Let’s talk about diagnosing dry mouth. Symptoms can actually go a long way in aiding in the diagnosis of this one. Symptoms of severe dry mouth may include:
- Needing water to chew and swallow food
- Choking or coughing on food
- Not being able to speak for long periods of time without constantly sipping water
- A dry mouth, frequent dental caries or dental complications
- A dry, red, raw tongue. Altered taste or a burning and tingling sensation on the tongue
- Sores and cracks in and around the mouth
- A dry throat with a dry cough
Diagnostic testing is aimed at the salivary glands since they are the cause of the dry mouth symptoms in Sjögren’s. Sialometry, or Salivary flow rate, is a simple 15-minute test that can be completed in your doctor’s office. Some clinics administer this as an “unstimulated” test and others prefer a “stimulated” version. Stimulated involves chewing a piece of paraffin to stimulate saliva flow while unstimulated testing does not involve chewing anything. Either way, the test involves spitting in a measured cup or test tube to see how much can be collected in the 15-minute time frame. That amount is then compared to established norms.
More advanced testing is available but not as widely used in general practice. A Parotid sialography, for example, involves injecting x-ray dye into the salivary glands to follow salivary flow using X-rays. Salivary scintigraphy is a nuclear medicine test that can also evaluate salivary flow. For this test, a radioactive substance in injected into your vein and imaging traces the substance to your salivary glands. In Sjögren’s disease, this test would likely indicate decreased uptake and secretion of the radioactive isotope.
Other emerging tests may use ultrasound or MRI. Testing for dry mouth is an area that is experiencing rapid growth as we try to identify and manage debilitating dry mouth symptoms. I have personally only done the stimulated salivary flow rate test once. I find that most practitioners are satisfied to meet dry mouth criteria based on my subjective complaints (symptoms).
Once again we are unable to diagnose Sjögren’s with any of these tests alone. Dry mouth evaluation coupled with dry eye symptoms and other diagnostics are collected to add to the overall picture that eventually gets put together to form a diagnosis. In my next blog post, we’ll get into the lab work associated with Sjögren’s Disease.
Barbara Grubbs, Nurse Practitioner