A Cochrane Collaboration review of topical therapies for dry mouth concluded that chewing gum increased saliva production in those with residual secretory capacity. It has been used to provide symptomatic relief in patients suffering from xerostomia or salivary gland hypofunction. One approach to mitigate these symptoms is the use of sugar-free chewing gum which stimulates a strong flow of saliva through the separate and interactive effects of mastication and taste. Xerostomia can also lead to oral infection and increased incidence of dental caries. Symptoms include sensations of dryness or thirst, difficulty speaking, chewing and swallowing food, oral discomfort, and mouth soft tissue soreness. Xerostomia negatively affects the Oral Health Quality of Life index. The main factors causing decreased saliva generation include natural outcomes of aging, side effects of medication or medical procedures such as head and neck radiation therapy and haemodialysis, and specific medical or psychiatric conditions such as connective tissue disorders, diabetes, anxiety and depression. However, it is notable that subjective xerostomia does not always correspond with objective measures of salivary flow rate. Xerostomia is the subjective perception of oral dryness, and is often caused by salivary gland hypofunction resulting in low salivary output. It has been estimated that up to 39% of the non-institutionalised older adult population suffer from xerostomia, with a reported overall prevalence of 21.3% in males and 27.3% in females across ages 20 – 80 years. Future studies should eliminate sources of bias, standardise methods to measure salivary flow rate, and use a common instrument to measure subjective relief from xerostomia. Gum chewing is linked with improvements in self-reported levels of xerostomia (although it is noted that no significant effects were detected in five of the studies reviewed). Increasing the number of days over which gum is chewed increases the improvement in the rate of salivation. ConclusionsĬhewing gum can increase unstimulated salivary flow rate in elderly and medically compromised people with xerostomia. Of the 25 papers selected for the systematic review, six met the criteria to be included in the meta-analysis which confirmed a significant overall effect of gum on saliva flow outcomes compared to control (SMD = 0.44, 95% CI: 0.22-0.66 p = 0.00008 I 2 = 46.53%). Two of the 25 papers had a high overall risk of bias. Nine thousand six hundred and two studies were screened and 0.26% ( n = 25) met the inclusion criteria for the systematic review. We assessed risk of bias using Cochrane’s RoB 2 and ROBINS-I tools. We conducted a meta-analysis on studies where measurements of unstimulated whole salivary flow rate for both a gum chewing, and no gum chewing intervention (daily chewing of gum for two weeks or longer) were reported. All settings and study designs were included. The outcomes included salivary flow rate, self-reported xerostomia, and thirst. The intervention of interest was gum chewing. The study populations included: 1) elderly people with xerostomia (> 60 years old, any gender, and severity of xerostomia), and 2) medically compromised people with xerostomia. We searched electronic databases including Medline, Scopus, Web of Science, Embase, Cochrane Library (CDSR and Central), Google Scholar and the citations of review papers (last searched 31/03/23). The objective of this systematic review and meta-analysis was to investigate if gum chewing is an intervention that results in objective improvements in salivary flow rates and subjective relief from xerostomia. Symptoms include oral dryness thirst difficulty speaking, chewing, and swallowing food oral discomfort mouth soft tissue soreness and infections and rampant tooth decay. Xerostomia negatively affects quality of life.
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