31 Regional differences in perceived oral dryness checked in 20% of the case reports and 20% of the most important data are checked in 100% of the case reports [26]. Subjective oral dryness Before a patient visited the saliva clinic, he or she received several questionnaires by mail to fill out at home. These questionnaires included the Xerostomia Inventory (XI) which consists of 11 items on a 5-point Likert scale ranging from 1 = “never” to 5 = “very often.” The items are about oral dryness and mouth feel in the patients. Patients indicate in each item how often they suffer from problems with regard to mouth feel and oral dryness. The scores of the 11 items are summed resulting in a total XI score that ranges between 11 (no xerostomia) and 55 (extreme xerostomia) [11]. In addition, the patients received a newly developed Regional Oral Dryness Inventory (RODI) (Fig. 1). This questionnaire contains 9 schematic illustrations of different locations in the oral cavity. Four illustrations represent areas in the upper jaw: the upper lip, anterior part of the palate (including the rugae), inside part of the cheeks, and posterior part of the palate (from the rugae up to the end of the soft palate). Four illustrations represent areas in the lower jaw: the lower lip, floor of the mouth, posterior part of the tongue (from vallate papilla up to end of the tongue), and anterior part of the tongue (from tip of the tongue up to vallate papilla). Finally, one illustration represents the pharynx. At each location, the patient can indicate the severity of the perceived oral dryness using a 5-point Likert scale ranging from 1 = “no dryness” to 5 = “severe dryness.” Clinical oral dryness score During the visit to the saliva clinic, the Clinical Oral Dryness Score (CODS) was scored for all patients by a single examiner (DHJJ). The CODS was recorded before determining the salivary flow rates and analyzing the xerostomia questionnaires, so the examiner was not aware during the recording of the CODS whether a patient suffered from hyposalivation/ xerostomia or not. The examiner scored the patient’s mouth for the presence or absence of ten features of oral dryness: (1) mirror sticks to buccal mucosa; (2) mirror sticks to tongue; (3) tongue shows loss of papillae; (4) tongue lobulated/ fissured; (5) frothy saliva; (6) no saliva pooling in floor of mouth; (7) glassy appearance of other oral mucosa, especially palate; (8) debris on palate (excluding debris under dentures); (9) altered/smooth gingival architecture; and (10) active or recently restored (last 6 months) cervical caries (> 2 teeth) [27]. A specially designed form with illustrations of dry-mouth features from 2
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