163 Oral dryness and use of dry-mouth interventions INTRODUCTION Sjögren’s syndrome is an autoimmune disease that affects the exocrine lacrimal and salivary glands [1, 2]. As a result of progressive immunemediated damage to the salivary glands, Sjögren’s syndrome is associated with hyposalivation and xerostomia [1]. Both hyposalivation and xerostomia may induce comorbidities such as difficulty with swallowing, speaking and sleeping. Loss of the protective and antimicrobial properties of saliva may also increase the risk of oral diseases such as dental caries and oral candidiasis [1, 3]. This negatively affects the oral health and the quality of life [1, 4]. In order to relieve their dry mouth complaints, Sjögren’s syndrome patients seek for effective care and treatment. In early stages of Sjögren’s syndrome, when residual salivary function is still present, salivary flow can be stimulated, e.g. by the use of lozenges and chewing gums. Upon prescription, systemic pharmacotherapies, such as pilocarpine or cevimeline, might be used [4–6]. Alternatively, electrostimulation of the salivary glands and acupuncture have been reported to increase saliva production [4, 5]. However, when the salivary function is irreversibly impaired, only the use of saliva substitutes remains for the relief of oral problems. For this purpose, a wide range of salivary substitutes such as mouth sprays, gels and mouthwashes is available. Despite the fact that several dry-mouth interventions are available, their effectiveness seems to be limited. Although the use of pilocarpine is associated with a reduction in dry mouth symptoms, the effect size, clinical significance and duration of the effect remain unclear [4]. Furthermore, for cevimeline and electrostimulation, there is limited evidence with respect to increasing the salivary flow in Sjögren’s syndrome patients [4]. Besides, adverse events such as nausea, sweating or headache are commonly reported for individuals taking pilocarpine and cevimeline [4]. Additionally, these pharmacotherapies may be contraindicated in patients with comorbidity like chronic respiratory, cardiovascular or renal disease [6]. Taken together, there is no robust evidence that any of the treatments known is fully effective or leads to a widely supported satisfaction to relieve dry mouth complaints [5–7]. As a consequence, therapeutic advice of healthcare professionals to patients with Sjögren’s syndrome is difficult and generally based on a combination of dentist’s opinion, scientific literature, patients’ personal experience and availability of products [4]. The advice is usually related to the overall oral dryness severity. However, we have recently shown that there are important regional differences in perceived intra-oral dryness [8, 9]. Dry-mouth patients experienced the oral 8
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