In this article, we discuss the “Comparison of the effect of ginger and aloe vera mouthwashes on xerostomia in patients with type 2 diabetes: A clinical trial, triple-blind” (1).
Aim of study
To explore the effects of ginger and aloe vera mouthwashes on xerostomia (dry mouth) in the patients with diabetes.
Study method
A randomised, triple-blind, placebo-controlled trial of patients with diabetes mellitus and xerostomia. Participants were male and female and randomised to three groups which averaged 53 – 58 years of age. The study was carried out at the Diabetes Clinic of Bandar Abbas in Iran.
The following measures were made at the start and 14 days.
- Xerostomia symptom questionnaire with 10 questions (with 4 positive answers defined as xerostomia)
- Severity of xerostermia via a visual analog scale (VAS) (which was a 100 mm line where 0 = no xerostomia and 100 = severe).
Herbal preparation
Participants were randomised to the following groups and received the following mouthwashes: ginger 25%, aloe vera 50% and saline. These were prepared to the same colour and packaging.
They used 20 mls three times daily for 14 days. Patients were advised to keep the solution in the mouth for 1 minute and then discard.
Sample size
N=35 in each group
Results of study
There were no significant differences between the ages, severity of xerosomia and duration of diabetes between the three groups at the start of the study.
Table 2 (in the paper) shows the 10 questions asked such as “experience of dry mouth during meals” or “difficulty swallowing”. All three groups were similar at the start of the trial as shown by Chi-squared statistical tests which present the numbers of patients and percentage of the group in brackets (i.e. out of n=35 for each group).
After the intervention, five of the items were significantly improved by either ginger or aloe vera (p<0.05), and other items were near significance (waking up in the night due to thirst). For three items, using saline was as effective as the herbs, such as making swallowing less difficult.
The final statistical test (McNemar) compared the effects of ginger, aloe vera and saline before and after the mouthwash. For all ten items, ginger and aloe significantly improved the subjective symptoms of dry mouth. Although from the data the statistical results for the herbs aren’t reported separately, it is assumed from the write-up, that each comparison was significant at p<0.001.
With the severity data recorded on the VAS scale, ginger was most effective in reducing the symptoms followed by aloe vera and then saline.
Discussion
Dry mouth is a common symptom in diabetes and can affect swallowing and the enjoyment of food.
Previous studies had looked at aloe vera for its moisturising properties, and ginger for its anti-microbial and anti-inflammatory properties (2).
This study found that ginger, followed by aloe vera, formed an effective mouthwash for reducing the subjective symptoms and severity of dry mouth in patients with diabetes.
There were slightly more women in the ginger and aloe vera groups although the researchers did a multifactorial analysis and showed no influence from the date of onset of the menopause, sex or age of participants. Dry mouth and eyes can be a feature of menopause.
As a limitation, parts of this study relied on the patients carrying out the mouth washing consistently at home, and the questionnaire data was subjective. More reliable clinical measures such as estimating saliva flow would be useful in future studies.
More research would be useful to determine whether ginger or aloe vera is more preferential. Aloe is very bitter and a 25% (presumably w/v) mouthwash would still taste so. Ginger has a strong taste so it would be interesting to compare with milder and more refreshing tasting herbs like mint or balm.
Previous studies have looked at gels, herbal sprays, and this study used a mouthwash. Again, more research could be done to understand what format patients would prefer, and perhaps a spray would be useful when away from home, such as some of the claims to experience dry mouth whilst travelling. Another study has looked at ginger as a spray (3).
Conclusion
Ginger mouthwash, used for 14 days, significantly reduced xerostomia severity and eased some of the symptoms of dry mouth compared to saline. Aloe vera also relieved severity but to a lesser extent compared to ginger.
Ginger is a very accessible spice and mouthwashes can be made in the home. The authors suggest that nurses recommend it to patients with dry mouth to help with their oral health.
References
- Badooei, F., Imani, E., Hosseini-Teshnizi, S., Banar, M., & Memarzade, M. (2021). Comparison of the effect of ginger and aloe vera mouthwashes on xerostomia in patients with type 2 diabetes: A clinical trial, triple-blind. Medicina Oral, Patología Oral Y Cirugía Bucal, e408–e413. https://doi.org/10.4317/medoral.23998
- Rolfe, V. (2024). Research seeds ginger. Available: https://www.herbalreality.com/herbalism/herbal-research/research-seeds/research-seeds-ginger/
- Mardani, H., Ghannadi, A., Rashnavadi, B., & Kamali, R. (2017). The Effect of ginger herbal spray on reducing xerostomia in patients with type II diabetes. Avicenna J Phytomed. 7(4):=, 308-316. PMID: 28884081; PMCID: PMC5580869. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580869/
