Systematic Reviews on the Management of Xerostomia and Hyposalivation-An Umbrella Review.

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.

Protocol Registration: Prospero Registration CRD42022325854.