153 The severity of oral dryness and the use of drymouth interventions soft drinks or beer”, “sucking ice cubes” and “acupuncture” could be used less frequently due to the fact that they were less convenient or less easy to use. The cost of interventions could also influence the choice. For example, the costs of acupuncture are around $50–70 per session [23], while the effectiveness is questionable [5, 24, 25]. Side-effects, such as nausea, sweating or headache, have frequently been reported for individuals taking pilocarpine, which will negatively affect the number of patients choosing this intervention [5]. Application of saliva substitutes, such as mouth sprays and gels, provides a moisture-retaining coating over themouth. However, these products need to be applied frequently during the day and also the flavour is often experienced as unpleasant [7, 20]. Also, reimbursement of specific interventions for a particular patient group may also have affected their use. “Drinking water”, “moistening the lips” and “rinsing of the mouth” were the most frequently used interventions by all patient subgroups. Apparently, these interventions seem more popular than using chewing gum or using salivary substitutes. Obviously, drinking water can only temporarily relieve the sensation of a dry mouth [26, 27], because the viscosity of water does not change with increasing shear like saliva [28]. Besides, the moistening and lubrication effect of water is limited, due to limited surface retention and evaporation by the absence of salivary MUC5B [29]. Since irradiation in the head and neck region can damage the salivary glands [1, 2], it was expected that RTX would use chewing gum to relieve drymouth complaints less frequently than patients with oral dryness due to medication, where mechanical stimulation of the saliva secretion is possible. Surprisingly, there was no significant difference between these patient subgroups for “chewing gum”. The SS subgroup where progressive immunemediated self-destruction of the salivary glands occurs also did not differ in the use of chewing gum than High and LowMed subgroups (Table 4). This might be related to the severe overall dry-mouth experience in RTX patients and SS patients, as indicated by their extreme high XI scores and RODI scores [10]. However, in the early stages of Sjögren’s syndrome, some improvements can be obtained in salivary secretion by gustatory or pharmacological stimulation [30]. Several studies have reported that the effectiveness of mouth gel for the relief of dry-mouth seems to be limited as their use did not result in a satisfactory alleviation of dry-mouth complaints [6, 7, 22]. However, in the current study, a substantial number of patients used this product (ranging between 27.3 and 45.5%). In particular, SS, RTX and High Med patients had the highest percentages for the use of mouth gels. It is possible that these patient 7
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