Cochrane · intervention · CD009603
Interventions for the management of dry mouth: non‐pharmacological interventions
Furness, S, Bryan, G, McMillan, R, et al. · Cochrane Database of Systematic Reviews · 2013 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
21
current version
GRADE rated
7
No studies
8
Included studies
9
as reported
No studies 8 · 38.1%Ungraded 6 · 28.6%Very low 2 · 9.5%Low 5 · 23.8%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | People seeking treatment for symptoms of dry mouth (xerostomia) due to any cause (haemodialysis; hormonal disorders such as diabetes; autoimmune conditions such as Sjogren's Syndrome, systemic lupus erythematosus and rheumatoid arthritis; immune disorders such as AIDS and graft versus host disease; patients undergoing or having received radiotherapy; and medication-related xerostomia); participants must have had xerostomia at baseline | 366 adult participants randomised (9 RCTs); dry mouth due to radiotherapy for head and neck cancer (4 trials), Sjogren's Syndrome (3 trials), medication-related (1 trial) or mixed causes (1 trial); age range 12 to 77 years |
| Intervention | Non-pharmacological interventions such as acupuncture, electrostimulation or low level laser therapy for the management of xerostomia | Acupuncture (n=153, 5 trials); Electrostimulation devices (n=101 in 2 placebo-controlled trials; 3 trials total including 1 uncontrolled); Powered toothbrush (1 trial) |
| Comparison | Placebo / no treatment / another active non-systemic treatment such as topical salivary stimulants (comparisons with systemic treatments such as oral pilocarpine or cevimeline excluded) | Placebo/sham acupuncture; Placebo/sham electrostimulation device; Manual toothbrush |
| Outcomes | Primary: xerostomia (dry mouth) short term (4 weeks after start of treatment) and longer term (3 months after end of treatment). Secondary: duration of effectiveness; quality of life; patient satisfaction with treatment; adverse events; salivary flow (unstimulated whole saliva UWS or stimulated whole saliva SWS); oral health assessment | Mouth dryness (n=70); Unstimulated whole saliva end of treatment (n=71); Stimulated whole saliva end of treatment (n=71); Unstimulated whole saliva 12 months (n=54); Stimulated whole saliva 12 months (n=54); Adverse effects (narrative) |
| Study designs | Parallel group randomised controlled trials (cross-over studies excluded; trials comparing different frequencies of treatment included) | Parallel-group RCT (n=9) |
| Timing | Short term (4 weeks after start of treatment); longer term (3 months after end of treatment) | End of treatment (4-6 weeks); 12-month (1 year) follow-up |
Search date: 2013-04. Databases: The Cochrane Oral Health Group's Trials Register; The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID; AMED via OVID; CINAHL via EBSCO; CANCERLIT via PubMed; meta Register of Controlled Clinical Trials; ClinicalTrials.gov; reference lists
Questions and results
Current version onlyAcupuncture vs Placebo (sham acupuncture)
Population: Adults with dry mouth due to radiotherapy (head and neck cancer) or Sjogren's Syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Duration of effectiveness | no estimate extracted | 0 studies | No studies |
Quality of life | no estimate extracted | 0 studies | No studies |
Stimulated whole saliva (SWS) 12 months (1 year follow-up) | MD 0.28 [0.09, 0.47] | 2 studies · 54 participants | Low Downgraded: risk of bias, imprecision |
Dry mouth (mouth dryness, different scales) End of treatment (4-6 weeks) | SMD -0.34 [-0.81, 0.14] | 2 studies · 70 participants | Low Downgraded: risk of bias, publication bias |
Oral health assessment | no estimate extracted | 0 studies | No studies |
Unstimulated whole saliva (UWS) 12 months (1 year follow-up) | MD 0.06 [0.01, 0.11] | 2 studies · 54 participants | Low Downgraded: risk of bias, imprecision |
Patient satisfaction with treatment | no estimate extracted | 0 studies | No studies |
Adverse events | Acupuncture was associated with more adverse effects (tiny bruises and tiredness, mild and temporary); List 1998 noted significant eye discomfort; Pfister 2010 reported temporary increases in pain, minor bruising or… | 4 studies | Ungraded |
Unstimulated whole saliva (UWS) End of treatment (4-6 weeks) | MD 0.02 [0, 0.04] | 3 studies · 71 participants | Low Downgraded: risk of bias, inconsistency |
Stimulated whole saliva (SWS) End of treatment (4-6 weeks) | MD 0.19 [0.07, 0.31] | 3 studies · 71 participants | Low Downgraded: risk of bias, inconsistency |
Electrostimulation (device) vs Placebo (sham/placebo device)
Population: Adults with dry mouth due to Sjogren's Syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dry mouth (xerostomia) | Neither trial reported usable dry mouth data; Talal 1992: 'patients using the active device experienced relief from six of the most common symptoms of xerostomia secondary to Sjogren's Syndrome, with two of these… | NR | Ungraded |
Oral health assessment | no estimate extracted | 0 studies | No studies |
Quality of life | no estimate extracted | 0 studies | No studies |
Adverse events | Wong 2003 stated 'no adverse effects were caused by Codetron'; Steller 1988 and Talal 1992 did not mention whether adverse effects occurred | NR | Ungraded |
Patient satisfaction with treatment | no estimate extracted | 0 studies | No studies |
Stimulated whole saliva (SWS) End of treatment (4 weeks) | MD 0.16 [-0.05, 0.37] | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision |
Duration of effectiveness | no estimate extracted | 0 studies | No studies |
Unstimulated whole saliva (UWS) End of treatment (4 weeks) | MD 0.02 [-0.12, 0.16] | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision |
Powered toothbrush vs Manual toothbrush
Population: Adults with medication-related dry mouth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Unstimulated whole saliva (UWS) 45 minutes after brushing | MD -0.07 [-0.74, 0.60] | 1 study | Ungraded |
Stimulated whole saliva (SWS) 5 minutes after brushing | MD -0.13 [-1.92, 1.66] | 1 study | Ungraded |
Dry mouth (xerostomia) | Papas 2006 used a VAS to measure mouth dryness but did not report dry mouth outcome data | 1 study | Ungraded |
Acupuncture vs Placebo (sham acupuncture)
Population: Adults with dry mouth due to radiotherapy (head and neck cancer) or Sjogren's Syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Unstimulated whole saliva (UWS) 12 months (1 year follow-up) | MD 0.06 [0.01, 0.11] | 2 studies · 54 participants | Low Downgraded: risk of bias, imprecision |
Stimulated whole saliva (SWS) 12 months (1 year follow-up) | MD 0.28 [0.09, 0.47] | 2 studies · 54 participants | Low Downgraded: risk of bias, imprecision |
Stimulated whole saliva (SWS) End of treatment (4-6 weeks) | MD 0.19 [0.07, 0.31] | 3 studies · 71 participants | Low Downgraded: risk of bias, inconsistency |
Unstimulated whole saliva (UWS) End of treatment (4-6 weeks) | MD 0.02 [0, 0.04] | 3 studies · 71 participants | Low Downgraded: risk of bias, inconsistency |
Patient satisfaction with treatment | no estimate extracted | 0 studies | No studies |
Adverse events | Acupuncture was associated with more adverse effects (tiny bruises and tiredness, mild and temporary); List 1998 noted significant eye discomfort; Pfister 2010 reported temporary increases in pain, minor bruising or… | 4 studies | Ungraded |
Duration of effectiveness | no estimate extracted | 0 studies | No studies |
Quality of life | no estimate extracted | 0 studies | No studies |
Oral health assessment | no estimate extracted | 0 studies | No studies |
Dry mouth (mouth dryness, different scales) End of treatment (4-6 weeks) | SMD -0.34 [-0.81, 0.14] | 2 studies · 70 participants | Low Downgraded: risk of bias, publication bias |
Electrostimulation (device) vs Placebo (sham/placebo device)
Population: Adults with dry mouth due to Sjogren's Syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Stimulated whole saliva (SWS) End of treatment (4 weeks) | MD 0.16 [-0.05, 0.37] | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision |
Patient satisfaction with treatment | no estimate extracted | 0 studies | No studies |
Oral health assessment | no estimate extracted | 0 studies | No studies |
Adverse events | Wong 2003 stated 'no adverse effects were caused by Codetron'; Steller 1988 and Talal 1992 did not mention whether adverse effects occurred | NR | Ungraded |
Unstimulated whole saliva (UWS) End of treatment (4 weeks) | MD 0.02 [-0.12, 0.16] | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision |
Duration of effectiveness | no estimate extracted | 0 studies | No studies |
Quality of life | no estimate extracted | 0 studies | No studies |
Dry mouth (xerostomia) | Neither trial reported usable dry mouth data; Talal 1992: 'patients using the active device experienced relief from six of the most common symptoms of xerostomia secondary to Sjogren's Syndrome, with two of these… | NR | Ungraded |
Powered toothbrush vs Manual toothbrush
Population: Adults with medication-related dry mouth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dry mouth (xerostomia) | Papas 2006 used a VAS to measure mouth dryness but did not report dry mouth outcome data | 1 study | Ungraded |
Stimulated whole saliva (SWS) 5 minutes after brushing | MD -0.13 [-1.92, 1.66] | 1 study | Ungraded |
Unstimulated whole saliva (UWS) 45 minutes after brushing | MD -0.07 [-0.74, 0.60] | 1 study | Ungraded |
Acupuncture vs Placebo / no treatment / another active non-systemic treatment (e.g. topical salivary stimulant)
Population: People seeking treatment for symptoms of dry mouth (xerostomia) due to any cause (e.g. haemodialysis, hormonal disorders such as diabetes, autoimmune conditions such as Sjogren's Syndrome/SLE/rheumatoid arthritis, immune disorders, radiotherapy, or medications)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Salivary flow - stimulated whole saliva (SWS) | no estimate extracted | NR | No studies |
Salivary flow - unstimulated whole saliva (UWS) | no estimate extracted | NR | No studies |
Dry mouth (xerostomia) Short term (4 weeks after start of treatment); longer term (3 months after end of treatment) | no estimate extracted | NR | No studies |
Patient satisfaction with treatment | no estimate extracted | NR | No studies |
Duration of effectiveness | no estimate extracted | NR | No studies |
Quality of life | no estimate extracted | NR | No studies |
Oral health assessment | no estimate extracted | NR | No studies |
Adverse events | no estimate extracted | NR | No studies |
Electrostimulation vs Placebo / no treatment / another active non-systemic treatment (e.g. topical salivary stimulant)
Population: People seeking treatment for symptoms of dry mouth (xerostomia) due to any cause (e.g. haemodialysis, hormonal disorders such as diabetes, autoimmune conditions such as Sjogren's Syndrome/SLE/rheumatoid arthritis, immune disorders, radiotherapy, or medications)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quality of life | no estimate extracted | NR | No studies |
Adverse events | no estimate extracted | NR | No studies |
Patient satisfaction with treatment | no estimate extracted | NR | No studies |
Salivary flow - stimulated whole saliva (SWS) | no estimate extracted | NR | No studies |
Oral health assessment | no estimate extracted | NR | No studies |
Dry mouth (xerostomia) Short term (4 weeks after start of treatment); longer term (3 months after end of treatment) | no estimate extracted | NR | No studies |
Duration of effectiveness | no estimate extracted | NR | No studies |
Salivary flow - unstimulated whole saliva (UWS) | no estimate extracted | NR | No studies |