17 General introduction, aim and outline of the thesis are comparable. In addition, parotid gland incision biopsy can overcome most of the disadvantages of labial gland excision biopsy [26, 36]. Taken together for a systematic and detailed investigation of xerostomia, hyposalivation, salivary gland function and gland inspection, the use of a combination of diagnostic tools (both objective and subjective parameters) is recommended. Dry-mouth interventions Effective management of dry-mouth complaints is important in order to improve the quality of life of those who seek treatment for their symptoms and to minimize associated oral problems [24]. In some patients it may be possible tomanage the problems associated with a dry mouth through optimal management of the underlying condition(s); for example, an adjustment of the medication used or its dosage. In individuals with mild symptoms sucking ice chips, frequent sipping of water, and reducing or avoiding irritants, such as alcohol, caffeine, smoking or hot, spicy foods may provide sufficient relief for their symptoms [24]. When there is some residual salivary function, saliva secretion can be stimulated with the use of topical sialagogues, such as using sugar-free chewing gums and lozenges [37]. Systemic pharmacotherapies with parasympathomimetic activity including pilocarpine and cevimeline could also stimulate the salivary secretion [37, 38]. Other interventions such as acupuncture, salivary neuro-electrostimulation and sialendoscopy have also been used to increase saliva production and, in some cases, might also lessen the associated dry-mouth symptoms [37, 39, 40]. Especially in Sjögren’s syndrome patients, sialendoscopy of the major salivary glands showed promising results as it increased the salivation and reduced oral dryness up to at least 60weeks [40]. However, when the salivary secretion is irreversibly impaired, e.g. as a consequence of radiotherapy, then salivary substitutes could be used as dry-mouth interventions. Examples of salivary substitutes are mouth washes, mouth gels and oral sprays [24, 37]. These substitutes help to moisturize the mucosa in absence of saliva [24]. State of the art in dry-mouth diagnostics and dry-mouth interventions Despite the wide range of questionnaires and clinical tests available, an accurate diagnosis of dry mouth is still challenging, due to the complex aetiology of dry mouth and the various potential underlying mechanisms. Besides, the current diagnostic methods map dry-mouth symptoms in general terms, but they do not adequately reveal the complexity of this problem and they are also not entirely discriminating. To illustrate, the total salivary flow rate 1
RkJQdWJsaXNoZXIy MTk4NDMw