68 Chapter 3 pooling in the floor of the mouth, and a tongue showing loss of papillae, can be associated with a moderate but significant reduction in mucosal wetness [31]. The combination of their findings with ours confirms that an important role in dry-mouth perception may be played by two regions: the floor of the mouth and the anterior and posterior tongue. Potentially, the RODI questionnaire would thus play a useful role in early dry-mouth screening, when a patient could be asked specifically about dryness of the floor of the mouth, and of the anterior and posterior tongue. If high RODI scores (score ≥ 3) are obtained for these regions, further dry-mouth diagnostics may be implemented. A possible limitation of the current study is that the patients included were allocated to the various dry-mouth patient groups on the basis of their selfreported answers to the European Medical Risk-Related History questionnaire [16, 17]. A patient’s health status was thus dependent on his or her reportage. In most cases, there was no confirmation by a physician or a pharmacist either that the patient had Sjögren’s syndrome, or had been irradiated in the head and/or neck region, or about the number of prescription medications that were used. While this information was sometimes confirmed in the referral letter or a medication overview provided by a pharmacist, it was not always available for all patients. The data of this study therefore need to be interpreted with caution. However, the European Medical Risk-Related History questionnaire has a high validity. In previous studies that compared the results of this questionnaire with those of a verbal history taken by a physician experienced in pre-assessment control, sensitivity ranged between 88% and 92%, and specificity was 98–99% [45, 46]. Another possible limitation of the current study is the bias that may have resulted from our collection of saliva at the beginning of a working day, when the unstimulated flow rate changes most rapidly [21]. However, as all patients had been randomly assigned to time slots between 8:00 and 12:00, this potential bias was evenly distributed over the total study sample.
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