187 Preferences of Sjögren’s syndrome patients for saliva substitutes INTRODUCTION Sjögren’s syndrome is an autoimmune disease that causes progressive damage to the exocrine glands including the salivary glands. As a consequence, Sjögren’s syndrome leads to hyposalivation and/or xerostomia [1, 2]. The resulting dry mouth may induce comorbidities such as difficulties with mastication, swallowing, speaking, and sleeping. In addition, the reduction of the protective properties of saliva may also increase the risk of developing dental caries and oral candidiasis [1, 3]. At 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, systemic pharmacotherapy, or electrostimulation of the salivary glands [4–6]. However, in case of an advanced disease process, when the salivary function is irreversibly impaired, saliva substitutes such as mouth sprays, gels, and mouthwashes can be applied for the relief of oral complaints [6, 7]. A substantial number of Sjögren’s syndrome patients are using or have used a saliva substitute in the past. In a recent study, this percentage ranged between 42.9 and 45.5% for the use of a mouth gel, while for the use of a mouth spray it ranged between 25.0 and 27.4% [7, 8]. The currently available saliva substitutes contain animal- and vegetablebased lubricants and thickeners like porcine gastric mucins, hydroxyethyl cellulose, or aloe vera [9]. However, these ingredients have limited ability to retain water and require specific environmental conditions to be effective. For example, porcine gastric mucins are effective only at an acidic pH and in a low ionic strength environment [9]. Besides, some compounds are easily removed from the oral cavity by swallowing or drinking, leading to limited duration of moistening and lubrication. Additionally, a number of substitutes have flavours such as “apple”, “lemon”, and “strawberry”. A reason for manufacturers using these flavours is that they can stimulate salivary secretion due to their gustatory effect [10]. However, more than the half of Sjögren’s syndrome patients reported that they discontinued the use of saliva substitutes after a short period of time. An unpleasant taste and sticky consistency were main reasons for their discontinuation [11, 12]. The sticky consistency may compromise masticatory function [13]. Also, the presence of animal-based products in salivary substitutes could induce objections in people from certain religious, cultural, and social backgrounds because these products may be against their beliefs [14]. However, to the best of our knowledge, no studies have investigated patients’ preference for characteristics of saliva substitutes, such as taste, 9
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