140 Chapter 7 saliva clinic of the Dutch Institute for Salivary Research in Bunschoten, the Netherlands, from October 2012 to April 2019. The following clinical data were retrieved: age, gender, health status, number of medications used, XI scores, RODI scores, unstimulated whole salivary flow rate (UWS), chewing-stimulated whole saliva flow rate (CH-SWS) and citric acid-stimulated whole saliva flow rate (A-SWS). The methods for collection of saliva, the salivary secretion rates and the scores on the questionnaires of the study sample have been described in detail previously [10]. In short, the patients were instructed not to eat, drink, chew gum, brush teeth, use mouthwash or smoke at least 1 h before their visit to the saliva clinic. The UWS was collected by the draining method in a pre-weighed plastic container [11]. Patients were asked to collect unstimulated saliva immediately after an initial swallow, by expectorating into the container as soon as they had collected the saliva in their mouth. During saliva collection, patients were not allowed to swallow. To collect CH-SWS, they were asked to chew a 5 × 5-cm sheet of parafilm (ParafilmM, Pechiney, Chicago, IL, USA) and to expectorate into a pre-weighed plastic container every 30 s. To stimulate A-SWS secretion, a citric acid solution (2% w/v) was applied with cotton buds to the lateral borders of the tongue at 30 s intervals [12]. When the collection period had finished, the plastic containers were reweighted, and the collected volume was determined by subtracting the weight of the container before collection. Salivary flow was calculated by dividing the volume collected (assuming 1 g of saliva equals 1 mL) by the collection time (min). Salivary flow rates were expressed in mL/min [11]. To limit circadian variations, saliva collection took place in all patients between 8:00 and 12:00 A.M. [13]. On the basis of their health status, determined with The European Medical Risk-Related History [14, 15], patients were allocated to subgroups, including patients using limited medications (< 4 different prescription medications; Low Med patients), patients using multiple medications (≥ 4 different prescription medications; High Med patients), patients treated with radiotherapy of head and neck area (RTX patients), patients treated with radiotherapy of head and neck area using multiple medications (RTX + High Med patients), Sjögren’s syndrome patients (SS patients), Sjögren’s syndrome patients using multiple medications (SS + High Med patients), and controls (none of the conditions listed above; no use of prescription medication). For the current study, the data from the subgroup RTX + High Med patients were not included due to the small number of patients (N = 6). An additional questionnaire collected data on interventions applied to relieve the feeling of oral dryness [16, 17]. These interventions are presented in Tables 4 and 5. The reported interventions were based on information provided
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