155 The severity of oral dryness and the use of drymouth interventions combination with the severity of their overall mouth dryness. Dryness of the mouth is associated with dryness of other regions of the body, such as the nose or eyes [35]. Therefore, it seems interesting to investigate which therapies people apply for dryness of these body parts, and to explore their relationship with the interventions against oral dryness. Surprisingly, no significant associations were found for SS in relation to any intervention. This outcome is contrary to a previous study which revealed in SS patients that dryness of the inside cheeks was significantly associated with the use of mouth gels, while dryness of posterior palate, anterior and posterior tongue was associated with drinking water, rinsing the mouth or drinking small volumes [17]. This discrepancy is probably attributed to the difference in included subjects in both studies. In the previous study, 87 SS patients were included, while in the present study, a much smaller number of SS patients was included, negatively affecting the statistical power of the analysis. A possible limitation of the present study is that the control subjects who visited the saliva clinic were a rather heterogeneous group. The reasons why they were referred to the clinic were diverse, varying from an inexplicably high caries incidence, having a metal taste to dry-mouth complaints which were not due to Sjögren’s syndrome, radiotherapy or medication. It is possible that their dry-mouth symptoms might be due to other reasons like (chronic) stress and depression, which can significantly reduce the salivary flow rate and cause xerostomia [36]. However, the median flow rate of the control subjects for unstimulated saliva was 0.22 mL/min, which is in the normal range [37]. Their mean dry-mouth experience (XI score) was 27.0, which was the lowest than other patient subgroups. This suggests that the possible contribution of dry-mouth patients to the control groups might be limited. Another potential limitation of the present study is that no data were available about the frequency of use, which may differ between different dry-mouth interventions. To exemplify, it is possible that Sjögren’s syndrome patients drank water multiple times a day, while they moistened their lips only once or twice a day. Knowledge of the frequency of use can contribute to tailored advice for dry-mouth patients in even more detail. Also, no data on the perceived effectiveness of the dry-mouth interventions were available. Therefore, future studies should include these parameters, for example by asking the patients to register the use of interventions in a diary for some time and to rate the effectiveness on their oral dryness using a Likert scale. In future research, it is important to investigate the frequency and efficacy of dry-mouth interventions in detail. 7
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