What do systematic reviews say?

Chewing gum vs Saliva substitute spray

Chewing gum (mechanical saliva stimulant) showed no clear difference in salivary flow (unstimulated whole saliva) compared with saliva substitute spray; GRADE not reported.

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  MD 0.01 [-0.01, 0.04]
  2 studies
  GRADE not reported

Mucin spray (Saliva Orthana) vs Placebo spray (base without mucin)

Mucin spray (Saliva Orthana) showed no clear difference in xerostomia (VAS mouth dryness) compared with placebo spray (base without mucin); GRADE not reported.

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  Duxbury 1989 (crossover): statistically significant improvement in dry mouth on a VAS favouring the mucin spray group (Analysis 1.2; SMD not numerically reported).
  1 study
  GRADE not reported

Physostigmine gel (1.8 mg) vs Placebo gel

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  Khosravani 2009 (crossover, low risk of bias, n=17): reduction in oral dryness (VAS area-under-curve over first 180 minutes) after 1.8 mg physostigmine gel; reported graphically, not usable for meta-analysis.
  1 study · 17 participants
  GRADE not reported

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

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  Ship 2007 reported xerostomia-related quality of life; no usable comparative data.
  1 study
  GRADE not reported

Mucoadhesive disk (carbomer/triglycerides + antimicrobial agents) vs Placebo disk

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  No difference in salivary flow rates between active and placebo disks.
  1 study
  GRADE not reported

Mucin-containing lozenge vs placebo control

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  Patient preference strongly favoured the mucin lozenge (P < 0.001, binomial test).
  1 study · 42 participants
  GRADE not reported

Buffered 'Prophylin' prophylactic gel vs Placebo gel

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  Attempts to measure saliva secretion failed because the elderly participants were unable to co-operate.
  1 study · 14 participants
  GRADE not reported

Carboxymethylcellulose (CMC) spray vs Salinum linseed oil spray

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  Andersson 1995 (crossover, n=20): more participants experienced a reduction in oral dryness with linseed (Salinum) spray than with CMC spray; crossover data not accounted for, no usable estimate.
  1 study · 20 participants
  GRADE not reported

Various saliva stimulants (chewable tablet, lozenges, chewing gum, CMC mouthrinse/sprays; 8-arm) vs Saliva substitutes / other products

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  Bjornstrom 1990 (8-arm crossover, high risk of bias, 106 enrolled, 55 used all 8 products): all products relieved dry mouth and difficulty talking/swallowing 'to some extent'; V6 chewing gum and Salivin lozenge ranked…
  1 study · 106 participants
  GRADE not reported

Oxygenated glycerol triester (OGT) spray vs Saliveeze (aqueous electrolyte) spray

Oxygenated glycerol triester (OGT) spray led to higher xerostomia (mouth dryness scale) compared with saliveeze (aqueous electrolyte) spray; GRADE not reported.

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  SMD 0.77 [0.38, 1.15]
  2 studies
  GRADE not reported

Mucin spray (Saliva Orthana) vs Placebo spray (base without mucin)

Mucin spray (Saliva Orthana) led to lower patient satisfaction / desire to continue treatment compared with placebo spray (base without mucin); GRADE not reported.

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  Sweeney 1997: majority in both groups wished to continue the allocated spray, no significant difference (Analysis 1.3). Duxbury 1989: 14/30 (46.6%) and 15/30 (50%) wished to continue Saliva Orthana and the spray base…
  2 studies
  GRADE not reported

CMC spray / HCC spray / HCC gel vs Liquid margarine (and between each other)

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  Furumoto 1998 (crossover, n=28, medians/IQR): median day-10 oral dryness (lower = less dry): CMC spray 28.00 (3.06), HCC spray 28.75 (2.23), HCC gel 27.75 (3.62), margarine 29.25 (5.06). Only HCC gel showed a…
  1 study · 28 participants
  GRADE not reported

Intraoral device releasing Biotene Oral Balance gel vs Manually administered bolus of the same gel

Intraoral device releasing Biotene Oral Balance gel led to lower xerostomia (Xerostomia Inventory) compared with manually administered bolus of the same gel; GRADE not reported.

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  SMD -1.01 [-1.44, -0.58]
  1 study · 22 participants
  GRADE not reported

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

Commercial mouthcare system (Biotene Oral Balance / Xerostom) showed no clear difference in salivary flow (unstimulated whole saliva) compared with usual care or CMC-based control; GRADE not reported.

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  MD 0.02 [-0.02, 0.06]
  2 studies
  GRADE not reported

V6 chewing gum / mucin chewing gum vs PTC chewing gum (xylitol/sorbitol/mannitol)

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  Olsson 1991 (crossover, high risk of bias, n=14): both gums increased saliva secretion, peaking 17.5 minutes after chewing started; significant treatment-by-period interaction; no per-group data presented.
  1 study · 14 participants
  GRADE not reported

Pilocarpine lozenge (3 mg or 5 mg) vs placebo control

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes

  Single dose (up to 3 hours)
  Taweechaisupapong 2006 (crossover): participants reported a statistically significant improvement in oral dryness after both 3 mg and 5 mg pilocarpine lozenges vs placebo (P <= 0.05); no usable data presented. No…
  1 study · 33 participants
  GRADE not reported

Mucin spray (Saliva Orthana) vs Placebo spray (base without mucin)

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  Blixt-Johansen 1992 (parallel, elderly long-term care, poor oral mucosa): oral mucosa improved in both groups but a much greater reduction in oral pathology in the mucin spray group; no data presented.
  1 study
  GRADE not reported

Carbopol (polyacrylic acid/acetate) spray vs Placebo spray

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  van der Reijden 1996 (crossover, Sjogren's syndrome): carbopol spray found partially effective; none of the sprays were completely effective; no data suitable for inclusion.
  1 study
  GRADE not reported

Intraoral device releasing Biotene Oral Balance gel vs usual care without an aid

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  Frost 2002 (crossover, n=30, Sjogren's syndrome): overall mouth dryness favoured the device but only nearly significant (median 4 (IQR 2 to 4) device vs 3 (2 to 4) control; P = 0.056). Speech (P = 0.003) and swallowing…
  1 study · 30 participants
  GRADE not reported

Mucin spray (Saliva Orthana) vs Placebo spray (base without mucin)

Mucin spray (Saliva Orthana) showed no clear difference in duration of relief of dryness compared with placebo spray (base without mucin); GRADE not reported.

• Interventions for the management of dry mouth: topical therapies 2011 · Cochrane All outcomes
  Duxbury 1989: no difference between mucin spray and placebo in the duration of relief of dryness (Analysis 1.4).
  1 study
  GRADE not reported