14 Chapter 1 Consequences of impaired salivary function There is hyposalivation when the unstimulated salivary flow rate is <0.1 mL/ min or <0.7 mL/min under stimulated conditions [16]. The overall prevalence of hyposalivation in older people is approximately 33% [20]. Persistent and severe hyposalivation commonly results in mucosal changes, an increased caries activity, oral fungal infections and a proclivity towards acute gingivitis [15, 21]. In addition, consequences such as disturbed taste sensation, impaired lubrication, dysphagia, difficulty with chewing, difficulty with speaking, fetor ex ore, fissures and ruptures of the lips are also very common. These consequences may lead to behavioral changes like avoiding certain foods. In turn, changes in dietary intake may result in nutritional deficiencies and atrophy of the masticatory muscles and decreased masticatory ability [15, 19]. Consequently, hyposalivation and its related symptoms and clinical consequences often have negative effects on social functioning, quality of life in general and oral health in particular [15, 22, 23]. Also xerostomia, the subjective sensation of dry mouth that in most cases is present throughout the day [15], is sometimes associated with hyposalivation. The prevalence of xerostomia ranges between 1-65%, dependent on parameters studies such as study sample, gender, age, used medications, and used diagnostic tool [8, 19, 24-26]. In the general population, this prevalence is estimated to be approximately 20%, with increased prevalence in females (up to 30%) and in the elderly (up to 50%) [8, 19, 24]. Discomfort, especially disturbed sleep at night, is the most common symptom associated with xerostomia [11]. Current diagnostic tools for xerostomia and hyposalivation In order to prevent the negative consequences of xerostomia and hyposalivation a careful and systematic diagnosis of their respective cause(s), symptoms and signs is essential. Also, analysis of glandular function and inspecting the salivary glands is supportive in dry-mouth diagnostics. Currently, several tools are available. Firstly, there are various questionnaires for the assessment of xerostomia. One of the most frequently used questionnaires, and also internationally validated, is the Xerostomia Inventory (XI) developed by Thomson et al. [27]. The XI consists of 11-items on a 5-point Likert scale, summated into a single continuous scale score for the severity of xerostomia [28, 29]. Van der Putten et al. proposed a shorter version of the Xerostomia Inventory: the Summated Xerostomia Inventory-Dutch. In this questionnaire, five items of the original XI were used, with a 3 point-Likert scale [28, 29]. On the other hand, Fox et al. developed a questionnaire with four items about
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