Patient‐related outcomes in Sjögren syndrome treated with stimulants of salivary secretion: Randomized clinical trial

Abstract

Objectives To investigate the impact of gustatory stimulants of salivary secretion (GSSS) on Sjögren's syndrome patients’ self‐perception of xerostomia, oral health‐related quality of life (OHRQoL) and salivary secretion. Methods A total of 110 Sjögren's syndrome patients were randomly allocated to be treated with either a malic acid lozenge or a citric acid mouthwash and then crossed over. Before and after the interventions, the Xerostomia Inventory 5 (SXI‐5‐PL) and the Oral Health Impact Profile (OHIP‐14‐PT) questionnaires (both in the Portuguese language) were administered to patients. Unstimulated, mechanical and gustatory‐stimulated salivary flows were determined. Repeated measures and between‐subject analyses were performed. Statistical significance was set at 5%. Results After the intervention and within each group, both GSSS elicited a reduction in the SXI‐5‐PL and OHIP‐14‐PT scores and an increase in salivary output, significant in the malic acid lozenge group. The malic acid treatment resulted in a greater effect size and percentage improvement than citric acid mouthwash. The malic acid lozenge also produced a significant greater salivary output than the citric acid rising solution. Conclusions In Sjögren's syndrome patients, lozenges containing malic acid increased saliva production and xerostomia relief, resulting in improved quality of life.

Oral-Health-Related Quality of Life in Adult Patients with Rheumatic Diseases—A Systematic Review

“…In a randomized clinical trial, the effect of malic acid on OHRQoL of patients with SS was tested. The largest improvement was recorded for psychological pattern [29]. Another study in patients with RA found correlations between disease activity and the pattern of psychosocial impact [17].…”

“…For a deeper understanding, the subscales of OHRQoL can be considered additionally. Because five studies did not compare subscales to a healthy control [14,17,28,29,32], and different subscales were applied, the comparability is limited. However, some interesting information can be derived from the findings: In the vast majority of studies with a control group (5/6), a significant effect of the subscale "physical disability" was confirmed without any predominant manifestation in one of the included diseases [8,11,20,30,34].…”

“…The OHIP and GOHAI questionnaires appear to be valid and reliable assessment measures for OHRQoL [5]. The available examinations showed appropriate validity for the applied questionnaires, and the majority of available information was provided for OHIP questionnaire [19,[28][29][30][31][32]. Only one study concluded OHIP 49 to be not precise and sensitive for patients with SSc and disease-specific questionnaires to be needed [19].…”

Assessment of DMFT Indexes, Salivary Flow Rate, Ph, and Detections of S.MUTANS Salivary Levels by a Quantitative Real-Time PCR in Polycystic Ovary Syndrome

“…There are studies in the literature evaluating the relationship between various systemic and autoimmune diseases and saliva pH. 35,36 Mumcu et al 37 reported in their study on patients with Behcet's disease that saliva pH was lower compared to the control group. Additionally, Loyola et al 38 reported in their study on Systemic Lupus Erythematosus (SLE) patients that the stimulated saliva flow rate and saliva pH values were lower than the control group, which caused an increase in the DMFT index values.…”

One year in review 2021: Sjögren's syndrome

“…In fact, the injection of a depot formulation of rapamycin into the lacrimal glands of a murine model of sialoadenitis was able to reduce inflammation and improve tear production with significantly lower amounts of drug, compared to systemic administration (89). A randomised clinical trial comparing the effect of citric acid solution and malic acid lozenges as salivary stimulants confirmed their ability to improve secretion and oralrelated quality of life, with the lozenges being more effective than the solution, maybe due to their stronger mechanical stimulation (90). Nevertheless, the increase of salivary secretion induced by pilocarpine does not seem to be effective in improving periodontal conditions, at least in the short period (91).…”