine the statistical significance of the differences between the mean shear bond strength values, a 1-way analysis of variance was used (␣⫽.05). Post-hoc multiple comparisons were made with Duncan’s multiple range analysis. Fractured surfaces of each specimen were also inspected with a stereomicroscope to evaluate failure modes. Results. A 1-way analysis of variance revealed significant differences between the test groups (P⫽.00). Bond strength values (MPa) from the highest to the lowest were as follows: Prompt L-Pop, 25.46 ⫾ 5.6; Prime&Bond NT, 18.99 ⫾ 4.93; Heliobond, 17.28 ⫾ 4.0; SE Bond, 16.21 ⫾ 2.6; PQ1, 15.60 ⫾ 2.8; Scotchbond MPP, 14.82 ⫾ 2.4; and Control, 10.55 ⫾ 1.6. Duncan’s multiple range post hoc analysis exhibited significant differences between the control group and the adhesive bonding agent groups (P⬍.05). There were also significant differences between the bonding agent groups (P⬍.05). Prompt L-Pop showed the highest bond strength values. Conclusion. Within the limitations of this study, bonding agents appear to have a strengthening effect on the shear bond strengths of the enamel/composite/porcelain interface of the materials tested. Bonding agents used in this study showed similar bond strength values except for Prompt L-Pop, which demonstrated the highest bond strength values. (J Prosthet Dent 2003;89:394-9.)

CLINICAL IMPLICATIONS In this in vitro study, the bonding agents tested produced a reliable bond between the porcelain, composite, and etched enamel surfaces. The easy-to-use products studied, such as self-etch, nonrinse, and 1-bottle single-step adhesive bond systems, produced bond strengths as high as the conventional 3-step products.

C

ontemporary restorative dentistry places a definite emphasis on adhesion. Accordingly, long-term survival of adhesive porcelain restorations depends on the success of a reliable bond between the porcelain, the composite luting agent, and the dental substrates. Numerous studies1-8 have evaluated the bond strength of the enamel/composite/ceramic joints. According to the lit-

Assistant Professor, Department of Prosthodontics. Assistant Professor, Department of Prosthodontics. c Associate Professor, Department of Prosthodontics.

erature, creating a porous ceramic surface texture, which is then silanated, is essential to obtain a reliable bond.1-6 On the other hand, a reliable enamel/composite/porcelain joint has 2 interfaces: a composite/porcelain interface and an enamel/composite interface.7 Enamel seems to be the primary adhesion source chosen when porcelain laminate veneers (PLV) are considered. In clinical studies evaluating the bond strength of the enamel/composite/porcelain joint, a reliable bond can be produced by the mechanical interlocking of polymerized luting composite to the acid-etched enamel.8 Be-

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a

b

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cause the enamel/composite bonding depends mostly on mechanical retention, the strength of this bond is related with the length, shape, and mechanical properties of the resinous tags. Mechanical properties of resinous tags, filler content, particle size, and wetting characteristics of the luting composite are closely related.9 High filler content provides strength, whereas small filler size improves wetting characteristics. With this perspective, bonding agents provide an appropriate interface between the etched enamel and the luting composite. Wetting characteristics of enamel and the interactions between the bonding material and the dental substrates have been studied in detail.1-3,10-14 Some authors recommend the use of bonding agents on the etched enamel surface before application of the luting composite to enhance the bond strength of the restoration.10,11,15,16 Others suggest that the bonding agents should only be used for dentinexposed situations.12-14,17 Wetting characteristics of enamel are also related with the surface energy of enamel.18 The relation between surface energy changes and wetting performance of the etched enamel was studied by Jardel et al.18 Interactions between the surface energy of the etched enamel and the wettability of the luting and bonding materials were also demonstrated.19,20 Recent applications of adhesive dentistry aim to simplify the bonding and luting procedures. Bonding performance of time-saving and simplified materials were evaluated in comparison with multistep products.21-24 Interfacial ultrastructure and resin tag penetration of the bonding agents into etched enamel was reported by Gordan et al.25 Differences in resin tag formation of a 1-bottle bonding agent in the etched and unetched enamel substrate was studied by Ferrari et al.26 The use of PLVs requires considerable support from the underlying composite and enamel to be able to resist stresses in the oral environment. Different bonding agents with different application techniques are currently used to provide support for PLVs. This in vitro study evaluated the effects of various bonding agents on the shear bond strengths of the enamel/composite/ porcelain joints.

MATERIAL AND METHODS Seventy discs of heat-pressed ceramic (IPS Empress; Ivoclar, Schaan, Liechtenstein) were fabricated for this study. Wax sprues 4 mm in diameter were invested and heat pressed with this alumina-reinforced ceramic material using the lost wax technique. After the heat-pressing procedure, the ceramic rods were cut into discs 4 mm in diameter and 3 mm in height. The discs were air abraded with 50-␮m desiccant alumina particles under 60-psi air-pressure, cleaned ultrasonically (Sonorex; Bandelin, Berlin, Germany), etched with 9.5% hydrofluoric acid for 20 seconds (Porcelain Etch; Ultradent, South JorAPRIL 2003

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dan, Utah), washed, dried, and silanated (Silane; Ultradent). Tooth specimens of 70 sound human molars and premolars extracted from individuals between the ages of 30 and 55 were stored in 0.1% thymol solution at room temperature until the laboratory procedures were conducted. Teeth were scaled using a hand instrument (Scaler H6/H7; Hu-Friedy, Chicago, Ill) and brushed (No: 9640.204.060; Komet, Gebr Lemgo, Germany) with a nonaromatic pumice at 6000 rpm until they were visually clean. The cleaned specimens were inspected using a magnifying glass under a halogen light (Compact Halogen Magnifier Combo 7310; EDM Zap Parts Inc, Lisle, Ill.) for any pre-existing minor cracks. A vertical planar enamel-bonding surface was prepared on the buccal or lingual enamel with a high-speed diamond disc (Bur no: 818.314.050; Komet). The specimen teeth were attached with a sticky wax (Wax C0341; Kerr, Romulus, Mich.) to a pin fixator (K9 Cutter; Kavo EWL, Leutkirch, Germany) on the vertically prepared surface to maintain a plane between the bonding surface and the shear loading axis of the universal testing machine (AG-I Series Autograph kgN50; Shimadzu, Osaka, Japan). The roots of each tooth were embedded in a plastic cylinder 20 mm in diameter and 15 mm in height, filled with autopolymerizing acrylic resin (Meliodent; Bayer UK Ltd, Newbury, United Kingdom) such that the coronal portion would be exposed. The pin fixator was detached after acrylic resin polymerization, and the specimen teeth were washed with boiling water to remove the sticky wax. Seventy enamel specimens were divided into 7 groups (n ⫽ 10) so that each group contained an equal number of molars and premolars. Different bonding materials were applied to each group in accordance with the manufacturer’s recommendations (Table I). The bonding material application protocols used in this study are described as follows: Group 1. The prepared enamel surfaces of the specimen teeth were etched with 37% orthophosphoric acid (Ultraetch; Ultradent) for 30 seconds and then rinsed and dried until a frosty white appearance was observed. Primer (Scotchbond MPP; 3M, St. Paul, Minn.) was applied, air thinned, then permitted to evaporate. Each specimen was painted with bond material (Scotchbond MPP; 3M), blot dried, and light polymerization was performed with an energy density of 480 mW/cm2 (Optilux; Demetron Inc, Danbury, Conn.) for 40 seconds. Group 2. The specimens were etched with the same protocol as in group 1. Primer (Syntac; Vivadent, Schaan, Liechtenstein) and bond material (Heliobond; Vivadent) were applied, air thinned, and then light polymerized for 40 seconds. Group 3. The prepared enamel surfaces were etched with the same protocol as in Groups 1 and 2, and the 395

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Table I. Bonding agents and application protocols Groups

Bonding agents and manufacturer

Etching

Priming

Bonding

1 2

Scotchbond MPP (3M, St. Paul, Minn.) Heliobond (Vivadent, Schaan, Liechtenstein) PQ1 (Ultradent, South Jordan, Utah) Clearfil SE Bond (Kuraray, Osaka, Japan) Prime&Bond NT (Dentsply DeTrey, Konstanz, Germany) Prompt L-Pop (Espe AG, Seefeld, Germany) Control

37% H3PO4 37% H3PO4

SMPP Primer Syntac

SMPP Bond Heliobond

3 4 5 6 7

bond material (PQ1; Ultradent), which is a combination of primer and adhesive bonding agent, was applied, air thinned, and light polymerized for 40 seconds. Group 4. Primed with a self-etching primer (Clearfil SE Primer; Kuraray, Osaka, Japan) blot dried and permitted to evaporate, and the adhesive bonding agent (Clearfil SE Bond; Kuraray) was applied. The bonding agents were then air thinned and light polymerized for 40 seconds. Group 5. The nonrinse conditioner (NRC; Dentsply DeTrey, Konstanz, Germany) was applied to the prepared enamel surfaces, blot dried, and permitted to evaporate. The bond material (Prime&Bond NT; Dentsply DeTrey) was then applied, air thinned, and light polymerized for 40 seconds. Group 6. One-step bond material (Prompt L-Pop; Espe AG, Seefeld, Germany) was applied to the prepared enamel specimens, air thinned, and light polymerized for 40 seconds. The prepared ceramic samples were then luted to the enamel surfaces with a dual-polymerizing resin cement (Opal Luting Composite; 3M). A 300 g standard weight was applied by placing a cylindrical steel block over the ceramic specimens. The cement was then exposed to peripheral light activation (Optilux; Demetron Inc, Danbury, Conn.) for 180 seconds. Group 7 (Control). The ceramic specimens were luted directly to the etched enamel surface with the composite cement without prior application of an adhesive bonding agent. Enamel-ceramic specimens were kept in a sealed container of distilled water at room temperature and left undisturbed for 30 days after cementation. The specimens were then loaded axially in a universal testing machine (AG-I Series Autograph kgN50; Shimadzu) with a crosshead speed of 0.05 mm/ min until fracture (Fig. 1). Shear bond strength at failure was measured and recorded for each group in MPa. The data were evaluated by 1-way analysis of variance (␣⫽.05). Afterwards, post hoc multiple comparisons were made with Duncan’s multiple range analysis. Fractured surfaces of each specimen were inspected with a stereomicroscope (SMXX; Carl Zeiss, Jena, Germany) for detection of failure modes. 396

37% H3PO4 Clearfil SE Primer (Self-etch) NRC

37% H3PO4

PQ1 Clearfil SE Bond Prime&Bond NT

Prompt L-Pop (Self-etch) —

—

Fig. 1. Shear testing alignment.

RESULTS Mean shear bond strength values and standard deviations of the specimen groups are listed in Table II. ANOVA analysis revealed significant differences between the groups (P⫽.00). Table III presents multiple comparisons computed with Duncan’s multiple range test. Groups not significantly different at the 0.05 level are presented as subsets. The mean shear bond strength in the control group was significantly lower than all other study groups (P⬍.05). Prompt L-Pop exhibited the highest shear bond strength value, and the differences with the other groups were significant (P⬍.05). No significant difference was observed between PQ1, SE Bond, and Heliobond (P⬎.05). The difference in shear bond strength values between Scotchbond MPP and Prime&Bond was also significant (P⬍.05). Failure modes and the number of occurrences are presented in Table IV. Three types of failure modes were observed in this study: adhesive failure in enamel-composite interface, adhesive failure in composite-porcelain VOLUME 89 NUMBER 4

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Table II. Shear bond strength means and standard deviations (MPa) of groups prepared with various bonding agents 95% CI for mean

Groups

N

Mean

SD

Lower Bound

Upper Bound

Scotchbond MPP Heliobond PQ1 SE Bond Prime&Bond Prompt L-Pop Control Total

10 10 10 10 10 10 10 70

14.82 17.28 15.60 16.21 18.99 25.46 10.55 16.66

2.40 4.00 2.80 2.62 4.93 5.60 1.56 5.29

13.10 14.41 13.59 14.33 15.47 21.46 9.44 15.48

16.53 20.14 17.60 18.08 22.52 29.47 11.66 17.83

Table III. Duncan’s multiple range analysis. Means for group in homogeneous subsets Subset for ␣ ⴝ .05 Groups

7 1 3 4 2 5 6

Control Scotchbond MPP PQ1 SE Bond Heliobond Prime&Bond Prompt L-Pop

N

1

10 10 10 10 10 10 10

10.55

2

14.82 15.60 16.21 17.28

3

4

15.60 16.21 17.28 18.99 25.46

Table IV. Failure mode data Group/Failure

C/E

A/E-Com

C/Com

A/Com-P

C/P

Scotchbond MPP Heliobond PQ1 SE Bond Prime&Bond Prompt L-Pop Control

— — — — — — —

3 2 5 2 2 3 8

7 8 2 6 8 1 1

— — 3 2 — 6 1

— — — — — — —

C/E, Cohesive failure mode in enamel; C/P, cohesive failure mode in porcelain; C/Com, cohesive failure mode in composite; A/E-Com, adhesive failure mode between enamel-composite interface; A/Com-P, adhesive failure mode between composite-porcelain interface.

interface, and cohesive failure in the composite luting agent. Pure enamel or pure ceramic cohesive failures were not observed. There were 8 adhesive failures between the enamel-composite interface in the control group, whereas the number of adhesive failures in the other study groups varied between 2 to 5.

DISCUSSION PLV’s increasing popularity depends primarily on the esthetic and conservative properties of the restorations; however, clinical durability is also of key importance. Bond strength may be the most important factor of durability. The statistical analysis performed revealed significant differences in the mean shear bond strength values among the 7 study groups. The shear bond APRIL 2003

strength values in the control group were significantly lower than the remaining groups. This finding is in accordance with the study of Sakaki et al,6 who demonstrated that the viscosity of the bonding agents increased with an elevation of filler content and that bonding agents with high filler content exhibited a reduced flexural strength. They also showed that bonding agents with low filler content demonstrated greater shear bond strengths than other bonding agents. Furthermore, the resinous tag length of the low-filler-containing material was longer than the others. It was reported that high filler content provided strength, whereas small filler particle size improved the wetting characteristics.4 Jardel et al18 showed the close relation between surface energy changes and wetting performance of the 397

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etched enamel. Wetting performance of the etched enamel is important in all types of adhesive restorations because of the close interaction between the surface energy of the etched enamel and the wettability of the luting and bonding material. The enamel-composite bond strength depends on these interactions.18-20 Weakness of the nonbonded control group in comparison with the bonding agent groups was also supported with failure mode data. Eight adhesive failures were detected throughout the 10 specimens of the control group. Adhesive failure counts in the enamel-composite interface ranged between 2 to 5 in the bonding agent groups. This study did not reveal any significant differences among the groups of etched and self-etched enamel. Contemporary approaches to adhesive dentistry attempt to shorten the application time and reduce the number of steps. Time-saving and simplified materials are preferred by many clinicians.22,24 Bonding performance of such materials has been inspected and compared with multistep products in several studies.5,21-23 Interfacial ultrastructure and resin tag penetration of bonding agents into the etched enamel were reported by Gordan et al,25 who found more consistent resin tag penetration of Panavia 21 and Scotchbond MPP materials in etched enamel than in Prime&Bond, unetched Prime&Bond, or Scotchbond MPP specimens. The latter 2 showed minimal or no adhesive penetration to the enamel surfaces.25 Resin tag formation of a 1-bottle bonding agent (Prime&Bond NT) in the etched and unetched enamel substrate was studied by Ferrari.26 A traditional etching pattern and resin tag formation were evident in the conventionally-etched enamel specimens. A similar etched pattern and resin tag formation were also observed in enamel specimens, which were conditioned with a nonrinse conditioner. The enamel shear bond strength of a 1-bottle nanofilled adhesive was compared with its unfilled predecessor (Prime&Bond NT and Prime&Bond 2.1 consequently) by Perdigao et al21 to observe resin tag penetration into the etched and non-rinse-conditioned enamel. The authors found the shear bond strengths to be 24.7 ⫾ 6.7 MPa for the unfilled agent with etched enamel and 27.0 ⫾ 5.4 MPa for the nanofilled 1-bottle agent on the non-rinse-conditioned enamel. The variation in specimen preparation technique may explain the differences in the results of the present study compared with previous studies. The preparation of specimens for this study attempted to simulate the clinical condition of the enamel/composite/porcelain joints. In previous studies that focused on the porcelain/composite bond strength, the critical interaction in the composite/enamel interface was omitted.2,4,7 These studies attempted to determine the force needed to displace composite cylinders that were polymerized directly against treated porcelain surfaces. This model does not 398

simulate the clinical situation, because there is only a thin layer of composite luting agent between the closely fitting enamel and porcelain surfaces. The shear stress analysis of the bonding of PLVs to enamel was studied with a similar testing technique by Stacey,4 and the shear testing of a combined enamel/composite/porcelain bond resulted in lower values from individual enamel/ composite and porcelain/composite bond strengths. According to the results of this study, the 1-step selfetching bonding material Prompt L-Pop showed the highest bond strength values and significant differences with the other groups. This finding agreed with the results of Issa et al,22 who reported mean shear bond strength values of the enamel/Prompt L-Pop/compomer joints and enamel/Prime&Bond 21/compomer joints as 31.12 and 14.67 MPa, respectively. The results of this study together with previous investigations support the reliability of the simplified bond materials. Further in vitro research is necessary to evaluate the shear bond strengths of various dental adhesive materials.

CONCLUSIONS This in vitro study provides further support for the use of bonding agents on etched enamel surfaces in luting procedures. Bond strength of the enamel/composite/porcelain joint was increased by the use of bonding materials. A significant difference was found among the bonding agents tested in this study. Scotchbond MPP, PQ1, SE Bond, Heliobond, and Prime&Bond NT showed similar strengthening effects on the enamel/composite/porcelain joint. Prompt L-Pop produced higher bond strength values compared to the other materials tested. REFERENCES 1. Hayakawa T, Horie K, Aida M, Kanaya H, Kobayashi T, Murata Y. The influence of surface conditions and silane agents on the bond of resin to dental porcelain. Dent Mater 1992;8:238-40. 2. Thurmond JW, Barkmeier WW, Wilwerding TM. Effect of porcelain surface treatments on bond strengths of composite resin bonded to porcelain. J Prosthet Dent 1994;72:355-9. 3. Chen JH, Matsumura H, Atsuta M. Effect of etchant, etching period, and silane priming on bond strength to porcelain of composite resin. Oper Dent 1998;23:250-7. 4. Stacey GD. A shear stress analysis of the bonding of porcelain veneers to enamel. J Prosthet Dent 1993;70:395-402. 5. Barkmeier WW, Menis DL, Barnes DM. Bond strength of a veneering porcelain using newer generation adhesive systems. Pract Periodontics Aesthet Dent 1993;5:50-5. 6. Sakaki T, Fukushima T, Kawai S, Matsumoto M. Effect of physical properties of direct bonding adhesives on bonding to etched enamel. J Prosthet Dent 1994;71:552-9. 7. Stangel I, Nathanson D, Hsu CS. Shear strength of the composite bond to etched porcelain. J Dent Res 1987;66:1460-5. 8. Myers CL, Rossi F, Cartz L. Adhesive taglike extensions into acid-etched tooth enamel. J Dent Res 1974;53:435-41. 9. Ferrari M, Cagidiaco CM, Mason PN. Morphologic aspects of the resindentin interdiffusion zone with five different dentin adhesive systems tested in vivo. J Prosthet Dent 1994;71:404-8. 10. Horn HR. A new lamination: porcelain bonded to enamel. N Y State Dent J 1983;49:401-3.

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11. Garber DA, Goldstein RE, Feinman RA. Porcelain laminate veneers. Chicago: Quintessence; 1988. p. 24-35. 12. Magne P, Douglas WH. Porcelain veneers: Dentin bonding optimization and biomimetic recovery of the crown. Int J Prosthodont 1999;12:111-21. 13. Sim C, Neo J, Chua EK, Tan BY. The effect of dentin bonding agents on the microleakage of porcelain veneers. Dent Mater 1994;10:278-81. 14. Burke FJ, Watts DC. Effect of differing resin luting systems on fracture resistance of teeth restored with dentin-bonded crowns. Quintessence Int 1998;29:21-7. 15. Calamia JR. Etched porcelain facial veneers: a new treatment modality based on scientific and clinical evidence. N Y J Dent 1983;53:255-9. 16. McConnell RJ, Boksman L, Jones G. Esthetic restoration of a primary canine in the adult dentition by means of an etched porcelain veneer: report of a case. Quintessence Int 1987;18:121-4. 17. Dumfahrt H. Porcelain laminate veneers: a retrospective evaluation after 1 to 10 years of service: Part 1-Clinical procedure. Int J Prosthodont 1999;12:505-13. 18. Jardel V, Degrange M, Picard B, Derrien G. Surface energy of etched ceramic. Int J Prosthodont 1999;12:415-8. 19. Burke FJ, Combe EC, Douglas WH. Dentine bonding systems: 1. Mode of action. Dent Update 2000;27:85-8, 90, 92-3. 20. el-Badrawy WA, el-Mowafy OM. Chemical versus dual curing of resin inlay cements. J Prosthet Dent 1995;73:515-24. 21. Perdigao J, Baratieri LN, Lopes M. Laboratory evaluation and clinical application of a new one-bottle adhesive. J Esthet Dent 1999;11:23-35. 22. Issa MH, Silikas N, Watts DC. Strength of a “no-bottle” adhesive system bonded to enamel and dentine. Dent Update 2000;27:484-7.

Noteworthy Abstracts of the Current Literature

23. Cardoso PE, Placido E, Francci CE, Perdigao J. Microleakage of class V resin-based composite restorations using five simplified adhesive systems. Am J Dent 1999;12:291-4. 24. Crisp RJ, Burke FJ. Evaluation of the handling of a new compomer and novel dispensing system in general dental practice. Quintessence Int 1998; 29:775-9. 25. Gordan VV, Vargas MA, Denehy GE. Interfacial ultrastructure of the resin-enamel region of three adhesive systems. Am J Dent 1998;11:13-6. 26. Ferrari M, Mannocci F, Kugel G, Garcia-Godoy F. Standardized microscopic evaluation of the bonding mechanism of NRC/Prime & Bond NT. Am J Dent 1999;12:77-83. Reprint requests to: DR CENK CURA ¨ NIVERSITESI DIS¸ HEKIMLIG˘ I FAKU¨ LTESI EGE U PROTETIK DIS¸ TEDAVISI ANABILIM DALI 35100 BORNOVA IZMIR TURKEY FAX: 90-232-3880325 E-MAIL: [email protected] Copyright © 2003 by The Editorial Council of The Journal of Prosthetic Dentistry. 0022-3913/2003/$30.00 ⫹ 0 doi:10.1067/mpr.2003.58

Dry mouth and nose in the older patient. What every PCP should know Bassichis BA, Marple BF. Geriatrics 2002;57:22-4, 29, 32.

Purpose. A comprehensive review of the factors causing dry mouth and dry nose for primary care physicians is presented. Discussion. The authors state that xerostomia and dry nose are common complaints of older individuals. Unlike dry nose, xerostomia is not a consequence of normal aging, and is usually associated with medical conditions or other factors. Salivary gland anatomy as it relates to the diagnosis and treatment of xerostomia is reviewed. Xerostomia can be attributed to 1 of 4 main causes: CNS conditions and conditions that affect the autonomic outflow pathways; medication side effects; salivary gland complications (Sjogren’s syndrome); or autoimmunity and electrolyte or fluid imbalance. Treatment and management of dry mouth include hydration, chewing sugarless gum or candy to stimulate salivary production; avoiding bulky and spicy foods, as well as carbonated beverages, caffeinated products, and alcohol; using mouthwash; using an air humidifier in the home; and visiting the dentist regularly for caries and periodontal prevention. The causes and treatment of geriatric rhinitis are provided. The goal for treatment of dry nose is to moisten the nasal cavity without creating more dryness, particularly from certain antihistamines. Conclusions. Dry mouth is usually attributed to medical conditions or other underlying causes, whereas dry nose is usually associated with age-related changes in nasal physiology and structure. General management of both conditions involves hydration of the involved tissues. 13 references. —RP Renner

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