Efficacy of saliva substitutes and stimulants in the treatment of dry mouth
Lydia See BDSc, MS
Master Program in Geriatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
Lydia See is currently a Senior Lecturer in Special Needs Dentistry, School of Dentistry and Health Sciences, Charles Sturt University.
Search for more papers by this authorMehdi Mohammadi DDS, MPH, MS
Master Program in Geriatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
Assistant Professor of Clinical Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
Search for more papers by this authorPhuu P. Han DDS, PhD
Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
Search for more papers by this authorRoseann Mulligan DDS, MS
Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
Search for more papers by this authorCorresponding Author
Reyes Enciso PhD
Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
Correspondence
Reyes Enciso, PhD, Associate Professor—Instructional, Division of Dental Public Health and Pediatric Dentistry, 925 West 34th St, room 4268, Herman Ostrow School of Dentistry of USC, Los Angeles, CA, 90089–0641 USA.
Email: [email protected]
Search for more papers by this authorLydia See BDSc, MS
Master Program in Geriatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
Lydia See is currently a Senior Lecturer in Special Needs Dentistry, School of Dentistry and Health Sciences, Charles Sturt University.
Search for more papers by this authorMehdi Mohammadi DDS, MPH, MS
Master Program in Geriatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
Assistant Professor of Clinical Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
Search for more papers by this authorPhuu P. Han DDS, PhD
Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
Search for more papers by this authorRoseann Mulligan DDS, MS
Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
Search for more papers by this authorCorresponding Author
Reyes Enciso PhD
Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
Correspondence
Reyes Enciso, PhD, Associate Professor—Instructional, Division of Dental Public Health and Pediatric Dentistry, 925 West 34th St, room 4268, Herman Ostrow School of Dentistry of USC, Los Angeles, CA, 90089–0641 USA.
Email: [email protected]
Search for more papers by this authorAbstract
Aims
To evaluate the efficacy of saliva substitutes and stimulants compared to placebo in improving findings of dry mouth not caused by Sjӧgren's.
Methods and Results
Four databases were searched (PubMed, Web of Science, Cochrane Library, and EMBASE) through March 2018. Only randomized controlled trials (RCT) using placebo interventions with dry mouth patients were included. Outcomes included salivary flow and self-reported patient improvement. The Cochrane Collaboration's tool for assessing risk of bias was used. A total of 348 references were reviewed, resulting in 7 RCTs with 257 dry mouth patients with 5 studies at high risk of bias, 1 unclear and 1 low risk being included. Topical spray of 1% malic acid increased unstimulated (Difference in Means [DM] = 0.096, 95% CI = 0.092-0.100; P < 0.001) and stimulated (DM = 0.203, 95% CI = 0.106-0.300; P < 0.001) salivary flow in 2 studies. Patients using 1% malic acid topical spray were 5.4 times more likely to report improvement compared to placebo (95% CI = 2.634-11.091; P < 0.001) in 2 studies. No significant improvements were found with other products when compared to placebo.
Conclusion
Use of 1% malic acid topical spray seems to improve dry mouth compared to placebo. Quality of the evidence was low due to risk of bias and imprecision.
CONFLICTS OF INTEREST
The authors have no conflicts of interest.
REFERENCES
- 1Hopcraft M, Tan C. Xerostomia: an update for clinicians. Aust Dent J. 2010; 55(3): 238-244. https://doi.org/10.1111/j.1834-7819.2010.01229.x.
- 2Wolff A, Joshi RK, Ekstrom J, et al. A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: a systematic review sponsored by the World Workshop on Oral Medicine VI. Drugs R D. 2017; 17(1): 1-28. https://doi.org/10.1007/s40268-016-0153-9.
- 3Yang WF, Liao GQ, Hakim SG, Ouyang DQ, Ringash J, Su YX. Is pilocarpine effective in preventing radiation-induced xerostomia? A systematic review and meta-analysis. Int J Radiat Oncol Biol Phys. 2016; 94(3): 503-511. https://doi.org/10.1016/j.ijrobp.2015.11.012.
- 4Furness S, Worthington H, Bryan G, Birchenough S, Mcmillan R. Interventions for the management of dry mouth: topical therapies. Cochrane Database Syst Rev. 2011; 7(12): CD008934s. https://doi.org/10.1002/14651858.CD008934.pub2.Copyright.
- 5Dost F, Farah CS. Stimulating the discussion on saliva substitutes: a clinical perspective. Aust Dent J. 2013; 58(1): 11-17. http://www.ncbi.nlm.nih.gov/pubmed/23441787. Accessed January 30, 2017.
- 6Han P, Suarez-Durall P, Mulligan R. Dry mouth: a critical topic for older adult patients. J Prosthodont Res. 2015; 59(1): 6-19. https://doi.org/10.1016/j.jpor.2014.11.001.
- 7Plemons JM, Al-Hashimi I, Marek CL. Managing xerostomia and salivary gland hypofunction. J Am Dent Assoc. 2014; 145(8): 867-873. https://doi.org/10.14219/jada.2014.44.
- 8Villa A, Connell CL, Abati S. Diagnosis and management of xerostomia and hyposalivation. Ther Clin Risk Manag. 2014; 11: 45-51. https://doi.org/10.2147/TCRM.S76282.
- 9Vivino F, Al-Hashimi I, Khan Z. Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with sjogren syndrome. Arch Intern Med. 1999; 159: 174-181.
- 10Davies AN, Thompson J. Parasympathomimetic drugs for the treatment of salivary gland dysfunction due to radiotherapy. Cochrane Database Syst Rev. 2015(10): CD003782. https://doi.org/10.1002/14651858.CD003782.pub3.
- 11 Cevimeline (Dental Lexi-Drugs). In: Lexicomp Online for Dentistry. Hudson, Ohio: Lexi-Comp, Inc.; 2012.
- 12 Pilocarpine (systemic). In: Lexicomp Online for Dentistry. Hudson, Ohio: Lexi-Comp, Inc.; 2012. https://online.lexi.com/lco/action/home.
- 13Sood AJ, Fox NF, O'Connell BP, et al. Salivary gland transfer to prevent radiation-induced xerostomia: a systematic review and meta-analysis. Oral Oncol. 2014; 50(2): 77-83. https://doi.org/10.1016/j.oraloncology.2013.10.010.
- 14Alpöz E, Çankaya H, Güneri P, et al. Impact of Buccotherm® on xerostomia: a single blind study. Spec Care Dent. 2015; 35(1): 1-7. https://doi.org/10.1111/scd.12074.
- 15Skrinjar I, Vucicevic Boras V, Bakale I, et al. Comparison between three different saliva substitutes in patients with hyposalivation. Clin Oral Investig. 2015; 19(3): 753-757. https://doi.org/10.1007/s00784-015-1405-8.
- 16Epstein JB, Stevenson-Moore P. A clinical comparative trial of saliva substitutes in radiation-induced salivary gland hypofunction. Spec Care Dentist. 1992; 12(1): 21-23. http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L31350611.
- 17Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7): e1000097. https://doi.org/10.1371/journal.pmed.1000097.
- 18Navarro Morante A, Wolff A, Bautista Mendoza GR, López-Jornet P. Natural products for the management of xerostomia: a randomized, double-blinded, placebo-controlled clinical trial. J Oral Pathol Med. 2017; 46(2): 154-160. https://doi.org/10.1111/jop.12487.
- 19Mercadante V, Al Hamad A, Lodi G, Porter S, Fedele S. Interventions for the management of radiotherapy-induced xerostomia and hyposalivation: a systematic review and meta-analysis. Oral Oncol. 2017; 66: 64-74. https://doi.org/10.1016/j.oraloncology.2016.12.031.
- 20 JPT Higgins, S Green, eds. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from https://training.cochrane.org/handbook.
- 21Cochran W. The combination of estimates from different experiments. Biometrics. 1954; 10: 101-129.
- 22Higgins J, Thompson S. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21: 1539-1558.
- 23Borenstein M, Hedges L V, Higgins JPT, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. 2010; 1(2): 97-111. https://doi.org/10.1002/jrsm.12.
- 24 GRADEpro GDT: GRADEpro Guideline Development Tool. 2015. gradepro.org.
- 25Epstein JB, Emerton S, Le ND, Stevenson-Moore P. A double-blind crossover trial of Oral Balance gel and Biotene toothpaste versus placebo in patients with xerostomia following radiation therapy. Oral Oncol. 1999; 35(2): 132-137.
- 26Gomez-Moreno G, Cabrera-Ayala M, Aguilar-Salvatierra A, et al. Evaluation of the efficacy of a topical sialogogue spray containing malic acid 1% in elderly people with xerostomia: a double-blind, randomized clinical trial. Gerodontology. 2014; 31(4): 274-280. https://doi.org/10.1111/ger.12034.
- 27Gomez-Moreno G, Guardia J, Aguilar-Salvatierra A, Cabrera-Ayala M, Mate-Sanchez de-Val J-E, Calvo-Guirado J-L. Effectiveness of malic acid 1% in patients with xerostomia induced by antihypertensive drugs. Med Oral Patol Oral Cir Bucal. 2013; 18(1): E49-E55. https://doi.org/10.4317/medoral.18206.
- 28Kerr AR, Corby PM, Shah SS, Epler M, Fisch GS, Norman RG. Use of a mucoadhesive disk for relief of dry mouth A randomized, double-masked, controlled crossover study. J Am Dent Assoc. 2010; 141(10): 1250-1256.
- 29Nagy K, Urban E, Fazekas O, Thurzo L, Nagy E. Controlled study of lactoperoxidase gel on oral flora and saliva in irradiated patients with oral cancer. J Craniofac Surg. 2007; 18(5): 1157-1164. https://doi.org/10.1097/scs.0b013e3180de6311.
- 30Sweeney MP, Bagg J, Baxter WP, Aitchison TC. Clinical trial of a mucin-containing oral spray for treatment of xerostomia in hospice patients. Palliat Med. 1997; 11(3): 225-232. https://doi.org/10.1177/026921639701100307.
- 31Hanchanale S, Adkinson L, Daniel S, Fleming M, Oxberry SG. Systematic literature review: xerostomia in advanced cancer patients. Support Care Cancer. 2015; 23(3): 881-888. https://doi.org/10.1007/s00520-014-2477-8.
- 32Davies AN. A comparison of artificial saliva and chewing gum in the management of xerostomia in patients with advanced cancer. Palliat Med. 2000; 14(3): 197-203. http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L30248547.
- 33Lovelace TL, Fox NF, Sood AJ, Nguyen SA, Day TA. Management of radiotherapy-induced salivary hypofunction and consequent xerostomia in patients with oral or head and neck cancer: meta-analysis and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; 117(5): 595-607. https://doi.org/10.1016/j.oooo.2014.01.229.
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