Could the use of saliva substitutes improve food oral processing in individuals with xerostomia? A systematic review

Abstract

Xersotomia is associated with food avoidance and low nutritional assessment. This review seeks to document whether products called “saliva substitutes” or “artificial saliva” can really replace saliva in food oral processing. Pubmed and Science Direct were searched for articles using the keywords “saliva substitutes” and “artificial saliva.” An advanced search was applied using the terms “xerostomia” and/or “food oral processing” and/or “eating” and/or “mastication” and/or “chewing” and/or “swallowing.” The analysis methods and the inclusion criteria were documented in a protocol published in the International prospective register of systematic reviews (PROSPERO with the registration number CRD42019124585). The search included 43 articles, published between 1979 and 2017. Among the included studies, 17 were observational studies, 5 were pilot studies, 21 were crossover studies, and 14 of these studies were blinded. The Strobe score for the included articles varied from 7.5 to 20. The possible effects of the use of saliva substitutes on the ingestion function were poorly investigated. No evidence was based on physiological studies. It is unknown whether using a saliva substitute has an effect on the composition and rheological properties of the food bolus, on the lubrication of the oral and laryngeal mucosa or on both phenomena. Moreover, saliva substitutes were not formulated to improve food oral processing and most of them are flavored. New saliva substitutes and artificial saliva should be designed and formulated to improve food oral processing.

The effect of artificial saliva on the control of dry mouth: a semi-experimental study on COVID-19 patients under Non-invasive mechanical ventilation

“…Old age, non-invasive mechanical ventilation, and COVID-19 will increase this effect, causing dry mouth. In the study of Piaton et al, the use of artificial saliva three times a day before meals effectively reduced dry mouth and oral mucosa disorders in the elderly [21], which is in line with the present study.…”

“…It can indicate the effectiveness of artificial saliva spray in reducing dry mouth. Studies also confirm the effectiveness of artificial saliva in improving oral health and the quality of life-related to oral health in patients [21]. In the study by Nuchit et al (2020) conducted on patients with head and neck cancer after radiotherapy, artificial saliva was associated with a reduction in dry mouth [22].…”

Effect of salivary fluid characteristics on the physical features of in vitro bread bolus: From the absence of saliva to artificially simulated hypersalivation

“…However, both parameters would be limited by the physiological features and oral abilities of each individual, and do not guarantee the formation of a safe bolus that can be swallowed. In clinical practice, the use of salivary substitutes can alleviate the effects of saliva deficiency but their convenience on bolus properties remains largely unknown (Piaton et al, 2021), and additional research in this area would be still required. The absence of saliva could be slightly palliated consuming certain types of food or drinks, such as carbonated beverages, moisture foods (cherry tomatoes, natural yoghurt, …) or citrus juice, either prior to or concurrently with food intake or to enhance saliva secretion and facilitate swallowing (Gavião et al, 2004).…”

Olfaction disorders in patients with pituitary adenoma after endoscopic transsphenoidal surgery: a qualitative study

“…In addition, for most patients complaining of dry mouth, nursing staff can educate patients to use various moist solutions to alleviate the problem (33,34). For instance, patients may make their lemon water to promote saliva secretion or use cucumber slices and honey to keep their mouths moist.…”