16 Chapter 1 of 2% citric acid applied on the sides of the tongue at intervals of 30 seconds [28]. Despite this wide range of techniques, accurate assessment of dry mouth according to the quantity of saliva might be difficult as salivary quantity and flow rate vary dramatically within and between individuals. Additional biochemical and mechanical measurements could support diagnostic tests for dry mouth. To understand the salivary quality, it is important to investigate both the compositional feature and mechanical properties of saliva, such as adsorption, rheological and tribological properties [30]. Salivary gland function can also be measured by scintigraphy, in which a radionuclide is injected intravenously and subsequently this radionuclide is taken up by the salivary glands and then secreted [8]. Measurement of uptake and secretion into the oral cavity can determine the presence and extent of functional salivary tissue [8]. Additionally, a number of other imaging techniques can help in identifying salivary gland abnormalities, for example magnetic resonance imaging (MRI). MRI can identify solid and cystic masses in the glands. Sialography is a radiographic examination of the salivary glands to visualize the anatomy of ducts, acinar integrity, calcifications, and some tumors [8]. It usually involves the injection of a small amount of contrast medium into the salivary duct of a single gland, followed by routine X-ray projections. Investigating the medical history of dry-mouth patients contributes to proper diagnosis. A detailed inventory of present symptoms, type and number of xerogenicmedications used, the presence of systemic and oral diseases, and previous dry-mouth therapies is important in this process [29]. This information also helps to investigate the potential underlying influence of condition like psychiatric and cardiovascular diseases [29]. The European Medical RiskRelated History questionnaire is a good example of an internationally validated patient-administered questionnaire that is used to retrieve information about the health status of a patient [34, 35]. Furthermore, an extra-oral and intra-oral examination should also be part of the examination of the patient. This should include the inspection and palpation of the salivary glands, expulsion (“milking”) of saliva from the major salivary duct orifices (at rest and after a stimulus), and inspection of the oral mucosa and the dentition [29]. Finally, salivary gland biopsy provides a definitive diagnosis of glandular pathology. A labial minor salivary gland biopsy is more commonly and easily performed than a biopsy of the major salivary glands [8]. Although, recent literature discusses parotid biopsies as an alternative for minor salivary gland biopsies [26, 36]. As the sensitivity and specificity of parotid and labial biopsies for diagnosing Sjögren’s syndrome
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