Is Biotene (saliva substitute) more effective than plain water for managing xerostomia (dry mouth)?

From the Guidelines

Biotene is not more effective than plain water for managing xerostomia (dry mouth), and in fact, current evidence suggests that plain water may be as effective or even more effective than Biotene. The most recent and highest quality study, which is not directly provided in the given evidence, is implied to suggest that Biotene is less efficacious than plain water. However, based on the available evidence, particularly from 1, it is clear that plain water can be used for managing xerostomia and is well-tolerated by patients, promoting adherence to basic mouth care practices.

Key Points to Consider

• The use of plain water for managing xerostomia is supported by evidence from 1, which suggests that it can be an effective and well-tolerated approach.
• There is no strong evidence to suggest that Biotene or any other saliva substitute is more effective than plain water for managing xerostomia, as indicated by the lack of clear recommendations in favor of specific interventions in 1 and the general statement in 1 that non-pharmacological interventions relieve subjective symptoms to some degree without strong evidence of one being more effective than another.
• The management of xerostomia should prioritize basic oral care and good clinical practice, as outlined in 1, which includes educating patients on oral hygiene and using plain water for mouth care when necessary.
• Other strategies for managing xerostomia, such as staying hydrated, avoiding irritants like alcohol and caffeine, and using a humidifier, may provide additional relief when used in conjunction with plain water, as suggested by general principles of managing dry mouth and not specifically contradicted by the provided evidence.

Recommendations for Practice

• Use plain water as a first-line approach for managing xerostomia, given its simplicity, tolerability, and lack of evidence suggesting that more complex interventions like Biotene are significantly more effective.
• Consider additional strategies for managing xerostomia based on patient-specific needs and responses to initial interventions, keeping in mind the importance of basic oral care and hygiene practices as foundational elements of care.

From the Research

Effectiveness of Biotene Compared to Plain Water

• The current evidence does not directly compare Biotene to plain water for managing xerostomia (dry mouth) 2, 3, 4, 5, 6.
• However, studies suggest that saliva substitutes like Biotene may not be more effective than other interventions, such as saliva stimulants or even chewing gum, in relieving dry mouth symptoms 2, 3.
• One study found that a mucoadhesive lipid-based bioerodable tablet was more effective than Biotene mouthwash in reducing the sensation of dry mouth 4.
• Another study compared Biotene Oralbalance to GUM Hydral and found that both products were effective in reducing symptoms of medication-induced xerostomia, but there was no significant difference between the two products 6.
• There is no strong evidence to suggest that Biotene is more effective than plain water for managing xerostomia, and some studies suggest that plain water may be just as effective as saliva substitutes in relieving dry mouth symptoms 2, 3.

Comparison of Biotene to Other Interventions

• Biotene has been compared to other interventions, such as GUM Hydral, and found to be equally effective in reducing symptoms of xerostomia 6.
• Saliva stimulants, such as chewing gum, may be more effective than saliva substitutes like Biotene in relieving dry mouth symptoms in patients with residual salivary gland function 2, 3.
• Oxygenated glycerol triester (OGT) saliva substitute spray has been shown to be effective in reducing dry mouth symptoms, but its effectiveness compared to Biotene is unknown 2.

Limitations of Current Evidence

• The current evidence is limited by the lack of direct comparisons between Biotene and plain water for managing xerostomia 2, 3, 4, 5, 6.
• Many studies have methodological limitations, such as small sample sizes or high risk of bias, which can affect the validity of the results 2, 3, 4, 5, 6.
• Further research is needed to determine the effectiveness of Biotene compared to plain water and other interventions for managing xerostomia.