Translation and Validation of the Arabic Version of the Xerostomia Inventory.

The purpose of this study was to explore the association of the clinical oral dryness score (CODS) with salivary flow rates, xerostomia inventory (XI), and bother index (BI). 147 patients were screened using CODS, which determined 10 features of oral dryness. Each feature contributed 1 point, and the total score varied from 0 to 10. Unstimulated (UWS), chewing-stimulated (CH-SWS) and acid-stimulated (A-SWS) whole salivary flows and the XI and BI were measured. Associations were explored with a bootstrapped Spearman rank correlation test (1000 × bootstrapping). Based on unstimulated salivary flow, 55 patients were classified as hyposalivators, 31 as low salivators, 48 as normosalivators and 13 as high salivators. Median CODS in the hyposalivation group was 5 (IQR 3–6) compared with 3 (IQR 2–5) in the low salivation group, 2 (IQR 1–4) in the normal salivation group and 2 (IQR 1–2.5) in the high salivation group. Significant associations between CODS and the other parameters were only found in the hyposalivation group between CODS and UWS (ρ(53) = − 0.513; p < 0.01), between CODS and CH-SWS (ρ(53) = − 0.453; p < 0.01), between CODS and A-SWS (ρ(53) = − 0.500; p < 0.01), CODS and XI (ρ(53) = 0.343; p < 0.001) and between CODS and BI (ρ(53) = 0.375; p = 0.01). In patients with hyposalivation, CODS is associated with unstimulated and stimulated salivary flow and XI and BI. CODS alone or a combination of CODS with a subjective measure, such as the XI or BI, could be recommended during routine clinical assessment to detect hyposalivation.

This study was conducted to generate and validate a cross-culturally adapted Korean version of the xerostomia inventory (XI), an 11-item questionnaire designed to measure the severity of xerostomia. The original English version of the XI was translated into Korean according to the guidelines for cross-cultural adaptation of health-related quality-of-life measures. Among a prospective cohort of primary Sjögren’s syndrome (pSS) in Korea, 194 patients were analyzed. Internal consistency was evaluated by using Cronbach’s alpha, and test-retest reliability was obtained by using an intraclass correlation coefficient (ICC) analysis. Construct validity was investigated by performing a correlation analysis between XI total score and salivary flow rate (SFR). Cronbach’s alpha for internal consistency was 0.868, and the ICC for test-retest reliability ranged from 0.48 to 0.827, with a median value of 0.72. Moderate negative correlations between XI score and stimulated SFR, unstimulated SFR, and differential (stimulated minus unstimulated) SFR were observed (Spearman’s rho, ρ = −0.515, −0.447, and −0.482, respectively; P < 0.001). The correlation analysis between the visual analogue scale (VAS) score of overall dryness and SFR indicated a smaller ρ value (−0.235 [P = 0.006], −0.243 [P = 0.002], and −0.252 [P = 0.003], respectively), which supports that XI more accurately reflects the degree of xerostomia in the pSS patients. In conclusion, the Korean version of the XI is a reliable tool to estimate the severity of xerostomia in patients with pSS.

Aims:To ascertain and compare between highly active antiretroviral therapy (HAART) and non-HAART patients, the stimulated salivary flow rates and unstimulated salivary flow rates (USFR and SSFR) and to correlate the salivary flow rates with immune suppression.Materials and Methods:One hundred human-immuno deficiency virus seropositive patients attending RAGAS-YRG CARE were examined and divided into two groups, a HAART group (patients on combination antiretroviral therapy) comprising 50 patients and a non-HAART group comprising 50 patients. The HAART group was followed every 3 months after the baseline visit (0) for a period of 9 months, during which a clinical oral examination and collection of unstimulated and stimulated saliva was done. Their salivary gland function was assessed using a xerostomia inventory during each visit. The study on non-HAART group was cross-sectional.Statistical Analysis:Statistical analysis were performed with the aid of the Statistical Package for the Social Sciences (SPSS version 10.05) software.Results:There was no significant difference in mean SSFR and USFR between the two groups at baseline. In the HAART group, the mean stimulated salivary flow rate increased from baseline to 3 months (P = 0.02), with the increase being maintained at 6 months and 9 months. When salivary flow rates were correlated with Cluster of Differentiation, CD4 counts, patients in the HAART group with a CD4 ≤ 200 at 6 months visit had a higher mean stimulated salivary flow rate when compared with patients with CD4 ≥ 200 (P = 0.02). The xerostomia inventory did not reveal any significant difference between the two groups and HAART was not significantly associated with xerostomia.Conclusion:In our study HAART was neither associated with xerostomia nor a reduction in salivary flow rate and immune suppression was not a significant factor for decreasing the salivary flow rate.

Background:Oral lichen planus and mouth dryness are common pathoses, yet not entirely understood. These two conditions may be associated, with a few studies investigating the relationship between mouth dryness and oral lichen planus providing conflicting results. None of the studies have explored the specific impact of disease treatment on mouth dryness.Objective:The purpose of this observational before and after comparison study was to examine the effect of treatment of oral lichen planus with topical corticosteroids on mouth dryness.Methods:Nineteen subjects with oral lichen planus were evaluated for the severity of xerostomia using a xerostomia inventory and a visual analogue scale. Stimulated and unstimulated whole salivary flow rates, unstimulated salivary pH and buffering capacity were also measured. All subjects were evaluated before and after treatment with topical corticosteroids.Results:All subjects reported xerostomia before treatment with topical corticosteroids, with 79% reporting a significant improvement (P = 0.03) after treatment. Topical corticosteroid treatment was not associated with statistically significant differences in stimulated or unstimulated salivary flow rates, unstimulated salivary pH or buffering capacity.Conclusion:The results of this study suggest that treatment of oral lichen planus with topical corticosteroids may decrease the severity of dry mouth symptoms.

Introduction: Menopausal women undergo many physiological changes, most of which are due to decreased estrogen production. Little is understood about the relationship between menopause and oral health. Aim and Objectives: To evaluate the association of menopausal status on subjective reports of oral discomfort and on the objective measurement of unstimulated whole salivary flow rate in healthy women. Materials and Methods: A total of 200 women, including 100 postmenopausal and 100 premenopausal women, were divided into two groups based upon their menstrual status. Group I consisted of 100 postmenopausal women in the age group of 44–76 years. Group II consisted of 100 premenopausal women in the age group of 31--45 years. Settings and Design: A standardized visual analog scale questionnaire was administered to obtain subjective sensation of oral discomfort. Unstimulated whole saliva was collected for 5 min by spitting method and the flow rate of saliva was measured per minute. Statistical analysis used: Chi-square, Student's t test, and analysis of variance (ANOVA) were applied. Results: The prevalence and intensity of the subjective symptoms of oral discomfort was significantly higher in postmenopausal women as compared to the premenopausal women (P < 0.001). The unstimulated whole salivary flow rates in pre- and postmenopausal women were 0.4 ± 0.13 and 0.2 ± 0.11 ml/min, respectively (P < 0.001). A significant association between symptoms of oral discomfort [burning sensation (P = 0.001), taste disorders (P < 0.001), dry mouth (P < 0.001)], and unstimulated salivary flow rate was seen in postmenopausal women. Conclusion: The results from this cross-sectional study of healthy females not being treated for any systemic disease, and not taking medications for any medical disorders indicated that the objective measurements of unstimulated whole salivary flow rate are influenced by menopause. In addition, subjective symptoms of oral discomfort are also associated with menopause.

BackgroundSjögren’s Syndrome compromises the exocrine function, producing xerostomia and xerophthalmia. It can appear as an isolated condition or associated with other autoimmune diseases (polyautoimmunity). The Unstimulated Salivary Flow rate (UWSF) is used to quantify saliva production. There is no objective evidence to differentiate the values in patients with Sjögren’s versus healthy people or patients with non-Sjögren’s sicca. The objective of the present review was to evaluate the UWSF in patients with Sjögren’s syndrome in comparison to controls (healthy and non-Sjögren’s sicca patients).MethodsA systematic literature review was carried out (PRISMA guidelines). Analytical observational studies of cases and controls, cross-sectional studies, cohort studies and randomized clinical trials (including healthy controls) were considered. The Medline/OVID, Lilacs, Embase, and Cochrane/OVID databases were consulted. MeSH, DeCS, keywords, and Boolean operators were used. The meta-analysis (RevMan 5.2) was done through the random-effects model [mean difference (MD)]. Level and quality of evidence were evaluated by the Oxford Center Levels of Evidence and Joanna Brigs list respectively.ResultsThirty-two articles were included (20 were case-control studies, 6 were cross-sectional, 2 prospective cohort, 2 retrospective cohort, and 2 studies were abstracts) and 28 were meta-analyzed. The unstimulated whole salivary flow rate in the Sjögren’s group was lower than in controls (healthy and patients with non-Sjögren Sicca syndrome) (MD-0.18 ml/min; 95% CI, − 0.24 to − 0.13; chi2-P-value < 0.00001). Heterogeneity was 97% and there was publication bias (funnel plot). The level of evidence was mostly 3 or 4. The quality of evidence was met (97% of items valued).ConclusionFor the first time, the unstimulated whole salivary flow rate is found to be lower in patients with Sjögren’s syndrome compared to controls (healthy and non-SS sicca) through a meta-analysis.Trial registrationPROSPERO CRD42020211325.

To determine which measure of the salivary flow rate, stimulated or unstimulated, is most strongly associated with pathologic changes in minor salivary gland (MSG) biopsy specimens, and to explore the correlation of salivary flow with oral surface damage, disease duration, and symptom severity in patients with primary Sjögren's syndrome (SS). In all patients (n = 32), a biopsy of the MSG was performed, and stimulated salivary flow was assessed. Beginning in 2002, unstimulated salivary flow was also assessed. Scores for the severity of symptoms, according to the decayed/missing/filled teeth (DMF) index, were recorded. Associations between measures of salivary flow and covariates characterizing pathology were examined. A definite association between stimulated salivary flow and the MSG focus score, the grade of MSG fibrosis, the duration of dry mouth symptoms, and the DMF score was observed. In contrast, unstimulated salivary flow was not associated with fibrosis, atrophy, the DMF score, or the duration of dry mouth symptoms. In patients with primary SS, the DMF score was associated with pathologic changes in the MSG. Among patients with sicca, 57.9% had an abnormal unstimulated salivary flow rate (versus 82.4% of patients with primary SS), and 15.2% had an abnormal stimulated salivary flow rate (versus 61.8% of patients with primary SS). Among patients with sicca, neither stimulated salivary flow nor unstimulated salivary flow was associated with the degree of fibrosis or atrophy or with the DMF score. Compared with unstimulated salivary flow, stimulated salivary flow appeared to be a better measure of inflammation (according to the focus score) and fibrosis. In patients with sicca, the unstimulated salivary flow rate appeared to be abnormal more commonly compared with the stimulated salivary flow rate. In the future, stimulated salivary flow may serve as a noninvasive surrogate biomarker of inflammation and fibrosis as well as a measure of response to treatment in patients with primary SS.

Effects of mouthwash interventions on xerostomia and unstimulated whole saliva flow rate among hemodialysis patients: A randomized controlled study

To evaluate the impact of oral alterations on the quality of life (QoL) of individuals with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). A case-control study in 32 individuals with RA, 28 with SLE, and 29 in the control group (CG). The questionnaire SF-36 (Medical Outcomes Study Short-Form 36) was used to evaluate the health-related quality of life (HRQoL), and OHIP-14 (Oral Health Impact Profile-14) was used to evaluate the oral health-related quality of life (OHRQoL). The severity of xerostomia was evaluated by the Xerostomia Inventory (XI). In the clinical examination, decayed (D-T), missing(M-T), and filled teeth (F-T) (DMF-T), periodontal status, plaque index (PI), gingival index (GI), unstimulated whole salivary flow rate (UWSFR), and stimulated whole salivary flow rate (SWSFR) were also assessed. Data were analyzed by Student's t tests, chi-square test, Kruskal-Wallis test, ANOVA, Pearson's correlation, and Spearman's correlation. Individuals with RA had a higher caries index (D-T/p = 0.004) and more frequent periodontal disease (PI/p = 0.017). In the SLE group, there was a significant lower salivary flow (SFR/p = 0.016, SFMS/p = 0.004) and severe xerostomia (p = 0.002). The impact of ORHQoL in individuals with RA occurred due to oral candidiasis, halitosis, and xerostomia, compromising the HRQoL. Overall, OHRQoL and HRQoL were more compromised in individuals with SLE, with xerostomia being the main oral problem. Individuals with RA and SLE present oral diseases with negative impact on their QoL. This study shows the main oral manifestations in rheumatic autoimmune diseases, with mainly xerostomia compromising the quality of life.

The study determined the relationship between chronic kidney disease (CKD) and changes in salivary flow and the complications of reduced salivary flow among African subjects with CKD compared with the controls. One hundred and eighty patients, 90 C KD and 90 controls were recruited, interviewed and examined. Stimulated and unstimulated saliva collection was done with standardized spitting method. Urinalysis and blood creatinine levels were determined and glomerular filtration rate (GFR) of each patient was calculated from the blood creatinine using Cockcroft and Gault formula. Statistical analysis was done using STATA 11 software. The mean stimulated and unstimulated whole salivary flow rate among CKD subjects were 4.07 ± 1.91 and 2.34 ± 0.99 ml/5 min respectively and is significantly lower than that of the controls which were 8.05 ± 3.95 ml/5 min and 3.82 ± 2.27 ml/5 min for stimulated and unstimulated flow rates. Oral signs of reduced salivary flow were found in 80% of CKD patients. The commonest oral finding was taste abnormalities others are burning sensation, halitosis and difficulty in mastication. Patients with CKD had reduced stimulated and unstimulated salivary flow rate. Reduced salivary flow was associated with oral lesions in majority (80%) of CKD patients, the commonest finding being taste abnormalities.

To determine whether salivary flow decreases as a function of aging. Meta-analysis. Literature review. Individuals aged 18 and older reported to be free of major systemic disease. Relevant studies were identified through a literature search of several databases, from their inception to June 2013. Studies were included if saliva had been collected on at least one occasion in subjects aged 18 and older and if the data were presented in a manner that enabled comparisons of younger and older participants. Differences in salivary flow rates between age groups were calculated for each salivary source and condition and reported as standardized mean differences (SMDs), standard errors (SEs) and 95% confidence intervals (CIs). The results were pooled using a random effects model. A separate analysis examining medication use was also conducted. Forty-seven studies were included. Whole (SMD = 0.551, SE = 0.056, 95% CI = 0.423-0.678, P < .001) and submandibular and sublingual (SMSL) (SMD = 0.582, SE = 0.123, 95% CI = 0.341-0.823, P < .001) salivary flow rates were reduced significantly in older participants and in unstimulated and stimulated conditions. In contrast, parotid and minor gland salivary flow rates were not significantly reduced with increasing age. Additionally, unstimulated and stimulated SMSL, and unstimulated whole salivary flow rates were significantly lower in older adults, regardless of medication usage. The aging process is associated with reduced salivary flow in a salivary-gland-specific manner; this reduction in salivary flow cannot be explained on the basis of medications. These findings have important clinical implications for maintaining optimal oral health in older adults.

Despite its high prevalence, xerostomia remains frequently misunderstood and often incorrectly assumed to be synonymous with reduced salivary flow. In reality, these two terms- xerostomia and hyposalivation - are not interchangeable. We aimed to quantify how Fox questionnaire and the Xerostomia Inventory (XI) relate to unstimulated salivary flow, identify the most informative items, and evaluate whether total scores and item‑based models discriminate clinically relevant hyposalivation thresholds and treatment‑related deterioration. We analyzed 101 adults with overactive bladder contributing 202 paired assessments (fixed order: off‑treatment baseline, on‑treatment follow‑up). Xerostomia was assessed using the Fox questionnaire (0-10) and Xerostomia Inventory (XI; 11-55). Unstimulated salivary flow (mL/min) was measured with the 5‑min spitting method. Associations between questionnaire scores and salivary flow were summarized using Pearson correlations. Discrimination for hyposalivation thresholds (<0.10, <0.066, <0.033 mL/min) was evaluated using ROC/AUC with cluster bootstrap 95% CIs; item‑based screening was explored using LASSO with patient‑level cross‑validation. Continuous associations: Fox scores were more strongly associated with salivary flow than XI (r = -0.356 vs -0.160), while Fox and XI totals were strongly correlated (r = 0.71). Threshold discrimination: for hyposalivation <0.10 mL/min, AUC was 0.704 for Fox and 0.586 for XI. A sparse XI item model (six items) improved discrimination compared with the XI total score (CV‑AUC 0.709 vs 0.580). During treatment, 29/101 participants met the deterioration endpoint (≥50% reduction in flow and/or incident hyposalivation). Questionnaire scores showed limited criterion validity for objective hypofunction. Fox performed better than XI for identifying hyposalivation, and item‑focused models were promising but exploratory. We propose a pragmatic diagnostic approach in which questionnaires quantify symptom burden and triage risk, while sialometry confirms hyposalivation when clinically relevant.

Dry mouth is a common oral condition in older adults, which correlates with dehydration, pH changes, and lubrication in the oral cavity, leading to an imbalance among bacterial activities of dental biofilms. However, the role of dry mouth and periodontal status in older adults has remained limited, especially among periodontal individuals who underwent supportive periodontal therapy (SPT). This study aimed to investigate the association between dry mouth and recurrent periodontitis in older adults undergoing SPT.This cross-sectional study included patients who were part of SPT. The factors of interest were collected by interviews, questionnaires, and clinical assessments. Oral moisture measurement, the clinical oral dryness score, unstimulated salivary flow rate (USSFR), and stimulated salivary flow rate (SSFR) were performed. Full mouth periodontal examination was performed and compared with the previous record of periodontal examination to identify a recurrence of periodontitis based on bleeding on probing (BOP), a change in pocket depth, and clinical attachment level. Descriptive analysis, both univariate and multivariate logistic regression, was performed to delineate the association between dry mouth and recurrent periodontitis.A total of 186 participants were recruited and divided into the recurrent periodontitis (n = 37) and the nonrecurrent periodontitis group (n = 149). Baseline demographics, medical and dental history of the two groups were similar. Participants with hyposalivation were greater in the recurrent group (35.1 vs. 16.1%, p = 0.02), and the mean of USSFR is lower than the nonrecurrent periodontitis group (0.38 vs. 0.53 mL/min, p = 0.01). To examine the relationship between various factors affecting the recurrent periodontitis by using multivariate regression analysis, results demonstrated odds ratio (OR) of hyposalivation and percentage of BOP (%BOP) in recurrent periodontitis at 2.63 (95% CI = 1.05-6.58), p = 0.04 and 1.04 (95% CI = 1.02-1.06), p < 0.001 after adjusting for confounding factors.This study supported the hypothesis that hyposalivation is associated with recurrent periodontitis demonstrated by USSFR and %BOP association. Consistent periodontal care, including an examination and guidance on managing dry mouth, has the potential to help older individuals with periodontitis maintaining their dental health.

Severe/frequent recurrent aphthous ulcers and salivary flow rates

No treatment is known to permanently increase salivary flow in patients with hyposalivation. The objective of this study was to investigate the effect of iron supplementation on salivary flow rate. A double-blind, randomized, placebo-controlled trial was carried out on 50 individuals with a low unstimulated whole salivary flow rate and low serum ferritin. Half the individuals received 60 mg iron orally twice a day for 3 months, while the other half received placebo. No statistically significant difference was found between the groups after treatment for the unstimulated flow rate and in the subjective assessments of oral dryness. The serum ferritin values increased significantly in the iron group but not in the placebo group. Oral supplementation with iron for 3 months has no effect on salivary flow rate among individuals with hyposalivation and low serum ferritin values.