Subjective Aspects of Dry Mouth
Xerostomia is not a trivial condition: it affects the day-to-day lives of sufferers in important ways. Appropriate definition and accurate measurement are critical for better understanding, monitoring and treatment of xerostomia. This chapter describes an
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Subjective Aspects of Dry Mouth W. Murray Thomson
Abstract
Xerostomia is not a trivial condition: it affects the day-to-day lives of sufferers in important ways. Appropriate definition and accurate measurement are critical for better understanding, monitoring and treatment of xerostomia. This chapter describes and evaluates the various measurement approaches. These range from single-item methods to multi-item summated rating scales. All have advantages and disadvantages. The one which is chosen depends on the use to which the data will be put, the need to minimise respondent burden, the ability to make comparisons with the findings of others and the research question being investigated.
Defining Dry Mouth: What Are We Talking About? Much of the literature on dry mouth either fails to adequately define the condition or is predicated on the assumption that everyone who feels dry mouth has demonstrably low salivary flow and everyone with low flow suffers the symptoms of dry mouth. Dry mouth has two possible manifestations. Xerostomia is the subjective feeling of dry mouth and can therefore be assessed only by directly questioning individuals [10]. Salivary gland hypofunction (SGH) results in salivary output (flow rate) which is lower than normal; it can therefore be determined by sialometry [21]. Individuals whose salivary flow rate is below a designated clinical threshold are categorised as having SGH. Given these definitions, xerostomia is a symptom, and SGH is a sign (a sign is observed by the clinician; a symptom can be detected only by asking the patient). The empirical evidence suggests that the two are not W.M. Thomson, BSc, BDS, MA, MComDent, PhD Dental Epidemiology and Public Health, Oral Sciences, Faculty of Dentistry, Sir John Walsh Research Institute, The University of Otago 280 Great King St, Dunedin, Otago 9054, New Zealand e-mail: [email protected] © Springer-Verlag Berlin Heidelberg 2015 G. Carpenter (ed.), Dry Mouth: A Clinical Guide on Causes, Effects and Treatments, DOI 10.1007/978-3-642-55154-3_7
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necessarily concurrent. For example, an epidemiological study of older South Australians found that approximately one in five had either xerostomia or SGH but that the two coincided in only one-sixth of those with either condition [31]. Thus, it is important to be specific when describing the occurrence of dry mouth. This chapter deals with the measurement and occurrence of xerostomia, the subjective manifestation of dry mouth.
Principles of (and Challenges in) Subjective Measurement By definition, measuring symptoms requires asking the individual: self-report is the only method available. Eight important attributes of self-report measures have been described [28], and they apply just as much to measuring xerostomia as they do to measuring entities such as oral-health-related quality of life. Those important attributes are having a conceptual model, reliability, validity, responsiveness, interpretability, respondent and administrative burden, alternative forms and cro
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