Interventions for the management of dry mouth: non-pharmacological interventions

  • Review
  • Intervention




Xerostomia is the subjective sensation of dry mouth. Common causes of xerostomia include adverse effects of many commonly prescribed medications, disease (e.g. Sjogren's Syndrome) and radiotherapy treatment for head and neck cancers. Non-pharmacological techniques such as acupuncture or mild electrostimulation may be used to improve symptoms.


To assess the effects of non-pharmacological interventions administered to stimulate saliva production for the relief of dry mouth.

Search methods

We searched the Cochrane Oral Health Group's Trials Register (to 16th April 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 3), MEDLINE via OVID (1948 to 16th April 2013), EMBASE via OVID (1980 to 16th April 2013), AMED via OVID (1985 to 16th April 2013), CINAHL via EBSCO (1981 to 16th April 2013), and CANCERLIT via PubMed (1950 to 16th April 2013). The metaRegister of Controlled Clinical Trials ( and ( were also searched to identify ongoing and completed trials. References lists of included studies and relevant reviews were also searched. There were no restrictions on the language of publication or publication status.

Selection criteria

We included parallel group randomised controlled trials of non-pharmacological interventions to treat dry mouth, where participants had dry mouth symptoms at baseline.

Data collection and analysis

At least two review authors assessed each of the included studies to confirm eligibility, assess risk of bias and extract data using a piloted data extraction form. We calculated mean difference (MD) and 95% confidence intervals (CI) for continuous outcomes or where different scales were used to assess an outcome, we calculated standardised mean differences (SMD) together with 95% CIs. We attempted to extract data on adverse effects of interventions. Where data were missing or unclear we attempted to contact study authors to obtain further information.

Main results

There were nine studies (total 366 participants randomised) included in this review of non-pharmacological interventions for dry mouth which were divided into three comparisons. Eight studies were assessed at high risk of bias in at least one domain and the remaining study was at unclear risk of bias.

Five small studies (total 153 participants, with dry mouth following radiotherapy treatment) compared acupuncture with placebo. Four were assessed at high risk and one at unclear risk of bias. Two trials reported outcome data for dry mouth in a form suitable for meta-analysis. The pooled estimate of these two trials (70 participants, low quality evidence) showed no difference between acupuncture and control in dry mouth symptoms (SMD -0.34, 95% CI -0.81 to 0.14, P value 0.17, I2 = 39%) with the confidence intervals including both a possible reduction or a possible increase in dry mouth symptoms. Acupuncture was associated with more adverse effects (tiny bruises and tiredness which were mild and temporary). There was a very small increase in unstimulated whole saliva (UWS) at the end of 4 to 6 weeks of treatment (three trials, 71 participants, low quality evidence) (MD 0.02 ml/minute, 95% CI 0 to 0.04, P value 0.04, I2 = 57%), and this benefit persisted at the 12-month follow-up evaluation (two trials, 54 participants, low quality evidence) (UWS, MD 0.06 ml/minute, 95% CI 0.01 to 0.11, P value 0.03, I2 = 10%). For the outcome of stimulated whole saliva (SWS, three trials, 71 participants, low quality evidence) there was a benefit favouring acupuncture (MD 0.19 ml/minute, 95% CI 0.07 to 0.31, P value 0.002, I2 = 1%) an effect which also persisted at the 12-month follow-up evaluation (SWS MD 0.28 ml/minute, 95% CI 0.09 to 0.47, P value 0.004, I2 = 0%) (two trials, 54 participants, low quality evidence).

Two small studies, both at high risk of bias, compared the use of an electrostimulation device with a placebo device in participants with Sjögren's Syndrome (total 101 participants). A further study, also at high risk of bias, compared acupuncture-like electrostimulation of different sets of points in participants who had previously been treated with radiotherapy. None of these studies reported the outcome of dry mouth. There was no difference between electrostimulation and placebo in the outcomes of UWS or SWS at the end of the 4-week treatment period in the one study (very low that provided data for these outcomes. No adverse effects were reported.

A single study at high risk of bias, compared the stimulatory effect of powered versus manual toothbrushing and found no difference for the outcomes of UWS or SWS.

Authors' conclusions

There is low quality evidence that acupuncture is no different from placebo acupuncture with regard to dry mouth symptoms, which is the most important outcome. This may be because there were insufficient participants included in the two trials to show a possible effect or it may be that there was some benefit due to 'placebo' acupuncture which could have biased the effect to the null. There is insufficient evidence to determine the effects of electrostimulation devices on dry mouth symptoms. It is well known that dry mouth symptoms may be problematic even when saliva production is increased, yet only two of the trials that evaluated acupuncture reported dry mouth symptoms, a worrying reporting bias. There is some low quality evidence that acupuncture results in a small increase in saliva production in patients with dry mouth following radiotherapy.

There is insufficient evidence to determine the effects of electrostimulation devices on dry mouth symptoms or saliva production in patients with Sjögren's Syndrome. Reported adverse effects of acupuncture are mild and of short duration, and there were no reported adverse effects from electrostimulation.




口腔乾燥は、口渇の主観的感覚である。口腔乾燥の主な原因は、一般的に処方される多くの薬剤の有害作用、疾患(シェーグレン症候群など)、頭頚部癌の放射線治療である。 鍼療法または弱い電気刺激などの非薬理学的方法が症状改善に用いられることがある。 




次に挙げるものを検索した:Cochrane Oral Health Group’s Trials Register(2013年4月16日まで)、Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 3)、 MEDLINE via OVID (1948年~2013年4月16日まで)、 EMBASE via OVID (1980年~2013年4月16日まで)、 AMED via OVID (1985年~2013年4月16日まで)、 CINAHL via EBSCO (1981年~2013年4月16日まで)、CANCERLIT via PubMed (1950年~2013年4月16日まで)。 また、The meta Register of Controlled Clinical Trials ( and (を検索し、進行中および完了した試験を同定した。 http://www.clinicaltrials.gov選択した研究の参考文献一覧および関連するレビューも検索した。使用言語および公開状況について制限はしなかった。




少なくとも2名のレビュー著者が選択された各試験の適格性を確認し、バイアスのリスクを評価し、パイロットデータ抽出フォームを用いてデータを抽出した。 連続アウトカムの平均差(MD)、95%信頼区間(CI)またはアウトカムの評価に異なるスケールが用いられた場合は、95%CIと標準化平均差(SMD)を算出した。 介入の有害作用に関するデータ抽出を試みた。 データが欠測または不明確であった場合、研究を実施した著者に連絡を取り、詳細情報の入手を試みた。



5つの小規模試験(放射線治療後にドライマウスが認められた計153名の参加者)では、鍼治療をプラセボと比較した。4件の試験はバイアスのリスクが高いと評価され、1件の試験ではリスクが不明確であった。2件の試験で、メタアナリシスに適した形式でアウトカムデータが報告された。これら2つの試験(参加者70名、エビデンスの質:低い)からプールされた推定値では、ドライマウスの症状で鍼治療群と対照群との差異がみられず(SMD -0.34、95% CI -0.81~0.14、p値0.17、I(2) =39%)、信頼区間はドライマウス症状の減少と増加の可能性のいずれも含んでいた。 鍼治療群では有害作用(軽度で一時的な小さな打撲傷および疲労)がより多く認められた。 4~6週の治療終了時に安静時唾液産生量(UWS)のわずかな増加が認められ(3試験、参加者71名、エビデンスの質:低い)(MD 0.02 mL/分、95% CI 0~0.04、 p値0.04、I(2)=57%)、この利益は12カ月の追跡評価時でも持続していた(2試験、参加者54名、エビデンスの質:低い)(UWS、MD 0.06 mL/分、95% CI 0.01~0.11、p値0.03、 I(2)=10%)。 刺激時唾液産生量(SWS、3試験、参加者71名、エビデンスの質:低い)のアウトカムについて、鍼治療群に利益がみられ(MD 0.19 mL/分、95% CI 0.07~0.31、p値0.002、I(2) =1%)、効果は12カ月の追跡評価時にも持続していた(SWS MD 0.28 mL/分、95% CI 0.09~0.47、p値0.004、 I(2)=0%)(2試験、参加者54名、エビデンスの質:低い)。

いずれもバイアスのリスクが高い小規模な2件の試験では、シェーグレン症候群患者(計101名の参加者)を対象として電気刺激装置とプラセボの装置の使用を比較した。 同じくバイアスのリスクが高いさらなる試験では、放射線治療歴のある参加者のさまざまなつぼで鍼様の電気刺激を比較した。 これらの試験ではドライマウスのアウトカムは報告されなかった。 1件の試験では、4週間の治療期間終了時に、UWSまたはSWSのアウトカムにおいて電気刺激およびプラセボに差異はみられなかった(これらのアウトカムに対するデータの質は極めて低い)。 有害作用は報告されなかった。



ドライマウス症状について鍼とプラセボ鍼との差異はみられないという質の低いエビデンスがあり、それが最も重要なアウトカムである。 これは、2件の試験に組み入れた参加者が有効性の可能性を示すには不十分であったこと、またはプラセボ鍼にある程度の利益がみられ、効果が無効になるバイアスが働いたことによる可能性がある。 ドライマウス症状に対する電気刺激装置の効果を判定するにはエビデンスが不十分である。 ドライマウス症状は、唾液産生が増加したときでも問題となることがよく知られているが、鍼療法を評価した試験のうちドライマウス症状を報告したのは2件の試験のみで、懸念すべき報告バイアスがみられた。 放射線治療後のドライマウス患者で鍼治療によって唾液産生がわずかに増加するという質の低いエビデンスがいくつかみられる。

シェーグレン症候群患者のドライマウス症状または唾液産生に対する電気刺激装置の効果を判定するにはエビデンスが不十分である。 報告された鍼治療の有害作用は軽度で持続時間が短かった。また、電気刺激による有害作用は報告されなかった。


《注意》この日本語訳は、臨床医、疫学研究者などによる翻訳のチェックを受けて公開していますが、訳語の間違いなどお気づきの点がございましたら、eJIM事務局までご連絡ください。なお、2013年6月からコクラン・ライブラリーのNew review, Updated reviewとも日単位で更新されています。eJIMでは最新版の日本語訳を掲載するよう努めておりますが、タイム・ラグが生じている場合もあります。ご利用に際しては、最新版(英語版)の内容をご確認ください。

Plain language summary

Non-drug treatments for dry mouth symptoms

Review question

This review, carried out by authors of the Cochrane Oral Health Group, has been produced to assess the effects of non-drug treatments used to stimulate saliva production for the relief of dry mouth (xerostomia) symptoms.


Dry mouth is a common problem with an estimated incidence of between 10% and 26% in men and between 10% and 33% in women, which may or may not be due to reduced saliva secretion. Common causes of dry mouth include the side effects of many commonly prescribed medications, diseases (such as Sjögren's syndrome where the immune system destroys tissues in the glands which produce saliva) and radiotherapy treatments for head and neck cancers.

Saliva moistens the skin in the mouth and helps to maintain oral health. The presence of saliva facilitates speech, acts to wash away food residue from around the teeth, neutralises potentially damaging food and bacterial acids, enhances a person's ability to taste the food, and generally lubricates the mouth. Saliva also acts to soften food, making it easier to chew and swallow. Enzymes in saliva start the digestion of starch and fats, and other substances in saliva, such as epidermal growth factors, promote tissue growth, differentiation and wound healing. The antibacterial, antifungal and antiviral agents in saliva balance the oral flora and help to prevent oral infections, while the minerals in saliva help to maintain tooth enamel.

Non-drug treatments such as acupuncture, mild electrical stimulation, lasers, tooth brushing and other stimulation techniques are used to improve dry mouth symptoms.

Study characteristics

The evidence on which this review is based was up-to-date as of 16 April 2013.

Nine studies were included in this review. A total of 366 adult participants took part in these trials, with an average of 40 participants per trial, and an age range from 12 to 77 years. The causes of dry mouth were radiotherapy for oral cancers in four trials, Sjögren's syndrome in three trials, medication-related in one trial, and in the remaining trial participants had a range of causes of dry mouth.

The included studies were divided into three groups, according the interventions evaluated.

1. Five small studies with a total 153 participants evaluated acupuncture.

2. Three studies evaluated electrostimulation devices.

3. One study evaluated a power toothbrush.

Key results

The five studies evaluating the effects of acupuncture in people who had dry mouth were generally of poor quality. There was no evidence of a difference in dry mouth symptoms, but there was some evidence of a small increase in saliva production which persisted for a year after the end of the acupuncture treatment. There may not have been enough people included in the trials to show a difference in dry mouth, or it may have been that both the real acupuncture and the 'placebo' acupuncture had some beneficial effect. Acupuncture was associated with more adverse effects (tiny bruises and tiredness which were mild and temporary).

The studies evaluating the effects of electrostimulation devices were poorly conducted and reported, and provided insufficient evidence to determine the effects of these devices on either dry mouth or saliva production.

The single small study of a powered versus a manual toothbrush also found no difference for either dry mouth or saliva production.

None of the included studies reported the outcomes of duration of effectiveness, quality of life, patient satisfaction, or oral health assessment.

Quality of the evidence

These studies were generally of poor quality (low and very low).

Laički sažetak

Liječenje suhih usta bez lijekova

Istraživačko pitanje

Ovaj sustavni pregled, koji su napravili autori Cochrane uredničke skupine za oralno zdravlje, proveden je za procjenu učinka različitih terapija koje ne uključuju lijekove, a koje se koriste za poticanje proizvodnje sline za ublažavanje simptoma suhoće usta (kserostomije) .

Dosadašnje spoznaje

Suha usta su čest problem. Procjenjuje se da je učestalost tog stanja između 10% i 26% u muškaraca i između 10% i 33% u žena, što može i ne mora biti posljedica smanjenog izlučivanja sline. Česti uzroci suhih usta uključuju nuspojave mnogih lijekova koji se često propisuju, određene bolesti (kao što je Sjögrenov sindrom u kojem imunološki sustav uništava tkiva u žlijezdama koje stvaraju slinu) i liječenje zračenjem (radioterapijom) kod raka glave i vrata.

Slina vlaži usta i pomaže u održavanju zdravlja usne šupljine. Prisutnost sline olakšava govor, ispire ostatke hrane oko zuba, neutralizira potencijalno štetnu hranu i kiselinu bakterija, poboljšava sposobnost osobe da osjeti okus hrane, i općenito podmazuje usta. Slina također omekšava hranu koju je tako lakše žvakati i progutati. Enzimi u slini počinju probavu škroba i masti, i drugih tvari u slini, kao što je epidermalni čimbenik rasta, promiču rast tkiva, diferencijaciju i zacjeljivanje rana. Antibakterijski (protiv bakterija), antifungalni (protiv gljiva) i antivirusni (protiv virusa) čimbenici u slini uravnotežuju mikrorganizme koji se nalaze u ustima i pomažu spriječiti infekcije u usnoj šupljini, dok minerali u slini pomažu održati zubnu caklinu.

Terapije koje ne uključuju lijekove, kao što su akupunktura, blaga električna stimulacije, laseri, četkanje zubi i druge tehnike stimulacije koriste se za ublažavanje simptoma suhih usta.

Obilježja istraživanja

Analizirani su dokazi objavljeni do 16. travnja 2013. godine.

U ovaj Cochrane sustavni pregled je uključeno devet pokusa. Ukupno 366 odraslih sudionika sudjelovalo je u ovim ispitivanjima, s prosjekom od 40 sudionika po pokusu. Raspon njihove dobi bio je od 12 do 77 godina. Uzroci suhoće usta u pronađenim studijama bili su radioterapija kod karcinoma usne šupljine u četiri pokusa, Sjögrenov sindrom u tri pokusa, nuspojava lijeka u jednom pokusu, a u ostalim pokusima sudionici su imali niz različitih uzroka suhoće usta.

Uključene su studije bile podijeljene u tri skupine, u skladu s intervencijama koje su ispitale.

1. Pet malih studija s ukupno 153 sudionika procijenilo je akupunkturu.

2. Tri studije procijenile su uređaje za elektrostimulaciju.

3. Jedna studija procijenila je električne zubne četkice.

Ključni rezultati

Pet studija koje su procijenile učinke akupunkture kod ljudi koji su imali suha usta uglavnom su bile loše kvalitete. Nije bilo dokaza o razlici u simptomima suhih usta, ali bilo je nekih dokaza o malom povećanju proizvodnje sline koji je trajao godinu dana nakon završetka terapije akupunkturom. Budući se radilo o malim studijama, moguće je da nije uključeno dovoljno pacijenata da bi se pokazala razlika za simptome suhih usta, ili je moguće da su i stvarna akupunktura i "placebo" akupunktura imale neki blagotvoran učinak. Akupunktura je povezana s više negativnih učinaka (sitnih modrica i umorom, koji su bili blagi i privremeni).

Pokusi koji su procijenili učinke uređaja za elektrostimulaciju bili su loše provedeni i opisani u znanstvenim radovima te nisu dali dovoljno dokaza kako bi se utvrdili učinci tih uređaja bilo na suha usta ili proizvodnju sline.

Jedan mali pokus u kojem je uspoređena električna u odnosu na običnu četkicu za zube također nije našao razliku bilo za suha usta ili proizvodnju sline.

Nijedan od uključenih pokusa nije opisao kao rezultat trajanje učinka terapije, kvalitetu života, zadovoljstva pacijenata, ili procjenu zdravlja usne šupljine.

Kvaliteta dokaza

Ovi pokusi su općenito bili loše kvalitete (niska i vrlo niska kvaliteta).

Bilješke prijevoda

Cochrane Hrvatska
Prevela: Božena Armanda
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:
























《注意》この日本語訳は、臨床医、疫学研究者などによる翻訳のチェックを受けて公開していますが、訳語の間違いなどお気づきの点がございましたら、eJIM事務局までご連絡ください。なお、2013年6月からコクラン・ライブラリーのNew review, Updated reviewとも日単位で更新されています。eJIMでは最新版の日本語訳を掲載するよう努めておりますが、タイム・ラグが生じている場合もあります。ご利用に際しては、最新版(英語版)の内容をご確認ください。