Severity Of Dry Mouth Research Articles

The Effect of Menthol Ice on Laparoscopic Cholecystectomy Patients' Thirst, Dry Mouth, Mouth Taste, and Bad Mouth Odor: A Randomized Controlled Trial

PurposeThis study aimed to determine the effect of menthol ice application on thirst, dry mouth, mouth taste, and bad mouth odor in patients who underwent laparoscopic cholecystectomy in the postoperative period. DesignThe study was conducted as a randomized controlled trial with an experimental design. MethodsThe study sample consisted of 90 patients who underwent laparoscopic cholecystectomy and met the inclusion criteria. Patients were divided into three groups by randomization program. Patients in the menthol ice and ice popsicle (ice prepared with drinking water only) group were administered menthol ice/ice popsicle (10ml) twice at 20 minutes intervals. Patients in the control group did not receive any intervention. Routine practices of the clinic were performed by the nurses of the general surgery clinic. Postoperative thirst intensity, severity of dry mouth, bad taste, and bad odor in the mouth were evaluated at 0, 20, and 40 minutes. FindingsThere was no statistically significant difference between the sociodemographic and clinical characteristics of the patients in the control group, menthol ice group, and ice popsicle group (p>0.05). It was found that there was a statistically significant difference between the groups in terms of thirst intensity and severity of dry mouth at times in patients in the control group, menthol ice, and ice popsicle group at the 20th and 40th minutes after the application (p<0.01). It was found that there was a statistically significant difference between the bad taste and bad odor sensation scores of the patients in the control and intervention groups at the 20th and 40th minutes after the application (p<0.05). ConclusionThe study concluded that menthol ice and ice popsicle application are effective strategies to reduce the intensity of thirst, severity of dry mouth, bad taste, and bad odor in postoperative patients.

Effect of chewing gum containing Zingiber officinale on dry mouth condition in haemodialysis patients compared to chewing gum without Zingiber officinale

IntroductionXerostomia is the most common presentation of salivary glands dysfunction affecting about 20% of the population. This study investigated the effect of ginger gum on xerostomia and quality of life in haemodialysis patients. MethodsThirty patients undergoing haemodialysis with dry mouth were randomly divided to ginger and placebo gum groups. At the beginning of the study, unstimulated and stimulated saliva samples were collected and Xerostomia Inventory (XI) and Oral Health Impact Profile (OHIP-Per14) questionnaires were administered. After 14 days, stimulated and unstimulated saliva samples were collected again and XI and OHIP-Per14 questionnaires were completed. Analysis of covariance was applied for statistical analysis. ResultsThe rate of unstimulated salivary flow (P=0.03) and oral health related quality of life (P=0.03) were significantly higher in patients that received ginger chewing gum. The amount of stimulated saliva (P=0.10) and the mean severity of dry mouth (P=0.19) were higher in patients receiving ginger gum compared to the placebo group, but the difference was not statistically significant. ConclusionWith regard to the effect of ginger gum on increasing unstimulated saliva and quality of life, it can be proposed as a safe, inexpensive, and available method to manage dry mouth.

Development and Proposal of a Novel Scoring System to Classify Dry Mouth Severity

Dry mouth is a common complaint with unmet treatment needs, reflected by the fact that more than 500 trials are registered on ClinicalTrials.gov. Comparisons across studies, however, are difficult as inclusion criteria vary widely. Additionally, the terms xerostomia and hyposalivation are often not separated. Thus, the aim of the present work was to develop a dry mouth severity score (DMSS) that incorporates published questionnaires and measures both xerostomia and hyposalivation and proposes a grading system that can be used as a common basis for inclusion into clinical trials. The DMSS was developed through the use of data from patients in the Dry Mouth Clinic, University of Oslo, Norway. Five groups of patients (n = 131) and controls (n = 59) were included: primary Sjögren’s syndrome, non-Sjögren’s syndrome, radiated head and neck cancer, psychiatry, and controls. The proposed DMSS includes five parameters with corresponding cut-off values given 1 point (p) each: the General Xerostomia Question ≥ 2, Summated Xerostomia Inventory ≥ 11, Clinical Oral Dryness Score ≥ 6, and secretion of unstimulated and chewing-stimulated whole saliva with cut-off values at ≤0.1 mL/min and ≤0.7 mL/min, respectively. The proposed score range for DMSS is 0–3, where score 0 corresponds to 0p, score 1 to 1–2p, score 2 to 3p, and score 3 to 4–5p. In the patient group, 65% had a high DMSS of 2 or 3, while 78% of the controls scored 0. The sensitivity and specificity were high (0.93 and 0.78, respectively), and the internal reliability was satisfactory (Cronbach’s alpha 0.80). The proposed DMSS represents a novel method to uniformly classify dry mouth patients for applicable comparison between clinical trials.

Dry mouth in patients with a life-limiting condition or frailty: a study protocol for two intervention studies and a nested qualitative sub-study (the Dry mOuth Project, DROP)

BackgroundDespite its prevalent and impactful nature, dry mouth remains an underexposed and undertreated symptom in patients with a life-limiting condition or frailty. The main contributing factors are a lack of awareness and knowledge amongst both healthcare professionals and patients, and a scarcity of effective, evidence-based interventions. In the DRy mOuth Project (DROP), we address these factors by investigating both a non-pharmacological and a pharmacological intervention: a nurse-led patient education program and locally applied pilocarpine.MethodsThis intervention-based research project consists of two parallel studies. The non-pharmacological study is a cluster non-randomized controlled trial in 228 palliative nursing home and hospital patients, investigating the effect of structured use of guidelines and of patient education on dry mouth symptoms. This intervention, a nurse-led patient education program (the Mouth Education Program, MEP), will be compared to care as usual, the control. The pharmacological study is a double-blind placebo-controlled randomized trial that examines the effect of locally applied pilocarpine drops in 120 patients with dry mouth symptoms. Both studies use the same mixed-methods study design, in which the primary outcome is the clinical response to the intervention at 4 weeks, as measured by a dry mouth severity score (numeric rating scale from 0 to 10). Other outcomes, as measured by questionnaires over a 12-week follow-up period, include durability of the effect, impact on quality of life and, adherence and acceptability of the intervention. In addition, the feasibility and cost-effectiveness are evaluated by means of questionnaires and focus groups with healthcare professionals, and interviews with patients.DiscussionThis study investigates the effectiveness and feasibility of two interventions for dry mouth symptoms in patients with life-limiting conditions or frailty. Due to the large-scale and mixed-method nature of the study, this study will also improve our understanding of dry mouth and its relating factors and of the patients’ and healthcare professionals’ experiences with symptoms, care and guidelines of dry mouth, including any perceived barriers and facilitators.Trial registrationNCT05964959 & NCT05506137.

The effect of age on the severity of dry mouth occurring in patients receiving high dose radioactive iodine treatment

Aims: Dry mouth of individuals causes many oral discomforts and undesirable conditions. In order to prevent such an undesirable situation from occurring, it is aimed to complete the Radioactive Iodine Therapy (RAI) treatment with less damage by mastering all possible factors. In our study, we aimed to find the level of the effect of the age factor.&#x0D; Methods: In this study, we included patients who received high-dose radioactive iodine treatment after total thyroidectomy for differentiated thyroid cancer and were hospitalized in our clinic. These patients were selected among the patients who applied to our hospital between 2021-2022. We specifically focused on patients who reported dry mouth and obtained salivary gland scintigraphies of their submandibular glands. Afterwards, we looked at the ratio of the age of the patients with the level of dry mouth. We analyzed the collected data using statistical methods.&#x0D; Results: The data analysis was performed using the Chi-square (χ2) test and the Spearman correlation test to examine the relationship between age and the severity of dry mouth in patients undergoing high-dose RAI treatment for thyroid cancer. Our hypotheses were two-sided, and statistical significance was considered at p-values ≤0.05. The results of our analysis revealed that there was no significant direct correlation between age and the severity of dry mouth in the patients. This suggests that age is not a determining factor for the occurrence or severity of dry mouth in individuals receiving high-dose RAI treatment.&#x0D; Conclusion: In our study, it was concluded that the age factor alone was not a determining factor in terms of the severity of dry mouth. Therefore, it is important to consider additional factors and potential underlying causes when evaluating and managing dry mouth in patients receiving high-dose RAI therapy for thyroid cancer.

Dry mouth effects from drugs used for depression, anxiety, schizophrenia and bipolar mood disorder in adults: systematic review.

Poor oral health is increasingly recognised as an important comorbidity in people with psychiatric illness. One risk factor is psychotropic-induced dry mouth. To perform a systematic review of the severity of dry mouth due to psychotropic drugs in adults (CRD42021239725). Study quality was assessed using the Cochrane risk of bias tool. We searched the following databases: PubMed, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL and Web of Science. We included randomised controlled trials (RCTs) measuring the severity of drug-induced hyposalivation and xerostomia. Eighteen RCTs with 605 participants were included. Severity of drug-induced dry mouth was compared among eight drug classes and/or against placebo. All studies were published 20 to 40 years ago and included tricyclic antidepressants (TCAs), serotonin specific reuptake inhibitors (SSRIs) and other drug classes. Meta-analysis was not feasible owing to design heterogeneity. TCAs caused more severe dry mouth, both objectively and subjectively, than placebo or other drug classes. SSRIs were generally associated with less severe symptoms. However, there was no information on antipsychotics or more recently available antidepressants, and there was minimal information on mood stabilisers. Most studies were on healthy subjects, limiting the generalisability of findings. Only one study measured both objective and subjective dry mouth, which have different clinical implications. Psychotropic-induced dry mouth is a poorly researched area, and well-designed RCTs of newer psychotropic drugs using standardised objective and subjective measures are indicated. Given the ongoing use of TCAs for treatment-resistant depression, prescribers need to remain vigilant for xerostomia.

The effect of oral zinc sulfate on prevention of chemotherapy-induced oral mucositis in breast cancer patients treated with adriamycin and cyclophosphamide; a double-blind randomized clinical trial

Introduction: One of the most important complications faced by cancer patients is chemotherapy-induced oral mucositis (CIOM). In addition, the role of orally used zinc sulfate in its prevention and treatment is still a controversial issue and the results in this regard have not been conclusive. Objectives: Evaluation the effect of zinc sulfate supplement on prevention of CIOM in breast cancer patients treated with adriamycin and cyclophosphamide was the aim of this study. Patients and Methods: The current double-blind randomized clinical trial was conducted on 87 patients with breast cancer. Consumption of two oral zinc sulfate tablets and two placebo tablets with food was prescribed in the case (44 patients) and control (43 patients) groups, respectively. During the 4 cycles of chemotherapy, the incidence and severity of CIOM, the onset time of mucositis from the start of chemotherapy, the severity of pain, and the severity of dry mouth were recorded. In addition, the patients’ quality of life was recorded using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Results: Findings revealed that the severity of CIOM in the first, second, and third sessions with the values of 1.22±1.01, 1.18±0.97 and 1.02±0.79, respectively, was significantly lower in the case group than the control group with the values of 1.91±0.89, 1.80±0.92, and 1.67±0.85, respectively (P&lt;0.05). In addition, the severity of pain and dry mouth in the first and second sessions of chemotherapy was significantly lower in the case group (P&lt;0.05). However, no significant difference was observed between the two groups in quality of life (P&gt;0.05). Conclusion: Oral zinc sulfate had a significant role in reduction of the incidence and severity of CIOM, the severity of dry mouth, and the severity of pain in the initial sessions of chemotherapy. However, no significant difference was in postponing the incidence of CIOM and the quality of life of patients in the case group. Trial Registration: This trial protocol was approved by the Iranian Registry of Clinical Trials (identifier: IRCT20150304021338N2; https://irct.ir/trial/51105, ethical code# IR.MUI.MED. REC.1399.277).

Prevalence of dry mouth in adult patients in primary health care

Objectives To determine the prevalence and severity of dry mouth by age, gender, presence of disease, and medication intake for patients aged 18 years and over, seeking primary health care on the west coast of Sweden (Region of Västra Götaland, VGR). Materials and methods Cross-sectional study conducted among patients (n = 374, age ≥ 18) visiting primary health care providers (n = 4) in VGR for any medical reasons. Patients were invited to participate by answering a single-item question, ‘Have you experienced dry mouth in the last six months?’ Patients giving positive answers (n = 163) were asked to fill in the 11-item Xerostomia Inventory (XI) questionnaire to determine the variability and severity of xerostomia. Patients replying ‘No’ (n = 211) to the single-item question were considered not to have xerostomia and included in the non-xerostomia group. Results The overall prevalence of xerostomia was 43.6% with a female dominance (61.2%). The prevalence in different age groups among females and males was similar. The number of medications and/or diseases are positively associated with xerostomia. Medication was a significant predictor of the prevalence of xerostomia, regardless of age and gender (p < .001). Patients with five or more medications had the highest prevalence of xerostomia (71.2%). Conclusion Patients seeking primary care on the west coast of Sweden have a high prevalence of xerostomia. Factors associated with xerostomia were female gender and medications and/or diseases. Awareness is required to manage patients with xerostomia in medical and dental care.

A Priori Knowledge of Maximum Achievable Organ at Risk Sparing: Impact on Organ Doses and Patient Reported Outcomes

IMRT planning is challenging, at least in part, due to the essentially-infinite number of possibilities, and since the planner is never sure that they have gotten "the best", or at least "nearly the best" achievable plan. We prospectively assessed the impact of providing IMRT planners with a priori knowledge of the maximum achievable dose sparing for organs at risk (OARs) for patients on both dosimetric and clinical endpoints. We hypothesized that a priori knowledge of maximum achievable sparing would improve dosimetric and clinical (i.e., patient reported outcome) measures.We examined patients receiving IMRT for oropharynx cancer on prospective clinical trials from 2012-2019 at our institution. A tool that generates estimates of maximum achievable dose sparing for organs at risk was used starting July 2016. Patients treated pre-implementation (i.e., baseline) and post-implementation (i.e., experimental) were compared for the endpoints: (1) Doses received by various OARs MINUS doses achievable (per the tool), termed the 'excess of feasible dose'; (2) Plan quality metrics (e.g., target homogeneity and conformity), and (3) Patient reported outcomes (PRO) per questionnaires completed at 3-, 6- and 12-months post-treatment.139 patients were analyzed (60-baseline cohort, 79-experimental). (1) The excess of feasible dose was lower in the experimental (vs baseline) cohort, for the contralateral parotid (9.6 vs 5.5 Gy; P < 0.001), the ipsilateral parotid (17.6 vs 6.8 Gy; P < 0.001), larynx (12.5 vs 8.2 Gy; P = < 0.001), oral cavity by (15.8 vs 14.3 Gy; P = 0.002), and contralateral submandibular gland (17.4 vs 17 Gy; P = 0.40). Lesser variation of excess of feasible dose (i.e., more consistent sparing) was seen in the experimental (vs. baseline) cohort for the parotid and contralateral submandibular glands (P < 0.05). (2) Some small differences in target homogeneity and conformity were observed but not felt to be clinically significant. (3) The average post-RT PROs were significantly better in the experimental cohort vs baseline at 6 months post-RT. Dry mouth severity, sticky saliva, meal enjoyment, severity of pain, and EAT10 composite (swallowing) were all significantly improved; P < 0.05).Clinical plans aided by an a priori estimate of maximum achievable dose sparing for OARs was associated with improved (and more consistent) OAR sparing and better clinical outcomes (i.e., better post-RT PROs). Clinical implementation of this tool can yield quantifiable dosimetric and patient benefits.

Chemosensory Function in Burning Mouth Syndrome a Comparative Cross-Sectional Study.

Taste and smell are considered to be functions that contribute to the maintenance of good nutritional status. The present study evaluates taste and smell function in patients with burning mouth syndrome (BMS) versus a control group. A cross-sectional study was made of 36 consecutive patients with BMS and 56 healthy patients. Smell was assessed using the Sniffin’ Sticks test, while taste was evaluated with Taste Strips. Oral quality of life was assessed with the Oral Health Impact Profile-14 (OHIP-14), and the severity of dry mouth with the Thompson Xerostomia Inventory. The patients with BMS had a mean age of 60.4 ± 10.5 years, while the controls had a mean age of 61.3 ± 19 years. No significant differences in smell were recorded between the two groups. In contrast, significant differences in taste function were observed between the patients with BMS and the controls. In the patients with BMS, 44.4% suffered taste alterations compared with the 3.4% healthy controls. Further studies in such patients are needed to allow improved management of the chemosensory problems, mouth dryness, and oral health-related quality of life in BMS.

PCN32 THE ROLE OF ORAL CARE IN THE PALLIATIVE CARE

The oral problems including dry mouth, stomatitis and candidiasis are one of the important problems which should be resolved in the palliative care. The purpose of this study was to investigate oral problems in this stage and improvement of dry mouth by oral care. Mouth care is an essential aspect of palliative care in all settings and should be considered part of daily routine patient care. Assessment and intervention should be instigated early to optimize patient comfort and prevent more serious problems and treatment complications. The study is a retrospective, quantitative analysis. Through a purposive sampling we analyzed records of tumor- and terminal stage patients who were involved in the service of the Pécs-Baranya County Hospice Foundation and met enroll criteria in 2018. The study subjects were consecutive terminally ill cancer patients admitted over the past half years. The following 3 items were retrospectively investigated. The incidences of these oral problems, the severity of dry mouth and complication with other oral problems and how can improvement of dry mouth use standard oral care by nursing staff. Descriptive (absolute- and relative frequency, variance, mean, modus, and mathematical statistics (correlation, chi-square test, variance-analysis (ANOVA), T-test) were done on the sample (p<0,05) using MS Excel and SPSS 22.0. The incidences of dry mouth, stomatitis, and candidiasis were significantly higher in the last hours. (p< 0.001). Severe cases of candidiasis were noted in 20.0% and dry mouth has benne reporter in 64.8% of people with advanced cancer and taste sensation diminishes in 25–50% of people living with cancer. Accurate diagnosis of oral problems and corresponding appropriate interventions are important for improving quality of end-of-life care.

Oral health in hematopoietic stem cells transplantation survivors

Objectives Complications of hematopoietic stem cell transplantation (HSCT) are common and may negatively impact the quality of life of patients. The aim of this study was to characterize the oral health status of a cohort of HSCT survivors. Study Design A retrospective medical record review was conducted for a select group of HSCT survivors seen at the Oral Medicine Clinic at Dana Farber Cancer Institute from July 2014 until October 2018 as part of the HSCT survivorship clinic. Data included past medical history, information on HSCT, and oral health status pre-HSCT and in survivors. Graft-versus-host disease (GVHD) was graded according to the National Institutes of Health Oral Mucosal Score. The Fox questionnaire was used to assess the severity of dry mouth. Descriptive statistics were used to summarize the data. Results A total of 89 patients were included (53.9% males; median age 58 years). All patients received a dental evaluation and the necessary treatment in the 3 months before HSCT to achieve optimal oral health. Acute myeloid leukemia was the most frequent diagnosis (39.3%; n = 35) followed by myelodysplastic syndrome (19.1%; n = 17). All patients underwent allogeneic stem cell transplantation (SCT), and 12.3% (n = 11) received total body irradiation. On examination (performed 339 days after HSCT; range 262–566 days), 55 patients (61.7%) had oral cGVHD (mild: 55.3%; moderate: 28.6%; severe: 16.1%) with lichenoid features (92.8%) and erythema (64.3%), and 42.8% had extraoral GVHD. Topical steroids were prescribed to 45 patients (50.5%). A median pain score of 5 (range 1–9) was reported by 21.3% of patients; 46.1% (n = 42) needed to avoid certain foods because of oral pain/sensitivity. Sixty-one patients had dry mouth (68.5%; median dryness score: 4 [range 1–10]); 34.1% (n = 31) had difficulty swallowing food and drink because of dryness; and 44% (n = 40) needed to sip liquids to swallow. Jaw tightness and taste changes were reported by 9 patients (9.9%) and 33 patients (36.2%), respectively. Sialagogues were prescribed to 9 patients (10.1%). Caries were identified in 7 patients. Conclusions Oral complications in HSCT survivors are common and may include GVHD, dry mouth, and taste changes. All patients must be screened prior to HSCT and followed up by a dentist periodically to assess the oral health status and modify treatment, if needed.

Palliative care assessment of dry mouth: what matters most to patients with advanced disease?

PurposeDry mouth is a highly prevalent and significant symptom in patients with advanced progressive diseases. It is a poorly understood area of research, and currently, there is no standardised outcome measure or assessment tool for dry mouth.MethodsTo assess responses to self-reported dry mouth questions, the impact of dry mouth, methods used to reduce symptoms and relevance of the questionnaire. A cross-sectional multisite study of 135 patients with advanced progressive disease experiencing dry mouth. Participants were located in the inpatient, day care, outpatient or community setting.ResultsThe majority (84.4%) of patients rated their dry mouth as moderate or severe using the verbal rating scale (VRS). Seventy-five percent (74.7%) had a numeric rating scale (NRS) score of 6 or more for dry mouth severity. Patients reported that dry mouth interfered most with talking and was the most important function to assess (median score 6 out of 10) followed by eating (median 5) and taste (median 5). Taking sips of drink was the most common and most effective self-management strategy. Over half of patients (54.6%) also reported impact on swallow and sleep and associated dryness of lips, throat and nasal passages.ConclusionsThis study highlights the severity of dry mouth in advanced disease. Important factors when assessing patients with dry mouth should include the functional impact on day-to-day activities including talking, dysphagia and sleep. Simple considerations for patients include provision of drinks and reviewing medications. This study could be used to develop a standardised assessment tool for dry mouth to use in clinical practice.

Inhibition of salivary secretion by tolterodine transdermal patch.

Tolterodine, a nonselective muscarinic antagonist available only as immediate release (IR) or extended release (ER) oral formulations, is used for the treatment of overactive bladder (OAB). This study aimed to compare the efficacy and extent of dry mouth adverse effects of tolterodine transdermal patch to the oral formulation. The two formulations have been examined through the muscarinic receptor binding tests conducted in bladder and salivary gland tissues and the salivary secretion tests conducted in rats. Comparable average tolterodine blood concentration levels were obtained 3h after oral administration of tolterodine 25mg/kg and 12h after transdermal application of tolterodine patch 6mg/8cm2. While Kd in the bladder tissue increased to a similar degree in both formulations of tolterodine, Kd in the salivary gland increased to a greater degree in the oral formulation. These results indicate that similar degree of inhibitory effects were observed in the bladder for both formulations while less inhibitory effects were observed in the salivary gland with tolterodine transdermal formulation compared to the oral formulation. For assessment of salivary secretion, tolterodine transdermal patch 6mg/8cm2 application resulted in significantly less inhibitory effects than oral tolterodine 25mg/kg. Therefore, this study suggests that tolterodine transdermal patch could be a useful formulation that provides uniform and consistent inhibitory effects to effectively control OAB symptoms with reduced severity of dry mouth in comparison to the oral formulation.

Clinical outcomes of concurrent chemoradiotherapy with volumetric modulated arc therapy in patients with locally advanced nasopharyngeal carcinoma

The purpose of this study was to analyze the clinical results of concurrent chemoradiotherapy (CCRT) with volumetric modulated arc therapy (VMAT) for nasopharyngeal carcinoma (NPC) patients. Patients with stage II-IVB NPC who received CCRT with VMAT between 2010 and 2014 were included in this study. The planned dose was 70Gy in 35 fractions. Twenty patients aged between 28 and 85years (median 60years) were assessed. With a median follow-up time of 47months, the 3-year overall survival and progression-free survival rates were 85 and 65%, respectively. The 3-year local, regional and distant control rates were 78, 88 and 79%, respectively. At 0, 3, 6 and 12months from CCRT, 19, 6, 3, and 1 patients had grade 2 dry mouth, respectively. No cases of grade 3 or worse dry mouth were observed. The severity of dry mouth was downgraded from grade 2 to grade 0 or 1 significantly earlier in younger patients (<70years, p=0.02) or patients in whom the mean dose to one parotid gland was lower (<26Gy, p=0.04). Our clinical results regarding CCRT with VMAT for NPC patients showed favorable survival rates while maintaining organ function.

Herbal Medicine for Xerostomia in Cancer Patients: A Systematic Review of Randomized Controlled Trials.

Background: Xerostomia (dry mouth) causes many clinical problems, including oral infections, speech difficulties, and impaired chewing and swallowing of food. Many cancer patients have complained of xerostomia induced by cancer therapy. Objective: The aim of this systematic review is to assess the efficacy of herbal medicine for the treatment of xerostomia in cancer patients. Materials and Methods: Randomized controlled trials investigating the use of herbal medicines to treat xerostomia in cancer patients were included. We searched the following 12 databases without restrictions on time or language. The risk of bias was assessed using the Cochrane Risk of Bias Tool. Results: Twenty-five randomized controlled trials involving 1586 patients met the inclusion criteria. A total of 24 formulas were examined in the included trials. Most of the included trials were insufficiently reported in the methodology section. Five formulas were shown to significantly improve the salivary flow rate compared to comparators. Regarding the grade of xerostomia, all formulas with the exception of a Dark Plum gargle solution with normal saline were significantly effective in reducing the severity of dry mouth. Adverse events were reported in 4 trials, and adverse effects of herbal medicine were reported in 3 trials. Conclusions: We found herbal medicines had potential benefits for improving salivary function and reducing the severity of dry mouth in cancer patients. However, methodological limitations and a relatively small sample size reduced the strength of the evidence. More high-quality trials reporting sufficient methodological data are warranted to enforce the strength of evidence regarding the effectiveness of herbal medicines.

The effect of submandibular gland preservation during level 1B neck dissection on postoperative xerostomia

ObjectiveCompare the presence and degree of postoperative xerostomia following preservation or excision of the submandibular gland (SMG) during level IB neck dissection (ND) without adjuvant radiation. MethodsRetrospective review with patient questionnaire administered to patients with pT1-2N0 oral squamous cell carcinoma (SCC) who underwent resection and ND with SMG preservation or SMG excision without postoperative radiation from 2011 to 2015. We analyzed an additional control group that was age and gender-matched and had not undergone oral resection or SMG excision. We compared the scores reported by the three groups from three questionnaires: University of Michigan Xerostomia Quality of Life (XeQoL), Short Form-8 (SF-8), and a xerostomia severity scale (XSS). Dry mouth severity (DMS) was calculated based on XSS scores among those complaining of any xerostomia. ResultsEleven SMG preservation group, 14 SMG excision group and 15 control group patients completed the survey. Complication and recurrence rates were comparable among experimental groups. No differences were identified between the two experimental groups for the XeQoL, SF-8, and XSS questionnaires (p=0.96, 0.87, 0.7). Control patients reported less xerostomia on XeQoL (p=0.046) and XSS (p=0.01) compared to the experimental groups combined with no statistical difference in SF-8 scores (p=0.25). No patients in either group developed regional recurrence in level IB. ConclusionSMG preservation, though technically and oncologically sound, does not appear in this study to reduce xerostomia. Oral resection with ND may result in some degree of xerostomia perception.

Does Systemic Disease Aggravate the Severity of Dry Mouth by Anticholinergics in Overactive Bladder Patients?

In overactive bladder (OAB) patients with systemic diseases, dry mouth tends to be more prominent owing to the effects of systemic diseases or related medications. We evaluated how systemic diseases affect dry mouth before and after anticholinergic treatment. OAB patients were enrolled in this study. The patients were divided according to the presence or absence of systemic diseases. Patients with systemic diseases were sub-grouped by the number of systemic diseases (only one or more than one disease). OAB symptoms score (OABSS), visual analogue scale (VAS) score for dry mouth, and body mass index (BMI) were measured. The statistical assessments were donewith independent T-tests and ANCOVAs. One hundred and four OAB patients were enrolled in this study. Seventy (67.3%) patients had systemic diseases and thirty-four (32.7%) patients did not. Age and BMI were higher in the systemic diseases group. The baseline VAS score of OAB in the systemic diseases group (15.9 &plusmn; 19.5) was higher than that in the OAB without systemic diseases group (4.1 &plusmn; 6.4) (P = .002). Even after age and BMI adjustment, the difference was significant. The follow-up VAS score was also different (P = .028), but the change in VAS score was not different (P = .280). In a sub-analysis, the change in VAS score in the group with two or more systemic diseases (23.6 &plusmn; 18.1) was higher than that in the group with only one systemic disease (12.5 &plusmn; 13.2) (P = .012). The severity of xerostomia after treatment with anticholinergics in OAB increases in patients with one systemic disease parallel to its severity before starting treatment. However, in patients with two or more systemic disease the magnitude of change in xedrostomia score is higher that we would expect in patients with no or one systemic diasese.

Comparison of mirabegron and imidafenacin for efficacy and safety in Japanese female patients with overactive bladder: A randomized controlled trial (COMFORT study).

To evaluate the efficacy and safety of mirabegron compared with imidafenacin for the treatment of female patients with overactive bladder. Patients (n = 89) were randomized to receive 0.1 mg imidafenacin twice daily (n = 47) or 50 mg mirabegron once daily (n = 42) for 12 weeks. The primary efficacy end-point was change in total Overactive Bladder Symptom Score. Secondary efficacy end-points included change in Overactive Bladder Symptom Score, 3-day micturition diary, International Prostate Symptom Score and Overactive Bladder Questionnaire. Safety assessments included adverse events, vital signs, post-void residual volume and patient-reported incidence, and severity of distinctive symptoms related to adverse events. The mirabegron group showed a significantly reduced mean total Overactive Bladder Symptom Score from baseline, but no significant differences were noted in change of total Overactive Bladder Symptom Score compared with the imidafenacin group. Significant improvements in secondary efficacy end-points were observed regarding the mean number of micturitions/24 h, mean number of urgency episodes/24 h, mean number of incontinence episodes/24 h, mean volume voided/micturition, total International Prostate Symptom Score and quality of life in both groups, with no significant differences between the groups. The overall incidence of adverse events and the incidence of dry mouth were significantly higher in the imidafenacin group than in the mirabegron group. Patient-reported incidence and the severity of dry mouth were significantly exacerbated in the imidafenacin group. Treatment with 50 mg mirabegron once daily effectively relieves overactive bladder symptoms in women with fewer adverse events than treatment with antimuscarinics.

Characteristics of Oral Problems and Effects of Oral Care in Terminally Ill Patients With Cancer.

Various distresses appear in the terminal stage of cancer. Oral problems including dry mouth, stomatitis and candidiasis are one of the important problems which should be resolved. The purpose of this study was to investigate oral problems in this stage and improvement of dry mouth by oral care. The study subjects were consecutive terminally ill cancer patients admitted over the past 2 years. Patients were divided based on the status of oral food intake into good oral food intake group (≥30%) and poor oral food intake group. The following 3 items were retrospectively investigated: 1) The incidences of these oral problems, 2) Severity of dry mouth and complication with other oral problems, 3) Improvement of dry mouth using standard oral care by nursing staff and specialist oral care including dentists as needed. There were 115 and 158 patients in good and poor oral intake groups, respectively. 1) The incidences of dry mouth, stomatitis, and candidiasis were significantly higher in poor oral intake group ( p < 0.001). 2) Severe cases of dry mouth (Grade-2&3) were noted in 20.0% and 64.8% in good and poor oral intake groups, respectively ( p < 0.0001). Candidiasis complication rate was significantly higher in poor oral intake group ( p = 0.0002). 3) The rate of dry mouth improvement by oral care was 100% in Grade-1, 86% in Grade-2 and 81% in Grade-3. Oral problems occur in many of terminally ill cancer patients. Accurate diagnosis of oral problems and corresponding appropriate interventions are important for improving quality of end-of-life care.