211 General discussion important nutrient for oral bacteria [10]. A recent systematic review reported that the MUC5B level in whole saliva is only significantly lower in patients who have been irradiated in the head and neck area [10]. In medication-induced dry-mouth patients and in SS patients, the MUC5B levels are not significantly lower, but the MUC5B glycosylation is significantly impaired in these patients [10]. Impaired glycosylation could negatively affect water binding, lubrication and thus salivary spinnbarkeit. Interestingly, in our studies using healthy volunteers, the MUC5B levels showed considerable variation among different intra-oral locations, with the anterior tongue having the highest levels (Chapter 6). Further studies on MUC5B levels at different intra-oral locations in patients with different causes of oral dryness, and investigation of the glycosylation of MUC5B at these locations, is crucial to increase our understanding about mouth dryness. Dry-mouth interventions There are multiple interventions to relieve mouth dryness. In this study, we investigated the effect of home care dry-mouth interventions on the perceived oral dryness and/or salivary secretion. It was concluded that perceived dryness and intra-oral dryness in particular were associated with the use of specific dry-mouth interventions (Chapters 7 and 8). In medication-induced dry-mouth patients, locally applied interventions, for example “using a mouth gel”, were associated with dryness of the anterior tongue in particular (Chapter 7). In SS patients “drinking water’’, “rinsing of the mouth”, and “drinking small volumes” were associated with the RODI scores of the posterior palate, and the anterior and posterior tongue, respectively. Also, the “use of a mouth gel’’ was associated with the RODI scores of the inside cheeks (Chapter 8). These findings can be used to give a more tailored therapeutic advice for dry-mouth patients. For example, based on the obtained findings, clinicians should suggest use of a mouth gel if the anterior tongue is experienced as (severe) dry in medication induced drymouth patients. For SS patients by contrast, the use of a mouth gel is based on dryness of the inside cheeks. These interesting findings underline that it is also very important to further investigate the efficacy of the available dry-mouth interventions, and their frequency of use. The perceived effectiveness of the dry-mouth interventions should also be evaluated; for example, by asking the patients to rate their effectiveness on a Likert scale. As the effectiveness of dry-mouth interventions might depend on the degree to which the salivary glands are still sensitive to stimulation, data on stimulated salivary secretion of the patients should also be collected [11]. 10
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