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Intervencije za liječenje suhih usta: topikalna terapija

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Abstract

Background

Xerostomia (the feeling of dry mouth) is a common symptom especially in older adults. Causes of dry mouth include medications, autoimmune disease (Sjögren's Syndrome), radiotherapy or chemotherapy for cancer, hormone disorders and infections.

Objectives

To determine which topical treatments for dry mouth are effective in reducing this symptom.

Search methods

We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (28 October 2011), The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4 2011), MEDLINE via OVID (1950 to 28 October 2011), EMBASE via OVID (1980 to 28 October 2011), CINAHL via EBSCO (1980 to 28 October 2011), AMED via OVID (1985 to 28 October 2011), CANCERLIT via PubMed (1950 to 28 October 2011).

Selection criteria

We included randomised controlled trials of topical interventions such as lozenges, sprays, mouthrinses, gels, oils, chewing gum or toothpastes for the treatment of dry mouth symptom. We classified interventions into two broad categories, saliva stimulants and saliva substitutes, and these were compared with either placebo or another intervention. We included both parallel group and crossover trials.

Data collection and analysis

Two or more review authors independently carried out data extraction and assessed risk of bias. Trial authors were contacted for additional information as required.

Main results

Thirty‐six randomised controlled trials involving 1597 participants met the inclusion criteria. Two trials compared saliva stimulants to placebo, nine trials compared saliva substitutes to placebo, five trials compared saliva stimulants directly with saliva substitutes, 18 trials directly compared two or more saliva substitutes, and two trials directly compared two or more saliva stimulants. Only one trial was at low risk of bias and 17 were at high risk of bias. 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 shows evidence of effectiveness compared to an electrolyte spray (standardised mean difference (SMD) 0.77, 95% confidence interval (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 show 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.

Authors' conclusions

There is no strong evidence from this review that any topical therapy is effective for relieving the symptom of dry mouth. OGT spray is more effective than an aqueous electrolyte spray (SMD 0.77, 95% CI 0.38 to 1.15) which is approximately equivalent to a mean difference of 2 points on a 10‐point VAS scale for mouth dryness. Chewing gums appear to increase saliva production in those with residual secretory capacity and may be preferred by patients, but there is no evidence that gum is better or worse than saliva substitutes. Integrated mouthcare systems and oral reservoir devices may be helpful but further research is required to confirm this. Well designed, adequately powered randomised controlled trials of topical interventions for dry mouth, which are designed and reported according to CONSORT guidelines, are required to provide evidence to guide clinical care. For many people the symptom of dry mouth is a chronic problem and trials should evaluate whether treatments are palatable, effective in reducing xerostomia, as well as the long‐term effects of treatments on quality of life of those with chronic dry mouth symptoms.

Laički sažetak

Postupci za liječenje suhih usta: lokalna terapija

Suha usta su čest problem s nizom uzroka. Simptomi mogu biti posljedica smanjene proizvodnje sline, ili promjene u sastavu sline, ali osjećaj suhoće usta također se može javiti u osoba s normalnom proizvodnjom sline. Radioterapija ili kemoterapija raka glave ili vrata i bolesti kao što su Sjörgenov sindrom, mogu uzrokovati smanjenu proizvodnju sline. Mnogi lijekovi koji se često propisuju povezani su s osjećajem suhih usta, bez obzira na normalnu proizvodnju sline. Poteškoće u govoru, žvakanju, gutanju i produljena suhoća usta dovode do povećanog rizika od karijesa i smanjuju kvalitetu života. U mnogih bolesnika suha usta ne mogu se liječiti, ali za postoje učinkoviti načini za ublažavanje simptoma suhih usta. Mnoge lokalne terapije (izravna primjena unutar usta) kao što su sprejevi, pastile, vodice za ispiranje usta, gelovi, ulja, gume za žvakanje ili paste za zube analizirane su u ovom Cochrane sustavnom pregledu, ali nema jakih dokaza da je bilo koje lokalno liječenje učinkovito za smanjenje osjećaja suhoće usta. Oksigenirani glicerol triester (OGT) je učinkovitiji zamjenski sprej za nadoknadu sline nego vodeni sprej koji se temelji na elektrolitima. Oralne sprave za otpuštanje gela ili sustav njege usta mogu biti učinkoviti, ali potrebna su daljnja istraživanja. Gume za žvakanje povećavaju proizvodnju sline, ali nema dokaza da je guma bolja ili gora od zamjenske sline. Kisele proizvode i one koji sadrže šećer treba izbjegavati.