[A PhD completed. General conclusions of doctoral research into regional mouth dryness]. / Serie: Hora est. Algemene conclusies promotieonderzoek naar regionale monddroogte.

Dry mouth has a complex aetiology which makes proper diagnosis complicated. Until now, dry mouth diagnosis has mainly focused on the overall oral dryness, without taking into account regional differences within the mouth. This research showed, among other things, that there are unique patterns of oral dryness, each with its own cause. For example, patients suffering from Sjogren's syndrome mainly experienced dryness of the posterior of the palate. Patients with dry mouth due to the side effects of medication, in contrast, experienced the front part of the tongue as the driest. These findings suggest that mapping of intraoral dryness may be a useful diagnostic tool to differentiate between possible causes of dry mouth.

Use and efficacy of dry-mouth interventions in Sjögren's disease patients and possible association with perceived oral dryness and patients' discomfort.

OBJECTIVES: Sjögren's disease (SjD) patients use various interventions to relief their oral dryness. However, the use and efficacy of these interventions have only partially been evaluated. The present study aims to investigate whether there is an association between the perceived oral dryness and discomfort of SjD patients and their use of specific interventions. MATERIALS AND METHODS: A cross-sectional study was performed among SjD patients, who completed several questionnaires to assess the severity of their oral dryness and an inventory of dry-mouth interventions. The perceived efficacy of each intervention was reported on a 5-point Likert-scale. RESULTS: The questionnaires were returned by 92 SjD patients. For relief of oral dryness, they mostly used "eating fruit", "drinking tea", "moistening the lips", "drinking water, and "drinking small volumes" (> 50%). Three interventions had a frequency of use ranging from 2-6 times/day, whereas, "drinking water" and "drinking small volumes" showed higher frequencies (> 14). The highest overall efficacy (≥ 3.5) was reported for "chewing gum" and "using a mouth gel". Furthermore, various dry-mouth interventions showed significant associations with oral dryness scores and/or patients' discomfort. For example, "drinking small volumes" and "using XyliMelts" were associated with the Bother Index score. CONCLUSION: Great variation was found in the use of dry-mouth interventions by the participants and the severity of the oral dryness and/or patients' discomfort seemed to affect their choice of intervention. Notably, the mostly used interventions did not show the highest reported efficacy. CLINICAL RELEVANCE: These findings might help SjD patients and clinicians in their choice of effective dry-mouth interventions.

Salivary film thickness and MUC5B levels at various intra-oral surfaces.

OBJECTIVES: In this study, we investigated the salivary film thickness and the MUC5B levels at various intra-oral locations in healthy volunteers, with a focus on the palate. Besides, measurements of the palatal surface area were included to explore the possible relationships between the palatal surface area and the palatal salivary film and MUC5B levels. MATERIALS AND METHODS: The salivary film thickness was determined using filter strips, which were pressed to the mucosal surfaces of five different intra-oral locations; conductance was then analysed using a Periotron. After elution of the strips, the MUC5B levels at various intra-oral locations were determined using ELISA. The palatal surface area was measured using an intra-oral scanner. The surface area was subsequently calculated using the software. RESULTS: The anterior tongue had the thickest salivary film and also the highest levels of MUC5B, while the anterior palate had the thinnest salivary film and lowest MUC5B levels. There was no association between the palatal surface area and the salivary film thickness of the palate. CONCLUSION: The salivary film and MUC5B levels are unequally distributed over the intra-oral regions of the soft tissues. The lack of association between the palatal surface area and the salivary film thickness indicates that a larger surface area is not associated with a relative thinner palatal salivary film. CLINICAL RELEVANCE: The results of the current study increase our understanding of saliva distribution in the oral cavity and could be used as reference values for future studies.

Correlations of palatal surface area with anthropometric dimensions of the head and face.

PURPOSE: Saliva distribution over the palatal surface plays an important role in the perception of dry mouth. It is envisaged that non-invasive estimation of the palatal surface area by anthropometric measurements of the head and face can be useful in the assessment of oral dryness. For this purpose, the relationship between the palatal surface area and anthropometric measurements of the head and face was investigated. METHODS: The palatal surface was measured in 51 healthy volunteers using an intra-oral scanner. The distances between anthropometric landmarks of the head and face were determined using an anatomical sliding caliper. Correlations between the palatal surface area and the anthropometric landmarks were investigated. RESULTS: The median palatal surface area for the total study population was found to be 2120.6 mm2. Virtually, all anthropometric measurements showed significant differences between females and males. Various head and face measurements had a significant correlation with the palatal surface area. However, these correlations disappeared when the participants were stratified based on their sex, with the exception of mandibular length and palatal width in females. CONCLUSION: The surface area of the palate correlates with nearly all anthropometric measurements of the head and face included in this study. Yet, the clinical applicability seems limited to females.

The relationship between the severity of oral dryness and the use of dry-mouth interventions by various subgroups of dry-mouth patients.

OBJECTIVE: Dry-mouth patients use different interventions to relieve their oral dryness. As recent studies showed that various subgroups of dry-mouth patients perceived different intra-oral regions as most dry, the present study investigated whether the use of dry-mouth interventions by various subgroups of dry-mouth patients was related to the perceived oral dryness as well as salivary flow rate. MATERIALS AND METHODS: Xerostomia Inventory (XI) scores, Regional Oral Dryness Score (RODI) scores and used dry-mouth interventions were extracted from the medical records of 528 patients visiting a saliva clinic. Based on their medical history, they were allocated into 6 subgroups. RESULTS: The subgroups of dry-mouth patients used a wide range of interventions to relieve their oral dryness. Sjögren's syndrome patients used most interventions more frequently than patients with oral dryness due to use of a limited number of medications and controls. Patients using medications showed associations between the total XI score and dry-mouth interventions aimed at the entire mouth. In medication using patients and controls, the locally applied intervention "using mouth gel" was associated with RODI scores of the anterior tongue. CONCLUSION: The use of dry-mouth interventions was associated with dry-mouth feelings. Use of interventions aimed to relieve dryness of the entire mouth was significantly associated with total XI score, while locally applied interventions were significantly associated with the severity of dryness at specific intra-oral regions, the anterior tongue in particular. CLINICAL RELEVANCE: The results will help clinicians to advise dry-mouth patients about the most suitable interventions for relief of oral dryness complaints.

The association between oral dryness and use of dry-mouth interventions in Sjögren's syndrome patients.

OBJECTIVE: Sjögren's syndrome patients use different dry-mouth interventions for the relieve of their oral dryness. Recently, it was shown that patients with dry-mouth complaints have regional differences in perceived intra-oral dryness. Therefore, the aim of the present study was to investigate whether the use of dry-mouth interventions is related to the perceived regional oral dryness. MATERIALS AND METHODS: A cross-sectional study was performed among Sjögren's patients. Volunteers could anonymously administer various questionnaires, including the Regional Oral Dryness Inventory (RODI), Xerostomia Inventory (XI), Bother Index (BI) and a list of dry-mouth interventions. RESULTS: Sjögren's syndrome patients use a wide variety for the relieve of oral dryness. "Drinking water'' and "moistening the lips'' were used most frequently. Dry-mouth interventions, "drinking water'', "rinsing of the mouth", and "drinking small volumes" had significant associations with the RODI-scores of the posterior palate, and anterior and posterior tongue, respectively. On the other hand, "using mouth gel'' had a significant association with the RODI-scores of the inside cheeks. CONCLUSION: Sjögren's syndrome patients are more likely to use mouth gels when their inside cheeks were experienced as most dry, while they drank water, rinsed their mouth or drank small volumes if the posterior palate, and anterior and posterior tongue were considered as dry. It can be concluded that intra-oral dryness affects dry-mouth perception and thereby also the use of the various dry-mouth interventions. CLINICAL RELEVANCE: The therapeutic choice of dry-mouth interventions by Sjögren's syndrome patients seems to some extent to be related to dryness at specific intra-oral regions.

[Is acupuncture effective for dry mouth?] / Helpt acupunctuur bij een droge mond?

Current therapies for dry mouth have several drawbacks and limitations. Therefore, some patients turn to alternative medicine, such as acupuncture. Three systematic reviews of the literature found that acupuncture may have a positive effect on reducing complaints. However, in these studies, no effect on the salivary secretion rate was observed. Considering the limited number of studies and the low quality of evidence, caution is advised when recommending acupuncture as an alternative therapy for dry mouth.

Differences in perceived intra-oral dryness in various dry-mouth patients as determined using the Regional Oral Dryness Inventory.

OBJECTIVES: Recently, it was shown that the Regional Oral Dryness Inventory (RODI) could determine differences in dry-mouth perception at different intra-oral locations. The main aim of this study was to determine whether the RODI might help to discriminate between various causes of oral dryness in dry-mouth patients. The second aim was to ascertain whether the RODI could become an additional diagnostic tool in dry-mouth patients. MATERIALS AND METHODS: Data were collected retrospectively from patients who visited a specialized saliva clinic. Salivary flow rates, Xerostomia Inventory scores, and RODI scores were extracted from the medical records. Patients were stratified into subgroups according to their health status. RESULTS: Five hundred twenty-eight patients participated in this study (mean age of 59.6 ± 16.0 years; 68.4% female). Specific patient groups differed with regard to the region of the mouth they experienced as the most and least dry. The posterior palate was the area perceived as most dry by controls and Sjögren patients. In patients using limited or multiple medications, it was the anterior tongue. RODI scores also differed significantly among dry-mouth patient groups: whereas controls and patients using limited medication had the lowest RODI scores and experienced less intra-oral dryness, Sjögren patients had the highest RODI scores. CONCLUSION: Our use of the RODI questionnaire showed that perceived intra-oral dryness differed between the various dry-mouth patients. CLINICAL RELEVANCE: The RODI can be a valuable clinical diagnostic tool in dry-mouth diagnostics, in which it can be used to discriminate between the various causes of oral dryness in patients.

[The relationship between xerostomia and saliva secretion in young adults]. / De relatie tussen xerostomie en speekselsecretie bij jongvolwassenen.

The relationship between xerostomia and reduced saliva secretion is known to occur in patients suffering from dry mouth. These are mainly (frail) older people experiencing reduced saliva secretion as a result of the use of medication. In the current research, we investigated whether the severity of xerostomia could be used as predictor for saliva secretion in young adults. 369 dentistry students participated in this study, of whom 33.4% were male and 66.6% were female, with an average age of 20.2 ± 2.4 years. It was found that the severity of xerostomia in the young adult students had a weak correlation with the unstimulated saliva secretion rate. This indicates that dry mouth complaints in this age group are not a good predictor for saliva secretion. In addition, it is concluded that hyposalivation is not restricted to older people or to specific patient groups, but that even among a trial population of young adults, individuals can suffer from dry mouth and/or reduced saliva secretion.

[Intraoral differences in perceived oral dryness as determined by means of the Regional Oral Dryness Inventory]. / Intraorale verschillen in ervaren monddroogte, bepaald door middel van de Regional Oral Dryness Inventory.

A sensation of dry mouth can be determined with a general questionnaire, the Xerostomia Inventory (XI). This questionnaire, however, does not distinguish among regional differences of oral dryness. In this study, therefore, a new questionnaire was evaluated, the Regional Oral Dryness Inventory (RODI), quantifying the severity of dryness in various intraoral locations. 337 patients participated in this study with an average age of 54 ± 17 years. It appeared there is a significant difference in the sensation of dry mouth between different intraoral locations; the perceived dryness scored highest for the posterior palate and lowest for the floor of the mouth. Introduction of the RODI might help to discriminate among different potential causes of oral dryness in patients. The RODI is highly accessible and easy to carry out in dental practices during routine clinical assessment.

Determination of intra-oral surface areas by cone-beam computed tomography analysis and their relation with anthrometric measurements of the head.

PURPOSE: Determination of intra-oral surface areas might contribute to our understanding of the physiology of the oral cavity and oral diseases. In previous studies, the intra-oral surface area was determined using a laborious and technically challenging method. Our aim was to develop an easy and non-invasive method to determine the intra-oral surface areas. METHODS: In this study, we used cone-beam computed tomography (CBCT) and digital analysis in 20 human cadavers to determine various intra-oral surface areas, based on digital segmentation. Next, we explored whether there was a relationship between various intra-oral surface areas and anthropometric measurements of the head using Pearson correlation coefficient. RESULTS: Using CBCT and digital analysis, it was possible to determine various intra-oral surface areas. On average, the total intra-oral surface area was 173 ± 19 cm2. Moderate, statistical significant correlations were observed between (1) the length of the head and the palatal surface area, as well as (2) the depth of the head and the surface area of the tongue. These correlations suggest the feasibility of estimating intra-oral surface areas without relying on CBCT imaging. CONCLUSIONS: This study presents a technique for measuring the intra-oral surface areas by CBCT imaging in combination with digital analysis. The results of this study suggest that anthropometric measurements of the head might be used to estimate the surface areas of the palate and tongue.