Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, lack of blinding, selective outcome reporting), byinconsistency (variability in results) and byimprecise results (few patients for each comparison).
A Cochrane review [Abstract] 1 on topical interventions for the treatment of dry mouth symptom included 36 studies with a total of 1 597 subjects. The trials compared saliva stimulants (lozenges, chewing gums, toothpastes) and saliva substitutes (viscous products applied to the oral mucosa in the form of sprays, gels, oils, mouthwashes, mouthrinses, pastilles or viscous liquids) either to placebo or to each other. Due to the range of interventions, comparisons and outcome measures in the trials, meta-analysis was possible for only a few comparisons. Oxygenated glycerol triester (OGT) saliva substitute spray showed evidence of effectiveness compared to an electrolyte spray (standardised mean difference [SMD] 0.77, 95% CI 0.38 to 1.15) which corresponds to approximately a mean difference of 2 points on a 10-point visual analogue scale (VAS) for mouth dryness. Both integrated mouthcare systems (toothpaste + gel + mouthwash) and oral reservoir devices showed promising results but there is insufficient evidence at present to recommend their use. Although chewing gum is associated with increased saliva production in the majority of those with residual capacity, there is no evidence that gum is more or less effective than saliva substitutes.
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