176 Chapter 8 DISCUSSION The present study was designed to explore the possible associations between the perceived (regional) oral dryness of Sjögren’s syndrome patients, and patients’ use of dry-mouth interventions. Sjögren’s syndrome patients use various interventions to relieve their oral dryness. Of those interventions, “drinking water” and “moistening the lips’’ were the most frequently used. Besides, there were some clear associations between perceived oral dryness and some interventions applied, illustrated by the significant odds ratios between general dry-mouth interventions, “drinking water’’, “rinsing of the mouth”, and “drinking small volumes” and the RODI scores of the posterior palate, anterior and posterior tongue, respectively. On the other hand, “using mouth gel’’ was significantly associated with the RODI scores of the inside cheeks. This observation could indicate that the use of these dry-mouth interventions is affected by the intra-oral dryness, measured by the RODI questionnaire. The Sjögren’s syndrome patients in the current study experienced the posterior palate and the pharynx as most dry. This observation could be explained by the fact that several factors make the hard palate more susceptible to oral dryness than other intra-oral locations. These factors include paucity of palatal glands, gravity, and evaporation during openmouth breathing [20–22]. Besides, it is envisaged that saliva-related changes also contribute to the dry mouth feeling of Sjögren’s syndrome patients: an altered sialochemical composition, such as higher concentrations of sodium, chloride and phosphate [23]; a higher protein concentration on the palate [24]; a significantly reduced saliva film on the hard palate; a reduced spinnbarkheit of unstimulated whole saliva; and an altered glycosylation of salivary mucins [16]. All these factors seem to negatively influence the wetting of the posterior palate and the pharynx. In contrast, the Sjögren’s syndrome patients experienced the floor of the mouth and inside cheeks as least dry. These regions include the orifices of the major salivary gland [20]. Because of their proximity to the orifices of the salivary glands, the saliva film in these regions is probably more moisturizing than the saliva film on the palate [21, 25–27]. The current study findings are consistent with our previous study which reported the perceived intraoral dryness for various dry-mouth patients [8], including Sjögren’s patients as well as patients with polypharmacy and patients treated with radiotherapy. In that previous study, it was also found that the posterior palate was also the most dry in Sjögren’s syndrome patients, while
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