Effect of 0.1% pilocarpine mouthwash on xerostomia: double‐blind,randomised controlled trial

The objective of this study was to evaluate the effect of 0.1% pilocarpine mouthwash in xerostomic patients. Sixty volunteers were randomly allocated to two groups. The experimental group used 0.1% pilocarpine solution, and the control group used 0.9% saline. The short‐ and long‐term effects of pilocarpine were investigated by measuring the severity of oral dryness, minor salivary flow rates and unstimulated whole salivary flow rate at predetermined times. The severity of oral dryness was decreased in both groups at 0, 30 and 60 min after mouthwashing, with no significant difference between the groups. Buccal and labial secretions were increased in both groups, but only the experimental group exhibited increased palatal secretion. Labial and palatal secretions, but not buccal secretion, differed between the groups. The unstimulated whole salivary flow rate was increased in the experimental group and differed from that in the control group. After 4 weeks, the severity of oral dryness was decreased in both groups and did not differ between them. The oral dryness at night or on awakening significantly decreased in both groups, with no significant difference between them, but the oral dryness at other times of the day and the difficulty in swallowing foods were not significantly changed in both groups. Minor salivary and unstimulated whole salivary flow rates did not increase in both groups. Until 1 h after mouthwashing, 0.1% pilocarpine mouthwash increased minor salivary and unstimulated whole salivary secretions, but was not superior compared with 0.9% saline at relieving subjective oral dryness.     

Efficacy of lycopene‐enriched virgin olive oil for treating burning mouth syndrome: a double‐blind randomised

Burning mouth syndrome (BMS) is an intensive chronic oral mucosal pain condition of unknown aetiology. The aim of this study was to evaluate the clinical performance of lycopene‐enriched virgin olive oil used to treat the condition, comparing this with a placebo. This study took the form of a double‐bind, randomised clinical trial. A total of 60 patients with BMS were randomly divided into two groups: Group I (n = 30) treated with lycopene‐enriched virgin olive oil (300 ppm) (1·5 mL three times a day) and Group II (n = 30) treated with a placebo (1·5 mL three times a day). Evaluations were made before and after 12 weeks of product/placebo application. Symptoms were evaluated by VAS, whilst patient psychological profiles were assessed using the HAD scale and patient quality of life using the Oral Health Impact Profile‐14 (OHIP‐14) and the Medical Outcome Short Form Health Survey questionnaire (SF36). Fifty patients completed the 12‐week treatment (26 in Group I and 24 in Group II). Visual analogue scale pain values improved in both groups but without statistically significant differences between the groups (P = 0·57). Oral quality of life also improved. Four patients in Group I (treatment) left the study and six left Group II (placebo). No patients experienced any adverse effects resulting from treatment at any of the evaluation times. Patients were lost from the sample due to lack of compliance. It was found that the lipid profile did not change during the 3‐month study period as a result of the application of lycopene‐enriched olive oil (Group I); nor did any change occur in the placebo group (Group II). In this way, the placebo effect was seen to be strong. The topical lycopene‐enriched virgin olive oil is a very safe and an effective similar way that the placebo for treating patients with BMS. However, future studies are required to establish the treatment for patients with chronic and painful syndrome.     

Assessment of the use of sialogogues in the clinical management of patients with xerostomia

This study was conducted to assess the clinical efficacy and adverse effects of pilocarpine, bethanechol and cevimeline In patients with xerostomia. In this open‐label crossover assessment in 20 patients with xerostomia, a one‐ to two‐week course of each medication with a one‐week washout period was prescribed. Side effects, symptoms, whole stimulated and unstimulated saliva were measured. Each sialogogue was found to increase saliva and decrease symptoms. A mixed‐effects analysis showed a greater increase in stimulated saliva on bethanechol compared to pilocarpine (0.106, p=0.0272). Increased sweating was the most common side effect, experienced more frequently with pilocarpine as compared to bethanechol (p=0.0588) or cevimeline (p= 0.0143). A carryover effect beyond the washout period was seen. Effects on saliva and side effects vary between sialogogues, suggesting a benefit of trials with different sialogogues to determine individual patient preference. The observed carryover effect suggests that intermittent treatment may be an alternative to continuous treatment with sialogogues.     

Impact of xerostomia on oral health and quality of life among adults infected with HIV‐1

The study investigated the impact of xerostomia on oral health and quality of life (QoL) among patients infected with human immunodeficiency virus (HIV) who were attending for routine HIV monitoring in Australia. This cross‐sectional, self‐administered questionnaire survey and oral screening (OS) included 100 subjects who were HIV positive. The OS was conducted by a dentist blinded to the subject's survey responses. Xerostomia was determined by asking the subjects a single question. Subjects with xerostomia were found to have increased caries activity and poorer QoL, especially in the psychological dimensions of the oral health impact profile. Age and duration of HIV infection were associated with xerostomia. Early diagnosis of xerostomia and intervention with preventive dental care would potentially reduce caries and improve QoL among patients infected with HIV‐1. Ongoing chronic inflammation of salivary glands despite the beneficial effects of antiretroviral therapy may play a role in the etiology of xerostomia in patients infected with HIV and requires further study.     

Effect of oral iron supplementation on unstimulated salivary flow rate: a randomized, double-blind, placebo-controlled trial

BACKGROUND: No treatment is known to permanently increase salivary flow in patients with hyposalivation. The objective of this study was to investigate the effect of iron supplementation on salivary flow rate. METHODS: A double-blind, randomized, placebo-controlled trial was carried out on 50 individuals with a low unstimulated whole salivary flow rate and low serum ferritin. Half the individuals received 60 mg iron orally twice a day for 3 months, while the other half received placebo. RESULTS: No statistically significant difference was found between the groups after treatment for the unstimulated flow rate and in the subjective assessments of oral dryness. The serum ferritin values increased significantly in the iron group but not in the placebo group. CONCLUSION: Oral supplementation with iron for 3 months has no effect on salivary flow rate among individuals with hyposalivation and low serum ferritin values.     

Oral mutans streptococci levels following use of a xylitol mouth rinse: a double‐blind,randomized, controlled clinical trial

Xylitol‐sweetened chewing gum has cariostatic properties, but is not suitable for all patients. This study evaluated the effect of xylitol rinse on mutans streptococci (MS) levels in the mouth. One hundred and five subjects with high salivary MS levels were randomly assigned to one of three groups. Subjects in the positive control group (N = 35) chewed two xylitol gum pellets for at least 5 minutes three times daily (xylitol dose: 4.3g/day). The experimental group (N = 36) rinsed with 20 mL of an aqueous solution of xylitol twice daily for 60 seconds (dose: 4.4g/day). The negative control group (N = 34) used neither product. No attempt was made to change the subjects’ diet. Mean MS levels at baseline were 5.6 (0.1) in positive control, 5.4 (0.1) in experimental, and 5.5 (0.1) in negative control groups. After 3 months, MS levels were 4.4 (0.2), 4.4 (0.2), and 4.9 (0.2), respectively. Differences between groups were not significant by ANOVA (p = .2); however, MS levels tended to be lower in the experimental and positive control groups. Xylitol rinse and chewing gum caused a similar but statistically insignificant reduction in MS levels in the mouth.     

A clinical trial of a novel emulsion for potential use as a saliva substitute in patients with radiation‐induced xerostomia

Researchers have recently developed a novel oily formulation for potential use as a saliva substitute for the treatment of dry mouth. The aim of this randomised, crossover study was to compare this new formulation to a currently available saliva substitute and a control of water on measures of mastication, subjective feeling of oral dryness and product acceptability. Forty participants treated with radiotherapy to the head and neck and experiencing xerostomia were invited to participate in the trial. Each participant trialled all three products in a randomised order. The effect of each product was measured using the Test of Masticating and Swallowing Solids (TOMASS), the Shortened Xerostomia Inventory (SXI) and a questionnaire designed to test patient acceptability of each product. Outcome data were gathered in a single session after the first administration of each product to evaluate immediate effects and after 7 days of use to evaluate longer‐term effects. Statistical analyses consisted of repeated‐measures analysis of variance and mixed models. There was no evidence that application of the three formulations had an effect on any of the TOMASS measures, either immediately or after one week of use (P > 0·05). There was a significant main effect of formulation on the SXI score (P = 0·02). Application of the novel emulsion resulted in a clinically small but significant improvement in SXI score (P < 0·01); however, application of methylcellulose (P = 0·21) and water (P = 0·81) resulted in no significant difference. There was no difference in participant acceptability between the three products (P = 0·32). The novel oily emulsion showed no clinically significant benefit over two existing products for relief of xerostomia. Indeed, none of the three products demonstrated significant change in patient outcomes.