Randomized trial of the efficacy and safety of a new oral spray for drug-induced xerostomia

Comparative Mucosal Wetting Capacity of Novel and Commercial Saliva Substitute Formulations: An in vitro Study

Purpose

This study evaluated the effectiveness of novel, inexpensive saliva substitute formulas (Rangsit University (RSU) preparation) in maintaining mucosal wetness compared with commercial products.

Materials and Methods

In vitro experiments were conducted using swine tongues to assess the wetness of various RSU saliva substitute solutions and gels, with four flavors each (sweet mint, sweet vanilla, sweet-sour mint, and sweet-sour lemon), compared with water, hospital-based mouth rinse from a government dental school, and commercial products (Biotene® mouthwash and GC Dry Mouth Gel®). The wetness was measured at baseline and at 0, 10, 20, 30, 60, and 120 minutes using a digital moisture analyzer.

Results

All saliva substitutes consistently maintained a higher relative wetness than water, particularly beyond 60 minutes (p < 0.001). RSU solutions with a sour flavor (sweet-sour mint and sweet-sour lemon) had a similar wetness to commercial saliva substitute mouthwash at all times. These solutions were more effective in maintaining higher relative wetness over time than those without a sour flavor (sweet mint and sweet vanilla) (p < 0.05) and provided more wetness than the hospital-based mouth rinse at 120 minutes. The RSU solution formula also provided comparable wetness to RSU gel preparation at every time point. While RSU gel formulas initially provided comparable wetness to water, they maintained significantly higher wetness at 60 minutes (p = 0.029) and 120 minutes (p = 0.002). These results were similar to those of commercial saliva substitute gel, which maintained stable wetness since application up to 120 minutes (p = 0.052).

Conclusion

Our novel saliva substitute formulas show similar effectiveness to commercial products in maintaining mucosal wetness. These inexpensive products could be a viable alternative for patients with dry mouth who cannot afford commercial formulations.

World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia

OBJECTIVE

The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth.

STUDY DESIGN

A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized.

RESULTS

From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains.

CONCLUSION

There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.

Could the use of saliva substitutes improve food oral processing in individuals with xerostomia? A systematic review

Xersotomia is associated with food avoidance and low nutritional assessment. This review seeks to document whether products called "saliva substitutes" or "artificial saliva" can really replace saliva in food oral processing. Pubmed and Science Direct were searched for articles using the keywords "saliva substitutes" and "artificial saliva." An advanced search was applied using the terms "xerostomia" and/or "food oral processing" and/or "eating" and/or "mastication" and/or "chewing" and/or "swallowing." The analysis methods and the inclusion criteria were documented in a protocol published in the International prospective register of systematic reviews (PROSPERO with the registration number CRD42019124585). The search included 43 articles, published between 1979 and 2017. Among the included studies, 17 were observational studies, 5 were pilot studies, 21 were crossover studies, and 14 of these studies were blinded. The Strobe score for the included articles varied from 7.5 to 20. The possible effects of the use of saliva substitutes on the ingestion function were poorly investigated. No evidence was based on physiological studies. It is unknown whether using a saliva substitute has an effect on the composition and rheological properties of the food bolus, on the lubrication of the oral and laryngeal mucosa or on both phenomena. Moreover, saliva substitutes were not formulated to improve food oral processing and most of them are flavored. New saliva substitutes and artificial saliva should be designed and formulated to improve food oral processing.

A randomised controlled pilot trial of two interventions to manage dry mouth in pre-operative elective surgical patients

BACKGROUND

Dry mouth is a common perioperative patient complaint. There are a number of treatments used for dry mouth in other settings which are effective. None have been tested previously in the perioperative setting. Interventions to Manage Dry mouth (IM DRY) compared the effect of water and a saliva substitute on mouth dryness. The primary objective was to demonstrate the feasibility of conducting a large randomised controlled trial and secondary scientific aims were to assess treatment potential efficacy.

METHODS

Single blind, pilot randomised controlled trial (RCT) of 101 pre-operative elective surgical patients who were randomised to water or saliva substitute (Biotene oral rinse, GlaxoSmithKline, Australia) at a tertiary, university hospital. Dry mouth was assessed by 100 mm visual analogue scale (VAS) and 5-point Likert score.

RESULTS

One hundred participants completed follow-up and comprised the analysis dataset. All feasibility outcomes were achieved (recruitment rate > 5 participants a week, >95% completeness of the dataset, study protocol acceptability to staff, acceptability to participants > 66% and adherence to time limits within the protocol). Mean recruitment rate was 6 participants per week. These data were 99% complete. There were no adverse side effects or complications noted. There were no concerns raised by staff regarding acceptability. Overall, there was a mean of 30 min (± SD 5 min) between delivery of the intervention and the assessment, 30 min being the target time. The difference in VAS post intervention was - 11.2 mm (95% CI - 17.3 to - 5.1 mm) for water and - 12.7 mm (95% CI - 18.7 to - 6.7 mm) for saliva substitute. The proportion of patients who had improved dry mouth increased from 52% for water to 62% for saliva substitute.

CONCLUSIONS

IM DRY successfully achieved its primary feasibility aims: recruitment rate, completeness of these, acceptability and protocol adherence. Saliva substitutes, used in the perioperative management of dry mouth, may be a simple, inexpensive, and low risk solution to help alleviate this common complaint. A large randomised controlled trial is feasible and is currently recruiting (ANZCTR 12619000132145).

ETHICS AND TRIAL REGISTRATION

Northern A New Zealand Health and Disability Ethics Committee (reference 17/NTA/152). Australian New Zealand Clinical Trials Registry (Number: 12618001270202). Registered retrospectively 18 October 2018.

Efficacy of Artificial Salivary Substitutes in Treatment of Xerostomia: A Systematic Review

Aim:

To provide an update on artificial saliva used to maintain the health of the oral cavity of patients with severe hyposalivation.

Materials and Methods:

A literature search was conducted in April 2018 in three electronic databases (The Cochrane Central Register of Controlled Trials [CENTRAL], PubMed, and Embase) by combining key words and terms related to the population and intervention of the topic.

Results:

The databases search resulted in 455 titles and abstracts. Of these, 21 were judged to meet inclusion criteria and full texts were read. Finally, 10 clinical trials were included for qualitative synthesis.

Conclusion:

Published evidence suggests that all the artificial saliva products tested in included studies reduced symptoms of xerostomia. These products should specifically be selected according to the patients’ concerns and needs. However, the included studies presented a wide range of products and suffered from high risk of bias. Therefore, long-term randomized controlled trials on effects of various products are required.

Buccal adhesive films with moisturizer- the next level for dry mouth syndrome?

This study was undertaken to prepare films by solvent evaporation method comprising well-known polymers in order to investigate their potential for buccal suitability. Mucoadhesive films were manufactured using different polymers such as ethyl cellulose, hydroxyethyl cellulose, hydroxypropyl methylcellulose as well as carboxymethyl cellulose. Buccal films were evaluated in regards of mucoadhesiveness, swelling and physico-chemical properties. Furthermore rheological measurement and adhesion study were carried out on the buccal porcine mucosa. Moreover, allantoin as humectant was incorporated and trans-mucosal water loss was determined. The results showed that physico-chemical, buccal adhesive and swelling properties varied depending on the composition of the polymers. The findings indicated films containing allantoin to be suitable for buccal application. In completion, adhesive films are appropriate and promising formulations in the treatment of various disease in the intraoral cavity.