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Interventions for treating burning mouth syndrome

  • Review
  • Intervention

Authors


Abstract

Background

Burning mouth syndrome (BMS) is a term used for oral mucosal pain (burning pain or discomfort in the tongue, lips or entire oral cavity) without identifiable cause. General population prevalence varies from 0.1% to 3.9%. Many BMS patients indicate anxiety, depression, personality disorders and impaired quality of life (QoL). This review updates the previous versions published in 2000 and 2005.

Objectives

To determine the effectiveness and safety of any intervention versus placebo for symptom relief and changes in QoL, taste, and feeling of dryness in people with BMS.

Search methods

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 31 December 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 11) in the Cochrane Library (searched 31 December 2015), MEDLINE Ovid (1946 to 31 December 2015), and Embase Ovid (1980 to 31 December 2015). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication when searching the electronic databases

Selection criteria

Randomised controlled trials (RCTs) comparing any treatment against placebo in people with BMS. The primary outcomes were symptom relief (pain/burning) and change in QoL. Secondary outcomes included change in taste, feeling of dryness, and adverse effects.

Data collection and analysis

We used standard methodological procedures expected by Cochrane. Outcome data were analysed as short-term (up to three months) or long-term (three to six months).

Main results

We included 23 RCTs (1121 analysed participants; 83% female). Interventions were categorised as: antidepressants and antipsychotics, anticonvulsants, benzodiazepines, cholinergics, dietary supplements, electromagnetic radiation, physical barriers, psychological therapies, and topical treatments.

Only one RCT was assessed at low risk of bias overall, four RCTs' risk of bias was unclear, and 18 studies were at high risk of bias. Overall quality of the evidence for effectiveness was very low for all interventions and all outcomes.

Twenty-one RCTs assessed short-term symptom relief. There is very low-quality evidence of benefit from electromagnetic radiation (one RCT, 58 participants), topical benzodiazepines (two RCTs, 111 participants), physical barriers (one RCT, 50 participants), and anticonvulsants (one RCT, 100 participants). We found insufficient/contradictory evidence regarding the effectiveness of antidepressants, cholinergics, systemic benzodiazepines, dietary supplements or topical treatments. No RCT assessing psychological therapies evaluated short-term symptom relief.

Four studies assessed long-term symptom relief. There is very low-quality evidence of a benefit from psychological therapies (one RCT, 30 participants), capsaicin oral rinse (topical treatment) (one RCT, 18 participants), and topical benzodiazepines (one RCT, 66 participants). We found no evidence of a difference for dietary supplements or lactoperoxidase oral rinse. No studies assessing antidepressants, anticonvulsants, cholinergics, electromagnetic radiation or physical barriers evaluated long-term symptom relief.

Short-term change in QoL was assessed by seven studies (none long-term).The quality of evidence was very low. A benefit was found for electromagnetic radiation (one RCT, 58 participants), however findings were inconclusive for antidepressants, benzodiazepines, dietary supplements and physical barriers.

Secondary outcomes (change in taste and feeling of dryness) were only assessed short-term, and the findings for both were also inconclusive.

With regard to adverse effects, there is very low-quality evidence that antidepressants increase dizziness and drowsiness (one RCT, 37 participants), and that alpha lipoic acid increased headache (two RCTs, 118 participants) and gastrointestinal complaints (3 RCTs, 138 participants). We found insufficient/contradictory evidence regarding adverse events for anticonvulsants or benzodiazepines. Adverse events were poorly reported or unreported for cholinergics, electromagnetic radiation, and psychological therapies. No adverse events occurred from physical barriers or topical therapy use.

Authors' conclusions

Given BMS' potentially disabling nature, the need to identify effective modes of treatment for sufferers is vital. Due to the limited number of clinical trials at low risk of bias, there is insufficient evidence to support or refute the use of any interventions in managing BMS. Further clinical trials, with improved methodology and standardised outcome sets are required in order to establish which treatments are effective. Future studies are encouraged to assess the role of treatments used in other neuropathic pain conditions and psychological therapies in the treatment of BMS.

Plain language summary

Interventions for treating burning mouth syndrome

Review question

Which treatments help to relieve symptoms for people with burning mouth syndrome (BMS)?

Background

BMS is a common painful condition. Symptoms include burning, dryness or uncomfortable sensations in the mouth and changes to taste, with no obvious underlying medical or dental cause. BMS is usually persistent and suffered long term, and can lead to a reduced quality of life (QoL). Currently, scientific research suggests that BMS is caused by underlying damage to the nerves. There are many treatments available including drugs for anxiety, other psychological conditions and increasing saliva production, protective barriers and treatments applied to the mouth surface amongst others.

Study characteristics

This review of studies was carried out through Cochrane Oral Health, and the evidence is current up to 31 December 2015.

We found 23 studies (assessing 1121 people; 83% were women), published between 1995 and 2015 to include in this review. Twenty-one studies assessed short-term (up to three months) symptom relief, and four studies assessed long-term (from three to six months) symptom relief. Seventeen studies provided information about side effect occurrence, seven studies assessed a measure of QoL, and two studies assessed changes in taste and feeling of dryness.

All of the 23 treatments included in this review were compared to a placebo (fake treatment): antidepressants and antipsychotics (two studies), antiseizure drugs (one study), types of tranquillisers (four studies), saliva stimulants (one study), dietary supplements (12 studies), directed energy waves (one study), physical barriers (one study), psychological therapies (one study), and treatments applied to the mouth surface (five studies).

Key results

Short-term symptom relief

We found evidence of short-term symptom relief for directed energy waves (one study, 58 participants), a type of tranquilliser used topically (that is held in the mouth before being removed, and which also acts as an antiseizure drug) called clonazepam (two studies, 111 participants), thin plastic tongue covers (one study, 50 participants), and an antiseizure drug called gabapentin (one study, 100 participants).

There was no difference in short-term symptom relief found for antidepressants, saliva stimulants, and another type of tranquilliser used systemically (one that is swallowed) also called clonazepam. We were unable to show whether dietary supplements or treatments applied to the mouth surface provide symptom relief in the short term or not.

Short-term relief was not reported for the single study that assessed a psychological therapy.

Long-term symptom relief

We found evidence of long-term symptom relief for psychological therapy (one study, 30 participants), chili pepper mouthrinse (one study, 18 participants) and the topical tranquilliser called clonazepam (one study, 66 participants).

We found there was no difference in long-term symptom relief for dietary supplements or treatments applied to the mouth surface.

Studies which assessed antidepressants, directed energy waves, saliva stimulants, antiseizure drugs, or physical barriers did not evaluate long-term symptom relief.

Change in QoL

There was evidence of short-term improvement in QoL for directed energy waves (one study, 58 patients), although no difference was found for antidepressants, tranquillisers, dietary supplements and physical barriers. No study assessed long-term QoL changes.

Change in taste or feeling of dryness

A few studies assessed short-term change in taste or feeling of dryness (none evaluated these outcomes long-term), but there was not enough evidence to judge the effects of treatment on these outcomes.

Side effects

Side effects were more likely to be experienced with antidepressants (dizziness and drowsiness more likely: one study, 37 people), and with a dietary supplement called alpha lipoic acid (also known as ALA) with or without other ingredients (headaches more likely: two studies, 118 people; and upset stomachs more likely: three studies, 138 people).

Quality of the evidence
Overall, we found very low-quality evidence for each short- and long-term outcome we investigated (symptom relief; changes in QoL, taste and feeling of dryness; and side effects) in all types of assessed treatment: antidepressants and antipsychotics, antiseizure drugs, types of tranquillisers, saliva stimulants, dietary supplements, directed energy waves, physical barriers (except side effects, which was assessed as low quality), psychological therapies, and treatments applied to the mouth surface. As we found so few studies at low risk of bias, we are currently unable to prove or disprove the effectiveness of any treatments for managing BMS.

Laički sažetak

Postupci za liječenje sindroma pečenja usta

Istraživačko pitanje

Cilj ovog Cochrane sustavnog pregleda bio je analizirati dokaze iz kliničkih pokusa u kojima su ispitane terapije za koje se smatra da pomažu ublažavanju simptoma u osoba sa sindromom pečenja usta.

Dosadašnje spoznaje

Sindrom pečenja usta je često i bolno stanje. Simptomi uključuju pečenje, suhoću ili neugodan osjećaj u ustima i promjene okusa, bez vidljivog (jasnog) osnovnog medicinskog ili stomatološkog uzroka. Sindrom pečenja usta je obično dugotrajan, a može dovesti do smanjenja kvalitete života (QoL). U ovom trenutku znanstvena istraživanja pokazuju da je sindrom pečenja usta uzrokovan oštećenjem živaca. Postoje mnoge dostupne terapije, uključujući lijekove za anksioznost i druga psihološka stanja, lijekove za veću proizvodnju sline, zaštitne barijere i terapije koje se primjenjuju na površinu usta.

Obilježja uključenih istraživanja

Ovaj pregled studija je proveden u okviru Cochrane skupine za oralno zdravlje. Dokazi se odnose na istraživanja objavljena do 31. prosinca 2015. godine.

Pronašli smo 23 studije u kojima je sudjelovalo 1121 ljudi (83% su bile žene). Objavljene su između 1995. i 2015. godine. Dvadeset i jedna studija je procjenjivala kratkoročno (do tri mjeseca) ublažavanje simptoma, a četiri studije su procjenjivale dugoročno (od tri do šest mjeseci) ublažavanje simptoma. Sedamnaest studija je navelo podatke o pojavi nuspojava, sedam studija je procjenjivalo mjeru kvalitete života, a dvije studije su procjenjivale promjene u okusu i osjećaj suhoće.

Sve terapije uključene u ovaj pregled su uspoređene s placebom (lažno liječenje). Analizirane terapije su bile: antidepresivi i antipsihotici (dvije studije), lijekovi protiv konvulzija (jedna studija), vrste sredstava za smirenje (četiri studije), stimulatori izlučivanja sline (jedna studija), dodaci prehrani (12 studija), usmjerena energija valova (jedna studija), fizičke zapreke (jedna studija), psihološke terapije (jedna studija) i terapije koje se primjenjuju na površinu usta (pet studija).

Ključni rezultati

Kratkoročno ublažavanje simptoma

Pronašli smo dokaze o kratkoročnom ublažavanju simptoma kod usmjerene energije valova (jedna studija, 58 sudionika), klonazepama - vrste sredstava za smirenje koja se koristi lokalno (koji se drži u ustima prije nego se ukloni i koji također djeluje kao antikonvulzivni lijek; dvije studije, 111 sudionika), tanke plastične navlake za jezik, (jedna studija, 50 sudionika),i antikonvulzivnog lijeka gabapentina (jedna studija, 100 sudionika).

Nije bilo razlike u ublažavanju kratkoročnih simptoma nakon terapije antidepresivima, stimulansima sline i klonazepama - druge vrste sredstva za smirenje koji se uzima na usta. Nismo bili u mogućnosti pokazati da li dodaci prehrani ili terapije primijenjene na površinu usta osiguravaju ublažavanje simptoma u kratkom roku ili ne.

Kratkoročno ublažavanje simptoma nije bilo prikazano ni za jednu studiju koja je ispitivala psihološku terapiju.

Dugoročno ublažavanje simptoma

Pronašli smo dokaze o dugoročnom ublažavanju simptoma za psihološke terapije (jedna studija, 30 sudionika), sredstva za ispiranje usta (jedna studija,18 sudionika) i lokalno davanje sredstva za smirenje pod nazivom klonazepam (jedna studija, 66 sudionika).

Pronašli smo da nije bilo razlike u dugoročnom ublažavanju simptoma za dodatke prehrani ili liječenja primijenjenog na površini usta.

Studije koje su ispitivale antidepresive, usmjerenu energiju valova, stimulanse sline, antikonvulzivne lijekove, ili psihološke barijere nisu procijenile dugoročno ublažavanje simptoma.

Promjena u kvaliteti života

Bilo je dokaza o kratkoročnom poboljšanju kvalitete života kod usmjerene energije valova (jedna studija, 58 bolesnika), premda nije bilo razlike pronađene kod antidepresiva, sredstava za smirenje, dodataka prehrani i tjelesnim barijerama. Ni jedna studija nije procijenila dugoročne promjene kvalitete života.

Promjena okusa ili osjećaja suhoće

Nekoliko studija je procjenjivalo kratkoročne promjene u okusu ili osjećaju suhoće (nijedna nije ocjenjivala ove rezultate dugoročno), ali nije bilo dovoljno dokaza za procijeniti učinke liječenja na tim rezultatima.

Nuspojave

Nuspojave su češće zabilježene nakon uzimanja antidepresiva (vrtoglavica i pospanost: jedna studija, 37 ljudi) i uz dodatak prehrani pod nazivom alfa lipoična kiselina (ALA), sa ili bez drugih sastojaka (glavobolja: dvije studije, 118 ljudi, te želučane tegobe: tri studije, 138 ljudi).

Kvaliteta dokaza
Sveukupno, pronašli smo vrlo nisku kvalitetu dokaza za svaki kratkoročni i dugoročni rezultat koji smo istražili (ublažavanje simptoma, promjene u kvaliteti života, okusa i osjećaj suhoće, te nuspojave) u svim vrstama analiziranih terapija: antidepresivi i antipsihotici, antikonvulzivni lijekovi, vrste sredstva za smirenje, stimulansi sline, dodatci prehrani, usmjerena energiju valova, tjelesne barijere (osim nuspojava, koje su bile procijenjene kao niska kvaliteta), psihološke terapije i terapije koje se primjenjuju na površinu usta. Budući smo našli svega nekoliko studija s niskim rizikom pristranosti, trenutno nismo u mogućnosti dokazati ili opovrgnuti učinkovitost bilo koje terapije za liječenje sindroma pečenja usta.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Ivana Sruk
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr

Резюме на простом языке

Вмешательства при лечении синдрома жжения полости рта

Вопрос обзора

Какие способы лечения помогают облегчить симптомы у пациентов с синдромом жжения полости рта (синдромом обожженного рта)?

Актуальность

Синдром жжения полости рта (синдром обожженного рта) – это распространенное болезненное состояние. Среди симптомов выделяют жжение, сухость и ощущение дискомфорта в полости рта, а также изменения вкуса без каких-либо очевидных медицинских или стоматологических причин. Синдром жжения полости рта, как правило, сохраняется долгое время и может приводить к снижению качества жизни. В настоящее время научные исследования позволяют предположить, что синдром жжения полости рта связан, в основном, с повреждением нервов. Существует много способов лечения, включая средства, применяемые при тревоге и других психологических состояниях, повышающие слюноотделение, защитные барьеры и, среди прочих, наносимые непосредственно в полости рта.

Характеристика исследований

Этот обзор исследований был проведен Кокрейновской группой по здоровью полости рта; доказательства актуальны на 31 декабря 2015 года.

Для включения в этот обзор мы нашли 23 исследования (в которых оценивали 1121 участника; 83% из них – были женщины), опубликованных с 1995 по 2015 год. В 21 исследовании оценивали краткосрочное (до 3 месяцев) облегчение симптомов, а в 4 исследованиях – долгосрочное (от 3 до 6 месяцев) облегчение симптомов. В 17 исследованиях сообщали о возникновении побочных эффектов, в 7 исследованиях измеряли качество жизни, а в 2 исследованиях оценивали изменения вкуса и ощущения сухости.

Все 23 способа лечения, включенные в этот обзор, сравнивали с плацебо (фиктивным лечением): антидепрессанты и антипсихотики (2 исследования), противосудорожные средства (1 исследование), различные транквилизаторы (4 исследования), стимуляторы слюноотделения (1 исследование), пищевые добавки (12 исследований), волны направленной энергии (1 исследование), физические барьеры (1 исследование), психотерапия (1 исследование) и средства, наносимые в полости рта (5 исследований).

Основные результаты

Краткосрочное облегчение симптомов

Мы обнаружили доказательства в отношении краткосрочного облегчения симптомов при использовании волн направленной энергии (1 исследование, 58 участников), местного транквилизатора (удерживаемого в полости рта перед удалением и действующего также как противосудорожное средство) клоназепама (2 исследования, 111 участников), тонких пластинок для покрытия языка (1 исследование, 50 участников) и противосудорожного средства габапентина (1 исследование, 100 участников).

При использовании антидепрессантов, стимуляторов слюноотделения и другого, системного транквилизатора (принимаемого внутрь), клоназепама - различий в отношении краткосрочного облегчения симптомов не было. Мы не смогли выяснить, обеспечивают ли краткосрочное облегчение симптомов пищевые добавки или средства, наносимые в полости рта.

О краткосрочном облегчении симптомов не сообщали в 1 исследовании, посвященном психотерапии.

Долгосрочное облегчение симптомов

Мы обнаружили доказательства в отношении долгосрочного облегчения симптомов при использовании психотерапии (1 исследование, 30 участников), ополаскивателей полости рта на основе перца чили (1 исследование, 18 участников) и местного транквилизатора клоназепама (1 исследование, 66 участников).

Мы обнаружили, что при использовании пищевых добавок или средств, наносимых в полости рта, различий в отношении долгосрочного облегчения симптомов не было.

В исследованиях, посвященных антидепрессантам, волнам направленной энергии, стимуляторам слюноотделения, противосудорожным средствам или физическим барьерам, долгосрочное облегчение симптомов не оценивали.

Изменения в качестве жизни

Были доказательства в отношении краткосрочного улучшения качества жизни при использовании волн направленной энергии (1 исследование, 58 пациентов), в то время как для антидепрессантов, транквилизаторов, пищевых добавок и физических барьеров различий обнаружено не было. Ни в одном из исследований не оценивали в долгосрочной перспективе качество жизни.

Изменения вкуса и ощущения сухости

В нескольких исследованиях оценивали краткосрочные изменения вкуса или ощущения сухости (ни в одном из исследований эти исходы не оценивали в долгосрочной перспективе), однако, чтобы судить о влиянии лечения на эти исходы, доказательств недостаточно.

Побочные эффекты

Побочные эффекты с большей вероятностью возникали при использовании антидепрессантов (чаще – головокружение и сонливость: 1 исследование, 37 человек) и пищевой добавки под названием "альфа-липоевая кислота" (АЛК) с другими ингредиентами или без них (чаще – головные боли: 2 исследования, 118 человек; и нарушения пищеварения: 3 исследования, 138 человек).

Качество доказательств
В целом, мы обнаружили доказательства очень низкого качества по всем изученным краткосрочным и долгосрочным исходам (облегчение симптомов; изменения в качестве жизни; изменения вкуса и ощущения сухости; побочные эффекты) при использовании всех видов оцениваемого лечения: антидепрессантов и антипсихотиков, противосудорожных средств, различных транквилизаторов, стимуляторов слюноотделения, пищевых добавок, волн направленной энергии, физических барьеров (кроме побочных эффектов, где качество было оценено как низкое), психотерапии и средств, наносимых в полости рта. В связи с тем, что мы обнаружили так мало исследований с низким риском смещения, в настоящее время мы не можем доказать или опровергнуть эффективность какого-либо из способов лечения синдрома жжения полости рта.

Заметки по переводу

Перевод: Кукушкин Михаил Евгеньевич. Редактирование: Юдина Екатерина Викторовна. Координация проекта по переводу на русский язык: Cochrane Russia - Кокрейн Россия (филиал Северного Кокрейновского Центра на базе Казанского федерального университета). По вопросам, связанным с этим переводом, пожалуйста, обращайтесь к нам по адресу: cochrane.russia.kpfu@gmail.com; cochranerussia@kpfu.ru

Ringkasan bahasa mudah

Intervensi untuk merawat sindrom mulut terbakar

Soalan ulasan

Rawatan yang manakah membantu melegakan gejala untuk orang-orang yang ada sindrom mulut terbakar (SMT)?

Latar belakang

SMT adalah satu keadaan lazim yang sakit.Antara gejala-gejalanya termasuklah rasa terbakar, kering dan rasa tidak selesa dalam mulut dan perubahan kepada rasa, tanpa sebab tersirat perubatan atau pergigian yang jelas.SMT sering berterusan untuk jangka panjang, dan boleh membawa kepada pengurangan kualiti hidup (QoL).Pada masa kini, kajian saintifik mencadangkan SMT adalah disebabkan oleh kecederaan kepada saraf.Terdapat banyak rawatan sedia ada termasuklah ubat untuk kerisauan, keadaan psikologi lain dan peningkatan penghasilan air liur, halangan perlindungan dan rawatan-rawatan yang diaplikasi pada permukaan mulut.

Ciri kajian

Ulasan kajian dibuat melalui Kumpulan Kesihatan Oral Cochrane, dan bukti adalah terkini sehingga 31 Disember 2015.

Kami mendapati terdapat 23 kajian (menilai 1121 orang, 83% adalah wanita), yang diterbitkan antara 1995 dan 2015 untuk dimasukkan ke dalam ulasan ini.Dua puluh satu kajian menilai pengurangan gejala yang untuk jangka pendek, dan empat kajian menilai pengurangan gejala melegakandalam jangka panjang (dari tiga hingga enam bulan).Tujuh belas kajian memberi maklumat tentang kejadian kesan sampingan, tujuh kajian menilai ukuran QoL, dan dua kajian menilai perubahan rasa dan rasa kering.

Kesemua 23 rawatan yang dimasukkan dalam ulasan ini membandingkan plasebo (rawatan palsu): antidepresan dan antipsikotik (dua kajian), ubat antisawan (satu kajian), pelbagai penenang (empat kajian), perangsang air lur (satu kajian), suplemen diet (12 kajian), gelombang tenaga terarah (satu kajian), halangan fizikal (satu kajian), terapi psikologi (satu kajian), dan rawatan yang diaplikasi pada permukaan mulut (lima kajian).

Keputusan utama

Pengurangan gejala jangka pendek

Kami mendapati bukti untuk kelegaan jangka pendek bagi gelombang tenaga terarah (satu kajian, 58 peserta), sejenis penenang yang diguna secara topikal (disimpan di dalam mulut sebelum dikeluarkan, dan juga bertindak sebagai ubat antisawan) yang dipanggil clonazepam (dua kajian, 111 peserta), plastik nipis penutup lidah (satu kajian, 50 peserta), dan sejenis ubat antisawan dipanggil gabapentin (satu kajian, 100 peserta)

Tiada perbezaan yang didapati untuk pengurangan jangka pendek bagi antidepresan, perangsang air liur, dan sejenis penenang yang digunakan secara sistemik (yang ditelan) yang dipanggil clonazepam. Kami tidak dapat menunjukkan sama ada suplemen diet atau rawatan yang diaplikasi pada permukaan mulut mengurangkan gejala jangka pendek atau tidak.

Pengurangan jangka pendek tidak dilaporkan dari kajian tunggal yang menilai terapi psikologi.

Pengurangan gejala jangka panjang

Kami mendapati bukti pengurangan gejala jangka panjang bagi terapi psikologi (satu kajian, 30 peserta), ubat kumur mulut cili lada hitam (satu kajian, 18 peserta) dan penenang topikal yang dipanggil clonazepam (satu kajian, 66 peserta.

Kami mendapati tiada perbezaan pengurangan gejala bagi suplemen diet atau rawatan-rawatan yang diaplikasi pada permukaan mulut.

Kajian-kajian yang menilai antidepresan, gelombang tenaga terarah, perangsang air liur, ubat antisawan, atau halangan fizikal tidak menilai pengurangan gelaja jangka panjang.

Perubahan QoL

Terdapat bukti jangka pendek peningkatan QoL bagi gelombang tenaga terarah (satu kajian, 58 peserta), walaupun tiada perbezaan ditemui bagi antidepresan, penenang, suplemen diet dan halangan fizikal.Tiada kajian yang menilai perubahan jangka panjang QoL.

Perubahan rasa atau rasa kering

Beberapa kajian menilai kelegaan jangka pendek bagi rasa dan kekeringan (tiada penilaian hasil jangka panjang), namun tiada cukup bukti untuk menentukan kesan rawatannya.

Kesan sampingan

Lebih kesan sampingan dialami dengan antidepresan (lebih cenderung pening dan mengantuk: satu kajian, 37 orang), dan suplemen diet yang dipanggil asid lipoik alfa (juga dikenali ALA) sama ada ditambah atau tanpa bahan lain (lebih cenderung sakit kepala: dua kajian, 118 orang; lebih cenderung gangguan perut: tiga kajian, 138 orang).

Kualiti bukti
Secara keseluruhannya, kami mendapati bukti adalah berkualiti rendah bagi setiap hasil jangka pendek dan panjang yang disiasat (kelegaan gejala; perubahan Qol, rasa dan kekeringan; dan kesan sampingan) bagi semua rawatan yang dinilai: antidepresan dan antipsikotik, ubat antisawan, pelbagai penenang, perangsang air liur, suplemen diet, gelombang tenaga terarah, halangan fizikal (kecuali kesan sampingan yang dinilai sebagai berkuailti rendah), terapi psikologi dan rawatan yang diaplikasi pada permukaan mulut. Oleh kerana kami mendapati kajian berisiko bias rendah yang sangat sedikit, kami tidak dapat membuktikan atau menyangkal keberkesanan sebarang rawatan untuk menguruskan SMT.

Catatan terjemahan

Diterjemahkan oleh Noorliza Mastura Ismail (Kolej Perubatan Melaka-Manipal). Disunting oleh Tuan Hairulnizam Tuan Kamauzaman (Universiti Sains Malaysia). Untuk sebarang pertanyaan berkaitan terjemahan ini sila hubungi noorliza.mastura@manipal.edu.my.