Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Complementary Medicine and Therapies
Published in: BMC Complementary Medicine and Therapies 1/2018

Open Access 01-12-2018 | Research article

A systematic review of the effects of acupuncture on xerostomia and hyposalivation

Authors: Zainab Assy, Henk S. Brand

Published in: BMC Complementary Medicine and Therapies | Issue 1/2018

Login to get access

Abstract

Background

Saliva is fundamental to our oral health and our well-being. Many factors can impair saliva secretion, such as adverse effects of prescribed medication, auto-immune diseases (for example Sjögren’s syndrome) and radiotherapy for head and neck cancers. Several studies have suggested a positive effect of acupuncture on oral dryness.

Methods

Pubmed and Web of Science were electronically searched. Reference lists of the included studies and relevant reviews were manually searched. Studies that met the inclusion criteria were systematically evaluated. Two reviewers assessed each of the included studies to confirm eligibility and assessing the risk of bias.

Results

Ten randomized controlled trials investigating the effect of acupuncture were included. Five trials compared acupuncture to sham/placebo acupuncture. Four trials compared acupuncture to oral hygiene/usual care. Only one clinical trial used oral care sessions as control group. For all the included studies, the quality for all the main outcomes has been assessed as low. Although some publications suggest a positive effect of acupuncture on either salivary flow rate or subjective dry mouth feeling, the studies are inconclusive about the potential effects of acupuncture.

Conclusions

Insufficient evidence is available to conclude whether acupuncture is an evidence-based treatment option for xerostomia/hyposalivation. Further well-designed, larger, double blinded trials are required to determine the potential benefit of acupuncture. Sample size calculations should be performed before before initiating these studies.
Literature
1.
Wolff A, Fox PC, Porter S, Konttinen YT. Established and novel approaches for the Management of Hyposalivation and Xerostomia. Curr Pharm Des. 2012;18:5515–21.CrossRefPubMed
2.
Berk LB, Shivnani AT, Small W. Pathophysiology and management of radiation-induced xerostomia. J Support Oncol. 2005;3:191–200.PubMed
3.
Rydholm M, Strang P. Acupuncture for patients in hospital-based home care suffering from xerostomia. J Palliat Care. 1999;15(4):20–3.PubMed
4.
Blom M, Lundeberg T. Long-term follow-up of patients treated with acupuncture for xerostomia and the influence of additional treatment. Oral Dis. 2000;6(1):15–24.CrossRefPubMed
5.
6.
Hanchanale S, Adkinson L, Daniel S, Fleming M, Oxberry SG. Systematic literature review: xerostomia in advanced cancer patients. Support Care Cancer. 2015;23(3):881–8.CrossRefPubMed
7.
Porter SR, Scully C, Hegarty AM. An update of the etiology and management of xerostomia. Oral Surg Oral Med Oral Pathol Oral. 2004;97:28–46.CrossRef
8.
Guggenheimer J, Moore PA. Xerostomia: etiology, recognition and treatment. J Am Dent Assoc. 2003;134(1):61–9.CrossRefPubMed
9.
Nieuw Amerongen AV, ECI V. Current therapies for xerostomia and salivary gland hypofunction associated with cancer therapies. Support Care Cancer. 2003;11:226–31.PubMed
10.
Kahn ST, Johnstone PA. Management of xerostomia related to radiotherapy for head and neck cancer. Oncology (Williston Park). 2005;19(14):1827–32. discussion 1832–4, 1837–9
11.
Cohen AJ, Menter A, Hale L. Acupuncture: role in comprehensive cancer care--a primer for the oncologist and review of the literature. Integr Cancer Ther. 2005;4(2):131–43.CrossRefPubMed
12.
Naik PN, Kiran RA, Yalamanchal S, Kumar VA, Goli S, Vashist N. Acupuncture: an alternative therapy in dentistry and its possible applications. Med Acupunct. 2014;26(6):308–14.CrossRefPubMedPubMedCentral
13.
Sagar SM. Acupuncture as an evidence-based option for symptom control in cancer patients. Curr Treat Options in Oncol. 2008;9(2–3):117–26.CrossRef
14.
Lin J-G, Chen Y-H. The role of acupuncture in cancer supportive care. Am J Chin Med. 2012;40(02):219–29.CrossRefPubMed
15.
O’Regan D, Filshie J. Acupuncture and cancer. Auton Neurosci Basic Clin. 2010;157(1–2):96–100.CrossRef
16.
Blom M, Lundeberg T, Dawidson I, Angmar-Månsson B. Effects on local blood flux of acupuncture stimulation used to treat xerostomia in patients suffering from Sjögren’s syndrome. J Oral Rehabil. 1993;20(5):541–8.CrossRefPubMed
17.
Deng G, Cassileth B. Acupuncture in cancer care. Integr Oncol. 2011;173(10):744.
18.
Standish LJ, Kozak L, Congdon S, Kramer S. Acupuncture is underutilized in hospice and palliative medicine. Dtsch Zeitschrift fur Akupunkt. 2009;52(1):54–5.CrossRef
19.
Lu W. Acupuncture for side effects of chemoradiation therapy in cancer patients. Semin Oncol Nurs. 2005;21:190–5.CrossRefPubMed
20.
Deng G, Vickers A, Yeung KS, Cassileth BR. Acupuncture: Integration into cancer care. J Soc Integr Oncol. 2006;4(2):86–92.PubMed
21.
Braga FP, Sugaya NN, Hirota SK, Weinfeld I, Magalhaes MH, Migliari DA. The effect of acupuncture on salivary flow rates in patients with radiation-induced xerostomia. Minerva Stomatol. 2008;57(0026–4970):343–8.PubMed
22.
Simcock R, Fallowfield L, Jenkins V. Group acupuncture to relieve radiation induced xerostomia: a feasibility study. Acupunct Med. 2009;27(3):109–13.CrossRefPubMed
23.
24.
Furness S, Bryan G, McMillan R, Worthington HV. Interventions for the management of dry mouth: non-pharmacological interventions. Cochrane Database Syst Rev. 2013;8(9):CD009603.
25.
Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. 2011. Available from www.​handbook.​cochrane.​org.
26.
Alimi D, Poulain P, Cornillot P. Étude contrôlée randomisée évaluant l ’ action de l ’ auriculothérapie dans la xérostomie induite par la radiothérapie des tumeurs de la tête et du cou. Randomized controlled study assessing the action of auricular acupuncture in xerostomia induced by ra. Rev Odontostomatol. 2012;41:245–59.
27.
Blom M, Dawidson I, Angmar-Månsson B. The effect of acupuncture on salivary flow rates in patients with xerostomia. Oral Surg Oral Med Oral Pathol. 1992;73(3):293–8.CrossRefPubMed
28.
Blom M, Dawidson I, Fernberg JO, Johnson G, Angmar-Mânsson B. Acupuncture treatment of patients with radiation-induced xerostomia. Eur J Cancer Part B Oral Oncol. 1996;32(3):182–90.CrossRef
29.
do Braga FP, Lemos Junior CA, Alves FA, Migliari DA. Acupuncture for the prevention of radiation-induced xerostomia in patients with head and neck cancer. Braz Oral Res. 2011;25(2):180–5.CrossRefPubMed
30.
List T, Lundeberg T, Lundström I, Lindström F, Ravald N. The effect of acupuncture in the treatment of patients with primary Sjögren’s syndrome. A controlled study. Acta Odontol Scand. 1998;56(2):95–9.CrossRefPubMed
31.
Meng Z, Kay Garcia M, Hu C, Chiang J, Chambers M, Rosenthal DI, et al. Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma Zhiqiang. Cancer. 2012;118(13):3337–44.CrossRefPubMed
32.
Meng Z, Kay Garcia M, Hu C, Chiang J, Chambers M, Rosenthal DI, et al. Sham-controlled, randomised, feasibility trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma. Eur J Cancer. 2012;48(11):1692–9.CrossRefPubMed
33.
Cho JH, Chung WK, Kang W, Choi SM, Cho CK, Son CG. Manual acupuncture improved quality of life in cancer patients with radiation-induced xerostomia. J Altern Complement Med. 2008;14(5):523–6.CrossRefPubMed
34.
Pfister DG, Cassileth BR, Deng GE, Yeung KS, Lee JS, Garrity D, et al. Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. J Clin Oncol. 2010;28(15):2565–70.CrossRefPubMedPubMedCentral
35.
Simcock R, Fallowfield L, Monson K, Solis-Trapala I, Parlour L, Langridge C, et al. Arix: a randomised trial of acupuncture V oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer. Ann Oncol. 2013;24(3):776–83.CrossRefPubMed
36.
Heidel RE. Causality in statistical Power : isomorphic properties of measurement, research design, effect size, and sample size. Scientifica (Cairo). Hindawi Publishing Corporation. 2016;2016(1):5.
37.
Tsang R, Colley L, Lynd LD. Inadequate statistical power to detect clinically significant differences in adverse event rates in randomized controlled trials. J Clin Epidemiol. 2009;62:609–16.CrossRefPubMed
38.
Sjögren P, Hedström L. Sample size determination and statistical power in randomized controlled trials. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(5):652–3.CrossRefPubMed
39.
Odgaard-Jensen, Vist G, Timmer A, Kunz R, Akl EA, Schünemann H, Briel M, Nordmann AJ, Pregno S, Oxman AD. Randomisation to protect against selection bias in healthcare trials (review). Cochrane Database Syst Rev. 2011;13(4):MR000012.
40.
41.
Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA. 1995;273(5):408–12.CrossRefPubMed
42.
Jüni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. Br Med J. 2001;323(July):42–6.CrossRef
43.
Balk EM, Bonis PAL, Moskowitz H, Schmid CH, Ioannidis JPA, Wang C, et al. Correlation of quality measures with estimates of treatment effect in meta-analyses of randomized controlled trials. JAMA. 2002;287(22):2973–82.CrossRefPubMed
44.
Vincent C, Richardson P. The evaluation of therapeutic acupuncture: concepts and methods. Pain. 1986;24(1):1–13.CrossRefPubMed
45.
Thomas M, Lundberg T. Importance of modes of acupuncture in the treatment of chronic nociceptive low back pain. Acta Anaesthesiol Scand. 1994;38(1):63–9.CrossRefPubMed
46.
Hróbjartsson A, Thomsen ASS, Emanuelsson F, Tendal B, Hilden J, Boutron I, et al. Observer bias in randomized clinical trials with measurement scale outcomes: a systematic review of trials with both blinded and nonblinded assessors. CMAJ. 2013; https://​doi.​org/​10.​1503/​cmaj.​120744.
47.
48.
Dumville JC, Torgerson DJ, Hewitt CE. Reporting attrition in randomised controlled trials. BMJ Br Med J. 2006;332(7547):969–71.CrossRef
49.
50.
Huang TL, Chien CY, Tsai WL, Liao KC, Chou SY, Lin HC, et al. Long-term late toxicities and quality of life for survivors of nasopharyngeal carcinoma treated with intensity-modulated radiotherapy versus non-intensity-modulated radiotherapy. Head Neck. 2015;38(Suppl 1):E1026–32. https://​doi.​org/​10.​1002/​hed.​24150.PubMed
51.
Vissink A, van Luijk P, Langendijk JA, Coppes RP. Current ideas to reduce or salvage radiation damage to salivary glands. Oral Dis. 2015;21(1):e1–10.CrossRefPubMed
52.
Duarte VM, Liu YF, Rafizadeh S, Tajima T, Nabili V, Wang MB. Comparison of dental health of patients with head and neck cancer receiving IMRT vs conventional radiation. Otolaryngol Head Neck Surg. 2014;150(1):81–6.CrossRefPubMed
53.
Al-Mamgani A, van Rooij P, Verduijn GM, Mehilal R, Kerrebijn JD, Levendag PC. The impact of treatment modality and radiation technique on outcomes and toxicity of patients with locally advanced oropharyngeal cancer. Laryngoscope. 2013;123(2):386–93.CrossRefPubMed
54.
Morrison A, Polisena J, Husereau D, Moulton K, Clark M, Fiander M, et al. The effect of English-language restriction on systematic review-based meta-analyses: a systematic review of empirical studies. Int J Technol Assess Health Care. 2012;28(2):138–44.CrossRefPubMed
55.
Pham B, Klassen TP, Lawson ML, Moher D. Language of publication restrictions in systematic reviews gave different results depending on whether the intervention was conventional or complementary. J Clin Epidemiol. 2005;58:769–76.CrossRefPubMed
56.
Moher D, Pham B, Lawson ML, Klassen TP. The inclusion of reports of randomised trials published in languages other than English in systematic reviews. Health Technol Assess. 2003;7:1–90.CrossRefPubMed
57.
Dawidson I, Blom M, Lundeberg T, Angmar-Månsson B. The influence of acupuncture on salivary flow rates in healthy subjects. J Oral Rehabil. 1997;24(3):204–8.CrossRefPubMed
58.
Deng G, Hou BL, Holodny AI, Cassileth BR. Functional magnetic resonance imaging (fMRI) changes and saliva production associated with acupuncture at LI-2 acupuncture point: a randomized controlled study. BMC Complement Altern Med. 2008;8(37):1–7.
59.
Sasportas LS, Hosford DN, Sodini MA, Waters DJ, Zambricki EA, Barral JK, et al. Cost-effectiveness landscape analysis of treatments addressing xerostomia in patients receiving head and neck radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(1):e37–51.CrossRefPubMedPubMedCentral
60.
Dabic DT, Jurisic S, Boras VV, et al. The effectiveness of low-level laser therapy in patients with drug-induced Hyposalivation: a pilot study. Photomed Laser Surg. 2016;34(9):389–93.
Metadata
Title
A systematic review of the effects of acupuncture on xerostomia and hyposalivation
Authors
Zainab Assy
Henk S. Brand
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2018
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/s12906-018-2124-x

Other articles of this Issue 1/2018

BMC Complementary Medicine and Therapies 1/2018 Go to the issue

Research article

Use of biologically-based complementary medicine in breast and gynecological cancer patients during systemic therapy

Research article

The association between cold hypersensitivity in the hands and feet and chronic disease: results of a multicentre study

Research article

Anti-methicillin-resistance Staphylococcus aureus (MRSA) compounds from Bauhinia kockiana Korth. And their mechanism of antibacterial activity

Research article

Huatuo Zaizao pill ameliorates cognitive impairment of APP/PS1 transgenic mice by improving synaptic plasticity and reducing Aβ deposition

Research article

Yiqihuoxue decoction protects against post-myocardial infarction injury via activation of cardiomyocytes PGC-1α expression

Research article

Antidiabetic activity, glucose uptake stimulation and α-glucosidase inhibitory effect of Chrysophyllum cainito L. stem bark extract