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The effect of toothpicks containing flavoring and flavoring plus jambu extract (spilanthol) to promote salivation in patients diagnosed with opioid-induced dry mouth (xerostomia)

Bennet Davis, MD, Kathy Davis, ANP-C, Sandy Bigelow, PhD, DABT, Patricia Healey, MPH

Abstract


Objective: To determine if the use of toothpicks infused with flavoring and flavoring plus the food additive spilanthol (Xerosticks™) improve saliva flow in people with opioid-induced dry mouth.

Design: Time series, nonrandomized, double-blind within-subject design.

Setting: Private practice/academic multidisciplinary pain and palliative care clinic.

Participants: Ten subjects with opioid-induced dry mouth were recruited, and all finished the study.

Methods: Salivary flow and pH were measured consecutively at baseline, following use of a mango-flavored toothpick, and again after use of a mango-flavored toothpick infused with spilanthol. Salivary flow rates and saliva pH were compared between flavored and baseline, between flavored + spilanthol and baseline, and between the flavored and flavored + spilanthol. Mouthfeel of each toothpick was assessed using the Bluestone Mouthfeel Questionnaire.

Outcomes: The primary measure was salivary flow, and the secondary measures were salivary pH and mouthfeel.

Results: Saliva flow increased 440 percent over baseline with use of a flavored toothpick and 628 percent over baseline with similarly flavored toothpicks infused with spilanthol, and these differences are significant (p = 0.00002). Saliva pH increased with both toothpicks (p = 0.04). The addition of spilanthol produced a greater increase in salivary flow (p = 0.05) compared to control toothpicks with flavoring alone. Furthermore, addition of spilanthol improved the “mouthfeel” of the toothpick (p = 0.00001).

Conclusions: Toothpicks infused with either flavoring or flavoring plus spilanthol are likely to be an effective remedy for opioid-induced dry mouth. Addition of spilanthol may improve effectiveness over flavoring alone and may be better accepted because spilanthol appears to improve mouthfeel.


Keywords


opioid, opiate, dry mouth, xerostomia, sialogogue, salivary flow, saliva, spilanthes, spilanthol, toothpick, jambu plant, dental caries

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References


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DOI: http://dx.doi.org/10.5055/jom.2017.0409

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