206 Chapter 10 GENERAL DISCUSSION Various aetiologies cause dry mouth. Therefore, its diagnosis is complex. Despite the availability of a broad spectrum of both objective as well as subjective diagnostic tools, their total effectiveness seems insufficient and limited in discriminating between the various causes of dry mouth. In addition, the factors that affect the choice of dry-mouth interventions by patients are not fully understood. Altogether, this makes a proper diagnosis, and subsequent therapeutic advice very challenging. The research presented in this thesis aimed to improve the assessment of dry mouth by introducing a new method for measuring the perceived dryness at various intra-oral locations. As the palatal surface plays an important role in the perception of dry mouth, the effect of the palatal surface area on the salivary distribution was investigated in particular. Also, the use of dry-mouth interventions amongst various dry-mouth patients was investigated to better understand which factors affect the choice and use of these interventions. In brief, this thesis concluded that the newly developed questionnaire, the Regional Oral Dryness Inventory (RODI), can quantify the severity of perceived dryness at various locations in the mouth. Next, by using the RODI we were able to identify differences in patterns of perceived intra-oral dryness among different patient groups. For example, Sjögren’s Syndrome (SS) patients experienced the posterior palate as most dry, while patients suffering from dry mouth due to medication experienced the anterior tongue as most dry. As for the intra-oral surface area, quantifying this surface area was possible with both cone-beam computed tomography (CBCT) as well as using an intraoral scanner in combination with digital analysis. There was no association found between the palatal surface size and the salivary film thickness covering the palate. Another interesting finding was that the use of various dry-mouth interventions was associated with the perceived overall oral dryness or with specific pattens of intra-oral mouth dryness, indicating that severity and location of mouth dryness seem to affect the choice of dry-mouth intervention. Developments in dry-mouth screening The Xerostomia Inventory (XI) is an internationally validated questionnaire, used to measure the severity of mouth dryness in general, but it is not well suited to discriminate between various dry-mouth patients. However, with the help of the RODI, it is now possible to differentiate in the perceived dryness at various intra-oral locations and find patient-specific patterns as well. For example, SS patients experienced the posterior palate as most dry and had
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