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Open Access Rheumatology: Research and Reviews 2019:11 11–18
Open Access Rheumatology: Research and Reviews Dovepress
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ORiginAl ReseARch
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Open Access Full Text Article
http://dx.doi.org/10.2147/OARRR.S188937
correlation between Xerostomia index, clinical
Oral Dryness scale, and essPRi with different
hyposalivation tests
Ola hijjaw
1
Mohammad Alawneh
1
Khaled Ojjoh
1
hazem Abuasbeh
1
Ahmad Alkilany
1
nabeel Qasem
1
Mohammad Al-essa
1
saif Aldeen AlRyalat
2
1
Department of internal Medicine,
The University of Jordan, Amman
11942, Jordan;
2
Department of
Ophthalmology, The University of
Jordan, Amman 11942, Jordan
Background and objective: Xerostomia is a subjective measure of dry mouth, while hyposali-
vation is an objective measure of reduced saliva flow rate. In this study, we aim to assess the
association between commonly used xerostomia scoring systems, with different hyposalivation
measures among Sjogren Syndrome (SS) patients.
Methods: In a cohort of SS patients, we assessed xerostomia using Xerostomia index, clinical
oral dryness scale (CODS), and the European League Against Rheumatism SS Patient-Reported
Index (ESSPRI), and we assessed hyposalivation using unstimulated whole saliva flow (UWS),
stimulated whole saliva flow (SWS), and stimulated parotid flow (SPF). We analyzed the asso-
ciation between xerostomia and hyposalivation using association tests in SPSS.
Results: We included a total of 49 patients in this study, of which 34 (68%) had primary SS,
and 15 (32%) had secondary. CODS was significantly correlated with SWS (P=0.048), with a
negative correlation coefficient of 0.216, and with SPF (P=0.009), with a negative correlation
coefficient of 0.291. The dryness domain of ESSPRI was significantly correlated with UWS
(P=0.031) with a negative correlation coefficient of 0.233.
Conclusion: CODS is the scoring system with the highest correlation with hyposalivation,
particularly SWS and SPF, followed by ESSPRI dry domain, which is correlated with UWS.
Xerostomia index is not correlated with hyposalivation.
Keywords: Sjogren syndrome, xerostomia, hyposalivation, XI, CODS, ESSPRI
Introduction
Sjogren’s syndrome (SS) is a chronic autoimmune disease affecting mainly the exocrine
glands, especially the lacrimal and salivary glands. It is the second most common
autoimmune rheumatic disease.
1
Its prevalence ranges between 0.1% and 4.8% with
a female to male ratio of 9:1, mostly in the age of 40–60 years.
2
Generally, SS is clas-
sified into primary SS, which occurs alone without any other associated disease, and
secondary SS, which is associated with other diseases such as rheumatoid arthritis and
systemic lupus erythematosus.
3
SS has a wide variety of presentations and can affect
almost any organ, but it typically presents with dryness of eyes and mouth.
4
Xerostomia and hyposalivation are two concepts used in the diagnostic criteria of SS,
which are distinguishable from each other. Xerostomia is a subjective measure, when the
patient reports a daily feeling of dry mouth, while hyposalivation is an objective quantifi-
able measure of reduced saliva flow rate.
5
Multiple scoring system has been developed
to assess xerostomia and several tests for hyposalivation. Three scoring systems we
will discuss in our study include Xerostomia index (XI), clinical oral dryness scale
(CODS), and the European League Against Rheumatism SS Patient-Reported Index
correspondence: saif Aldeen AlRyalat
Department of Ophthalmology, The
University of Jordan, Queen Rania str.,
Amman 11942, Jordan
Tel +962 798 914 594
email saifryalat@yahoo.com
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