Sir, in their excellent update on Sjögren's syndrome (BDJ 2012; 213: 353–357) A. J. Carr and co-authors indicate that artificial saliva products may have limitations in effectiveness. This suggestion is supported by a recent study we performed at the national meeting of the Dutch Sjögren's Patients Federation. This meeting took place on 6 October 2012, and was attended by approximately 350 patients with Sjögren's disease. Seventy-two patients approached randomly were interviewed about their current and past use of artificial saliva products.

Sixty percent of the interviewed patients with Sjögren's disease reported that they ever had used an artificial saliva spray, 67% had ever used a gel-based oral lubricant and 25% a special mouthrinse. However, more than half of the patients had discontinued the use of these products. Currently, only 21% of the patients were still using an artificial saliva spray, 28% a gel-based lubricant and 14% a special mouthrinse.

The major reasons for discontinuation of artificial saliva products were lack of effectiveness and taste. Another frequently reported reason for discontinuation of gel-based oral lubricants was that patients considered it too 'sticky'. The availability of artificial saliva products in stores and the price of the product were only rarely mentioned as reason to discontinue its use.

We conclude that many patients with Sjögren's disease consider the effectiveness and taste of the currently available artificial saliva products as inadequate. There seems to be a need for novel, effective products that provide long lasting relieve, are easy to administer and non-sticky, and have a pleasant taste. For the development of effective artificial saliva products, it might be wise to consult patients with Sjögren's disease about product characteristics at an early stage of the development process.

1. Amsterdam