Diagnosing Xerostomia and Salivary Gland Hypofunction (SGH)

There are numerous questionnaires used to assess dry mouth symptoms, including various quality of life scales and some specific instruments such as the Xerostomia Questionnaire (XQ) [22] and the Xerostomia Inventory (XI) [47], [48]. An extensive discussion of the different instruments (objective and subjective) to measure Xerostomia is available in the article by Sasportas et al. [49].

Diagnosing Xerostomia

Dr. Roseanne Mulligan, DDS, MS, Geriatric Dentistry Online Postgraduate Dental Degree Program, USC Dentistry

Dr. Roseanne Mulligan, DDS, MS

The Xerostomia Inventory (XI), is reliable, reflects many manifestations of the xerostomic experience, has appropriate wording, is grounded in the experiences of xerostomic sufferers and is easy to administer. For example, it could be mailed to the patients for them to fill out and bring to their next appointment; it does not need the presence of the dentist or a trained staff member to collect the information.

The XI consists of an 11-item summated rating scale with each response assigned a score between 1 and 5 and the combined total score calculated into a sum ranging from 11 to 55, that represents the severity of the underlying Xerostomia. A score of 11 is characterized as very mild Xerostomia and 55 represents severe Xerostomia [50].

The XI has been validated to provide a both a discriminative measure of the severity of dry mouth symptoms as well as serve as a responsive measure to determine the success of interventions for dry mouth. A change in XI score of 6 or more points is likely to be clinically meaningful [20], [50].

Further Reading: Geriatric Dental Care: Older Adults and Oral Conditions

Xerostomia Inventory Questions

These are the 11 questions from the XI that individuals are asked to choose a response for, from never 1, hardly ever 2, occasionally 3, fairly often 4, very often 5.

  1. My mouth feels dry
  2. I have difficulty in eating dry foods
  3. I get up at night to drink
  4. My mouth feels dry when eating a meal
  5. I sip liquids to aid in swallowing food
  6. I suck sweets or cough lollies to relieve dry mouth
  7. I have difficulties swallowing certain foods
  8. The skin of my face feels dry
  9. My eyes feels dry
  10. My lips feel dry
  11. The inside of my nose feels dry

Diagnosing Salivary Hypofunction (SGH)

There are many ways to measure salivary flow from individual glands, combined oral surfaces (whole mouth measurement), during rest (drooling) or when stimulated (chewing a neutral substances or gustatory stimulants) [51]. Some of the methods are more relevant for research based collections [51], [52] and others are more practical for the clinicians to perform in their practice. Navazesh et al. provides an extensive review on saliva collection methods [51], [52], [53], [54].

Smith recommended a whole simulated saliva collection consisting of having each subject chew on two pieces of gauze for 1 min, the weights of the gauzes having been measured before and after the exercise. This method is simple and inexpensive, and requires minimal equipment. It has been demonstrated to be a reliable method of assessment of the function of the salivary glands in patients with dry mouth [55].

Another method of interest is an adaptation of the Schirmer Test used to measure eye dryness [56]. Chen et al. recommended the Modified Schirmer Test (MST) to provide a quick screening for salivary gland hypofunction in any office setting; as it is performed in less than 5 min, is inexpensive, does not need sophisticated equipment and has acceptance from the patients [14].

Further Reading: Geriatric Dentistry: Understanding the Role of Saliva

Postgraduate Degrees in Geriatric Dentistry

Are you looking for improved ways to diagnose, treat, and manage the oral healthcare of older patients? Explore the Herman Ostrow School of Dentistry of USC’s online master’s and certificate program in Geriatric Dentistry.

About the Authors

The article, “Dry mouth: A critical topic for older adult patients,” was authored by Phuu Han, Piedad Suarez-Durall, and Roseann Mulligan, Director Geriatric Dentistry Master and Certificate programs at the Herman Ostrow School of Dentistry of USC, and was originally published by Elsevier in the Journal of Prosthodontic Research.


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