Table Info

Table 5.

Inter- and intra-group comparisons of the Challacombe scale and log candidal concentrations

Intervals	Challacombe scale for clinical oral dryness (Mean ± SD)		p-value	Log candidal concentrations (Mean ± SD)		p-value
Intervals	Group A	Group B	p-value	Group A	Group B	p-value
Baseline	5.96 ± 2.33	5.92 ± 2.38	0.954^ns	1.23 ± 0.66	1.29 ± 0.69	0.679^ns
After 2 weeks	2.78 ± 1.86	2.96 ± 1.65	0.733^ns	1.06 ± 0.36	1.17 ± 0.31	0.254^ns
p-value	< 0.001*	< 0.001*	-	0.414^ns	0.284^ns	-

* significant (p < 0.05). ns: non-significant (p > 0.05); SD: standard deviation. -: no data

Declarations

Acknowledgments

The authors would like to thank Dr. Mohamed Zaki, lecturer of pharmaceuticals in the Faculty of Pharmacy at Al Azhar University, Cairo, Egypt, for preparing both the study and control treatment.

Author contributions

AM: Conceptualization, Formal analysis, Investigation, Resources, Writing—original draft. BE: Conceptualization, Data curation, Methodology, Project administration, Supervision, Validation, Visualization, Writing—review & editing. ME: Methodology, Project administration, Supervision, Validation. WAE: Conceptualization, Data curation. ST: Methodology, Project administration, Validation, Visualization. MZ: Conceptualization, Data curation, Methodology, Project administration, Supervision, Validation, Writing—review & editing. All authors read and approved the submitted version.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The study was performed following the Declaration of Helsinki, and the protocol was approved by the Research Ethics Committee in the Faculty of Dentistry at Cairo University [approval no 16 2 20]. The trial is registered on clinicaltrials.gov, identifier: NCT04252209.

Consent to participate

Informed consent to participate in the study was obtained from all participants.

Consent to publication

Not applicable.

Availability of data and materials

The datasets used and/or analyses used during the current study are available from the corresponding author upon reasonable request.

Funding

Not applicable.

Copyright

Publisher’s note

Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

References

de Campos WG, Esteves CV, Costa K, de Andrade ACP, Domaneschi C. Xerostomia in the older adult population, from diagnosis to treatment : a literature review. Clinical and Laboratorial Research in Dentistry. 2019;2019:157759. [DOI]

Bilal Talha, Swarnkar SA, editors. Xerostomia. Treasure Island: StatPearls; 2023. [PubMed]

Maleki-Fischbach M, Kastsianok L, Koslow M, Chan ED. Manifestations and management of Sjögren’s disease. Arthritis Res Ther. 2024;26:43. [DOI] [PubMed] [PMC]

Aoun G, Nasseh I, Berberi A. Evaluation of the oral component of Sjogren’s syndrome: An overview. J Int Soc Prev Community Dent. 2016;6:278–84. [DOI] [PubMed] [PMC]

Dost F, Farah CS. Stimulating the discussion on saliva substitutes: a clinical perspective. Aust Dent J. 2013;58:11–7. [DOI] [PubMed]

Ramos-Casals M, Brito-Zerón P, Bombardieri S, Bootsma H, Vita SD, Dörner T, et al.; EULAR-Sjogren Syndrome Task Force Group. EULAR recommendations for the management of Sjogren’s syndrome with topical and systemic therapies. Ann Rheum Dis. 2020;79:3–18. [DOI] [PubMed]

Vinke J, Kaper HJ, Vissink A, Sharma PK. Dry mouth: saliva substitutes which adsorb and modify existing salivary condition films improve oral lubrication. Clin Oral Investig. 2020;24:4019–30. Erratum in: Clin Oral Investig. 2020;24:4031. [DOI] [PubMed] [PMC]

Vadcharavivad S, Boonroung T. Effects of two carboxymethylcellulose-containing saliva substitutes on post-radiation xerostomia in head and neck cancer patients related to quality of life. Asian Biomedicine. 2013;7:193–202. [DOI]

Nair JJ, Singh TP. Sjogren’s syndrome: Review of the aetiology, Pathophysiology & Potential therapeutic interventions. J Clin Exp Dent. 2017;9:e584–9. [DOI] [PubMed] [PMC]

10.

Seher F, Hosein M, Ahmed J. Role of Coconut Oil Pulling On Oral Health–An Overview. Journal of The Pakistan Dental Association. 2018;27:94–9. [DOI]

11.

Cooper AJ. Xerostomia : Help Patients Cope, Have Hope. Int J Dent & Oral Heal. 2018;4:153–6.

12.

Dhingra K. Aloe vera herbal dentifrices for plaque and gingivitis control: a systematic review. Oral Dis. 2014;20:254–67. [DOI] [PubMed]

13.

Zeng W, Parus A, Barnes C, Hiro M, Robson M and Payne W. Aloe vera—Mechanisms of Action, Uses, and Potential Uses in Plastic Surgery and Wound Healing. Surgical Science. 2020;11:312–28. [DOI]

14.

Zou H, Liu Z, Wang Z, Fang J. Effects of Aloe Vera in the Treatment of Oral Ulcers: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Oral Health Prev Dent. 2022;20:509–16. [DOI] [PubMed] [PMC]

15.

Morales-Bozo I, Rojas G, Ortega-Pinto A, Espinoza I, Soto L, Plaza A, et al. Evaluation of the efficacy of two mouthrinses formulated for the relief of xerostomia of diverse origin in adult subjects. Gerodontology. 2012;29:e1103–12. [DOI] [PubMed]

16.

Atashi V, Yazdannik A, Mahjobipoor H, Ghafari S, Bekhradi R, Yousefi H. The Effects of Aloe vera-Peppermint (Veramin) Moisturizing Gel on Mouth Dryness and Oral Health among Patients Hospitalized in Intensive Care Units: A Triple-Blind Randomized Placebo-Controlled Trial. J Res Pharm Pract. 2018;7:104–10. [DOI] [PubMed] [PMC]

17.

Badooei F, Imani E, Hosseini-Teshnizi S, Banar M, Memarzade M. Comparison of the effect of ginger and aloe vera mouthwashes on xerostomia in patients with type 2 diabetes: A clinical trial, triple-blind. Med Oral Patol Oral Cir Bucal. 2021;26:e408–13. [DOI] [PubMed] [PMC]

18.

Mangaiyarkarasi SP, Manigandan T, Elumalai M, Cholan PK, Kaur RP. Benefits of Aloe vera in dentistry. J Pharm Bioallied Sci. 2015;7:S255–9. [DOI] [PubMed] [PMC]

19.

Dayrit FM. The Properties of Lauric Acid and Their Significance in Coconut Oil. J Am Oil Chem Soc. 2015;92:1–15. [DOI]

20.

Khijmatgar S, Reddy U, Hegde M, Fabbro M. Effects of coconut oil on oral health status of patients with poor oral hygiene: Systematic review and meta-analysis. Journal of International Oral Health. 2021;13:519–32. [DOI]

21.

Hamad AA, Lodi G, Porter S, Fedele S, Mercadante V. Interventions for dry mouth and hyposalivation in Sjogren’s syndrome: A systematic review and meta-analysis. Oral Dis. 2019;25:1027–47. [DOI] [PubMed]

22.

Choudhary R, Reddy SS, Nagaraju R, Nagi R, Rathore P, Sen R. Effectiveness of pharmacological interventions for Sjogren syndrome - A systematic review. J Clin Exp Dent. 2023;15:e51–63. [DOI] [PubMed] [PMC]

23.

Morales-Bozo I, Ortega-Pinto A, Alcayaga GR, Saavedra JPA, Flores OS, Puente CL, et al. Evaluation of the effectiveness of a chamomile (Matricaria chamomilla) and linseed (Linum usitatissimum) saliva substitute in the relief of xerostomia in elders. Gerodontology. 2017;34:42–8. [DOI] [PubMed]

24.

Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, et al.; International Sjogren’s Syndrome Criteria Working Group. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Arthritis Rheumatol. 2017;69:35–45. [DOI] [PubMed] [PMC]

25.

Challacombe SJ, Osailan SM, Proctor GB. Clinical Scoring Scales for Assessment of Dry Mouth. In: Carpenter G, editor. Dry Mouth. Berlin: Heidelberg; 2015. pp.119–32. [DOI]

26.

Tooyama H, Matsumoto T, Hayashi K, Kurashina K, Kurita H, Uchida M, et al. Candida concentrations determined following concentrated oral rinse culture reflect clinical oral signs. BMC Oral Health. 2015;15:150. [DOI] [PubMed] [PMC]

27.

Kumar B, Kashyap N, Avinash A, Chevvuri R, Sagar MK, Shrikant K. The composition, function and role of saliva in maintaining oral health: A review. International Journal of Contemporary Dental and Medical Reviews. 20217;2017:011217. [DOI]

28.

Salum FG, Medella-Junior FdAC, Figueiredo MAZ, Cherubini K. Salivary hypofunction: An update on therapeutic strategies. Gerodontology. 2018;35:305–16. [DOI] [PubMed]

29.

Billings M, Dye BA, Iafolla T, Grisius M, Alevizos I. Elucidating the role of hyposalivation and autoimmunity in oral candidiasis. Oral Dis. 2017;23:387–94. [DOI] [PubMed] [PMC]

30.

Barbe AG, Schmidt-Park Y, Hamacher S, Derman SHM, Noack MJ. Efficacy of GUM^® Hydral versus Biotène^®Oralbalance mouthwashes plus gels on symptoms of medication-induced xerostomia: a randomized, double-blind, crossover study. Clin Oral Investig. 2018;22:169–80. [DOI] [PubMed]

31.

Ludwar L, Mannel H, Hamacher S, Noack MJ, Barbe AG. Oil pulling to relieve medication-induced xerostomia: A randomized, single-blind, crossover trial. Oral Dis. 2022;28:373–83. [DOI] [PubMed]

32.

Lim C, In J. Considerations for crossover design in clinical study. Korean J Anesthesiol. 2021;74:293–9. [DOI] [PubMed] [PMC]

33.

Skrinjar I, Boras VV, Bakale I, Rogulj AA, Brailo V, Juras DV, et al. Comparison between three different saliva substitutes in patients with hyposalivation. Clin Oral Investig. 2015;19:753–7. [DOI] [PubMed]

34.

López-Pintor RM, Ramírez L, Serrano J, Pedro Md, Fernández-Castro M, Casañas E, et al. Effects of Xerostom^® products on xerostomia in primary Sjogren’s syndrome: A randomized clinical trial. Oral Dis. 2019;25:772–80. [DOI] [PubMed]

35.

Piboonratanakit P, Ferreira JN, Pravinvongvuthi K, Maison K, Urkasemsin G, Boonroung T, et al. Trehalose versus carboxymethylcellulose oral spray for relieving radiation-induced xerostomia in head and neck cancer patients: a randomized controlled trial. BMC Oral Health. 2023;23:288. [DOI] [PubMed] [PMC]

36.

Fox PC, Busch KA, Baum BJ. Subjective reports of xerostomia and objective measures of salivary gland performance. J Am Dent Assoc. 1987;115:581–4. [DOI] [PubMed]

37.

Assery MKA. Efficacy of Artificial Salivary Substitutes in Treatment of Xerostomia: A Systematic Review. J Pharm Bioallied Sci. 2019;11:S1–12. [DOI] [PubMed] [PMC]

38.

Javanbakht S, Shaabani A. Carboxymethyl cellulose-based oral delivery systems. Int J Biol Macromol. 2019;133:21–9. [DOI] [PubMed]

39.

Sánchez M, González-Burgos E, Iglesias I, Gómez-Serranillos MP. Pharmacological Update Properties of Aloe Vera and its Major Active Constituents. Molecules. 2020;25:1324. [DOI] [PubMed] [PMC]

40.

Pierce JL, Tanner K, Merrill RM, Miller KL, Kendall KA, Roy N. Swallowing Disorders in Sjogren’s Syndrome: Prevalence, Risk Factors, and Effects on Quality of Life. Dysphagia. 2016;31:49–59. [DOI] [PubMed]

41.

Błochowiak K. Smell and Taste Function and Their Disturbances in Sjogren’s Syndrome. Int J Environ Res Public Health. 2022;19:12472. [DOI] [PubMed] [PMC]

42.

Surjushe A, Vasani R, Saple DG. Aloe vera: a short review. Indian J Dermatol. 2008;53:163–6. [DOI] [PubMed] [PMC]

43.

Šijan Gobeljić M, Milić V, Pejnović N, Damjanov N. Chemosensory dysfunction, Oral disorders and Oral health-related quality of life in patients with primary Sjogren’s syndrome: comparative cross-sectional study. BMC Oral Health. 2020;20:187. [DOI] [PubMed] [PMC]

44.

Shahryari M, Bibak B, Khaksari M, Keshavarzi Z, Salmani N, Shirazpour S, et al. Anti-edema effect of Aloe vera leaf extract following traumatic brain injury: Role of pro-inflammatory cytokines. Avicenna J Phytomed. 2021;11:380–93. [DOI] [PubMed] [PMC]

45.

Paul S, Modak D, Chattaraj S, Nandi D, Sarkar A, Roy J, et al. Aloe vera gel homogenate shows anti-inflammatory activity through lysosomal membrane stabilization and downregulation of TNF-α and Cox-2 gene expressions in inflammatory arthritic animals. Futur J Pharm Sci. 2021;7:12. [DOI]

46.

Varma SR, Sivaprakasam TO, Arumugam I, Dilip N, Raghuraman M, Pavan KB, et al. In vitro anti-inflammatory and skin protective properties of Virgin coconut oil. J Tradit Complement Med. 2018;9:5–14. [DOI] [PubMed] [PMC]