Authors’ response

Abstract

We thank Dr Kapit for his interest in our article and the interesting points raised in his letter. Since measurement of dryness from observation alone after the administration of an antisialagogue is subjective, a formal record was not made. However, it was the clinician’s general impression that significant dryness was noted in approximately 50% of subjects after the atropine sulphate.Since oral dryness is a subjective complaint, there can be considerable variations in the patients’ threshold of discomfort and therefore how they report their experiences in the questionnaire. Dawes1Dawes C. Physiological factors affecting salivary flow rate, oral sugar clearance, and the sensation of dry mouth in man.J Dent Res. 1987; 66: 648-653Crossref PubMed Google Scholar stated that subjects experienced the sensation of dry mouth when the normal flow rate of unstimulated saliva was reduced by 40% to 50%; this is a significant reduction and might not have been experienced by all subjects in this study because of the low dose of atropine sulphate administered. A further consideration is the effect of stressful situations on salivary flow. Placement of an orthodontic appliance can be stressful for some patients; because it is a new experience, it might influence salivary flow. Another variable mentioned is ingestion of food before the administration of the drug. Because salivary flow is influenced by various factors, including ingestion of food, it would be difficult, if not impossible, to control for all these factors.We found no clinically or statistically significant differences in bond failure rates after atropine sulphate use with either brackets or bonded molar tubes in this randomized clinical trial. However, as with any subject, all evidence from well-conducted studies should be considered before drawing conclusions. We thank Dr Kapit for his interest in our article and the interesting points raised in his letter. Since measurement of dryness from observation alone after the administration of an antisialagogue is subjective, a formal record was not made. However, it was the clinician’s general impression that significant dryness was noted in approximately 50% of subjects after the atropine sulphate. Since oral dryness is a subjective complaint, there can be considerable variations in the patients’ threshold of discomfort and therefore how they report their experiences in the questionnaire. Dawes1Dawes C. Physiological factors affecting salivary flow rate, oral sugar clearance, and the sensation of dry mouth in man.J Dent Res. 1987; 66: 648-653Crossref PubMed Google Scholar stated that subjects experienced the sensation of dry mouth when the normal flow rate of unstimulated saliva was reduced by 40% to 50%; this is a significant reduction and might not have been experienced by all subjects in this study because of the low dose of atropine sulphate administered. A further consideration is the effect of stressful situations on salivary flow. Placement of an orthodontic appliance can be stressful for some patients; because it is a new experience, it might influence salivary flow. Another variable mentioned is ingestion of food before the administration of the drug. Because salivary flow is influenced by various factors, including ingestion of food, it would be difficult, if not impossible, to control for all these factors. We found no clinically or statistically significant differences in bond failure rates after atropine sulphate use with either brackets or bonded molar tubes in this randomized clinical trial. However, as with any subject, all evidence from well-conducted studies should be considered before drawing conclusions. Does atropine sulphate improve orthodontic bond survival?American Journal of Orthodontics and Dentofacial OrthopedicsVol. 133Issue 2PreviewThe article, “Does atropine sulphate improve orthodontic bond survival? A randomized clinical trial” in the November issue (Ponduri S, Turnbull N, Birnie D, Ireland AJ, Sandy JR. Am J Orthod Dentofacial Orthop 2007;132:663-70), reports a well-constructed clinical trial. Care was taken to eliminate the practitioner variable, and, also, using each patient as a control is well contrived. I have some questions for the authors concerning information that would have, in my estimation, made the conclusions drawn more substantive. Full-Text PDF