The diagnosis of salivary gland dysfunction is predicated on a comprehensive evaluation of the patient. It typically begins by assessing the patient’s chief complaint, identification of conditions or predisposing factors in the patient’s medical and social histories, and a physical examination.32,33
Document the character, duration, progression, and domain, of the patient’s chief complaint and its relationship to physiologic function. Determine why the patient is seeking care. Is it a perceived dryness of oral tissues or lack of lubrication when talking, chewing, or swallowing? Is it an awareness of mucosal irritation or a problem with denture retention? Is it a perception of dygeusia, hypogeusia, or ageusia? Is it halitosis? Are the symptoms chronic or did they develop acutely?
Identify past and present medical conditions, document history of adverse drug effects, record drugs /medications taken by the patient.32 Many patients do not recognize nonprescription medications as drugs and, therefore, do not mention the habitual use of aspirin, decongestants, antihistamines, many other over-the-counter medications, and the use of oral healthcare products. Inquire about dietary supplements or special diets the patient may be on. Determine if any of the medical conditions may contribute to salivary dysfunction.32,33 Identify drugs that cause hyposalivation.
The personal habits of the patient, i.e., lifestyle may also reveal important clues that may lead to the diagnosis of hyposalivation. Inquire about patterns of fluid, fermentable carbohydrate, acidic food and drink intake; snacking patterns; and the use of caffeine. Excessive use of tobacco and alcohol, and the use of illicit substances may produce symptoms whose significance is lost without knowledge of the patient’s recreational habits. The patient’s social history should also alert the clinician to the presence of occupational and cultural factors and provide insight into the patient’s emotional state.
Subjective assessment of salivation may include a simple questionnaire requiring a “yes” or “no” response to four questions (Box A).34 A visual analogue or an ordinal scale based on ranked categories, e.g., “I have no – slight – severe – annoying feeling of dry mouth,” may also provide subjective data.35 Objective evaluation begins with an assessment of labial and mucosal dryness; a determination of the presence or absence of fissuring and/or loss of filiform papillae of the tongue; a quantitative assessment of salivary flow; biopsy: and clinical presence of candidal infections.
Box A. Subjective Assessment of Salivation.
Increased caries activity and/or the presence of dental erosions and associated dentinal hypersensitivity may reflect persistent dry mouth. Further objective data may be obtained from visual assessment of mandibular labial gland secretion, of salivary flow associated with the palpation of the major salivary glands, and the presence or absence of pooling of saliva on the floor of the mouth. Finally, determining the volume of resting and stimulated saliva produced over time provides quantitative data of salivary function.36