67 Differences in perceived intra-oral dryness salivary glands. As one would expect, these patient groups also had the highest XI scores and RODI scores for all intra-oral regions. The severe mouth dryness (both overall dry-mouth experience and intraoral dryness) they experienced may have been due to the reduced flow rate, but also to altered rheological properties of saliva, and altered glycosylation of mucins. The RODI questionnaire nonetheless seemed capable of differentiating between dry-mouth patient groups. For example, SS patients could easily be differentiated from controls, Low Med, and High Med patients, as Low Med and High Med patients experienced the anterior tongue as the most dry, while SS patients experienced the posterior palate as the most dry. On the other hand, SS patients had more severe dryness of the posterior palate than controls. These differences in intra-oral dryness can be diagnosed only using the RODI questionnaire and not the XI, as the latter is used only to diagnose the overall dry-mouth experience. For this reason, the RODI questionnaire may be a valuable tool in dry-mouth diagnostics. It is interesting to note that there were no significant differences between RODI scores in RTX patients. Even when these scores were compared with those of other patient groups, few regions showed intra-oral differences. These results might be related to a lack of statistical power, as the RTX group only comprised 10 subjects. However, RTX patients are not usually difficult to identify, because they can indicate whether they have been treated with radiotherapy of the head and neck region. Most patients will also have been referred to their dentist before and after radiotherapy [43, 44]. With regard to the association between the RODI score and the total XI scores in various dry-mouth patients, the correlations in the RTX, SS, and SS + High Med patient groups were stronger than the other patient groups. The correlations for these patients were especially strong for the floor of the mouth and for the anterior and posterior tongue (Table 7). These indicate that patients with a very dry mouth overall (higher XI scores) will also experience more severe oral dryness on the floor of the mouth, and on the anterior and posterior tongue (higher RODI scores for these regions). A previous study that used the Clinical Oral Dryness Score (CODS), a clinical tool to semi-quantitatively assess oral dryness, also found that the CODS items “No saliva pooling in the floor of mouth” and “Tongue fissured” scored higher in the hyposalivation group [18]. This idea was supported by Osailan and co-workers, who reported that the clinical features of oral dryness that are included in the CODS—such as fissured or depapillated tongue, and lack of saliva pooling in the floor of the mouth—are recognized signs of chronic hyposalivation [31]. Other clinical features of their study, such as a mirror sticking to the tongue, a lack of saliva 3
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