34 Chapter 2 the original publication was used to score each feature [27]. The scores from the ten features were added together resulting in a total CODS ranging from 0 (no oral dryness) to 10 (extreme oral dryness). Sialometry The patients were instructed not to eat, drink, chew gum, brush teeth, use mouthwash, or smoke for at least 1 h before their visit to the saliva clinic. The procedure to determine the saliva secretion rate has been described by Jager and co-workers [28]. At the time of the collection of saliva, patients were placed in a quiet room and asked to sit in an upright position. The UWS was collected by the draining method in a pre-weighed plastic container [29]. To collect unstimulated saliva, patients were asked to immediately collect saliva after an initial swallow. Afterwards, they were asked to expectorate in the container as soon as they collected saliva. During saliva collection, the patients were not allowed to swallow. To collect CH-SWS, patients were asked to chew a 5 × 5-cm sheet of parafilm (Parafilm M, Pechiney, Chicago, IL, USA) with a frequency of approximately 60 chews per minute. The patients were instructed to expectorate the saliva every 30 s into a pre-weighed plastic container during a 5 min period. For stimulation of A-SWS secretion, a citric acid solution (2% w/v) was applied with cotton buds on the lateral borders of the tongue at 30 s intervals [30]. After the collection period was finished, the plastic containers were reweighed, and the collected volume was determined by subtracting the weight of the container prior to collection. The salivary flow was calculated by dividing the collected volume (assuming 1 g of saliva equals 1 mL) by collection time (min). Salivary flow rates were expressed in mL/min [29]. To determine whether patients suffered from hyposalivation, the following cut-off values were used: UWS < 0.10 mL/min, CH-SWS < 0.70 mL/min, and ASWS < 0.70 mL/min [8]. Data analysis The data were processed in Microsoft Excel and then converted into SPSS, version 25.0 (IBM Corp SPSS Statistics, Armonk, NY, USA) for the statistical analysis. The Shapiro– Wilk test was used to assess the normality of the data. The data were presented as median, and their interquartile range (IQR) as all parameters were not normally distributed. The mean and standard deviation were also reported to clarify relatively small differences. A Friedman test was conducted for the scores of the RODI and XI scores, followed by a Wilcoxon signed-rank test as post hoc procedure.
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