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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


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.


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

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Furness S, Worthington HV, Bryan G, et al.: Interventions for the management of dry mouth: Topical therapies. Cochrane Database Syst Rev. 2011; (12): CD008934.

Humphrey SP, Williamson RT: A review of saliva: Normal composition, flow, and function. J Prosthet Dent. 2001; 85(2): 162-169.

Fenoll-Palomares C, Muñoz-Montagud JV, Sanchiz V, et al.: Unstimulated salivary flow rate, pH and buffer capacity of saliva in healthy volunteers. Rev Esp Enferm Dig. 2004; 96(11): 773-783.

Guggenheimer J: Xerostomia: Etiology, recognition, and treatment. J Am Dent Assoc. 2003; 134(1): 61-69.

Looström H, Åkerman S, Ericson D, et al.: Tramadol-induced oral dryness and pilocarpine treatment: Effects on total protein and IgA. Arch Oral Biol. 2011; 56: 395-400.

Moore RA, McQuay HJ: Prevalence of opioid adverse events in chronic non-malignant pain- Systematic review of randomized trials of oral opioids. Arthritis Res Ther 2005; 7: R1046-1051.

Götrick B, Åkerman S, Ericson D, et al.: Oral pilocarpine for treatment of opioid-induced oral dryness in healthy adults. J Dent Res. 2004; 83(5): 393-397.

Zunt S: Oral health care for cancer patients—Determining and managing salivary gland function in cancer patients: A fact sheet for dental professionals. Available at Published 2010. Accessed April 28, 2015.

Christen AG, Christen JA: A historical glimpse of toothpick use: Etiquette, oral and medical conditions. J Hist Dent. 2003; 51: 61-69.

Budnick LD: Toothpick-related injuries in the United States, 1979 through 1982. J Am Med Assoc. 1984; 252: 796-797.

Cockerill FR, Wilson WR, Van Scoy RE: Traveling toothpicks. Mayo Clin Proc. 1983; 58(9): 613-616.

Steenvoorde P, Moues CM, Viersma JH: Gastric perforation due to the ingestion of a hollow toothpick: Report of a case. Surg Today. 2002; 32: 731-733.

Iwasaki Y, Tanabe M, Kobata K, et al.: TRPA1 agonists—allyl isothiocyanate and cinnamaldehyde—induce adrenal secretion. Biosci Biotechnol Biochem. 2008; 72: 2608-2614.

Ulbricht C, Seamon E, Windsor RC, et al.: An evidencebased systematic review of cinnamon (Cinnamomum spp.) by the Natural Standard Research Collaboration. J Diet Suppl. 2011; 8(4): 378-454.

Paulraj J, Govindarajan R, Palpu P: The genus Spilanthes ethnopharmacology, phytochemistry, and pharmacological properties: A review. Adv Pharmacol Sci. 2013; 2013: 510298. Available at Accessed April 21, 2015.

Shannon I: Specific gravity and osmolality of human parotid fluid. Caries Res. 1969; 3: 149-158.

Kerr AR, Corby PM, Kalliontzi K, et al.: Comparison of two mouthrinses in relation to salivary flow and perceived dryness. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 119(1): 59-64.

Ship J, Corby P, Fisch G, et al.: Reliability and validity of mouthfeel questionnaire with salivary flow rates. Abstract 1255 presented at the International Association of Dental Research Meeting, 2009, Miami, Florida.

Osalian SM: Clinical assessment of oral dryness: Development of a scoring system related to salivary flow and mucosal wetness. Oral Med. 2012; 114(5): 597-603.

Navazesh M, Kuma SKS: Measuring salivary flow: Challenges and opportunities. J Am Dent Assoc. 2008; 139: 35S-40S.

Leksrisompong K, Lopetcharat B, Guthrie, et al.: Preference mapping of lemon lime carbonated beverages with regular and diet beverage consumers. J Food Sci. 2013; 78: S320-S328.



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