Prevalence of xerostomia and its associated risk factors among Saudi population: a cross-sectional survey

Norah Alkanani; Meisam Alburaiki; Asma Alhabib; Wejdan Alabsi; Hind Alasmari; Ghady Alqahtani; Nishath Sayed Abdul

doi:10.12688/f1000research.75694.1

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Research Article

Prevalence of xerostomia and its associated risk factors among Saudi population: a cross-sectional survey

[version 1; peer review: 1 approved, 1 not approved]

Norah Alkanani ¹, Meisam Alburaiki¹, Asma Alhabib¹, [...] Wejdan Alabsi¹, Hind Alasmari², Ghady Alqahtani¹, Nishath Sayed Abdul¹

Norah Alkanani ¹, Meisam Alburaiki¹, [...] Asma Alhabib¹, Wejdan Alabsi¹, Hind Alasmari², Ghady Alqahtani¹, Nishath Sayed Abdul¹

PUBLISHED 10 Oct 2022

Author details Author details

¹ College of Denistry, Riyadh Elm University, Riyadh, 13781, Saudi Arabia
² Ministry of Health, Riyadh, 13781, Saudi Arabia

Norah Alkanani
Roles: Investigation, Methodology, Writing – Original Draft Preparation

Meisam Alburaiki
Roles: Investigation, Methodology, Writing – Original Draft Preparation

Asma Alhabib
Roles: Investigation, Methodology, Writing – Original Draft Preparation

Wejdan Alabsi
Roles: Investigation, Methodology, Writing – Original Draft Preparation

Hind Alasmari
Roles: Writing – Review & Editing

Ghady Alqahtani
Roles: Investigation, Methodology, Writing – Original Draft Preparation

Nishath Sayed Abdul
Roles: Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background: Xerostomia is a condition that has been shown to have a negative impact on the quality of life. Thus, exploring the associated risk factors and conditions needs special attention. There is still a lack of complete information regarding this condition among the Saudi population.
Methods: In this cross-sectional questionnaire-based survey, 30-70 years old were included. Demographic data with systemic and dental- related history was collected. The presence of xerostomia and the risk factors such as age, sex, history of smoking, history of systemic disease, and medication history are noted. All the results were tabulated and subjected to statistical analysis using SPSS.
Results: The prevalence of xerostomia was 42.3%. The prevalence of xerostomia was found to be increasing with age. For gender, xerostomia was significantly higher among women than men (p<0.05). There was a statistically significant association between xerostomia and associated diseases such as gastrointestinal disorders, endocrine disorder, blood diseases, cardiovascular disorders, and allergies (p<0.001). Only 12.5% of participants who had xerostomia were smokers and 44.2% of participants who had xerostomia were using medications.
Conclusions: There is a high prevalence of xerostomia among the Saudi population, with a higher prevalence in the older age group and women. An association between systemic disease and medication history was also noted. Dental practitioners need to be alert to this condition.

Keywords

Xerostomia, prevalence, risk factors, saliva

Corresponding author: Norah Alkanani

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2022 Alkanani N et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Alkanani N, Alburaiki M, Alhabib A et al. Prevalence of xerostomia and its associated risk factors among Saudi population: a cross-sectional survey [version 1; peer review: 1 approved, 1 not approved]. F1000Research 2022, 11:1154 (https://doi.org/10.12688/f1000research.75694.1) First published: 10 Oct 2022, 11:1154 (https://doi.org/10.12688/f1000research.75694.1) Latest published: 10 Oct 2022, 11:1154 (https://doi.org/10.12688/f1000research.75694.1)

Introduction

Saliva plays an important role in the defense mechanism of the oral cavity. Its role in the mastication and digestion process including lubrication and protection of oral mucosa is well known. Moreover, its impact on demineralization of teeth, phonation, taste sensation, buffering action and clearance, and antibacterial activity has been well documented.¹ Any alternation in the saliva thus changes the functionality of the oral cavity. However, decreased salivation or xerostomia is considered to be of greater concern for the oral cavity.²

Patients with salivary gland hypo-function suffer from dry mouth, halitosis, oral burning sensation, increased aversion and difficulty in swallowing dry foods, less tolerance to spices, acidic, and crunchy food.³ They often complain of taste changes. Geriatric patients and denture wearers have difficulties wearing them. This is because the denture-wearers with xerostomia frequently experience tissue friability due to lack of lubrication and often require frequent sips of water.⁴ They also feel an increased need to drink water when swallowing. This total alteration in the oral cavity function thus shows the impact of xerostomia on the health-related quality of life in patients.⁵

The etiology of xerostomia varies from the use of medications to exposure to head and neck radiations therapy. Chemotherapy or normal aging as a causal factor of xerostomia is still under study, but other possible contributing factors for xerostomia include uncontrolled diabetes, chronic graft-versus-host disease, Sjogren’s syndrome, vasculitis, dehydration, malnutrition, psychogenic conditions, and immune deficiencies.⁶

Over the last decade, the research on xerostomia and its effects on the oral health of patients has substantially increased. However, there are still some unanswered questions regarding the occurrence of this condition. To find out the exact cause of xerostomia and its prevalence in the general population, and in the specific population such as smokers has been tested with mixed results.⁷ A systematic review was conducted, which explains the data and directs us to explore the causes among any given population in a different environment. A review of the literature regarding the prevalence of xerostomia among Scandinavians in 2006 reported variations from 0.9% to 64.8%.⁸ This wide range explains the need for more clarity in this area. It should also be noted that most of these studies were concentrated in one part of the world; Scandinavia and most of the study population were aged 50 years and over. The prevalence of xerostomia reported among different populations and countries varies. In Japan it is 35% (2016),⁹ 25.8% (2010) in Korea,¹⁰ 14.4% (2012) in Thailand,¹¹ and 21% (1999) in Australia.¹²

Cross-sectional data obtained in 2017 from the longitudinal study of The Dunedin Multidisciplinary Health and Development involving 923 people reported that xerostomia does not only affects people of older age. The study involving individuals aged around 32 years has shown xerostomia affecting 1 in 10 individuals. However, the reported prevalence cannot be compared due to the heterogeneity in the study population and the methodology followed which was questionnaire- based.¹³ The prevalence of dry mouth among men and women in various studies showed that, in older individuals, predominance was seen more among women (10 to 33%) compared to men (10 to 26%) which may be due to the effects of menopause.⁵^,⁹^,¹⁴^,¹⁵ Research on the prevalence of xerostomia among the Saudi population has shown a paucity of information.¹⁶ Thus, the present study was designed to investigate the prevalence of xerostomia among adults in Saudi society and explore the possible risk factors and symptoms associated with this condition.

Methods

Study design

A cross-sectional questionnaire e-survey²⁵ was carried out using Google forms and distributed via the social networks such as WhatsApp, Twitter, Facebook, and Messenger. To reduce information bias, the questionnaire was pretested and all questions in the questionnaire were clarified before the study. The survey was pretested with a group of randomly selected male and female subjects through WhatsApp. The population was a random sample of the university population and their details were gathered from the university class list. These subjects were not included in the final analysis.

An optimum sample size of 755 people between the ages of 30-70 was obtained. The sample size was calculated with a confidence interval of 95%, a margin of error of 5% and an estimated proportion of the population suffering from xerostomia of 0.5. All participants 30 years and older were eligible for the study.

Setting

The study was conducted at the college of Dentistry, Riyadh Elm University, Riyadh during the month of September 2020. The duration of data collection was three weeks starting from September 1^st, 2020 to September 28^th, 2020. Reminder emails and messages were sent during the data collection period to the participants.

Ethical statement

This study was approved by the Ethics Committee of the College of Dentistry (IRB approval number: RC/IRB/2016/583), Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia on 16th November, 2017. Consent was obtained from all participants in this study for publication of the data. Specifically the participants were informed at the start of the e-survey that starting the survey would be taken as agreement for consent to participate.

Study population

The targeted population was the general public living around the central region of Saudi Arabia. The survey link was distributed across social media (Email, Facebook, WhatsApp, and Instagram). Participants under 30 years old were excluded from the final sample evaluation.

Data collection

The questionnaire had two main sections: participants’ demographics (gender, age group, place of residence and the items that measured participants’ medical and dental status which included disease, diabetes status, BP level, thyroid disorder, allergies, depression and physiological related items. The questionnaire was prepared with possible items to be included taken from a previous study that reported the prevalence of xerostomia in different countries.¹⁵ While recording the medication history, the participants were asked “Are you taking any medication?”; if yes, then the type of medications were recorded. The participants were asked about smoking habits (Do you smoke?). The participants were also asked about oral lesions, “Do you feel any oral lesion in your mouth?”; if yes, then the type of oral lesion was recorded. Most of the responses of the items included in the survey were coded as yes =1 and no = 0.

Statistical analysis

Data was initially gathered in Excel sheet then coded and transformed to the SPSS (statistical package for social sciences) version 24 (IBM, Armonk, NY: USA, RRID:SCR_016479) for analysis purposes. Descriptive statistics were calculated such as frequency and percentages and were presented in the form of tables. For association between the categorical (binary) variables Fisher’s Exact test was applied. A p-value of <0.05 was considered statistically significant.

Results

A total 1063 responded to the survey. Participants less than 30 years old were excluded giving a response rate of 71%. Among 755 respondents, the majority were women (75.8%) (the full dataset can be found in the Underlying data²²). The prevalence of xerostomia was 42.3%. Prevalence of xerostomia was found to increase with age. The highest prevalence was seen among those aged 60-70 years old (53.3%) and the least among those aged 30-39 years old (38.8%). Xerostomia was shown to have a statistically significant association between males and females for age groups 30-39 years and 50-59 years old, respectively (p < 0.05) (Table 1).

Table 1. Prevalence of xerostomia based on age and gender.

Age (Years)	Gender	All		Xerostomia		p-value
Age (Years)	Gender	n	%	n	%	p-value
30-39	Female	246	71.3	103	41.9	0.044*
	Male	99	28.7	31	31.3
	Total	345	45.7	134	38.8
40-49	Female	145	84.8	63	43.4	0.481
	Male	26	15.2	12	46.2
	Total	171	22.6	75	43.9
50-59	Female	142	79.3	67	47.2	0.041*
	Male	37	20.7	11	29.7
	Total	179	23.7	78	43.6
60-70	Female	39	65.0	24	61.5	0.071
	Male	21	35.0	8	38.1
	Total	60	7.9	32	53.3

* Shows statistically significant at 0.05.

The most common diseases associated with xerostomia are gastrointestinal (61.12%) and psychological (50.47%) disorders. There was a statistically significant association between xerostomia and the diseases considered in the present study (p < 0.05) (Table 2).

Table 2. Prevalence of xerostomia among patients with a medical condition.

		n	%	p-value
Do you have any gastrointestinal disorders?	Yes	195	61.1	0.0001*
Do you have any gastrointestinal disorders?	No	124	38.9	0.0001*
Do you have an endocrine disorder such as diabetes mellitus or thyroid disorders?	Yes	94	29.5	0.0001*
	No	225	70.5	0.0001*
Do you have blood diseases such as anemia?	Yes	66	20.7	0.0001*
Do you have blood diseases such as anemia?	No	253	79.3	0.0001*
Do you have or have you ever had psychological disorders such as depression, anxiety, etc.?	Yes	161	50.5	0.867
	No	158	49.5	0.867
Do you have any allergies?	Yes	121	37.9	0.0001*
Do you have any allergies?	No	198	62.1	0.0001*
Do you have any cardiovascular disorders such as valve diseases, hypertension, etc.?	Yes	61	19.1	0.0001*
	No	258	80.9	0.0001*

* Shows statistically significant at 0.05.

Analysis of the areas where dryness was felt along with the oral cavity revealed different results. Lips, throat, nose, and skin (66.8%) were highest, followed by lip cracking (55.5%). Other signs and symptoms such as waking up to drink water (52.67%), bad breath (halitosis) (45.77%), always thirsty (45.5%), and difficulty eating dry food (35.4%) were closely associated (Table 3).

Table 3. Prevalence of reported symptoms of xerostomia.

		n	%	p-value
Do you feel burning sensation?	Yes	41	12.9	0.0001*
Do you feel burning sensation?	No	278	87.1	0.0001*
Do you have a bad breath or halitosis?	Yes	146	45.8	0.131
Do you have a bad breath or halitosis?	No	173	54.2	0.131
Do you feel any oral diseases in your mouth?	Yes	39	12.2	0.0001*
Do you feel any oral diseases in your mouth?	No	280	87.8	0.0001*
Do you feel lip cracking?	Yes	177	55.5	0.051
Do you feel lip cracking?	No	142	44.5	0.051
Do you feel difficulties and impairments related to speaking, swallowing, and taste sensation?	Yes	76	23.8	0.0001*
	No	243	76.2	0.0001*
Do you feel dryness in other areas of the body including the lip, throat, eye, nose, and, skin?	Yes	213	66.8	0.0001*
	No	106	33.2	0.0001*
Do you feel you need to wake up to drink water?	Yes	168	52.7	0.341
Do you feel you need to wake up to drink water?	No	151	47.3	0.341
Do you feel always thirsty?	Yes	145	45.5	0.104
Do you feel always thirsty?	No	174	54.5	0.104
Do you feel difficulty eating dry food?	Yes	113	35.4	0.0001*
Do you feel difficulty eating dry food?	No	206	64.6	0.0001*

* Shows statistically significant at 0.05.

Association with smoking and medication history yielded the following outcome. Only 12.5% of the participants who had xerostomia were smokers (p < 0.05) and 44.2% of participants who had xerostomia were under medications (p < 0.05). The most common drugs that were associated with the highest prevalence of xerostomia were related to the medications taken for cardiovascular diseases and endocrinological agents (Table 4).

Table 4. Prevalence of xerostomia by medications.

		Xerostomia		Total	p-value
		Yes	No	Total	p-value
Endocrinologic agents	Yes	47	0	47	0.0001*
Endocrinologic agents	No	272	436	708	0.0001*
Antidyslipidemic	Yes	25	0	25	0.0001*
Antidyslipidemic	No	294	436	730	0.0001*
Cardiovascular disease	Yes	30	0	30	0.0001*
Cardiovascular disease	No	289	436	725	0.0001*
Psychotherapeutic	Yes	16	0	16	0.0001*
Psychotherapeutic	No	303	436	739	0.0001*
Respiratory agents	Yes	8	0	8	0.001*
Respiratory agents	No	311	436	747	0.001*
Nutritional therapeutics	Yes	19	0	19	0.0001*
Nutritional therapeutics	No	300	436	736	0.0001*
Gastrointestinal agents	Yes	6	0	6	0.004*
Gastrointestinal agents	No	313	436	749	0.004*
Neurological medications	Yes	2	0	2	0.09
Neurological medications	No	317	436	753	0.09
Antihistamine	Yes	12	0	12	0.0001*
Antihistamine	No	307	436	743	0.0001*
Pain medication	Yes	8	0	8	0.001*
Pain medication	No	311	436	747	0.001*
Anticoagulant	Yes	0	0	0	–
Anticoagulant	No	319	436	755	–
Others	Yes	29	0	29	0.0001*
Others	No	290	436	726	0.0001*

* Shows statistically significant at 0.05.

Discussion

As per our knowledge and literature review, not many studies have been conducted on the prevalence of xerostomia in Saudi Arabia. This study is of substantial sample size and targets the local population. The methodology employed in the present study was of a similar standard to a previous study¹⁶ in regards to data collection, the questionnaire approach, data processing, and the large sample size which led to a clear and complete outcome of this study. The response rate of the questionnaire survey was good, thus providing support to generalize the findings to the population under study.

The current study investigated the prevalence of risk factors of xerostomia among adults in Saudi Arabia. In this study prevalence of xerostomia was found to be 42.3%. This finding is higher compared to other studies by Hahnel et al. (16%)¹⁷ and Villa and Abati (19.6%).¹⁸ However, it was lower than a study done by So et al. (70.1%).⁸ Reported prevalence in the present study compared to previous studies may be due to methodology with some studies following clinical examination and others following questionnaires. There are other factors such as age group variation and gender variation in the selected studies.

This cross-sectional study evaluated the prevalence of xerostomia in a wide age range group of those 30 to 70 years old. Most studies on xerostomia have been investigated on institutionalized adults.¹²^,¹⁵^,¹⁷ There are very few studies available on people under 50 years old, especially among young populations. Thus, this study provides new information regarding xerostomia among those aged 30-50 years.

Studies across different countries have shown variation in the prevalence of xerostomia which may be because of several variables such as the age of the participants, gender, and methodology followed, including the sample size, the content of the questions, cultural difference, eating habits and the guidelines used for the diagnosis of xerostomia and heterogeneity in selected criteria. In the present study, an increase in the prevalence of xerostomia among older age groups is mainly due to existing concurrent medical conditions and the use of medications for the same medical conditions. There could be other possible factors including geriatric malnutrition and age-related changes in the composition of saliva.¹⁹

The comparison of xerostomia between men and women in the present study found it was significantly more prevalent among women in a specific age group (60 to 70 years old). Similar reports have been published previously showing that individuals who have been through menopause are affected more compared to the younger age groups. Hormonal influence on the salivary glands and other related factors may be responsible for this. It has been reported that the increased association of medical conditions among women and medications taken for the management of these is responsible for the higher prevalence of xerostomia seen in this group.²⁰ The mental health of an individual has been shown to have a strong influence on dry mouth, which (mental health) is seen at a higher rate in women than men.²¹^,²²

It is also understood that there is a significant association between age, systemic diseases, and medication intake and xerostomia. A study by Villa and Abati stated that people with mental disorders or high nervousness complained about xerostomia at the highest rates. Commonly used drugs for mental disorders or high nervousness including anticholin- ergics, antihistamines, and antidepressants all have been correlated with studies of xerostomia.¹⁶^,²³ Smoking and its association with xerostomia in the present study was similar to the previous study. Non-smokers showed less prevalence of xerostomia compared to heavy and chain smokers.²⁴ Similar reports were seen in the study by Villa and Abati with no significant association between smoking and xerostomia.¹⁸

One of the limitations of this study is that it was based on the perception of the patient as it is questionnaire-based. Though this approach has been used in many similar studies, subjective variation in the expression of the xerostomia differs and it may not reflect the true picture of xerostomia in an individual. Moreover, the condition may be over or underestimated depending on the tolerance capacity of the individual. An oral examination with necessary tests could overcome this problem. Another limitation related to the sample is the predominance of women. The ratio of men and women may have an impact on the results on prevalence among the two. Though a considerably higher sample size was obtained compared to the previous studies, further exploration of the risk factors is warranted in future studies with a larger sample size.

Conclusion

The prevalence of xerostomia seems to be higher among the Saudi population. Associated risk factors such as age, sex, systemic diseases, and medications associated with xerostomia should alert general dentists about this condition. Dissemination of this information among practicing dentists will help gain insight into xerostomia among the Saudi population and ways of managing the condition. Dentists must learn the necessary skill to improve the condition of patients with xerostomia as it can impact quality of life.

Data availability

Underlying data

Figshare: Prevalence of xerostomia and its associated risk factors among Saudi population: A cross-sectional survey. https://doi.org/10.6084/m9.figshare.17205863.v2.²⁵

This project contains the following underlying data:

- Data.xlsx (data collected for the study containing the demographic characteristics and smoking habits of the participants, and the items that measured participants’ medical and dental status.

Extended data

Figshare: Prevalence of xerostomia and its associated risk factors among Saudi population: A cross-sectional survey. https://doi.org/10.6084/m9.figshare.17205863.v2.²⁵

This project contains the following extended data:

- Questionnaire

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

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Author details Author details

¹ College of Denistry, Riyadh Elm University, Riyadh, 13781, Saudi Arabia
² Ministry of Health, Riyadh, 13781, Saudi Arabia

Norah Alkanani
Roles: Investigation, Methodology, Writing – Original Draft Preparation

Meisam Alburaiki
Roles: Investigation, Methodology, Writing – Original Draft Preparation

Asma Alhabib
Roles: Investigation, Methodology, Writing – Original Draft Preparation

Wejdan Alabsi
Roles: Investigation, Methodology, Writing – Original Draft Preparation

Hind Alasmari
Roles: Writing – Review & Editing

Ghady Alqahtani
Roles: Investigation, Methodology, Writing – Original Draft Preparation

Nishath Sayed Abdul
Roles: Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

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https://doi.org/10.12688/f1000research.75694.1

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© 2022 Alkanani N et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Alkanani N, Alburaiki M, Alhabib A et al. Prevalence of xerostomia and its associated risk factors among Saudi population: a cross-sectional survey [version 1; peer review: 1 approved, 1 not approved]. F1000Research 2022, 11:1154 (https://doi.org/10.12688/f1000research.75694.1)

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Reviewer Report 08 Mar 2025

Dalia Ghalwash, Oral Medicine and Periodontology, Faculty of Dentistry, The British University in Egypt, El Sherouk City, Egypt

Approved

https://doi.org/10.5256/f1000research.79600.r344277

This study represents a cross-sectional, questionnaire-based survey to explore the prevalence of xerostomia and its associated risk factors among the Saudi population.
Exploring the risk factors associated with xerostomia is an important topic that needs special attention since xerostomia affects the quality of ... Continue reading

This study represents a cross-sectional, questionnaire-based survey to explore the prevalence of xerostomia and its associated risk factors among the Saudi population.
Exploring the risk factors associated with xerostomia is an important topic that needs special attention since xerostomia affects the quality of life.

This cross-sectional study evaluated the prevalence of xerostomia in a wide age range group of those 30 to 70 years old. Demographic data with systemic and dental- related history was collected. The presence of xerostomia and the risk factors such as age, sex, history of smoking, history of systemic disease, and medication history are noted. Xerostomia affected 42.3% of cases, especially in older age groups, and was significantly higher among women. There was a statistically significant association between xerostomia and gastrointestinal disorders, endocrine disorders, blood diseases, cardiovascular disorders, and allergies.

This study is of an appropriate sample size and targets the general public living around the central region of Saudi Arabia. The prevalence of xerostomia seems to be higher among the Saudi population. Dissemination of this information among practicing dentists will help gain insight into xerostomia among the Saudi population and ways of managing the condition. Dentists must learn the necessary skills to improve the condition of patients with xerostomia, as it can impact the quality of life.

This is an important area of research that lacks complete information, especially in Arab countries. The work is clearly presented, but it would be beneficial if the study included more cities and a larger sample size.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

References

1. Ghalwash D, El-Gawish A, Ammar A, Hamdy A, et al.: Epidemiology of Sjogren's syndrome in a sample of the Egyptian population: a cross-sectional study.J Int Med Res. 2024; 52 (10): 3000605241289292 PubMed Abstract | Publisher Full Text
2. Ghalwash D, Abou-Bakr A, Ammar A, Hamdy A, et al.: Prevalence profile of burning mouth syndrome in a sample of Egyptian population: A cross-sectional clinical based study. Exploration of Medicine. 2024. Publisher Full Text

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Oral Medicine, diagnosis, epidemiologic studies. Detection and prevention of oral cancer. Periodontology and implant dentistry

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report 13 Feb 2025

W Murray Thomson, Department of Oral Sciences, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand

Not Approved

https://doi.org/10.5256/f1000research.79600.r363932

General comments

The way in which the sample was obtained (internet volunteers) means that it is a convenience sample. Convenience samples cannot give us prevalence estimates, and so that term should not be used in the title ... Continue reading

General comments

The way in which the sample was obtained (internet volunteers) means that it is a convenience sample. Convenience samples cannot give us prevalence estimates, and so that term should not be used in the title or the paper itself. That three-quarters of the respondents were female indicates clearly that this was not a representative sample.

Nowhere do the authors tell us exactly what question(s) they used to measure self-reported dry mouth (xerostomia). I had to follow a link to the questionnaire and find it myself – which is not good enough. Also, the question they used was not a good measure. It is bound to over-estimate the proportion of their sample with dry mouth. I suggest that they read the following paper: Thomson WM. Issues in the epidemiological investigation of dry mouth. Gerodontology 22: 65-76 (2005 [Ref-1]). Chapter 7 in Guy Carpenter’s book on dry mouth (Dry mouth: a clinical guide on causes, effects and treatments. Edited by Guy Carpenter. Springer Science and Business Media, 2015 [Ref-2]. [ISBN 978-3-642-55153-6]) will also be useful.

Section comments

1. Introduction
In its current form, this fails to make a useful case for conducting the study. The Introduction should make a compelling, scientifically-based case for conducting the study. Consider using the classic 3-paragraph structure: para 1, what we know; para 2, what we don't know; para 3, why this study was done.

The term 'total alteration' may not be very meaningful and should be avoided.
Medications are by far the most important risk factor for dry mouth – see the latest US Surgeon-General report on oral health.

The authors should read carefully the systematic review by Agostini et al. (2018 [Ref-3]). How common is dry mouth? Systematic review and meta-regression analysis of prevalence estimates. Brazilian Dental Journal 29: 606-618 (2018).

The final paragraph is particularly untidy – the phrase “predominance was seen more among women… compared to men…” is a mystery. First, predominance in what sense? Second, don’t use the awful “compared to” – use “than”.

The last sentence of the Intro would be appropriate if they had used a population-based random sample, but they did not. And the term ‘explore” is inappropriate.

2. Methods

Do not refer to your pretest group as a “population” or as “subjects”. They were neither – they were a convenience sample of volunteers… it doesn’t matter whether you sampled them randomly or not – the sampling frame was not a complete list of the population.

Sample size determination was done with an assumed prevalence of 50% - which is too high (see the Agostini et al paper) – and no reference to back it up..

Change “demographics” to “demographic characteristics”.

As pointed out above, you have not described how you measured your dependent variable – that’s a major omission

3. Results

Use the past tense in describing your study and its findings.

In the Results text, do not repeat Table data – the reader can see the data in the Tables; authors should draw reader's attention to the important parts and features. Have one paragraph of Results text per Table – this helps the reader to navigate your paper – and introduce each Table at the beginning of its paragraph, not at the end. Avoid using the term "compared to" when making comparisons - use 'than' (eg. “Rates were higher among males compared to females” should be written as “Rates were higher among males than females”). Take a close look at the more highly cited and recent papers, to get an idea of how it is done.

Present %, means and SDs to only 1 decimal place, not 2.

There is an over-reliance on P values – concentrate instead on what the data show. See Amrhein et al, Nature 2019 [Ref-4]; 567: 305-307.

You cannot say that xerostomia “increased with age” – you did not see it “increase”; rather, it was more common among those in the older age groups.

4. Discussion
In the Discussion and conclusion, use the term 'findings' rather than 'results'.

Please organise your discussion in a better manner. See Docherty and Smith, BMJ 1999 [Ref-5]; 318: 1224-5 for reference. We encourage that structure – and it is the one recommended in the STROBE guidelines. As a general rule, the first paragraph of the Discussion should briefly reiterate what the study did and what it showed. The second paragraph should address the weaknesses of the study design and measures, etc. The paragraphs which follow should then discuss how the findings support or refute the current literature. The final paragraph should tie it all together – so what? Where next? What are the implications for practice?

When comparing rates in your study with those reported by others, you have to look critically at the design and reporting of those other studies and pay attention only to the sound studies with representative samples and appropriate measurement of the condition under study.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

References

1. Thomson WM: Issues in the epidemiological investigation of dry mouth.Gerodontology. 2005; 22 (2): 65-76 PubMed Abstract | Publisher Full Text
2. Dry Mouth. 2015. Publisher Full Text
3. Agostini BA, Cericato GO, Silveira ERD, Nascimento GG, et al.: How Common is Dry Mouth? Systematic Review and Meta-Regression Analysis of Prevalence Estimates.Braz Dent J. 2018; 29 (6): 606-618 PubMed Abstract | Publisher Full Text
4. Amrhein V, Greenland S, McShane B: Scientists rise up against statistical significance.Nature. 2019; 567 (7748): 305-307 PubMed Abstract | Publisher Full Text
5. Docherty M, Smith R: The case for structuring the discussion of scientific papers. BMJ. 1999; 318 (7193): 1224-1225 Publisher Full Text

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Dental epidemiology and health services research; life-course research; gerodontology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

CITE

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VERSION 1 PUBLISHED 10 Oct 2022

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Version 1 10 Oct 22	read	read

W Murray Thomson, The University of Otago, Dunedin, New Zealand
Dalia Ghalwash, The British University in Egypt, El Sherouk City, Egypt

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Reviewer Report

2 Views

08 Mar 2025 | for Version 1

Dalia Ghalwash, Oral Medicine and Periodontology, Faculty of Dentistry, The British University in Egypt, El Sherouk City, Egypt

2 Views Cite this report Responses(0)

Approved

This study represents a cross-sectional, questionnaire-based survey to explore the prevalence of xerostomia and its associated risk factors among the Saudi population.
Exploring the risk factors associated with xerostomia is an important topic that needs special attention since xerostomia affects the quality of life.

This cross-sectional study evaluated the prevalence of xerostomia in a wide age range group of those 30 to 70 years old. Demographic data with systemic and dental- related history was collected. The presence of xerostomia and the risk factors such as age, sex, history of smoking, history of systemic disease, and medication history are noted. Xerostomia affected 42.3% of cases, especially in older age groups, and was significantly higher among women. There was a statistically significant association between xerostomia and gastrointestinal disorders, endocrine disorders, blood diseases, cardiovascular disorders, and allergies.

This study is of an appropriate sample size and targets the general public living around the central region of Saudi Arabia. The prevalence of xerostomia seems to be higher among the Saudi population. Dissemination of this information among practicing dentists will help gain insight into xerostomia among the Saudi population and ways of managing the condition. Dentists must learn the necessary skills to improve the condition of patients with xerostomia, as it can impact the quality of life.

This is an important area of research that lacks complete information, especially in Arab countries. The work is clearly presented, but it would be beneficial if the study included more cities and a larger sample size.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

References

1. Ghalwash D, El-Gawish A, Ammar A, Hamdy A, et al.: Epidemiology of Sjogren's syndrome in a sample of the Egyptian population: a cross-sectional study.J Int Med Res. 2024; 52 (10): 3000605241289292 PubMed Abstract | Publisher Full Text
2. Ghalwash D, Abou-Bakr A, Ammar A, Hamdy A, et al.: Prevalence profile of burning mouth syndrome in a sample of Egyptian population: A cross-sectional clinical based study. Exploration of Medicine. 2024. Publisher Full Text

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Oral Medicine, diagnosis, epidemiologic studies. Detection and prevention of oral cancer. Periodontology and implant dentistry

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (0)

Back to all reports

Reviewer Report

3 Views

13 Feb 2025 | for Version 1

W Murray Thomson, Department of Oral Sciences, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand

3 Views Cite this report Responses(0)

Not Approved

General comments

The way in which the sample was obtained (internet volunteers) means that it is a convenience sample. Convenience samples cannot give us prevalence estimates, and so that term should not be used in the title or the paper itself. That three-quarters of the respondents were female indicates clearly that this was not a representative sample.

Nowhere do the authors tell us exactly what question(s) they used to measure self-reported dry mouth (xerostomia). I had to follow a link to the questionnaire and find it myself – which is not good enough. Also, the question they used was not a good measure. It is bound to over-estimate the proportion of their sample with dry mouth. I suggest that they read the following paper: Thomson WM. Issues in the epidemiological investigation of dry mouth. Gerodontology 22: 65-76 (2005 [Ref-1]). Chapter 7 in Guy Carpenter’s book on dry mouth (Dry mouth: a clinical guide on causes, effects and treatments. Edited by Guy Carpenter. Springer Science and Business Media, 2015 [Ref-2]. [ISBN 978-3-642-55153-6]) will also be useful.

Section comments

1. Introduction
In its current form, this fails to make a useful case for conducting the study. The Introduction should make a compelling, scientifically-based case for conducting the study. Consider using the classic 3-paragraph structure: para 1, what we know; para 2, what we don't know; para 3, why this study was done.

The term 'total alteration' may not be very meaningful and should be avoided.
Medications are by far the most important risk factor for dry mouth – see the latest US Surgeon-General report on oral health.

The authors should read carefully the systematic review by Agostini et al. (2018 [Ref-3]). How common is dry mouth? Systematic review and meta-regression analysis of prevalence estimates. Brazilian Dental Journal 29: 606-618 (2018).

The final paragraph is particularly untidy – the phrase “predominance was seen more among women… compared to men…” is a mystery. First, predominance in what sense? Second, don’t use the awful “compared to” – use “than”.

The last sentence of the Intro would be appropriate if they had used a population-based random sample, but they did not. And the term ‘explore” is inappropriate.

2. Methods

Do not refer to your pretest group as a “population” or as “subjects”. They were neither – they were a convenience sample of volunteers… it doesn’t matter whether you sampled them randomly or not – the sampling frame was not a complete list of the population.

Sample size determination was done with an assumed prevalence of 50% - which is too high (see the Agostini et al paper) – and no reference to back it up..

Change “demographics” to “demographic characteristics”.

As pointed out above, you have not described how you measured your dependent variable – that’s a major omission

3. Results

Use the past tense in describing your study and its findings.

In the Results text, do not repeat Table data – the reader can see the data in the Tables; authors should draw reader's attention to the important parts and features. Have one paragraph of Results text per Table – this helps the reader to navigate your paper – and introduce each Table at the beginning of its paragraph, not at the end. Avoid using the term "compared to" when making comparisons - use 'than' (eg. “Rates were higher among males compared to females” should be written as “Rates were higher among males than females”). Take a close look at the more highly cited and recent papers, to get an idea of how it is done.

Present %, means and SDs to only 1 decimal place, not 2.

There is an over-reliance on P values – concentrate instead on what the data show. See Amrhein et al, Nature 2019 [Ref-4]; 567: 305-307.

You cannot say that xerostomia “increased with age” – you did not see it “increase”; rather, it was more common among those in the older age groups.

4. Discussion
In the Discussion and conclusion, use the term 'findings' rather than 'results'.

Please organise your discussion in a better manner. See Docherty and Smith, BMJ 1999 [Ref-5]; 318: 1224-5 for reference. We encourage that structure – and it is the one recommended in the STROBE guidelines. As a general rule, the first paragraph of the Discussion should briefly reiterate what the study did and what it showed. The second paragraph should address the weaknesses of the study design and measures, etc. The paragraphs which follow should then discuss how the findings support or refute the current literature. The final paragraph should tie it all together – so what? Where next? What are the implications for practice?

When comparing rates in your study with those reported by others, you have to look critically at the design and reporting of those other studies and pay attention only to the sound studies with representative samples and appropriate measurement of the condition under study.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

References

1. Thomson WM: Issues in the epidemiological investigation of dry mouth.Gerodontology. 2005; 22 (2): 65-76 PubMed Abstract | Publisher Full Text
2. Dry Mouth. 2015. Publisher Full Text
3. Agostini BA, Cericato GO, Silveira ERD, Nascimento GG, et al.: How Common is Dry Mouth? Systematic Review and Meta-Regression Analysis of Prevalence Estimates.Braz Dent J. 2018; 29 (6): 606-618 PubMed Abstract | Publisher Full Text
4. Amrhein V, Greenland S, McShane B: Scientists rise up against statistical significance.Nature. 2019; 567 (7748): 305-307 PubMed Abstract | Publisher Full Text
5. Docherty M, Smith R: The case for structuring the discussion of scientific papers. BMJ. 1999; 318 (7193): 1224-1225 Publisher Full Text

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Dental epidemiology and health services research; life-course research; gerodontology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

Respond to this report

Responses (0)

[1] 1. Kumar B, Kashyap N, Avinash A, et al.: The composition, function and role of saliva in maintaining oral health: A review. Int. J. Contemp. Dent. Med. Rev. 2017; 2017.

[2] 2. Maddu N: Functions of saliva. Saliva and Salivary Diagnostics. IntechOpen;2019.

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[4] 4. Warde P, Kroll B, O'sullivan B, et al.: A phase II study of Biotene in the treatment of postradiation xerostomia in patients with head and neck cancer. Support Care Cancer. 2000; 8(3): 203–208. PubMed Abstract | Publisher Full Text

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[6] 6. Escobar A, Aitken-Saavedra JP: Xerostomia: an update of causes and treatments. Salivary Glands-New Approaches in Diagnostics and Treatment. 2018. Publisher Full Text

[7] 7. Talha B, Swarnkar SA: Xerostomia. StatPearls. Treasure Island FL:© 2021, StatPearls Publishing LLC; 2021.

[8] 8. Orellana MF, Lagravère MO, Boychuk DG, et al.: Prevalence of xerostomia in population-based samples: a systematic review. J. Public Health Dent. 2006; 66(2): 152–158. PubMed Abstract | Publisher Full Text

[9] 9. Ohara Y, Hirano H, Yoshida H, et al.: Prevalence and factors associated with xerostomia and hyposalivation among community-dwelling older people in Japan. Gerodontology. 2016; 33(1): 20–27. PubMed Abstract | Publisher Full Text

[10] 10. So JS, Chung SC, Kho HS, et al.: Dry mouth among the elderly in Korea: a survey of prevalence, severity, and associated factors. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2010; 110(4): 475–483. PubMed Abstract | Publisher Full Text

[11] 11. Samnieng P, Ueno M, Shinada K, et al.: Association of hyposalivation with oral function, nutrition and oral health in community-dwelling elderly Thai. Community Dent. Health. 2012; 29(1): 117–123. PubMed Abstract PubMed Abstract

[12] 12. Thomson WM, Chalmers JM, Spencer AJ, et al.: The occurrence of xerostomia and salivary gland hypofunction in a population- based sample of older South Australians. Special care in dentistry: official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry. 1999; 19(1): 20–23. PubMed Abstract | Publisher Full Text

[13] 13. Johns D: Radiotherapy related xerostomia in head and neck oncology: A systematic review. Ann. Oncol. 2017; 28: v390–v391. Publisher Full Text

[14] 14. Nederfors T, Isaksson R, Mörnstad H, et al.: Prevalence of perceived symptoms of dry mouth in an adult Swedish population--relation to age, sex and pharmacotherapy. Community Dent. Oral Epidemiol. 1997; 25(3): 211–216. PubMed Abstract | Publisher Full Text

[15] 15. Johansson AK, Johansson A, Unell L, et al.: Self-reported dry mouth in 50- to 80-year-old Swedes: Longitudinal and cross-sectional population studies. J. Oral Rehabil. 2020; 47(2): 246–254. Publisher Full Text

[16] 16. Farsi J: Prevalence of self-reported xerostomia in a cross- sectional population in the western province of Saudi Arabia. Saudi Dent J. 2005; 17(1).

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[21] 21. Agha-Hosseini F, Moosavi MS, Mirzaii-Dizgah I: Salivary flow, testosterone, and femur bone mineral density in menopausal women with oral dryness feeling. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2013; 115(5): 612–616. PubMed Abstract | Publisher Full Text

[22] 22. Eliasson L, Carlén A, Laine M, et al.: Minor gland and whole saliva in postmenopausal women using a low potency oestrogen (oestriol). Arch. Oral Biol. 2003; 48(7): 511–517. PubMed Abstract | Publisher Full Text

[23] 23. Fox PC, Atkinson JC, Macynski AA, et al.: Pilocarpine treatment of salivary gland hypofunction and dry mouth (xerostomia). Arch. Intern. Med. 1991; 151(6): 1149–1152. Publisher Full Text

[24] 24. Johansson AK, Johansson A, Unell L, et al.: A 15-yr longitudinal study of xerostomia in a Swedish population of 50-yr-old subjects. Eur. J. Oral Sci. 2009; 117(1): 13–19. PubMed Abstract | Publisher Full Text

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Prevalence of xerostomia and its associated risk factors among Saudi population: a cross-sectional survey

Abstract

Keywords

Introduction

Methods

Study design

Setting

Ethical statement

Study population

Data collection

Statistical analysis

Results

Table 1. Prevalence of xerostomia based on age and gender.

Table 2. Prevalence of xerostomia among patients with a medical condition.

Table 3. Prevalence of reported symptoms of xerostomia.

Table 4. Prevalence of xerostomia by medications.

Discussion

Conclusion

Data availability

Underlying data

Extended data

References

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