Badooei F, Imani E, Hosseini-Teshnizi S, Banar M, Memarzade MR. Comparison of the effect of ginger and aloe vera mouthwashes on xerostomia in patients with type 2 diabetes: A clinical trial, triple-blind. Med Oral Patol Oral Cir Bucal. July 1, 2021;26(4):e408-e413. doi: 10.4317/medoral.23998.
Diabetes mellitus is a chronic metabolic disorder with growing implications worldwide. It is characterized by elevated blood sugar and impaired carbohydrate metabolism. Complications from diabetes include cardiovascular disease, neuropathy and nephropathy, and oral complications. Xerostomia is among the main oral complications in patients diagnosed with diabetes. Xerostomia is characterized as abnormal dryness, often leading to infections, mouth ulcers, tooth decay, difficulties speaking, chewing, and swallowing food, atrophic changes in oral mucosa, respiratory tract infections and problems, and bacteria accumulation. Bacterial infections in the oral cavity have been associated with local and systemic complications including stomatitis, periodontitis, sepsis, arthritis, and endocarditis.
Studies have shown that pharmacological interventions fail to provide comprehensive, efficient, and long-term management of xerostomia. Alternative medicines have begun to play an important role in managing complications associated with diabetes. Ginger (Zingiber officinale, Zingiberaceae) root and aloe vera (Aloe vera, Asphodelaceae) gel are two herbal medicines that may provide symptomatic relief in patients with diabetes diagnosed with xerostomia. Ginger contains volatile oils shown to reduce nausea and vomiting, aid metabolic syndrome and weight loss, provide pain relief, and reduce inflammation and oxidation. Studies have shown that ginger increases salivation and stimulates salivary glands. Aloe vera gel has been shown to have a strong moisturizing effect. The purpose of this triple-blind, randomized controlled trial was to determine the efficacy of ginger and aloe vera mouthwashes on xerostomia in patients diagnosed with diabetes.
Patients referred to Bandar Abbas Diabetes Center (Bandar Abbas, Iran) were recruited for the study. A total of 105 patients were evenly randomized to the saline (code A), aloe vera (code B), and ginger (code C) groups. Patients were included who were diagnosed with diabetes with xerostomia; had no known allergies to ginger or aloe vera and no active oral ulcers or infections; were not excessively physically active; were not using any type of mouthwash or artificial saliva product; agreed to participate; and were of mental and physical ability to use mouthwash. Exclusion criteria included unwillingness to continue, death, and migration.
All three mouthwashes were prepared by Barij Esans Company (Tehran, Iran) and packaged identically. The ginger mouthwash contained 25% ginger, aloe vera contained 50% aloe vera, and 100% saline in the control mouthwash. Patients were instructed to use 20 mL mouthwash three times a day after meals for 14 days and to swirl the designated mouthwash in their mouths for one minute before spitting. Specific details of the protocol were not included.
At baseline, patients completed a demographic information questionnaire that was also used to determine the presence of xerostomia symptoms including subjective sensation of abnormal dryness of the oral cavity. Additionally, severity of xerostomia was determined using a visual analog scale (VAS). At the end of the 14-day study, patients completed the questionnaires a second time to measure the difference between xerostomia scores based on VAS responses before and after the intervention.
Most of the patients in the three groups were female-identified, and most patients had other systemic diseases in addition to diabetes. No significant differences were observed between the groups for any of the measurements at baseline. Xerostomia symptoms, including need to drink water to swallow dry foods, sense of decreased salivation, experience of mouth dryness after waking up, and feeling dry mouth during travel, improved significantly in the ginger (P < 0.001) and aloe vera (P < 0.05) groups compared to the control. Ginger and aloe vera were shown to significantly reduce all symptoms of xerostomia (P < 0.001). In descending order, ginger, aloe vera, and saline had the highest effects on decreasing xerostomia. No significant correlation was seen among the variables of age, sex, and onset of menopause and xerostomia.
Limitations of this study included inability to directly monitor mouthwash use since patients used mouthwashes at home. Additionally, questionnaires were self-reported; thus, beyond the control of researchers. Within these limitations, the authors conclude that, "ginger mouthwash can significantly reduce the xerostomia complications in patients with diabetes." They recommend using ginger mouthwash to reduce dry mouth and improve oral health and quality of life in patients diagnosed with diabetes with xerostomia complication.
The authors declare no conflicts of interest.