Research Article|Articles in Press

World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia.

Published:March 06, 2023DOI:

      Statement of clinical relevance

      • There is a high variability in outcome domains and measures used in the assessment of xerostomia, highlighting the need to develop a core outcome set to harmonize evidence to better inform clinical decision-making for dry mouth management.



      The purpose of this study was to identify all outcome domains utilized in clinical studies of xerostomia, i.e. subjective sensation of dry mouth. This study is part of the extended project ‘World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research (WONDER)’ to develop a core outcome set (COS) for dry mouth.

      Study design

      A systematic review was performed on MEDLINE, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human subjects from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy. Corresponding outcome measures were summarized.


      From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures was consistently utilized across all the studies. Severity of xerostomia and physical functioning were the two most frequently assessed domains.


      There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment in order to enhance comparability across studies and facilitate synthesis of robust evidence for the management of patients with xerostomia.

      Key words

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        • Jamieson LM
        • Thomson WM.
        Xerostomia: its prevalence and associations in the adult Australian population.
        Australian dental journal. 2020; 65: S67-s70
        • Niklander S
        • Veas L
        • Barrera C
        • Fuentes F
        • Chiappini G
        • Marshall M.
        Risk factors, hyposalivation and impact of xerostomia on oral health-related quality of life.
        Brazilian oral research. 2017; 31: e14
        • Villa A
        • Connell CL
        • Abati S.
        Diagnosis and management of xerostomia and hyposalivation.
        Therapeutics and clinical risk management. 2015; 11: 45-51
        • Johansson AK
        • Johansson A
        • Unell L
        • Ekbäck G
        • Ordell S
        • Carlsson GE.
        Self-reported dry mouth in 50- to 80-year-old Swedes: Longitudinal and cross-sectional population studies.
        Journal of oral rehabilitation. 2020; 47: 246-254
        • Hopcraft MS
        • Tan C.
        Xerostomia: an update for clinicians.
        Australian dental journal. 2010; 55 (quiz 353): 238-244
        • Chaudhury NM
        • Shirlaw P
        • Pramanik R
        • Carpenter GH
        • Proctor GB.
        Changes in Saliva Rheological Properties and Mucin Glycosylation in Dry Mouth.
        Journal of dental research. 2015; 94: 1660-1667
        • Zussman E
        • Yarin AL
        • Nagler RM.
        Age- and flow-dependency of salivary viscoelasticity.
        Journal of dental research. 2007; 86: 281-285
        • Thomson WM
        • Chalmers JM
        • Spencer AJ
        • Ketabi M.
        The occurrence of xerostomia and salivary gland hypofunction in a population-based sample of older South Australians.
        Special care in dentistry: official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry. 1999; 19: 20-23
        • Wolff A
        • Joshi RK
        • Ekström J
        • et al.
        A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI.
        Drugs R D. 2017; 17: 1-28
        • Villa A
        • Abati S.
        Risk factors and symptoms associated with xerostomia: a cross-sectional study.
        Australian dental journal. 2011; 56: 290-295
        • Saleh J
        • Figueiredo MA
        • Cherubini K
        • Salum FG.
        Salivary hypofunction: an update on aetiology, diagnosis and therapeutics.
        Arch Oral Biol. 2015; 60: 242-255
        • Delli K
        • Spijkervet FK
        • Kroese FG
        • Bootsma H
        • Xerostomia Vissink A.
        Monographs in oral science. 2014; 24: 109-125
        • Assery MKA.
        Efficacy of Artificial Salivary Substitutes in Treatment of Xerostomia: A Systematic Review.
        J Pharm Bioallied Sci. 2019; 11: S1-s12
        • Liu G
        • Qiu X
        • Tan X
        • Miao R
        • Tian W
        • Jing W.
        Efficacy of a 1% malic acid spray for xerostomia treatment: A systematic review and meta-analysis.
        Oral Dis. 2021;
        • Cheng CQ
        • Xu H
        • Liu L
        • et al.
        Efficacy and safety of pilocarpine for radiation-induced xerostomia in patients with head and neck cancer: A systematic review and meta-analysis.
        J Am Dent Assoc. 2016; 147: 236-243
        • Witsell DL
        • Stinnett S
        • Chambers MS.
        Effectiveness of cevimeline to improve oral health in patients with postradiation xerostomia.
        Head Neck. 2012; 34: 1136-1142
        • Assy Z
        • Brand HS.
        A systematic review of the effects of acupuncture on xerostomia and hyposalivation.
        BMC Complement Altern Med. 2018; 18: 57
        • Strietzel FP
        • Lafaurie GI
        • Mendoza GR
        • et al.
        Efficacy and safety of an intraoral electrostimulation device for xerostomia relief: a multicenter, randomized trial.
        Arthritis and rheumatism. 2011; 63: 180-190
        • Baum BJ
        • Alevizos I
        • Zheng C
        • et al.
        Early responses to adenoviral-mediated transfer of the aquaporin-1 cDNA for radiation-induced salivary hypofunction.
        Proceedings of the National Academy of Sciences of the United States of America. 2012; 109: 19403-19407
        • Pringle S
        • Van Os R
        • Coppes RP.
        Concise review: Adult salivary gland stem cells and a potential therapy for xerostomia.
        Stem Cells. 2013; 31: 613-619
        • Dörner T
        • Posch MG
        • Li Y
        • et al.
        Treatment of primary Sjögren's syndrome with ianalumab (VAY736) targeting B cells by BAFF receptor blockade coupled with enhanced, antibody-dependent cellular cytotoxicity.
        Ann Rheum Dis. 2019; 78: 641-647
        • van Nimwegen JF
        • Mossel E
        • van Zuiden GS
        • et al.
        Abatacept treatment for patients with early active primary Sjögren's syndrome: a single-centre, randomised, double-blind, placebo-controlled, phase 3 trial (ASAP-III study).
        The Lancet Rheumatology. 2020; 2: e153-e163
        • Prinsen CA
        • Vohra S
        • Rose MR
        • et al.
        How to select outcome measurement instruments for outcomes included in a "Core Outcome Set" - a practical guideline.
        Trials. 2016; 17: 449
        • Williamson PR
        • Altman DG
        • Blazeby JM
        • et al.
        Developing core outcome sets for clinical trials: issues to consider.
        Trials. 2012; 13: 132
      1. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. 2021;372:n71.

        • Dodd S
        • Clarke M
        • Becker L
        • Mavergames C
        • Fish R
        • Williamson PR.
        A taxonomy has been developed for outcomes in medical research to help improve knowledge discovery.
        Journal of clinical epidemiology. 2018; 96: 84-92
        • Vitali C
        • Bombardieri S
        • Jonsson R
        • et al.
        Classification criteria for Sjögren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group.
        Ann Rheum Dis. 2002; 61: 554-558
        • Shiboski CH
        • Shiboski SC
        • Seror R
        • et al.
        2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts.
        Arthritis & rheumatology (Hoboken, N.J.). 2017; 69: 35-45
        • Seror R
        • Ravaud P
        • Mariette X
        • et al.
        EULAR Sjogren's Syndrome Patient Reported Index (ESSPRI): development of a consensus patient index for primary Sjogren's syndrome.
        Ann Rheum Dis. 2011; 70: 968-972
        • Challacombe SJ
        • Osailan SM
        • Proctor GB.
        Clinical scoring scales for assessment of dry mouth.
        Dry mouth. 2015; (Springer): 119-132
        • Benn AM
        • Broadbent JM
        • Thomson WM.
        Occurrence and impact of xerostomia among dentate adult New Zealanders: findings from a national survey.
        Australian dental journal. 2015; 60: 362-367
        • Thomson WM
        • Chalmers JM
        • Spencer AJ
        • Williams SM.
        The Xerostomia Inventory: a multi-item approach to measuring dry mouth.
        Community dental health. 1999; 16: 12-17
        • Henson BS
        • Inglehart MR
        • Eisbruch A
        • Ship JA.
        Preserved salivary output and xerostomia-related quality of life in head and neck cancer patients receiving parotid-sparing radiotherapy.
        Oral oncology. 2001; 37: 84-93
        • Beetz I
        • Burlage FR
        • Bijl HP
        • et al.
        The Groningen Radiotherapy-Induced Xerostomia questionnaire: development and validation of a new questionnaire.
        Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology. 2010; 97: 127-131
        • Eisbruch A
        • Kim HM
        • Terrell JE
        • Marsh LH
        • Dawson LA
        • Ship JA.
        Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer.
        International journal of radiation oncology, biology, physics. 2001; 50: 695-704
        • Pai S
        • Ghezzi EM
        • Ship JA.
        Development of a Visual Analogue Scale questionnaire for subjective assessment of salivary dysfunction.
        Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2001; 91: 311-316
        • Thomson WM
        • van der Putten GJ
        • de Baat C
        • et al.
        Shortening the xerostomia inventory.
        Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2011; 112: 322-327
        • Buchholzer S
        • Faure F
        • Tcheremissinoff L
        • et al.
        Novel Multidisciplinary Salivary Gland Society (MSGS) Questionnaire: An International Consensus.
        The Laryngoscope. 2022; 132: 322-331
        • Suh KI
        • Lee JY
        • Chung JW
        • Kim YK
        • Kho HS.
        Relationship between salivary flow rate and clinical symptoms and behaviours in patients with dry mouth.
        Journal of oral rehabilitation. 2007; 34: 739-744
        • Assy Z
        • Jager DHJ
        • Mashhour E
        • Bikker FJ
        • Brand HS.
        Regional differences in perceived oral dryness as determined with a newly developed questionnaire, the Regional Oral Dryness Inventory.
        Clinical oral investigations. 2020; 24: 4051-4060
      2. Ship J, Corby P, Fisch G, et al. Reliability and validity of mouthfeel questionnaire with salivary flow rates. Abstract. Vol 12552009.

        • Bowman SJ
        • Everett CC
        • O'Dwyer JL
        • et al.
        Randomized Controlled Trial of Rituximab and Cost-Effectiveness Analysis in Treating Fatigue and Oral Dryness in Primary Sjögren's Syndrome.
        Arthritis & rheumatology (Hoboken, N.J.). 2017; 69: 1440-1450
        • Gibson B
        • Periyakaruppiah K
        • Thornhill MH
        • Baker SR
        • Robinson PG.
        Measuring the symptomatic, physical, emotional and social impacts of dry mouth: A qualitative study.
        Gerodontology. 2020; 37: 132-142
        • Al-Nawas B
        • Al-Nawas K
        • Kunkel M
        • Grötz KA
        Quantifying radioxerostomia: salivary flow rate, examiner's score, and quality of life questionnaire.
        Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft ... [et al]. 2006; 182: 336-341
        • Meirovitz A
        • Murdoch-Kinch CA
        • Schipper M
        • Pan C
        • Eisbruch A.
        Grading xerostomia by physicians or by patients after intensity-modulated radiotherapy of head-and-neck cancer.
        International journal of radiation oncology, biology, physics. 2006; 66: 445-453
        • Williamson PR
        • Altman DG
        • Bagley H
        • et al.
        The COMET Handbook: version 1.0.
        Trials. 2017; 18: 280
        • Simms MLK-S M.
        • Wiriyakijja P.
        • Niklander S.E.
        • Santos-Silva A.R.
        • Sankar V.
        • Kerr A.R.
        • Jensen S.B.
        • Ni Riordain R.
        • Delli K.
        • Villa A
        World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Salivary Hypofunction.
        Manuscript submitted for publication. 2022;
        • Boers M
        • Kirwan JR
        • Wells G
        • et al.
        Developing core outcome measurement sets for clinical trials: OMERACT filter 2.0.
        Journal of clinical epidemiology. 2014; 67: 745-753
        • Riley P
        • Glenny AM
        • Hua F
        • Worthington HV.
        Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy.
        The Cochrane database of systematic reviews. 2017; 7Cd012744
        • Furness S
        • Worthington HV
        • Bryan G
        • Birchenough S
        • McMillan R.
        Interventions for the management of dry mouth: topical therapies.
        The Cochrane database of systematic reviews. 2011; Cd008934
        • Soares MS
        • Chimenos-Küstner E
        • Subirá-Pifarrè C
        • Rodríguez de Rivera-Campillo ME
        • López-López J
        Association of burning mouth syndrome with xerostomia and medicines.
        Medicina oral, patologia oral y cirugia bucal. 2005; 10: 301-308
        • Soini H
        • Routasalo P
        • Lauri S
        • Ainamo A.
        Oral and nutritional status in frail elderly.
        Special care in dentistry: official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry. 2003; 23: 209-215
        • Strietzel FP
        • Martín-Granizo R
        • Fedele S
        • et al.
        Electrostimulating device in the management of xerostomia.
        Oral Dis. 2007; 13: 206-213
        • Flink H.
        Studies on the prevalence of reduced salivary flow rate in relation to general health and dental caries, and effect of iron supplementation.
        Swed Dent J Suppl. 2007; (52 p preceding table of contents): 3-50
        • Kossioni AE
        • Kossionis GE
        • Polychronopoulou A.
        Self-reported oral complaints in older mentally ill patients.
        Geriatrics & gerontology international. 2013; 13: 358-364
        • Ohara Y
        • Hirano H
        • Watanabe Y
        • et al.
        Factors associated with self-rated oral health among community-dwelling older Japanese: A cross-sectional study.
        Geriatrics & gerontology international. 2015; 15: 755-761
        • Viljakainen S
        • Nykänen I
        • Ahonen R
        • et al.
        Xerostomia among older home care clients. Community dentistry and oral epidemiology. 2016; 44: 232-238
        • Iwasaki M
        • Yoshihara A
        • Ito K
        • et al.
        Hyposalivation and dietary nutrient intake among community-based older Japanese.
        Geriatrics & gerontology international. 2016; 16: 500-507
        • Ohara Y
        • Hirano H
        • Yoshida H
        • et al.
        Prevalence and factors associated with xerostomia and hyposalivation among community-dwelling older people in Japan.
        Gerodontology. 2016; 33: 20-27
        • Iwasaki M
        • Borgnakke WS
        • Yoshihara A
        • et al.
        Hyposalivation and 10-year all-cause mortality in an elderly Japanese population.
        Gerodontology. 2018; 35: 87-94
        • Flink H
        • Bergdahl M
        • Tegelberg A
        • Rosenblad A
        • Lagerlöf F.
        Prevalence of hyposalivation in relation to general health, body mass index and remaining teeth in different age groups of adults.
        Community dentistry and oral epidemiology. 2008; 36: 523-531
        • Toida M
        • Nanya Y
        • Takeda-Kawaguchi T
        • et al.
        Oral complaints and stimulated salivary flow rate in 1188 adults.
        J Oral Pathol Med. 2010; 39: 407-419
        • Navazesh M
        • Mulligan R
        • Karim R
        • et al.
        Effect of HAART on salivary gland function in the Women's Interagency HIV Study (WIHS).
        Oral Dis. 2009; 15: 52-60
        • Okamoto A
        • Miyachi H
        • Tanaka K
        • Chikazu D
        • Miyaoka H.
        Relationship between xerostomia and psychotropic drugs in patients with schizophrenia: evaluation using an oral moisture meter.
        Journal of clinical pharmacy and therapeutics. 2016; 41: 684-688
        • Gupta VK
        • Malhotra S
        • Sharma V
        • Hiremath SS.
        The Influence of Insulin Dependent Diabetes Mellitus on Dental Caries and Salivary Flow.
        International journal of chronic diseases. 2014; 2014790898
        • Mochida Y
        • Yamamoto T
        • Fuchida S
        • Aida J
        • Kondo K
        Does poor oral health status increase the risk of falls?: The JAGES Project Longitudinal Study.
        PloS one. 2018; 13e0192251
        • Fallon BS
        • Chase TJ
        • Cooke EM
        • et al.
        The use of BokaFlo™ instrument to measure salivary flow.
        BMC oral health. 2021; 21: 191
        • Gil-Montoya JA
        • Barrios R
        • Sánchez-Lara I
        • et al.
        Prevalence of Drug-Induced Xerostomia in Older Adults with Cognitive Impairment or Dementia: An Observational Study.
        Drugs & aging. 2016; 33: 611-618
        • Crawford AA
        • Lewis S
        • Nutt D
        • et al.
        Adverse effects from antidepressant treatment: randomised controlled trial of 601 depressed individuals.
        Psychopharmacology. 2014; 231: 2921-2931
        • Lynge Pedersen AM
        • Nauntofte B
        • Smidt D
        • Torpet LA
        Oral mucosal lesions in older people: relation to salivary secretion, systemic diseases and medications.
        Oral Dis. 2015; 21: 721-729
        • Busato IM
        • Thomaz M
        • Toda AI
        • et al.
        Prevalence and impact of xerostomia on the quality of life of people living with HIV/AIDS from Brazil.
        Special care in dentistry: official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry. 2013; 33: 128-132
        • Saes Busato IM
        • Antoni CC
        • Calcagnotto T
        • Ignácio SA
        • Azevedo-Alanis LR
        Salivary flow rate, buffer capacity, and urea concentration in adolescents with type 1 diabetes mellitus.
        Journal of pediatric endocrinology & metabolism: JPEM. 2016; 29: 1359-1363
        • Lester S
        • Rischmueller M
        • Tan L
        • et al.
        Sicca Symptoms and their Association with Chronic Rhinosinusitis in a Community Sample.
        The open rheumatology journal. 2012; 6: 170-174
        • Ramos-Casals M
        • Brito-Zerón P
        • Solans R
        • et al.
        Systemic involvement in primary Sjogren's syndrome evaluated by the EULAR-SS disease activity index: analysis of 921 Spanish patients (GEAS-SS Registry).
        Rheumatology (Oxford, England. 2014; 53: 321-331
        • Cafaro G
        • Perricone C
        • Baldini C
        • et al.
        Significance of anti-La/SSB antibodies in primary Sjögren's syndrome patients with combined positivity for anti-Ro/SSA and salivary gland biopsy.
        Clinical and experimental rheumatology. 2020; 38: 53-56
        • Zheng L
        • Tong L
        • Du F
        • Ren H
        • Xiao L.
        Effect of three-dimensional conformal radiotherapy and intensity-modulated radiotherapy on parotid gland function and quality of life in patients with nasopharyngeal carcinoma.
        American journal of translational research. 2021; 13: 5272-5279
        • Deming FP
        • Al-Hashimi I
        • Haghighat N
        • et al.
        Comparison of salivary calmodulin binding proteins in Sjögren's syndrome and healthy individuals.
        J Oral Pathol Med. 2007; 36: 132-135
        • Ramos-Casals M
        • Brito-Zerón P
        • García-Carrasco M
        • Font J.
        Sarcoidosis or Sjögren syndrome? Clues to defining mimicry or coexistence in 59 cases.
        Medicine. 2004; 83: 85-95
        • Negoro A
        • Umemoto M
        • Fujii M
        • et al.
        Taste function in Sjögren's syndrome patients with special reference to clinical tests.
        Auris, nasus, larynx. 2004; 31: 141-147
        • Ramos-Casals M
        • Brito-Zerón P
        • Yagüe J
        • et al.
        Hypocomplementaemia as an immunological marker of morbidity and mortality in patients with primary Sjogren's syndrome.
        Rheumatology (Oxford, England). 2005; 44: 89-94
        • Helenius LM
        • Meurman JH
        • Helenius I
        • et al.
        Oral and salivary parameters in patients with rheumatic diseases.
        Acta odontologica Scandinavica. 2005; 63: 284-293
        • Sánchez-Guerrero J
        • Pérez-Dosal MR
        • Cárdenas-Velázquez F
        • et al.
        Prevalence of Sjögren's syndrome in ambulatory patients according to the American-European Consensus Group criteria.
        Rheumatology (Oxford, England). 2005; 44: 235-240
        • Nishiyama S
        • Miyawaki S
        • Yoshinaga Y.
        A study to standardize quantitative evaluation of parotid gland scintigraphy in patients with Sjögren's syndrome.
        The Journal of rheumatology. 2006; 33: 2470-2474
        • Novljan MP
        • Rozman B
        • Jerse M
        • et al.
        Comparison of the different classification criteria sets for primary Sjögren's syndrome.
        Scandinavian journal of rheumatology. 2006; 35: 463-467
        • Alamanos Y
        • Tsifetaki N
        • Voulgari PV
        • Venetsanopoulou AI
        • Siozos C
        • Drosos AA.
        Epidemiology of primary Sjögren's syndrome in north-west Greece, 1982-2003.
        Rheumatology (Oxford, England). 2006; 45: 187-191
        • Márton K
        • Boros I
        • Varga G
        • et al.
        Evaluation of palatal saliva flow rate and oral manifestations in patients with Sjögren's syndrome.
        Oral Dis. 2006; 12: 480-486
        • Salliot C
        • Gottenberg JE
        • Bengoufa D
        • Desmoulins F
        • Miceli-Richard C
        • Mariette X
        Anticentromere antibodies identify patients with Sjögren's syndrome and autoimmune overlap syndrome.
        The Journal of rheumatology. 2007; 34: 2253-2258
        • van den Berg I
        • Pijpe J
        • Vissink A.
        Salivary gland parameters and clinical data related to the underlying disorder in patients with persisting xerostomia.
        European journal of oral sciences. 2007; 115: 97-102
        • Imanguli MM
        • Atkinson JC
        • Mitchell SA
        • et al.
        Salivary gland involvement in chronic graft-versus-host disease: prevalence, clinical significance, and recommendations for evaluation.
        Biol Blood Marrow Transplant. 2010; 16: 1362-1369
        • Aliko A
        • Ciancaglini R
        • Alushi A
        • Tafaj A.
        Sicca symptoms, and lacrimal and salivary flow in Albanian patients with rheumatoid arthritis.
        J Oral Pathol Med. 2010; 39: 651-656
        • Deschasse G
        • Steenpass V
        • Couturier P
        • Diot E
        • Maillot F
        • Maruani A.
        Sicca syndrome in hospitalized older adults: prevalence and comparison of objective and subjective symptoms.
        Journal of the American Geriatrics Society. 2011; 59: 2178-2179
        • Zalewska A
        • Knaś M
        • Waszkiewicz N
        • Waszkiel D
        • Sierakowski S
        • Zwierz K.
        Rheumatoid arthritis patients with xerostomia have reduced production of key salivary constituents.
        Oral surgery, oral medicine, oral pathology and oral radiology. 2013; 115: 483-490
        • Artico G
        • Freitas RS
        • Santos Filho AM
        • Benard G
        • Romiti R
        • Migliari DA
        Prevalence of Candida spp., xerostomia, and hyposalivation in oral lichen planus–a controlled study.
        Oral Dis. 2014; 20: e36-e41
        • Knas M
        • Zalewska A
        • Waszkiewicz N
        • et al.
        Salivary: flow and proteins of the innate and adaptive immunity in the limited and diffused systemic sclerosis.
        J Oral Pathol Med. 2014; 43: 521-529
        • Djukić LJ
        • Roganović J
        • Brajović MD
        • Bokonjić D
        • Stojić D.
        The effects of anti-hypertensives and type 2 diabetes on salivary flow and total antioxidant capacity.
        Oral Dis. 2015; 21: 619-625
        • Notarstefano C
        • Croia C
        • Pontarini E
        • et al.
        A clinical and histopathological analysis of the anti-centromere antibody positive subset of primary Sjögren's syndrome.
        Clinical and experimental rheumatology. 2018; 36: 145-149
        • Lee KA
        • Lee SH
        • Kim HR.
        Diagnostic and predictive evaluation using salivary gland ultrasonography in primary Sjögren's syndrome.
        Clinical and experimental rheumatology. 2018; 36: 165-172
        • Castrejón-Morales CY
        • Granados-Portillo O
        • Cruz-Bautista I
        • et al.
        Omega-3 and omega-6 fatty acids in primary Sjögren's syndrome: clinical meaning and association with inflammation.
        Clinical and experimental rheumatology. 2020; 38: 34-39
        • López-Morales J
        • Cortes-Muñoz D
        • Astudillo-Ángel M
        • Hernández-Molina G.
        Persistent serological activity in primary Sjögren's syndrome.
        Clinical rheumatology. 2020; 39: 919-923
        • Serrano J
        • López-Pintor RM
        • Ramírez L
        • et al.
        Risk factors related to oral candidiasis in patients with primary Sjögren's syndrome.
        Medicina oral, patologia oral y cirugia bucal. 2020; 25: e700-e705
        • Sharma R
        • Chaudhari KS
        • Kurien BT
        • et al.
        Sjögren Syndrome without Focal Lymphocytic Infiltration of the Salivary Glands.
        The Journal of rheumatology. 2020; 47: 394-399
        • Acar-Denizli N
        • Horváth IF
        • Mandl T
        • et al.
        Systemic phenotype related to primary Sjögren's syndrome in 279 patients carrying isolated anti-La/SSB antibodies.
        Clinical and experimental rheumatology. 2020; 38: 85-94
        • Donati V
        • Ferro F
        • Governato G
        • et al.
        Total area of inflammatory infiltrate and percentage of inflammatory infiltrate identify different clinical-serological subsets of primary Sjögren's syndrome better than traditional histopathological parameters.
        Clinical and experimental rheumatology. 2020; 38: 195-202
        • Lacombe V
        • Lacout C
        • Lozac'h P
        • et al.
        Unstimulated whole saliva flow for diagnosis of primary Sjögren's syndrome: time to revisit the threshold?.
        Arthritis research & therapy. 2020; 22: 38
        • Tsukamoto M
        • Suzuki K
        • Tsunoda K
        • Ikeura K
        • Kameyama K
        • Takeuchi T.
        Value of labial salivary gland histopathology for diagnosis of Sjögren's syndrome in patients with anti-centromere antibody positivity.
        International journal of rheumatic diseases. 2020; 23: 1024-1029
        • Jousse-Joulin S
        • Gatineau F
        • Baldini C
        • et al.
        Weight of salivary gland ultrasonography compared to other items of the 2016 ACR/EULAR classification criteria for Primary Sjögren's syndrome.
        Journal of internal medicine. 2020; 287: 180-188
        • Sebastian A
        • Woytala P
        • Madej M
        • et al.
        Is it possible to not perform salivary gland biopsy in targeted patients according to unstimulated salivary flow results in patients with suspected Sjögren's syndrome?.
        Rheumatology international. 2021; 41: 1125-1131
        • Barcelos F
        • Martins C
        • Madeira N
        • et al.
        Lymphocyte subpopulations in Sjögren's syndrome are distinct in anti-SSA-positive patients and related to disease activity.
        Clinical rheumatology. 2021; 40: 2791-2804
        • Lopes AI
        • Machado-Neves R
        • Honavar M
        • Pereira PR.
        The role of minor salivary glands' biopsy in the diagnosis of Sjögren's syndrome and other systemic diseases.
        European journal of internal medicine. 2021; 94: 69-72
        • García-González M
        • González-Soto MJ
        • Gómez Rodríguez-Bethencourt M
        • Ferraz-Amaro I
        The validity of salivary gland scintigraphy in Sjögren's syndrome diagnosis: comparison of visual and excretion fraction analyses.
        Clinical rheumatology. 2021; 40: 1923-1931
        • Bredahl SK
        • Reibel J
        • Pedersen AML.
        Value of multilevel sectioning of labial salivary gland biopsies in the diagnosis of Sjögren's syndrome.
        Oral surgery, oral medicine, oral pathology and oral radiology. 2021; 131: 85-91
        • Luo J
        • Liao X
        • Zhang L
        • et al.
        Transcriptome Sequencing Reveals Potential Roles of ICOS in Primary Sjögren's Syndrome.
        Frontiers in cell and developmental biology. 2020; 8592490
        • Friedman JA
        • Miller EB
        • Green L
        • Huszar M
        • Schattner A.
        A community-based cohort of 201 consecutive patients with primary Sjögren's syndrome in Israel: Ashkenazi patients compared with those of Sephardic descent.
        Clinical and experimental rheumatology. 2006; 24: 274-280
        • Field EA
        • Fear S
        • Higham SM
        • et al.
        Age and medication are significant risk factors for xerostomia in an English population, attending general dental practice.
        Gerodontology. 2001; 18: 21-24
        • Younai FS
        • Marcus M
        • Freed JR
        • et al.
        Self-reported oral dryness and HIV disease in a national sample of patients receiving medical care.
        Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2001; 92: 629-636
        • Komurcu S
        • Nelson KA
        • Walsh D
        • Ford RB
        • Rybicki LA.
        Gastrointestinal symptoms among inpatients with advanced cancer.
        The American journal of hospice & palliative care. 2002; 19: 351-355
        • Tarkkila L
        • Linna M
        • Tiitinen A
        • Lindqvist C
        • Meurman JH.
        Oral symptoms at menopause–the role of hormone replacement therapy.
        Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2001; 92: 276-280
        • Ulshöfer B
        • Bihr A-M
        • Bödeker R-H
        • Schwantes U
        • Randomised Jahn H-P.
        Double-Blind, Placebo-Controlled Study on the Efficacy and Tolerance of Trospium Chloride in Patients with Motor Urge Incontinence.
        Clinical Drug Investigation. 2001; 21: 563-569
        • Sandberg GE
        • Wikblad KF.
        Oral dryness and peripheral neuropathy in subjects with type 2 diabetes.
        Journal of diabetes and its complications. 2003; 17: 192-198
        • Wolfe F
        • Michaud K.
        Prevalence, risk, and risk factors for oral and ocular dryness with particular emphasis on rheumatoid arthritis.
        The Journal of rheumatology. 2008; 35: 1023-1030
        • Desoutter A
        • Soudain-Pineau M
        • Munsch F
        • Mauprivez C
        • Dufour T
        • Coeuriot JL.
        Xerostomia and medication: a cross-sectional study in long-term geriatric wards.
        The journal of nutrition, health & aging. 2012; 16: 575-579
        • Wilberg P
        • Hjermstad MJ
        • Ottesen S
        • Herlofson BB.
        Chemotherapy-associated oral sequelae in patients with cancers outside the head and neck region.
        Journal of pain and symptom management. 2014; 48: 1060-1069
        • Lee HN
        • An JY
        • Lee KM
        • Kim EJ
        • Choi WS
        • Kim DY.
        Salivary gland dysfunction after radioactive iodine (I-131) therapy in patients following total thyroidectomy: emphasis on radioactive iodine therapy dose.
        Clinical imaging. 2015; 39: 396-400
        • Porter J
        • Ntouva A
        • Read A
        • Murdoch M
        • Ola D
        • Tsakos G.
        The impact of oral health on the quality of life of nursing home residents.
        Health and quality of life outcomes. 2015; 13: 102
        • Kamińska-Pikiewicz K
        • Bachanek T
        • Chałas R.
        The incidence of oral dryness in people over 65 years living in Lublin.
        J Current Issues in Pharmacy and Medical Sciences. 2015; 28 (%): 250-253
        • Suzuki S
        • Kojima Y
        • Takayanagi A
        • et al.
        Relationship between Obstructive Sleep Apnea and Self-assessed Oral Health Status: An Internet Survey.
        The Bulletin of Tokyo Dental College. 2016; 57: 175-181
        • Serin G
        • Karabulut G
        • Kabasakal Y
        • Kandiloğlu G
        • Akalin T.
        The Importance of Minor Salivary Gland Biopsy in Sjögren Syndrome Diagnosis and the Clinicopathological Correlation.
        Turk patoloji dergisi. 2016; 32: 65-69
        • Guastaferro R
        • Rosi IM
        • Milos R
        • Messina E
        • Cerra A
        • Bonetti L.
        Development of a screening tool to assess dehydration in hospitalized older population: a diagnostic, observational study.
        Professioni infermieristiche. 2018; 71: 178-187
        • González-Arriagada WA
        • Ramos LMA
        • Andrade MAC
        • Lopes MA.
        Efficacy of low-level laser therapy as an auxiliary tool for management of acute side effects of head and neck radiotherapy.
        Journal of cosmetic and laser therapy: official publication of the European Society for Laser Dermatology. 2018; 20: 117-122
        • Pasalic D
        • Funk RK
        • García JJ
        • et al.
        Magnitude of benefit for adjuvant radiotherapy following minimally invasive surgery in intermediate to high risk HPV-positive oropharyngeal squamous cell carcinoma.
        Oral oncology. 2018; 82: 181-186
        • Diamond-Rossi SA
        • Jonklaas J
        • Jensen RE
        • et al.
        Looking under the hood of "the Cadillac of cancers:" radioactive iodine-related craniofacial side effects among patients with thyroid cancer.
        Journal of cancer survivorship: research and practice. 2020; 14: 847-857
        • Pinto VL
        • Fustinoni SM
        • Nazário ACP
        • Facina G
        • Elias S.
        Prevalence of xerostomia in women during breast cancer chemotherapy.
        Revista brasileira de enfermagem. 2020; 73e20190785
        • Pasadyn SR
        • Warren CB
        • Wilson RG.
        Utility of salivary gland biopsy in diagnosing Sjogren's syndrome in a POTS patient population.
        Autonomic neuroscience: basic & clinical. 2020; 227102694
        • Marcott S
        • Dewan K
        • Kwan M
        • Baik F
        • Lee YJ
        • Sirjani D.
        Where Dysphagia Begins: Polypharmacy and Xerostomia.
        Federal practitioner: for the health care professionals of the VA, DoD, and PHS. 2020; 37: 234-241
        • Vivas Á J
        • Bautista-Vargas M
        • Portacio S
        • et al.
        Reproducibility of minor salivary gland biopsy reports in Sjögren's syndrome and its correlation with disease biomarkers.
        Clinical rheumatology. 2021; 40: 2285-2292
        • Jorkjend L
        • Johansson A
        • Johansson AK
        • Bergenholtz A.
        Resting and stimulated whole salivary flow rates in Sjögren's syndrome patients over time: a diagnostic aid for subsidized dental care?.
        Acta odontologica Scandinavica. 2004; 62: 264-268
        • Sung JM
        • Kuo SC
        • Guo HR
        • Chuang SF
        • Lee SY
        • Huang JJ.
        Decreased salivary flow rate as a dipsogenic factor in hemodialysis patients: evidence from an observational study and a pilocarpine clinical trial.
        Journal of the American Society of Nephrology: JASN. 2005; 16: 3418-3429
        • Jham BC
        • Teixeira IV
        • Aboud CG
        • Carvalho AL
        • Coelho Mde M
        • Freire AR
        A randomized phase III prospective trial of bethanechol to prevent radiotherapy-induced salivary gland damage in patients with head and neck cancer.
        Oral oncology. 2007; 43: 137-142
        • Khovidhunkit SO
        • Suwantuntula T
        • Thaweboon S
        • Mitrirattanakul S
        • Chomkhakhai U
        • Khovidhunkit W.
        Xerostomia, hyposalivation, and oral microbiota in type 2 diabetic patients: a preliminary study.
        Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 2009; 92: 1220-1228
        • Pedersen AM
        • Bardow A
        • Nauntofte B.
        Salivary changes and dental caries as potential oral markers of autoimmune salivary gland dysfunction in primary Sjogren's syndrome.
        BMC clinical pathology. 2005; 5: 4
        • Yalçin F
        • Gurgan S
        • Gurgan T.
        The effect of menopause, hormone replacement therapy (HRT), alendronate (ALN), and calcium supplements on saliva.
        The journal of contemporary dental practice. 2005; 6: 10-17
        • Zhao Y
        • Kang J
        • Zheng WJ
        • et al.
        Evaluation of international classification criteria (2002) for primary Sjögren's syndrome in Chinese patients.
        Chinese medical sciences journal = Chung-kuo i hsueh k'o hsueh tsa chih. 2005; 20: 190-193
        • Leal SC
        • Bittar J
        • Portugal A
        • Falcão DP
        • Faber J
        • Zanotta P.
        Medication in elderly people: its influence on salivary pattern, signs and symptoms of dry mouth.
        Gerodontology. 2010; 27: 129-133
        • Borges BC
        • Fulco GM
        • Souza AJ
        • de Lima KC.
        Xerostomia and hyposalivation: a preliminary report of their prevalence and associated factors in Brazilian elderly diabetic patients.
        Oral health & preventive dentistry. 2010; 8: 153-158
        • Ryo K
        • Ito A
        • Takatori R
        • et al.
        Effects of coenzyme Q10 on salivary secretion.
        Clinical biochemistry. 2011; 44: 669-674
        • Devauchelle-Pensec V
        • Morvan J
        • Rat AC
        • et al.
        Effects of rituximab therapy on quality of life in patients with primary Sjögren's syndrome.
        Clinical and experimental rheumatology. 2011; 29: 6-12
        • Antero DC
        • Parra AG
        • Miyazaki FH
        • Gehlen M
        • Skare TL.
        Secondary Sjögren's syndrome and disease activity of rheumatoid arthritis.
        Revista da Associacao Medica Brasileira (1992). 2011; 57: 319-322
        • Springborg LK
        • Moller MN.
        Submandibular gland excision: long-term clinical outcome in 139 patients operated in a single institution.
        Eur Arch Otorhinolaryngol. 2013; 270: 1441-1446
        • Jeong SY
        • Kim HW
        • Lee SW
        • Ahn BC
        • Lee J.
        Salivary gland function 5 years after radioactive iodine ablation in patients with differentiated thyroid cancer: direct comparison of pre- and postablation scintigraphies and their relation to xerostomia symptoms.
        Thyroid: official journal of the American Thyroid Association. 2013; 23: 609-616
        • Brozzi F
        • Rago T
        • Bencivelli W
        • et al.
        Salivary glands ultrasound examination after radioiodine-131 treatment for differentiated thyroid cancer.
        Journal of endocrinological investigation. 2013; 36: 153-156
        • Helenius-Hietala J
        • Ruokonen H
        • Grönroos L
        • et al.
        Self-reported oral symptoms and signs in liver transplant recipients and a control population.
        Liver transplantation: official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2013; 19: 155-163
        • Daikeler T
        • Mauramo M
        • Rovó A
        • et al.
        Sicca symptoms and their impact on quality of life among very long-term survivors after hematopoietic SCT.
        Bone marrow transplantation. 2013; 48: 988-993
        • Juusela P
        • Tanskanen M
        • Nieminen A
        • et al.
        Xerostomia in hereditary gelsolin amyloidosis.
        Amyloid: the international journal of experimental and clinical investigation: the official journal of the International Society of Amyloidosis. 2013; 20: 39-44
        • Kumar NN
        • Panchaksharappa MG
        • Annigeri RG.
        Modified schirmer test–a screening tool for xerostomia among subjects on antidepressants.
        Arch Oral Biol. 2014; 59: 829-834
        • Rahnama M
        • Madej-Czerwonka B
        • Jastrzębska-Jamrogiewicz I
        • Jamrogiewicz R.
        Analysis of the influence of parenteral cancer chemotherapy on the health condition of oral mucosa.
        Contemporary oncology (Poznan, Poland). 2015; 19: 77-82
        • Annette Milton B
        • Bhambal A
        • Nair P
        Evaluation of Sialometric Analysis of Patients Suffering from Depressive Disorders.
        Kathmandu University medical journal (KUMJ). 2015; 13: 134-139
        • Ramsay DS
        • Rothen M
        • Scott JM
        • Cunha-Cruz J.
        Tooth wear and the role of salivary measures in general practice patients.
        Clinical oral investigations. 2015; 19: 85-95
        • Soo Roh S
        • Wook Kim D
        • Jin Baek H
        Association of Xerostomia and Ultrasonographic Features of the Major Salivary Glands After Radioactive Iodine Ablation for Papillary Thyroid Carcinoma.
        AJR. American journal of roentgenology. 2016; 207: 1077-1081
        • Sembler-Møller ML
        • Belstrøm D
        • Locht H
        • Pedersen AML.
        Proteomics of saliva, plasma, and salivary gland tissue in Sjögren's syndrome and non-Sjögren patients identify novel biomarker candidates.
        Journal of proteomics. 2020; 225103877
        • Lee KA
        • Lee SH
        • Kim HR.
        Ultrasonographic Changes of Major Salivary Glands in Primary Sjögren's Syndrome.
        Journal of clinical medicine. 2020; 9
        • La Paglia GMC
        • Sanchez-Pernaute O
        • Alunno A
        • et al.
        Ultrasound salivary gland involvement in Sjogren's syndrome vs. other connective tissue diseases: is it autoantibody and gland dependent?.
        Clinical rheumatology. 2020; 39: 1207-1215
        • Banava S
        • Houshyari M
        • Safaie T.
        The effect of casein phosphopeptide amorphous calcium phosphate fluoride paste (CPP-ACPF) on oral and salivary conditions of patients undergoing chemotherapy: A randomized controlled clinical trial.
        Electronic physician. 2015; 7: 1535-1541
        • Navazesh M
        • Mulligan R
        • Barrón Y
        • et al.
        A 4-year longitudinal evaluation of xerostomia and salivary gland hypofunction in the Women's Interagency HIV Study participants.
        Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2003; 95: 693-698
        • Busato IM
        • Ignácio SA
        • Brancher JA
        • Grégio AM
        • Machado MA
        • Azevedo-Alanis LR.
        Impact of xerostomia on the quality of life of adolescents with type 1 diabetes mellitus.
        Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2009; 108: 376-382
        • Osterhus IN
        • Skogedal N
        • Akre H
        • Johnsen UL
        • Nordgarden H
        • Asten P.
        Salivary gland pathology as a new finding in Treacher Collins syndrome.
        Am J Med Genet A. 2012; 158A: 1320-1325
        • Márton K
        • Madléna M
        • Bánóczy J
        • et al.
        Unstimulated whole saliva flow rate in relation to sicca symptoms in Hungary.
        Oral Dis. 2008; 14: 472-477
        • Tomasik B
        • Papis-Ubych A
        • Stawiski K
        • et al.
        Serum MicroRNAs as Xerostomia Biomarkers in Patients With Oropharyngeal Cancer Undergoing Radiation Therapy.
        International journal of radiation oncology, biology, physics. 2021; 111: 1237-1249
        • Chambers MS
        • Posner M
        • Jones CU
        • et al.
        Cevimeline for the treatment of postirradiation xerostomia in patients with head and neck cancer.
        International journal of radiation oncology, biology, physics. 2007; 68: 1102-1109
        • Weissbart SJ
        • Lewis R
        • Smith AL
        • Harvie HS
        • Miller JM
        • Arya LA.
        Impact of Dry Mouth on Fluid Intake and Overactive Bladder Symptoms in Women taking Fesoterodine.
        The Journal of urology. 2016; 195: 1517-1522
        • Shinohara C
        • Ito K
        • Takamatsu K
        • et al.
        Factors associated with xerostomia in perimenopausal women. The journal of obstetrics and gynaecology research. 2021; 47: 3661-3668
        • Choi JH
        • Kim MJ
        • Kho HS.
        Oral health-related quality of life and associated factors in patients with xerostomia.
        International journal of dental hygiene. 2021; 19: 313-322
        • Beetz I
        • Steenbakkers RJ
        • Chouvalova O
        • et al.
        The QUANTEC criteria for parotid gland dose and their efficacy to prevent moderate to severe patient-rated xerostomia.
        Acta oncologica (Stockholm, Sweden). 2014; 53: 597-604
        • Dawes C
        • Odlum O.
        Salivary status in patients treated for head and neck cancer.
        Journal (Canadian Dental Association). 2004; 70: 397-400
        • Hogan P
        • Charles PD
        • Wooten Watts M
        • Massey JM
        • Miller T
        • Mackowiack J
        Severity and impact of xerostomia in patients treated with botulinum toxin type b for cervical dystonia: Observations on the quality of life of patients with xerostomia.
        Current therapeutic research, clinical and experimental. 2004; 65: 161-171
        • Shimosato M
        • Asai K
        • Yokomichi N
        • Nagano K
        • Sakane N.
        Diagnostic accuracy of patient-reported dry mouth as a predictor for oral dryness in terminally ill cancer patients.
        Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. 2021; 29: 2743-2748
        • Omezli MM
        • Torul D.
        Evaluation of the xerostomia, taste and smell impairments after Covid-19.
        Medicina oral, patologia oral y cirugia bucal. 2021; 26: e568-e575
        • Femiano F
        • Rullo R
        • di Spirito F
        • Lanza A
        • Festa VM
        • Cirillo N.
        A comparison of salivary substitutes versus a natural sialogogue (citric acid) in patients complaining of dry mouth as an adverse drug reaction: a clinical, randomized controlled study.
        Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2011; 112: e15-e20
        • Yamada H
        • Nakagawa Y
        • Wakamatsu E
        • et al.
        Efficacy prediction of cevimeline in patients with Sjögren's syndrome.
        Clinical rheumatology. 2007; 26: 1320-1327
        • Jose A
        • Singh ML
        • Magnuson B
        • Farag A
        • Varghese R
        • Papas A.
        A randomized controlled study to evaluate an experimental moisturizing mouthwash formulation in participants experiencing dry mouth symptoms.
        Oral surgery, oral medicine, oral pathology and oral radiology. 2018; 126: 231-239.e235
        • Gandía M
        • Morales-Espinoza EM
        • Martín-González RM
        • et al.
        Factors influencing dry mouth in patients with primary Sjögren syndrome: usefulness of the ESSPRI index.
        Oral health and dental management. 2014; 13: 402-407
        • Miyamoto ST
        • Paganotti MA
        • Serrano É V
        • Giovelli RA
        • Valim V.
        Assessment of fatigue and dryness in primary Sjögren's syndrome: Brazilian version of "Profile of Fatigue and Discomfort - Sicca Symptoms Inventory (short form) (PROFAD-SSI-SF)".
        Revista brasileira de reumatologia. 2015; 55: 113-122
        • Capaccio P
        • Canzi P
        • Torretta S
        • et al.
        Combined interventional sialendoscopy and intraductal steroid therapy for recurrent sialadenitis in Sjögren's syndrome: Results of a pilot monocentric trial.
        Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery. 2018; 43: 96-102
        • Ambrósio LM
        • Rovai ES
        • França BN
        • et al.
        Effects of periodontal treatment on primary sjȫgren's syndrome symptoms.
        Brazilian oral research. 2017; 31: e8
        • Sharma D
        • Sandhya P
        • Vellarikkal SK
        • et al.
        Saliva microbiome in primary Sjögren's syndrome reveals distinct set of disease-associated microbes.
        Oral Dis. 2020; 26: 295-301
        • Descamps E
        • Henry J
        • Labeyrie C
        • et al.
        Small fiber neuropathy in Sjögren syndrome: Comparison with other small fiber neuropathies.
        Muscle & nerve. 2020; 61: 515-520
        • Jiang W
        • Zhang L
        • Zhao Y
        • He X
        • Hu C
        • Liu Y.
        The efficacy and mechanism for action of iguratimod in primary Sjögren's syndrome patients.
        International ophthalmology. 2020; 40: 3059-3065
        • Seror R
        • Gottenberg JE
        • Devauchelle-Pensec V
        • et al.
        European League Against Rheumatism Sjögren's Syndrome Disease Activity Index and European League Against Rheumatism Sjögren's Syndrome Patient-Reported Index: a complete picture of primary Sjögren's syndrome patients.
        Arthritis care & research. 2013; 65: 1358-1364
        • Meiners PM
        • Vissink A
        • Kroese FG
        • et al.
        Abatacept treatment reduces disease activity in early primary Sjögren's syndrome (open-label proof of concept ASAP study).
        Ann Rheum Dis. 2014; 73: 1393-1396
        • Theander E
        • Mandl T.
        Primary Sjögren's syndrome: diagnostic and prognostic value of salivary gland ultrasonography using a simplified scoring system.
        Arthritis care & research. 2014; 66: 1102-1107
        • De Vita S
        • Quartuccio L
        • Seror R
        • et al.
        Efficacy and safety of belimumab given for 12 months in primary Sjögren's syndrome: the BELISS open-label phase II study.
        Rheumatology (Oxford, England). 2015; 54: 2249-2256
        • Seror R
        • Theander E
        • Brun JG
        • et al.
        Validation of EULAR primary Sjögren's syndrome disease activity (ESSDAI) and patient indexes (ESSPRI).
        Annals of the rheumatic diseases. 2015; 74: 859-866
        • Zhou Y
        • Jin L
        • Kong F
        • et al.
        Clinical and immunological consequences of total glucosides of paeony treatment in Sjögren's syndrome: A randomized controlled pilot trial.
        International immunopharmacology. 2016; 39: 314-319
        • Jager DJ
        • Karagozoglu KH
        • Maarse F
        • Brand HS
        • Forouzanfar T.
        Sialendoscopy of Salivary Glands Affected by Sjögren Syndrome: A Randomized Controlled Pilot Study.
        Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons. 2016; 74: 1167-1174
        • Li B
        • Hou J
        • Yang Y
        • et al.
        Effectiveness of Traditional Chinese Medicine Compound JieDuTongLuoShengJin Granules Treatment in Primary Sjögren's Syndrome: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.
        Evidence-based complementary and alternative medicine: eCAM. 2017; 20171315432
        • Kim SY
        • Lee J
        • Choi YS
        • et al.
        Do I sound dry? Comparative voice analysis of primary Sjögren's syndrome.
        Clinical and experimental rheumatology. 2018; 36: 130-136
        • Fisher BA
        • Everett CC
        • Rout J
        • et al.
        Effect of rituximab on a salivary gland ultrasound score in primary Sjögren's syndrome: results of the TRACTISS randomised double-blind multicentre substudy.
        Ann Rheum Dis. 2018; 77: 412-416
        • Kimura-Hayama E
        • Criales-Vera S
        • Azpeitia-Espinosa L
        • et al.
        Elastographic ultrasound: an additional image tool in Sjögren's syndrome.
        International journal of rheumatic diseases. 2018; 21: 1293-1300
        • Karagozoglu KH
        • Vissink A
        • Forouzanfar T
        • Brand HS
        • Maarse F
        • Jager DHJ.
        Sialendoscopy enhances salivary gland function in Sjögren's syndrome: a 6-month follow-up, randomised and controlled, single blind study.
        Ann Rheum Dis. 2018; 77: 1025-1031
        • Liu X
        • Li X
        • Li X
        • et al.
        The efficacy and safety of total glucosides of peony in the treatment of primary Sjogren's syndrome: a multi-center, randomized, double-blinded, placebo-controlled clinical trial.
        Clinical rheumatology. 2019; 38: 657-664
        • Felten R
        • Devauchelle-Pensec V
        • Seror R
        • et al.
        Interleukin 6 receptor inhibition in primary Sjögren syndrome: a multicentre double-blind randomised placebo-controlled trial.
        Ann Rheum Dis. 2020;
        • van der Heijden EHM
        • Blokland SLM
        • Hillen MR
        • et al.
        Leflunomide-hydroxychloroquine combination therapy in patients with primary Sjögren's syndrome syndrome (RepurpSS-I): a placebo-controlled, double-blinded, randomised clinical trial.
        The Lancet Rheumatology. 2020; 2: e260-e269
        • Fernández-Martínez G
        • Zamora-Legoff V
        • Hernández Molina G.
        Oral health-related quality of life in primary Sjögren's syndrome.
        Reumatologia clinica. 2020; 16: 92-96
        • Park Y
        • Lee J
        • Park SH
        • Kwok SK.
        Male patients with primary Sjögren's syndrome: A distinct clinical subgroup?.
        International journal of rheumatic diseases. 2020; 23: 1388-1395
        • Wang X
        • Bootsma H
        • Terpstra J
        • et al.
        Progenitor cell niche senescence reflects pathology of the parotid salivary gland in primary Sjögren's syndrome.
        Rheumatology (Oxford, England). 2020; 59: 3003-3013
        • Karagozoglu KH
        • Helder M
        • Bot J
        • et al.
        Intraoperative visualisation and treatment of salivary glands in Sjögren's syndrome by contrast-enhanced ultrasound sialendoscopy (CEUSS): protocol for a phase I single-centre, single-arm, exploratory study.
        BMJ open. 2020; 10e033542
        • De Lucia O
        • Zandonella Callegher S
        • De Souza MV
        • et al.
        Ultrasound assessment of lacrimal glands: a cross-sectional study in healthy subjects and a preliminary study in primary Sjögren's syndrome patients.
        Clinical and experimental rheumatology. 2020; 38: 203-209
        • Al Tabaa O
        • Gouze H
        • Hamroun S
        • et al.
        Normal salivary gland ultrasonography could rule out the diagnosis of Sjögren's syndrome in anti-SSA-negative patients with sicca syndrome.
        RMD open. 2021; 7
        • Collins A
        • Lendrem D
        • Wason J
        • et al.
        Revisiting the JOQUER trial: stratification of primary Sjögren's syndrome and the clinical and interferon response to hydroxychloroquine.
        Rheumatology international. 2021; 41: 1593-1600
        • Başakci Çalik B
        • Gür Kabul E
        • Keskin A
        • Bozcuk S
        • Şenol H
        • Çobankara V
        Translation and validation of a Turkish version of the Xerostomia Inventory XI in patients with primary Sjögren's syndrome.
        Turkish journal of medical sciences. 2021; 51: 2477-2484
        • Sio TT
        • Lin HK
        • Shi Q
        • et al.
        Intensity Modulated Proton Therapy Versus Intensity Modulated Photon Radiation Therapy for Oropharyngeal Cancer: First Comparative Results of Patient-Reported Outcomes.
        International journal of radiation oncology, biology, physics. 2016; 95: 1107-1114
        • Chiang SH
        • Ho KY
        • Wang SY
        • Lin CC.
        Change in symptom clusters in head and neck cancer patients undergoing postoperative radiotherapy: A longitudinal study.
        European journal of oncology nursing: the official journal of European Oncology Nursing Society. 2018; 35: 62-66
        • Hu ZY
        • Feng XQ
        • Fu MR
        • Yu R
        • Zhao HL.
        Symptom patterns, physical function and quality of life among head and neck cancer patients prior to and after surgical treatment: A prospective study.
        European journal of oncology nursing: the official journal of European Oncology Nursing Society. 2020; 46101770
        • Aggarwal P
        • Hutcheson KA
        • Garden AS
        • et al.
        Determinants of patient-reported xerostomia among long-term oropharyngeal cancer survivors.
        Cancer. 2021; 127: 4470-4480
        • Meng Z
        • Garcia MK
        • Hu C
        • et al.
        Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma.
        Cancer. 2012; 118: 3337-3344
        • Meng Z
        • Kay Garcia M
        • Hu C
        • et al.
        Sham-controlled, randomised, feasibility trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma.
        European journal of cancer (Oxford, England: 1990). 2012; 48: 1692-1699
        • Lee E
        • Lee YH
        • Kim W
        • Kho HS.
        Self-reported prevalence and severity of xerostomia and its related conditions in individuals attending hospital for general health examinations.
        Int J Oral Maxillofac Surg. 2014; 43: 498-505
        • Matsuoka H
        • Chiba I
        • Sakano Y
        • Saito I
        • Abiko Y.
        The effect of cognitive appraisal for stressors on the oral health-related QOL of dry mouth patients.
        BioPsychoSocial medicine. 2014; 8: 24
        • Mercadante S
        • Aielli F
        • Adile C
        • et al.
        Prevalence of oral mucositis, dry mouth, and dysphagia in advanced cancer patients.
        Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. 2015; 23: 3249-3255
        • Kerr AR
        • Corby PM
        • Kalliontzi K
        • McGuire JA
        • Charles CA.
        Comparison of two mouthrinses in relation to salivary flow and perceived dryness.
        Oral surgery, oral medicine, oral pathology and oral radiology. 2015; 119: 59-64
        • Nikles J
        • Mitchell GK
        • Hardy J
        • et al.
        Testing pilocarpine drops for dry mouth in advanced cancer using n-of-1 trials: A feasibility study.
        Palliative medicine. 2015; 29: 967-974
      3. Nicolatou-Galitis O, Psyrri A. Trismus and reduced quality of life in patients with oral squamous cell carcinoma who received postoperative radiotherapy alone or combined with chemotherapy. 2017;35:222-222.

        • Markey JD
        • Morrel WG
        • Wang SJ
        • Ryan WR.
        The effect of submandibular gland preservation during level 1B neck dissection on postoperative xerostomia.
        Auris, nasus, larynx. 2018; 45: 123-127
        • VonStein M
        • Buchko BL
        • Millen C
        • Lampo D
        • Bell T
        • Woods AB.
        Effect of a Scheduled Nurse Intervention on Thirst and Dry Mouth in Intensive Care Patients.
        American journal of critical care: an official publication, American Association of Critical-Care Nurses. 2019; 28: 41-46
        • Kim JE
        • Lee SS
        • Lee C
        • et al.
        Therapeutic effect of intraductal saline irrigation in chronic obstructive sialadenitis.
        BMC oral health. 2020; 20: 86
        • Mousavian M
        • Sroussi H
        • Villa A
        • Cutler C
        • Treister N.
        Use of Prescription Sialagogues for Management of Xerostomia in Chronic Graft-versus-Host-Disease.
        Transplantation and cellular therapy. 2021; 27: 480.e481-480.e485
        • Kim JH
        • Ahn HJ
        • Choi JH
        • Jung DW
        • Kwon JS.
        Effect of 0.1% pilocarpine mouthwash on xerostomia: double-blind, randomised controlled trial.
        Journal of oral rehabilitation. 2014; 41: 226-235
        • Kim Y
        • Kim HI
        • Kho HS.
        Characteristics of men and premenopausal women with burning mouth symptoms: a case-control study.
        Headache. 2014; 54: 888-898
        • Dalodom S
        • Lam-Ubol A
        • Jeanmaneechotechai S
        • et al.
        Influence of oral moisturizing jelly as a saliva substitute for the relief of xerostomia in elderly patients with hypertension and diabetes mellitus.
        Geriatric nursing (New York, N.Y.). 2016; 37: 101-109
        • Yang G
        • Lin S
        • Wu Y
        • et al.
        Auricular Acupressure Helps Alleviate Xerostomia in Maintenance Hemodialysis Patients: A Pilot Study.
        Journal of alternative and complementary medicine (New York, N.Y.). 2017; 23: 278-284
        • Bukhari AF
        • Farag A
        • Papas A
        • Ganguly R
        • Campos H
        • Ramesh A
        Salivary glands ultrasonography as a diagnostic aid in Sjögren syndrome: A prospective pilot investigation.
        Oral surgery, oral medicine, oral pathology and oral radiology. 2021; 132: 172-181
        • Haddad P
        • Karimi M.
        A randomized, double-blind, placebo-controlled trial of concomitant pilocarpine with head and neck irradiation for prevention of radiation-induced xerostomia.
        Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology. 2002; 64: 29-32
        • Fife RS
        • Chase WF
        • Dore RK
        • et al.
        Cevimeline for the treatment of xerostomia in patients with Sjögren syndrome: a randomized trial.
        Archives of internal medicine. 2002; 162: 1293-1300
        • Wijers OB
        • Levendag PC
        • Braaksma MM
        • Boonzaaijer M
        • Visch LL
        • Schmitz PI.
        Patients with head and neck cancer cured by radiation therapy: a survey of the dry mouth syndrome in long-term survivors.
        Head Neck. 2002; 24: 737-747
        • Sussman D
        • Garely A.
        Treatment of overactive bladder with once-daily extended-release tolterodine or oxybutynin: the antimuscarinic clinical effectiveness trial (ACET).
        Current medical research and opinion. 2002; 18: 177-184
        • Shahdad SA
        • Taylor C
        • Barclay SC
        • Steen IN
        • Preshaw PM.
        A double-blind, crossover study of Biotène Oralbalance and BioXtra systems as salivary substitutes in patients with post-radiotherapy xerostomia.
        European journal of cancer care. 2005; 14: 319-326
        • Aragona P
        • Di Pietro R
        • Spinella R
        • Mobrici M.
        Conjunctival epithelium improvement after systemic pilocarpine in patients with Sjogren's syndrome.
        The British journal of ophthalmology. 2006; 90: 166-170
        • Dirix P
        • Nuyts S
        • Vander Poorten V
        • Delaere P
        • Van den Bogaert W.
        Efficacy of the BioXtra dry mouth care system in the treatment of radiotherapy-induced xerostomia.
        Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. 2007; 15: 1429-1436
        • Dirix P
        • Nuyts S
        • Vander Poorten V
        • Delaere P
        • Van den Bogaert W
        The influence of xerostomia after radiotherapy on quality of life: results of a questionnaire in head and neck cancer.
        Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. 2008; 16: 171-179
        • Ibn Yacoub Y
        • Rostom S
        • Laatiris A
        • Hajjaj-Hassouni N.
        Primary Sjögren's syndrome in Moroccan patients: characteristics, fatigue and quality of life.
        Rheumatology international. 2012; 32: 2637-2643
        • Gu MF
        • Su Y
        • Chen XL
        • et al.
        Quality of life and radiotherapy complications of Chinese nasopharyngeal carcinoma patients at different 3DCRT.
        Asian Pacific journal of cancer prevention: APJCP. 2012; 13: 75-79
        • Skrinjar I
        • Vucicevic Boras V
        • Bakale I
        • et al.
        Comparison between three different saliva substitutes in patients with hyposalivation.
        Clinical oral investigations. 2015; 19: 753-757
        • Salom M
        • Hachulla E
        • Bertolus C
        • Deschaumes C
        • Simoneau G
        • Mouly S.
        Efficacy and safety of a new oral saliva equivalent in the management of xerostomia: a national, multicenter, randomized study.
        Oral surgery, oral medicine, oral pathology and oral radiology. 2015; 119: 301-309
        • Ameri A
        • Heydarirad G
        • Rezaeizadeh H
        • Choopani R
        • Ghobadi A
        • Gachkar L.
        Evaluation of Efficacy of an Herbal Compound on Dry Mouth in Patients With Head and Neck Cancers: A Randomized Clinical Trial.
        Journal of evidence-based complementary & alternative medicine. 2016; 21: 30-33
        • Heiser C
        • Hofauer B
        • Scherer E
        • Schukraft J
        • Knopf A.
        Liposomal treatment of xerostomia, odor, and taste abnormalities in patients with head and neck cancer.
        Head Neck. 2016; 38: E1232-E1237
        • Chen MH
        • Chen CK
        • Chou HP
        • Chen MH
        • Tsai CY
        • Chang DM.
        Rituximab therapy in primary Sjögren's syndrome with interstitial lung disease: a retrospective cohort study.
        Clinical and experimental rheumatology. 2016; 34: 1077-1084
        • Garg A
        • Bhatnagar A
        • Tayal S
        • Singh UP.
        Merits of Oil Pulling Therapy in the Management of Xerostomia and Stomatopyrosis in Burning Mouth Syndrome.
        Journal of Clinical & Diagnostic Research. 2017; 11: 27-29
        • Rogus-Pulia NM
        • Gangnon R
        • Kind A
        • Connor NP
        • Asthana S.
        A Pilot Study of Perceived Mouth Dryness, Perceived Swallowing Effort, and Saliva Substitute Effects in Healthy Adults Across the Age Range.
        Dysphagia. 2018; 33: 200-205
        • Wang C
        • Wang P
        • Ouyang H
        • et al.
        Efficacy of Traditional Chinese Medicine in Treatment and Prophylaxis of Radiation-Induced Oral Mucositis in Patients Receiving Radiotherapy: A Randomized Controlled Trial.
        Integrative cancer therapies. 2018; 17: 444-450
        • Park HK
        • Kim HG
        • Yang DY
        • et al.
        Effect of combined solifenacin and aclatonium in preventing dry mouth in patients with overactive bladder.
        Lower urinary tract symptoms. 2019; 11: 56-60
        • Murakami M
        • Nishi Y
        • Harada K
        • et al.
        Impact of Oral Intake of Glucosylceramide Extracted from Pineapple on Xerostomia: A Double-Blind Randomized Cross-Over Trial.
        Nutrients. 2019; : 11
        • Morton L
        • Siu ATY
        • Fowler S
        • Zhou C
        • Nixon C
        • Campbell D.
        A randomised controlled pilot trial of two interventions to manage dry mouth in pre-operative elective surgical patients.
        Pilot and feasibility studies. 2020; 6: 89
        • Lee KA
        • Park JC
        • Park YK.
        Nutrient intakes and medication use in elderly individuals with and without dry mouths.
        Nutrition research and practice. 2020; 14: 143-151
        • Badooei F
        • Imani E
        • Hosseini-Teshnizi S
        • Banar M
        • Memarzade M.
        Comparison of the effect of ginger and aloe vera mouthwashes on xerostomia in patients with type 2 diabetes: A clinical trial, triple-blind.
        Medicina oral, patologia oral y cirugia bucal. 2021; 26: e408-e413
        • Mateos JJ
        • Setoain X
        • Ferre J
        • et al.
        Salivary scintigraphy for assessing the protective effect of pilocarpine in head and neck irradiated tumours.
        Nuclear medicine communications. 2001; 22: 651-656
        • Fox PC
        • Cummins MJ
        • Cummins JM.
        A third study on the use of orally administered anhydrous crystalline maltose for relief of dry mouth in primary Sjögren's syndrome.
        Journal of alternative and complementary medicine (New York, N.Y.). 2002; 8: 651-659
        • Frydrych AM
        • Davies GR
        • Slack-Smith LM
        • Heywood J
        An investigation into the use of pilocarpine as a sialagogue in patients with radiation induced xerostomia.
        Australian dental journal. 2002; 47: 249-253
        • Gornitsky M
        • Shenouda G
        • Sultanem K
        • et al.
        Double-blind randomized, placebo-controlled study of pilocarpine to salvage salivary gland function during radiotherapy of patients with head and neck cancer.
        Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2004; 98: 45-52
        • Nederfors T
        • Nauntofte B
        • Twetman S.
        Effects of furosemide and bendroflumethiazide on saliva flow rate and composition.
        Arch Oral Biol. 2004; 49: 507-513
        • Ringash J
        • Warde P
        • Lockwood G
        • O'Sullivan B
        • Waldron J
        • Cummings B
        Postradiotherapy quality of life for head-and-neck cancer patients is independent of xerostomia.
        International journal of radiation oncology, biology, physics. 2005; 61: 1403-1407
        • Pillemer SR
        • Brennan MT
        • Sankar V
        • et al.
        Pilot clinical trial of dehydroepiandrosterone (DHEA) versus placebo for Sjögren's syndrome.
        Arthritis and rheumatism. 2004; 51: 601-604
        • Nin T
        • Umemoto M
        • Negoro A
        • Miuchi S
        • Sakagami M.
        Nizatidine enhances salivary secretion in patients with dry mouth.
        Auris, nasus, larynx. 2008; 35: 224-229
        • Theander E
        • Andersson SI
        • Manthorpe R
        • Jacobsson LT.
        Proposed core set of outcome measures in patients with primary Sjögren's syndrome: 5 year follow up.
        The Journal of rheumatology. 2005; 32: 1495-1502
        • Veerasarn V
        • Phromratanapongse P
        • Suntornpong N
        • et al.
        Effect of Amifostine to prevent radiotherapy-induced acute and late toxicity in head and neck cancer patients who had normal or mild impaired salivary gland function.
        Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 2006; 89: 2056-2067
        • Flink H
        • Tegelberg A
        • Thörn M
        • Lagerlöf F.
        Effect of oral iron supplementation on unstimulated salivary flow rate: a randomized, double-blind, placebo-controlled trial.
        J Oral Pathol Med. 2006; 35: 540-547
        • Wu CH
        • Hsieh SC
        • Lee KL
        • Li KJ
        • Lu MC
        • Yu CL.
        Pilocarpine hydrochloride for the treatment of xerostomia in patients with Sjögren's syndrome in Taiwan–a double-blind, placebo-controlled trial.
        Journal of the Formosan Medical Association = Taiwan yi zhi. 2006; 105: 796-803
        • McMillan AS
        • Tsang CS
        • Wong MC
        • Kam AY.
        Efficacy of a novel lubricating system in the management of radiotherapy-related xerostomia.
        Oral oncology. 2006; 42: 842-848
        • Seitsalo H
        • Niemelä RK
        • Marinescu-Gava M
        • Vuotila T
        • Tjäderhane L
        • Salo T.
        Effectiveness of low-dose doxycycline (LDD) on clinical symptoms of Sjögren's syndrome: a randomized, double-blind, placebo controlled cross-over study.
        Journal of negative results in biomedicine. 2007; 6: 11
        • Taweechaisupapong S
        • Pesee M
        • Aromdee C
        • Laopaiboon M
        • Khunkitti W.
        Efficacy of pilocarpine lozenge for post-radiation xerostomia in patients with head and neck cancer.
        Australian dental journal. 2006; 51: 333-337
        • Roh JL
        • Kim HS
        • Kim AY.
        The effect of acute xerostomia on vocal function.
        Archives of otolaryngology–head & neck surgery. 2006; 132: 542-546
        • Sung JM
        • Kuo SC
        • Guo HR
        • Chuang SF
        • Lee SY
        • Huang JJ.
        The role of oral dryness in interdialytic weight gain by diabetic and non-diabetic haemodialysis patients.
        Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association. 2006; 21: 2521-2528
        • Alpöz E
        • Güneri P
        • Onder G
        • Cankaya H
        • Kabasakal Y
        • Köse T.
        The efficacy of Xialine in patients with Sjögren's syndrome: a single-blind, cross-over study.
        Clinical oral investigations. 2008; 12: 165-172
        • Cankaya H
        • Alpöz E
        • Karabulut G
        • Güneri P
        • Boyacioglu H
        • Kabasakal Y.
        Effects of hydroxychloroquine on salivary flow rates and oral complaints of Sjögren patients: a prospective sample study.
        Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2010; 110: 62-67
        • Eliasson L
        • Birkhed D
        • Carlén A.
        Feeling of dry mouth in relation to whole and minor gland saliva secretion rate.
        Arch Oral Biol. 2009; 54: 263-267
        • Meijer JM
        • Meiners PM
        • Vissink A
        • et al.
        Effectiveness of rituximab treatment in primary Sjögren's syndrome: a randomized, double-blind, placebo-controlled trial.
        Arthritis and rheumatism. 2010; 62: 960-968
        • Schiff E
        • Mogilner JG
        • Sella E
        • et al.
        Hypnosis for postradiation xerostomia in head and neck cancer patients: a pilot study.