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acupuncture:evaluation:stomatologie:03. xerostomie [19 Jun 2018 07:38] Nguyen Johan [1.1.1. Assy 2018] |
acupuncture:evaluation:stomatologie:03. xerostomie [28 Aug 2025 19:25] (Version actuelle) Nguyen Johan [1.3.3. Sjögren's Syndrome] |
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| + | /*English:Xerostomia*/ | ||
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| + | ======= Xerostomia ======= | ||
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| ====== Xérostomie : évaluation de l'acupuncture ====== | ====== Xérostomie : évaluation de l'acupuncture ====== | ||
| + | | //Articles connexes//: - [[acupuncture:conduites therapeutiques:stomatologie:03. xerostomie|conduites thérapeutiques]] - pathologie - acupuncture expérimentale - qigong - | | ||
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| ===== Revues systématiques et méta-analyses===== | ===== Revues systématiques et méta-analyses===== | ||
| + | | ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture | | ||
| + | | ☆☆ | Evidence for effectiveness of acupuncture | | ||
| + | | ☆ |Limited evidence for effectiveness of acupuncture | | ||
| + | | Ø |No evidence or insufficient evidence | | ||
| - | ==== Acupuncture générique ==== | + | ==== Generic Acupuncture ==== |
| - | === Assy 2018 === | + | |
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| + | ==== Al Hamad 2019 Ø ==== | ||
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| + | Al Hamad A, Lodi G, Porter S, Fedele S, Mercadante V. Interventions for dry mouth and hyposalivation in Sjögren's syndrome: A systematic review and meta-analysis. Oral Dis. 2019;25(4):1027-1047. {{:medias securises:acupuncture:evaluation:medecine interne. divers:al-hamad-204003.pdf|[204003]}}. [[https://doi.org/10.1111/odi.12952|DOI]] | ||
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| + | ^Objectives| Systematic review with meta-analysis of interventions for dry mouth symptoms and hyposalivation of Sjögren's syndrome (SS). | | ||
| + | ^Materials and methods|We searched MEDLINE, Cochrane Central and EMBASE up to February 2018 for randomized trials of interventions for dry mouth and hyposalivation of SS. The primary outcome was the mean change in xerostomia symptoms. The secondary outcomes included changes in salivary flow and quality of life. We used the Cochrane risk of bias tool for individual studies and the GRADE method to summarize the quality of evidence across studies for the included outcomes. | | ||
| + | ^Results|Thirty-six studies (3,274 patients) were included in the systematic review. Results from the meta-analyses showed high-quality evidence that pilocarpine was superior to placebo in reducing dry mouth symptoms. We found moderate quality of evidence that pilocarpine, rituximab and interferon-alpha were more effective than placebo in increasing salivary flow, with the relevant effect size being large for pilocarpine, and notably smaller for rituximab and interferon-alpha. | | ||
| + | ^ Conclusion|Clinicians should be very confident in the beneficial effects of pilocarpine upon dry mouth symptoms of SS and moderately confident that pilocarpine, rituximab and interferon-alpha can have beneficial effects upon salivary flow. Adverse events are common. The use of other treatment modalities cannot be supported on the basis of current evidence. | | ||
| + | | Acupuncture | the present systematic review suggests that there is no evidence that the use of DMARDs, acupuncture, laser acupuncture (2 studies), infliximab, etanercept and other interventions (gamma‐linolenic acid, dehydroepiandrosterone, omega‐3/vit E, nizatidine, a traditional chinese medicine compound) can reduce symptoms of dry mouth or increase salivary flow in individuals with SS.| | ||
| + | === Assy 2018 Ø === | ||
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| ^Conclusions| **Insufficient evidence is available** to conclude whether acupuncture is an evidence-based treatment option for xerostomia/hyposalivation. Further well-designed, larger, double blinded trials are required to determine the potential benefit of acupuncture. Sample size calculations should be performed before before initiating these studies. | | ^Conclusions| **Insufficient evidence is available** to conclude whether acupuncture is an evidence-based treatment option for xerostomia/hyposalivation. Further well-designed, larger, double blinded trials are required to determine the potential benefit of acupuncture. Sample size calculations should be performed before before initiating these studies. | | ||
| - | === Gil-Montoya 2016 === | + | === Gil-Montoya 2016 Ø=== |
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| ^Results|Finally, a total of 26 trials were identified that met the previously defined selection and quality criteria; 14 related to drug treatments for dry mouth, 10 with non-pharmacological treatment and 2 with alternative treatments. | | ^Results|Finally, a total of 26 trials were identified that met the previously defined selection and quality criteria; 14 related to drug treatments for dry mouth, 10 with non-pharmacological treatment and 2 with alternative treatments. | | ||
| ^Conclusions|Pilocarpine continues to be the best performing sialogogue drug for subjects with xerostomia due to radiation on head and neck cancer or diseases such as Sjogren's Syndrome. For patients with dry mouth caused solely by medication, there are some positive indications from the use of malic acid, along with other elements that counteract the harmful effect on dental enamel. In general, lubrication of oral mucous membrane reduces the symptoms, although the effects are short-lived. | | ^Conclusions|Pilocarpine continues to be the best performing sialogogue drug for subjects with xerostomia due to radiation on head and neck cancer or diseases such as Sjogren's Syndrome. For patients with dry mouth caused solely by medication, there are some positive indications from the use of malic acid, along with other elements that counteract the harmful effect on dental enamel. In general, lubrication of oral mucous membrane reduces the symptoms, although the effects are short-lived. | | ||
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| + | === Furness 2014 Ø=== | ||
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| + | Furness S, Bryan G, Mcmillan R, Birchenough S, Worthington HV. Interventions for the management of dry mouth: non-pharmacological interventions. Cochrane Database Syst Rev. 2013. {{:medias securises:acupuncture:evaluation:stomatologie:furness-170381.pdf|[170381].}} | ||
| + | ^Background| 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. | | ||
| + | ^Objectives|To assess the effects of non-pharmacological interventions administered to stimulate saliva production for the relief of dry mouth. | | ||
| + | ^Methods|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 (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov) 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, I(2) = 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 Xerostomia is the subjective sensation of dry mouth. Common causes of xerostomia include adverse effects of many commonly prescribed medications, disease (e.g. 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, I(2) = 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, I(2) = 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, I(2) = 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, I(2) = 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.| | ||
| === Jedel 2005 Ø === | === Jedel 2005 Ø === | ||
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| - | ==== Formes cliniques particulières ==== | + | ==== Special Clinical Forms ==== |
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| + | === Xerostomia in Advanced Cancer Patients. === | ||
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| + | == Hanchanale 2015 ☆ (Radiation-Induced Xerostomia excluded) == | ||
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| + | Hanchanale S, Adkinson L, Daniel S, Fleming M, Oxberry SG. Systematic literature review: xerostomia in advanced cancer patients. Support Care Cancer. 2015 Mar;23(3):881-8. {{:medias securises:acupuncture:evaluation:oncologie:hanchanale-159548.pdf|[159548].}} | ||
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| + | ^Purpose|Dry mouth (xerostomia) is one of the commonest symptoms in cancer patients and can adversely affect quality of life. The aim of this review was to determine the effectiveness of pharmacological and non-pharmacological interventions in treating xerostomia in adult advanced cancer patients.| | ||
| + | ^Methods|The literature search was performed in February 2014 using databases including EMBASE, MEDLINE, CINAHL, BNI and Cochrane library. The search was carried out using standard MeSH terms and was limited to adult population and English language. Studies investigating xerostomia secondary to head and neck cancer treatment and autoimmune disease were excluded. Titles and abstracts were screened and reviewed for eligibility. Only studies involving primary research were included in the analysis. | | ||
| + | ^Results|Six studies met the eligibility criteria for review: three randomized controlled trials and three prospective studies. The quality assessment and reporting was performed using PRISMA, Jadad and STROBE. **These studies compared acupuncture, pilocarpine, Saliva Orthana and chewing gum with each other or with placebo. All interventions were considered effective in treating xerostomia**. However, effectiveness versus placebo could not be demonstrated for Saliva Orthana. Meta-analysis could not be performed due to heterogeneity of the study type and intervention. | | ||
| + | ^Conclusion|Limited published data exists reporting the effectiveness of measures in the treatment of xerostomia in cancer patients. Based on primary research of low quality, firm conclusions cannot be drawn. However, pilocarpine, artificial saliva, chewing gum and **acupuncture can be tried based on the available data**. This highlights the explicit need to improve our evidence base. Properly constructed randomized controlled trials demonstrating effectiveness of pharmacological and non-pharmacological interventions for dry mouth are required| | ||
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| + | === Radiation-Induced Xerostomia in Cancer Patients=== | ||
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| + | | See [[acupuncture:evaluation:oncologie:03. xerostomie post-radique|corresponding item]] | | ||
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| + | === Sjögren's Syndrome === | ||
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| + | | See [[acupuncture:evaluation:medecine interne. divers:06. syndrome de sjogren|corresponding item]] | | ||
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| - | === Xérostomie post-radique === | ||
| - | |Voir l'[[acupuncture:evaluation:oncologie:03. xerostomie post-radique|article correspondant]] | | + | ===== Overviews of systematic reviews ===== |
| - | === Syndrome de Sjögren === | + | == Conte 2025 == |
| + | Conte DB, Marquezzan ME, Schneider LR, Gauer APM, Cattapan L, Corralo VDS, Rodrigues-Junior SA. Systematic Reviews on the Management of Xerostomia and Hyposalivation-An Umbrella Review. Gerodontology. 2025 Jun;42(2):165-176. https://doi.org/10.1111/ger.12809 | ||
| + | ^Introduction| Dry mouth is moderately prevalent in the older population. Pharmacological and non-pharmacological alternatives have been assessed to manage its manifestation. This umbrella review synthesised the evidence on approaches to managing xerostomia and hyposalivation.| | ||
| + | ^Material and methods| We searched for systematic reviews of interventions to manage dry mouth in Cochrane Database of Systematic Reviews, EMBASE, PubMed, Prospero and DARE databases (up to September 2023). References were managed and selected by reading titles and abstracts using Rayyan QCRI. Selection of studies, data extraction and methodological quality assessment (AMSTAR 2) were conducted independently, in duplicate. Data were extracted to a previously tested form that included information about dry mouth causes, interventions, outcomes and findings.| | ||
| + | ^Results| There were 3323 records. At the end of the selection process, 48 studies were included and had data extracted. Only three high-quality systematic reviews were found to support methods for managing dry mouth. Limited evidence suggests that topical therapies offer significant palliative or stimulating effects for relieving dry mouth symptoms. Furthermore, low-quality evidence indicates a slight increase in saliva production with acupuncture, dry mouth prevention with amifostine, and saliva stimulation using pilocarpine in patients who have undergone head and neck radiotherapy.| | ||
| + | ^Conclusion| Salivary substitutes and stimulants mostly acted as moisturisers and some as saliva stimulants, with short-term effect. More than 80% of the reviews were appraised as 'critically low' quality. Well-designed and well-reported systematic reviews are still needed to increase the level of evidence on dry mouth management methods.| | ||
| - | | Voir l' [[acupuncture:evaluation:medecine interne. divers:06. syndrome de sjogren|article correspondant]] | | ||
