Relief of dry mouth in type 2 diabetes and other causes

reference

Badooie F., Imani E., Hosseini-Teshnizi S. et al. Comparison of the effect of ginger and aloe vera flushing on xerostomy in patients with type 2 diabetes: a clinical study, triple blind. med oral patol oral cir bucal. 2021; 26 (4): E408-E413.

Study goal

Determination and comparison of the use of mouthwashes with ginger, aloe vera and normal saline solution for relieving xerostomy in patients with type 2 diabetes

draft

A triple -style study

participant

The investigators took up 105 participants and then divided them into 3 groups of 35. For all participants, type 2 diabetes and xerostomy was based on the Fox et al. and the visual analog scale (VAS) diagnosed, and they agreed to take part in the study.

The group with a normal saline solution consisted of 17 men and 18 women aged 58.13 ± 14.75 years. The Aloe Vera Group consisted of 11 men and 24 women aged 53.37 ± 11.57 years. The ginger group consisted of 15 men and 20 women aged 54.14 ± 9.35 years.

exclusion criteria were the presence of oral ulcers or infections, excessive physical activity, the use of mouthwashes or saliva substances, physical or mental restrictions or migration considerations.

Intervention

The participants received 20 ml either 25 % ginger, 50 % aloe vera or normal saline (control). The participants should keep the solution in the mouth for 1 minute and then cough up three times a day for 14 days. The investigators assessed the existence of xerostomy before and after the study based on one by Fox et al. developed 10-question survey in which the participant answers yes or no, and a linear vas from 0 to 100.

study parameters evaluated

The study evaluated the improvement of the subjective feeling of xerostomy, which was reflected in a lower total score from the FOX questionnaire and in a linear decrease in the vas.

Primary result measurement

Different in the total number of points before and after the intervention from the FOX questionnaire, validated with changes in the VAS, with a decrease in an improvement in the subjective feeling of xerostomy.

important knowledge

All 3 groups achieved a statistically significant improvement in xerostomy ( p <0.001). The ginger group had the highest reduction in the overall core (VAS2 - VAS1 = –6.12 ± 2.004 cm); Followed by the Aloe Vera Group (–4.08 ± 2.09 cm) and the saline solution (–2.48 ± 2.09 cm).

practice implications

The authors point out that xerostomy, a subjective feeling of dry mouth, occurs in up to 80 % of the diabetics, failed to draw attention to many other causes of xerostomy, including taking many medications, taking nutritional supplements, psychological factors, Sjögren syndrome, rheumatoid arthritis,, Lupus erythematodes, scleroderma, hypothyroidism, radiation of the head and neck area and salivary gland disease. ^{1,2 In such a prevalence, along with an obvious increase in autoimmune diseases of all kinds, it would be appropriate for all practitioners to be aware of the difficulties that are exposed to patients who are exposed to subjective symptoms of Dry the mouth suffer. In fact, an article from Deepak Daryani Xerostomy as the fourth most known known symptom.}

The authors explain the possible consequences of xerostomy, including infections of the oral cavity, accumulating bacteria that can be systemic, fungal infections, respiratory diseases and cardiovascular effects. Possible complications related to xerostomy are difficulties in speaking, swallowing or tasting dishes as well as the inability to keep denture. These are rather serious effects that all affect quality of life.

While several lenses have been implemented to determine the saliva flow rate, these are more relevant for the hyposalivation, which represents a decrease in the salivation of saliva flow from a normal innumerable flow rate from 0.3 to 0.4 ml/min to 0.1 ml/min or less. Investigation purposes. A pragmatic approach can be the use of a questionnaire developed by Sreebny and Valdini, in which the patient is asked: "Does your mouth usually feel dry?" This 1 question showed a sensitivity of 93%, a specificity of 68%, a positive predictive value of 54%and a negative prediction value of 98%. The addition of 3 related conditions (language difficulties, attempt to keep your mouth moist and get out of bed to drink) increased the specificity to 91 % and the positive prediction value to 75 %.

The addition of clinical signs certainly helps to diagnose xerostomy. Osailan et al. Those presented some of these clinical signs and confirmed, including: a mouthpiece or tongue lining or tongue spatula or tongue spatula, foamy saliva, lack of saliva in the mouth, loss of papillae on the back of the tongue, changed gum architecture, glassy appearance of the oral mucosa, loough or torn tongue, more than 2 teeth and torn and torture caries and Mucous membrane on the palate.

possible complications related to xerostomy are difficulties in speaking, swallowing or tasting dishes as well as the inability to keep dentures.

The use of aloe vera and ginger for the treatment of xerostomy has already been examined and its effectiveness is well documented. The choice of normal saline solution for use in the control group was interesting in this study. Of course, this seems to be contradictory, since the osmotic effect of the sodium chloride should pull liquid out of the mucous membrane just to be spit out, which leads to a deterioration of the condition. However, the results of the study indicate a reduction in the entire FOX and VAS scores, ie an improvement. So what gives? An answer can be found in the study carried out by Deepak Daryani and Gopakmar R., in which they found that the saliva of xerostomy patients contained more than triple in sodium and more than the two-time chloride than with control patients' saliva. moistened. It is not known whether this finding was known to the authors, and if so, a different control could have been considered.

No wonder that the frequent drinking of water is home remedies No. 1 for xerostomy patients. ^{5 water is subject to the same restriction as saliva substitutes and other liquids that are used to relieve the xerostomy symptoms, and this is the effect time that is usually less than 15 minutes. This restriction explains why most patients prefer liquids or sprays. 6 lozenges such as lemon candies are considered saliva stimulators, but only work if the salivary glands work normally, which is unfortunately not the case in many patients. This also applies to pharmacological stimulants such as Pilocarpin, which are associated with possible unpleasant side effects.}

The literature is robust with various natural products that have proven to be effective in relieving the symptoms of xerostomy, including but not limited: milk, olive oil, rapeseed oil, linseed oil, sesame oil, yams root mucus, eibian root, honey, propolis, chamomile, marile flower office essential oils and of course aloe vera and ginger. 7.8

aloe vera and ginger are excellent treatment options. They are familiar, easily available and have known security profiles. Both have an antibacterial, antiviral, antifungal, antioxidant and immune modulating. ^{9.10 show an antimicrobial effect against s mutans and lactobacilli SSP, 10.11 which are the primary pathogens, the tooth caries cause. 12 You are effective against candida albicans 10.13 and have proven to be just as effective against periodontitis. Salvation secretion stimulates when it is taken both systemically and topically.10 Aloe vera contains a sticky polysaccharide, acemannan, which increases its effectiveness and supports the hold of braces.}

While the authors do not provide any information about how the participants were blinded to the solution received, one has to ask how they have covered the various tastes of aloe vera, ginger and normal saline solution. The authors did not explain what effect the use of an essential oil such as peppermint or green mint would have had. However, the use of ginger and aloe vera has proven to be effective, and we should include them in our arsenal in treatment options for xerostomy patients.

Interestingly, it has been shown that ginger with rosemary in gel form or ginger, natural honey and bitter chocolate remain the tooth enamel as effectively as fluoride.