Salivary stimulation is aimed at preventing functional loss of salivary gland activity. Stimulation can be done mechanically, using chewing gum like stimulation, pharmacologically, or electrically using a transcutaneous electrical nerve stimulation. Salivery stimulation has been studied in patients with cancer for effects on oral mucositis.
Didem, A., Ayfer, E., & Ayse Ferda, O. (2014). The effect of chewing gum on oral mucositis in children receiving chemotherapy. Health Science Journal, 8, 373–382.
To determine if chewing gum is efficacious in the prevention and treatment of oral mucositis in children receiving chemotherapy regimens
Quasi-experimental study with a control group
Chewing gum was an effective option for preventing and treating oral mucositis in pediatric patients with acute lymphoblastic leukemia, acute myeloid leukemia, Hodgkin lymphoma, and Wilms tumors.
Eghbali, A., Taherkhanchi, B., Bagheri, B., & Sadeghi Sedeh, B. (2016). Effect of chewing gum on oral mucositis in children undergoing chemotherapy: A randomized controlled study. Iranian Journal of Pediatric Hematology and Oncology, 6(1), 9–14.
To study the effects of salivary stimulation using chewing gum on oral mucositis (OM) in children undergoing chemotherapy
Patients were randomized to a control group or experimental group. Control patients were given a mouth rinse of nystatin, diphenhydramine, and aluminum three times per day. The test group received the same mouth rinse plus sugar-free chewing gum six times per day for 15 days. The gum was chewed for about 30 minutes.
Prevalence of grade 1 (p < 0.05) and grade 2 (not significant) OM was lower in children who chewed the gum. Grade 3 mucositis was slightly higher among those chewing gum. No difference existed between groups in prevalence of grade 4 mucositis.
Chewing gum for salivary stimulation may help reduce inflammation with low grades of mucositis but shows no overall benefit for more severe mucositis.
Chewing sugar-free gum to increase salivary stimulation is a low-risk intervention that may help in low-grade mucositis cases but appears to have no overall efficacy in reducing the prevalence or severity of mucositis in children receiving chemotherapy. Further research regarding the potential role of salivary stimulation for the prevention or management of OM would be beneficial.
Gandemer, V., Le Deley, M., Dollfus, C., Auvrignon, A., Bonnaure-Mallet, M., Duval, M., … Schmitt, C. (2007). Multicenter randomized trial of chewing gum for preventing oral mucositis in children receiving chemotherapy. Journal of Pediatric Hematology/Oncology, 29, 86–94.
Patients chewed five to six pieces of fluoride-containing, sugar-free gum, sweetened with xylitol per day for 20 minutes per piece from the first day of chemotherapy to three days after course of treatment. Both groups practiced standard oral care, consisting of brushing teeth with a soft toothbrush and rinsing with sodium bicarbonate rinse.
The study was conducted between March 1999 and December 2002.
This was a randomized, controlled trial.
Researchers recorded the WHO grade of mucositis within first 21 days, time to development of grade 3–4 mucositis, incidence of any grade of mucositis, incidence of pain using a 70-point visual analogue scale, number of days of total parenteral nutrition, incidence of abdominal symptoms, and incidence of septicemia.
No significant differences were found between arms for severe mucositis endpoints.
Patients receiving less toxic regimens had a decrease in WHO grade 1–4 oral mucositis of 49% in the gum group and 72% in the control group (p = 0.03).
Pimenta Amaral, T. M., Campos, C. C., Moreira Dos Santos, T. P., Leles, C. R., Teixeira, A. L., Teixeira, M. M., et al. (2012). Effect of salivary stimulation therapies on salivary flow and chemotherapy-induced mucositis: a preliminary study. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 113(5), 628-637.
Analyze the effectiveness of two noninvasive mechanical and electrical therapies on salivary flow and severity of oral mucositis in patients undergoing allogeneic HCT.
Patients undergoing myeloablative conditioning for allogeneic HCT were randomized to four groups: (1) control group (no salivary stimulation therapy, (2) salivary stimulation using a mechanical chewing instrument, (3) TENS stimulation, and (4) combination of TENS and mechanical chewing. Saliva samples were obtained twice before HCT and three times after transplantation. Severity of mucositis was evaluated by a single examiner four days per week from day 7 to day 30 post-HCT. Patients assigned to the mechanical chewing used a silicone instrument and were instructed to perform mastication exercises after meals 4 times daily for 10 minutes. TENS stimulation was given 3 times a week for 30 minutes each, with electrodes placed at 3 regions of the face corresponding to parotid, submandibular, and sublingual salivery glands.
The study was comprised of 35 patients with a mean patient age of 33.56 years (SD = 12.46 years).
MALES 33.7%, FEMALES 66.3%
KEY DISEASE CHARACTERISTICS: All received conditioning with cyclophosphamide with or without busulfan for HCT. Cyclosporin in combination with methotrexate or mycophenolate mofetil was used for GVHD prophylaxis. All underwent allogeneic HCT. Underlying diseases were bone marrow aplasia, AML, ALL, Hodgkin’s lymphoma, and mantle cell lymphoma. 75% had malignant diseases.
SITE: Single site
SETTING TYPE: Inpatient
PHASE OF CARE: Active antitumor treatment
Single, blind, randomized controlled trial
Resting salivary flow showed a tendency toward decrease in all patients. In all therapy groups combined, salivary flow showed less of a decrease than control patients, but this difference was not significant. At the end of the study, the TENS and TENS plus chewing group showed an increase in salivary flow, while the other two groups showed a decline (p < 0.05). Mucositis occurred in 68.5% of patients. There were no differences in grades of mucositis between groups. There was a tendency of lower salivary flow in patients with mucositis of any grade.There were no significant differences seen in salivary TNF and IL-10 levels in relation to occurrence of mucositis.
Electrical salivary stimulation therapy, alone or combined with mechanical chewing therapy appeared to increase salivary flow when compared to chewing therapy alone or no salivary stimulation therapy; however, there was no significant difference seen in mucositis occurrence or severity based on study group or salivary flow.
Salivary flow decline may contribute to development and severity of oral mucositis. This study shows that electrical stimulation may improve salivary flow. Further research in this are is needed to fully evaluate the effectiveness of salivary stimulation in the management of oral mucositis.