What do systematic reviews say?

Commercial mouthcare system (Biotene Oral Balance / Xerostom) vs Usual care or CMC-based control

Commercial mouthcare system (Biotene Oral Balance / Xerostom) led to higher xerostomia (VAS mouth dryness) compared with usual care or CMC-based control; GRADE not reported.

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  SMD 1.11 [0.33, 1.89]
  1 study
  GRADE not reported

Rofecoxib (oral, 50 mg on first day then 25 to 50 mg per day for 4 days) vs Tinidazole (1 g per day for 3 days)

Rofecoxib (oral, 50 mg on first day then 25 to 50 mg per day for 4… showed no clear difference in total effective rate at 4 days compared with tinidazole (1 g per day for 3 days); GRADE not reported.

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  4 days
  RR 1.17 [0.95, 1.43]
  1 study · 60 participants
  GRADE not reported

Rofecoxib (oral, 50 mg on first day then 25 to 50 mg per day for 4 days) vs Tinidazole (1 g per day for 3 days)

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  4 days
  No adverse effects reported in translation.
  1 study · 60 participants
  GRADE not reported

Prednisone (oral, commencing 25 mg with phased dose reduction over 2 months) vs placebo

Prednisone (oral, commencing 25 mg with phased dose reduction over 2… led to lower time to resolution of first ulcer (days) compared with placebo; GRADE not reported.

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  2 months
  MD -6.35 [-6.74, -5.96]
  1 study · 40 participants
  GRADE not reported

Prednisone (oral, commencing 25 mg with phased dose reduction over 2 months) vs Montelukast (leukotriene receptor antagonist)

Prednisone (oral, commencing 25 mg with phased dose reduction over 2… led to lower time to resolution of first ulcer (days) compared with montelukast (leukotriene receptor antagonist); GRADE not reported.

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  2 months
  MD -2.40 [-2.76, -2.04]
  1 study · 40 participants
  GRADE not reported

Prednisone (oral, commencing 25 mg with phased dose reduction over 2 months) vs placebo

Prednisone (oral, commencing 25 mg with phased dose reduction over 2… led to lower total number of new lesions over 2-month treatment period compared with placebo; GRADE not reported.

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  2 months
  MD -4.20 [-4.84, -3.56]
  1 study · 40 participants
  GRADE not reported

Prednisone (oral, commencing 25 mg with phased dose reduction over 2 months) vs placebo

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  2 months
  Femiano 2003 (high risk of bias) reports days to resolution of pain and days to epithelialization of aphthae at 1 month, and number of aphthae per month after the first and second months; data presented as…
  1 study · 20 participants
  GRADE not reported

Prednisone (oral, commencing 25 mg with phased dose reduction over 2 months) vs placebo

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  2 months
  Femiano 2003: one significant adverse event (gastritis) for the prednisone group versus none for placebo. Femiano 2010: more drug-related adverse effects for those treated with prednisone than placebo.
  2 studies
  GRADE not reported

Prednisone (oral, commencing 25 mg with phased dose reduction over 2 months) vs Montelukast (leukotriene receptor antagonist)

Prednisone (oral, commencing 25 mg with phased dose reduction over 2… showed no clear difference in total number of new lesions over 2-month treatment period compared with montelukast (leukotriene receptor antagonist); GRADE not reported.

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  2 months
  MD -0.30 [-0.90, 0.30]
  1 study · 40 participants
  GRADE not reported

Prednisone (oral, commencing 25 mg with phased dose reduction over 2 months) vs Montelukast (leukotriene receptor antagonist)

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  2 months
  The study reported more drug-related adverse effects for those treated with prednisone than montelukast.
  1 study · 40 participants
  GRADE not reported

Gum chewing (sugar-free) vs Within-subject before/after comparison of soft gum vs hard gum (no no-gum control)

One small study found that chewing hard (but not soft) gum increased oral mucosal moisture.

• The effect of gum chewing on xerostomia and salivary flow rate in elderly and medically compromised subjects: a… 2023 All outcomes

  2-week chewing period (soft then hard gum, with 2-week wash-out) · Haemodialysis units, elderly / geriatric care, cancer and palliative care, and xerostomia / hyposalivation clinics (studies from multiple countries)
  Single study [22] (Nakagawa 2017): chewing hard gum significantly increased oral mucosal moisture whereas chewing soft gum did not.
  1 study · 12 participants
  GRADE not reported

Selenium vs no intervention

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  6 weeks after end of RT
  Insufficient evidence of differences for loss of taste or dysphagia; data largely unusable (no standard deviations). Ageusia milder in selenium group (not significant); dysphagia significant only at week 7 (P = 0.05)…
  1 study
  GRADE not reported

Pilocarpine vs no treatment/placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  End of RT
  Insufficient evidence of a difference: oral discomfort MD -18.00 (95% CI -37.41 to 1.41); eating difficulties MD -14.40 (95% CI -35.38 to 6.58); mucosal pain MD -14.80 (95% CI -37.07 to 7.47); oral complications RR…
  2 studies
  GRADE not reported

Antimicrobial lozenge vs placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  Over 6 months
  Insufficient evidence of a difference for global quality of life, mouth pain RR 0.94 (95% CI 0.66 to 1.33), sore/burning mouth RR 0.95 (95% CI 0.68 to 1.35), throat pain RR 0.79 (95% CI 0.56 to 1.12) (Duncan 2005)
  1 study
  GRADE not reported

Pilocarpine vs placebo

• Parasympathomimetic drugs for the treatment of salivary gland dysfunction due to radiotherapy 2015 · Cochrane All outcomes
  Both studies assessed oral discomfort and dysphonia (Johnson 1993; LeVeque 1993); pilocarpine reported to improve associated symptoms of salivary gland dysfunction (oral discomfort, dysphonia). No pooled data.
  2 studies · 278 participants
  GRADE not reported

Pilocarpine vs Artificial saliva

• Parasympathomimetic drugs for the treatment of salivary gland dysfunction due to radiotherapy 2015 · Cochrane All outcomes
  Davies 1994 assessed dysgeusia and dysphagia; pilocarpine reported more effective than mucin-based artificial saliva for dysgeusia. No pooled data.
  1 study · 20 participants
  GRADE not reported

Acupuncture vs sham

The review found no eligible studies for this question.

• Interventions for the management of dry mouth: non‐pharmacological interventions 2013 · Cochrane All outcomes
  no estimate extracted
  0 studies
  No studies found

Electrostimulation (device) vs Placebo (sham/placebo device)

The review found no eligible studies for this question.

• Interventions for the management of dry mouth: non‐pharmacological interventions 2013 · Cochrane All outcomes
  no estimate extracted
  0 studies
  No studies found

Carboxymethylcellulose (CMC) spray vs Placebo (spray base without CMC / water)

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  Donatsky 1982 (crossover, n=15, Sjogren's syndrome): CMC spray had a similar effect on oral dryness to the spray base, but was more effective than water. Paired crossover data not presented; effect size not estimable.
  1 study · 15 participants
  GRADE not reported

Reservoir biteguard device releasing a saliva substitute (with KY jelly + Saliva Orthana) vs Biteguard without reservoir (with KY jelly + Saliva Orthana)

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  More in the reservoir group experienced relief of an oral impact and fewer a new impact (OIDP), but no difference in the total impact score between groups.
  1 study · 86 participants
  GRADE not reported