title: Effects of gustatory stimulants of salivary secretion on salivary pH and flow in patients with Sjögren's syndrome: a randomized controlled trial.
abstract: OBJECTIVE
  To compare salivary pH changes and stimulation efficacy of two different gustatory stimulants of salivary secretion (GSSS) in patients with primary Sjögren syndrome.
  
  
  METHODS
  Portuguese Institute for Rheumatological Diseases.
  
  
  METHODS
  Double-blind randomized controlled trial.
  
  
  METHODS
  Eighty patients were randomized to two intervention groups. Sample size was calculated using an alpha error of 0.05 and a beta of 0.20.
  
  
  METHODS
  Participants were randomly assigned to receive a new GSSS containing a weaker malic acid, fluoride and xylitol or a traditionally citric acid-based one. Saliva collection was obtained by established methods at different times. The salivary pH of the samples was determined with a pH meter and a microelectrode.
  
  
  METHODS
  Salivary pH variations and counts of subjects with pH below 4.5 for over 1 min and stimulated salivary flow were the main outcome measures.
  
  
  RESULTS
  Both GSSS significantly stimulated salivary output without significant differences between the two groups. The new gustatory stimulant of salivary secretion presented an absolute risk reduction of 52.78% [33.42-72.13 (95% CI)] when compared with the traditional one.
  
  
  CONCLUSIONS
  In Xerostomic Primary Sjögren syndrome patients, gustatory stimulants of salivary secretion based on acid mail only with fluoride and xylitol present similar salivary stimulation capacity when compared to citric acid-based ones, besides significantly reducing the number of salivary pH drops below 4.5. This could be related to a diminished risk for dental erosion and should be confirmed with further studies.
authors.affiliation: Oral Biology and Biochemistry Group, Biomedical and Oral Sciences Research Unit (FCT Unit 4062), University of Lisbon School of Dental Medicine, Portugal. duartemd@yahoo.co.uk
authors.forename: Duarte Nuno
authors.initials: DN
authors.lastname: da Silva Marques
authors.forename: António Duarte Sola Pereira
authors.initials: AD
authors.lastname: da Mata
authors.forename: José Maria Vaz
authors.initials: JM
authors.lastname: Patto
authors.forename: Filipe Alexandre Duarte
authors.initials: FA
authors.lastname: Barcelos
authors.forename: João Pedro
authors.initials: JP
authors.lastname: de Almeida Rato Amaral
authors.forename: Miguel Constantino Mendes
authors.initials: MC
authors.lastname: de Oliveira
authors.forename: Cristina Gutierrez Castanheira
authors.initials: CG
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D002021:Buffers; D019343:Citric Acid / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005459:Fluorides / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008293:Malates / Q000627:therapeutic use*; D008839:Microelectrodes; D008875:Middle Aged; D012463:Saliva / Q000737:chemistry / Q000187:drug effects* / Q000378:metabolism; D012636:Secretory Rate / Q000187:drug effects; D012859:Sjogren's Syndrome / Q000188:drug therapy*; D013997:Time Factors; D014077:Tooth Erosion / Q000517:prevention & control; D014993:Xylitol / Q000627:therapeutic use*
chemical_list: D002021:Buffers; D008293:Malates; D019343:Citric Acid; C030298:malic acid; D005459:Fluorides; D014993:Xylitol