Authors: Duarte Nuno da Silva Marques¹, António Duarte Sola Pereira da Mata¹, José Maria Vaz Patto², Filipe Alexandre Duarte Barcelos², João Pedro de Almeida Rato Amaral¹, Miguel Constantino Mendes de Oliveira¹, Cristina Gutierrez Castanheira Ferreira¹ 

1 Oral Biology and Biochemistry Group, Biomedical and Oral Sciences Research Unit (Unidad FCT 4062), School of Dental Medicine of the University of Lisbon, Lisbon, Portugal; 

2 Portuguese Institute of Rheumatology, Lisbon, Portugal 

OBJECTIVES 

To compare two different types of gustatory stimulants of salivary secretion (GSSS) and the resulting changes in saliva pH and efficacy in salivary stimulation in patients with primary Sjögren’s Syndrome. PLACE Portuguese Institute of Rheumatology. 

TRIAL DESIGN 

Double blind, randomised and controlled. 

SUBJECTS 

80 patients were randomised into two treatment types. Sample size was determined by setting alpha level at 0.05 and a beta level at 0.20. 

MATERIALS AND METHODS 

Participants were randomised to receive either a new GSSS containing malic acid, fluoride and xylitol or a citric acid-based traditional one. Saliva samples were taken at different times, using the methods established. A pH meter and a microelectrode were used to measure salivary pH. 

MAIN VARIABLES ASSESSED 

Variations in salivary pH, the number of subjects with a pH below 4.5 for over 1 minute and stimulated salivary flow were among the main variables assessed. 

RESULTS 

Both GSSSs significantly stimulated saliva production, without great differences between groups. The new gustatory stimulant of salivary secretion showed an absolute risk reduction of 52.78% [33.42–72.13 (95% CI)] when compared to the traditional stimulant. 

CONCLUSIONS 

In patients with primary Sjögren’s Syndrome, the gustatory stimulants of salivary secretion containing malic acid alone with fluoride and xylitol showed a similar salivary stimulation capacity compared to the citric acid-based ones. Furthermore, the formulation with malic acid significantly reduced the number of times pH dropped below 4.5 compared with the citric acid formulation. This fact could be related to a minor risk for dental erosion, but needs to be confirmed through further study.