The Safety of Dronabinol and Nabilone: A Systematic Review and Meta-Analysis of Clinical Trials

Dronabinol, a natural cannabinoid, and its semi-synthetic derivative, nabilone, are marketed as medicines in several countries. The aim of our work was to systematically evaluate the frequency of adverse events related to dronabinol or nabilone treatment compared to placebo. Scientific databases were searched for placebo-controlled clinical studies of patients receiving either dronabinol or nabilone therapy with placebo control groups. This meta-analysis was reported following the PRISMA guidelines using the PICO format, and it was registered with the PROSPERO register. There were 16 trials included in the meta-analysis. In the nabilone studies, drowsiness was more than 7 times as frequent in patients treated with nabilone than in the placebo group (OR: 7.25; 95% CI: 1.64–31.95), and the risk of dizziness (OR: 21.14; 95% CI: 2.92–152.75) and dry mouth was also higher (OR: 17.23; 95% CI: 4.33–68.55). The frequency of headache was not different in the two groups. In case of dronabinol, the frequency of dry mouth (OR: 5.58; 95% CI: 3.19–9.78), dizziness (OR: 4.60 95% CI: 2.39–8.83) and headache (OR: 2.90; 95% CI: 1.07–7.85) was significantly higher in the dronabinol groups, whereas in case of nausea, drowsiness and fatigue there was no difference. The severity of adverse events was typically mild-to-moderate and transient. In a risk-benefit assessment, these adverse effects are acceptable compared to the achievable benefit. However, considering the diversity of the adverse effects, more studies are needed to provide a more accurate assessment on the side effect profiles of these two compounds.

The Effects of The Royal Jelly On Dry Mouth Sensation With Normal Saliva Function: A Double-Blind, Placebo-Controlled, Cross-Over Trial Clinical Study

Background: Because there are no standardized treatment methods for dry mouth sensation with normal salivary function, cases of dry mouth sensation continually suffer. The aim of this clinical study was to evaluate the effects of a royal jelly tablets on dry mouth sensation, in patients with normal salivary function. Methods: This double-blind randomized clinical trial was carried out in the Department of Oral and Maxillofacial Surgery, Tokyo Medical and Dental University Hospital between November, 2019 and April, 2020. This clinical trial was randomized, double-blind, and of a crossover design, with a four-week washout period. Each participant received either 800 mg of royal jelly tablets or placebo, daily for 12 weeks. Results: Differences in VAS scores between royal jelly tablets and placebo were evaluated at 4 and 12 weeks, and were significant. Differences in HADS and GHQ12 scores between those exposed to royal jelly tablets and placebo, at the evaluation period of 12 weeks, were statistically significant. A statistically significant decrease in HADS scores in the royal jelly tablet group, was observed over time. Conclusions: These findings show that daily consumption of royal jelly (800 mg) for 12 weeks was effective in alleviating dry mouth sensation with normal saliva function.Clinical trial registration numbers and the full date of first registration: ClinicalTrials.gov (jRCTs031190067); 02/08/2019

Over-The-Counter Oral Hygiene Products Misuse: A Case Report

Oral hygiene products (OHP) are recommended to maintain the teeth and health of the oral cavity tissues by assisting in lowering the plaque level as well as the opportunistic flora. Oral hygiene products could cause oral health problems that may vary in severity. Due to the availability of over-the-counter (OTC) medications and lack of knowledge, customers may misuse these products. An oral hygiene product is a double-edged sword; a customer would develop side effects from it without even knowing or correlating the source. Many signs and symptoms may appear on the patients such as oral and perioral burning sensations, swelling, erythema, dysgeusia, and dysphagia. To our knowledge and based on the review of English literature through PubMed Midline, this is the first case report of misuse because of an over-the-counter oral hygiene product in which the patient used a mouthwash continuously and aggressively for 15 days without knowing of its side effects. This case report presents an eighty-two-year-old, male patient who complained of pain, burning, swollen, and dry mouth and lips. The author discussed the most common ingredients of oral mouthwashes. Some active ingredients may irritate the oral mucosa and lips. Also, the author discussed the possible differential diagnosis of painful, sensitive, burning, swollen, and dry mouth and lips. This report is intended as an overview of a rare and unusual oral condition associated with the misuse of OTC oral hygiene products. The findings of the present study necessitated the need for clear verbal and written instructions to be provided to the patients before recommending or prescribing any type of medication.

Dental status of geriatric patients with disorder of cognitive functions and their medical and social characteristics

Aim: analysis of medical and social characteristics and assessment of the dental status of geriatric patients with cognitive impairment.Materials and methods. The study was carried out at the Department of Therapeutic Dentistry. We analyzed the responses and laboratory results of 43 patients aged 60–92 years. The main methods used in the study were: questioning (Fox test), sialometry, saliva pH determination, microbiological analysis (of the upper respiratory tract) for fungal microflora.Results obtained showed that an objective study of the secretory function of the salivary glands according to the method of M.M. Pozharitskaya found that the average rate was 0.2 ± 0.004 ml/min, and the average saliva pH was 5.7 ± 0.04. The medical and social portrait of a geriatric patient indicates that mainly patients with impaired cognitive functions seeking dental treatment and prophylaxis were women, whose average age was 76.03 ± 2.8 years, as a rule, they were representatives of the humanitarian and natural-scientific professions, 75% are married. According to the results of the Fox test, it was found that 60% of patients complained of dry mouth of a different nature. The perception of dry mouth was statistically significantly dependent on gender (P = 0.025) and the presence of chronic diseases (P = 0.004). Women (OR = 1.17, P = 0.026) with chronic diseases (OR = 2.97, P = 0.002) were more likely to suffer from dry mouth.

Evaluation of Jinlida Granules in Improvements to Standard-Reaching Rate of Blood Glucose and Type 2 Diabetes Mellitus Symptoms: Results of Secondary Analysis From 12-Week Trial

Background The previous study found that the Jinlida could significantly reduce levels of blood glucose and enhance the lowing-glucose action of metformin. However, the role of the standard-reaching rate of blood glucose and improving clinical symptoms in Jinlida has yet to be studied. We aimed to elaborate on the efficacy of Jinlida in Type 2 diabetics who experience clinical symptoms based on secondary analysis from the 12-week trial. Methods Data were analyzed from a 12-week, randomized, placebo-controlled, study of Jinlida. The standard-reaching rate of blood glucose, total symptom score, the efficacy of single symptom, symptom disappearance rate, symptom improvement rate was evaluated. Then, the correlation of the symptom effective rate and HbA1c was analyzed. Results 192 T2DM patients were randomly allocated to receive either Jinlida or a placebo for 12 consecutive weeks. The standard-reaching rate of HbA1c (<6.5%) was 25% in the treatment group when compared to 14.9% in the control group. (P=0.046); All the symptom exhibited a change difference, comparing the treatment group to the control group after 12 weeks’ intervention. (P< 0.05); Hunger, polyuria, dry mouth, sweating and dysphoria in chestpalms-soles symptoms exhibited a change difference in the treatment group, compared to that in the control group. (P<0.05). All the symptom exhibited a significant difference in symptom improvement rate. (P<0.05). Conclusions Jinlida glandule can effectively improve clinical symptoms of type 2 diabetics including thirsty, fatigue, hunger, polyuria, dry mouth, night-sweat, dysphoria in chenstplms-soles and constipation. It can be used as an effective adjuvant treatment for T2DM who experience those symptoms. However, these findings need to be further confirmed by evidence-based medicine.

Role of hormone replacement therapy in relieving oral dryness symptoms in postmenopausal women: a case control study

Background To evaluate the efficacy of hormone replacement therapy in relieving oral symptoms in postmenopausal women presenting with genitourinary symptoms along with oral dryness. Methods A case–control study was conducted after selecting 60 postmenopausal women. Oral dryness status of all the patients was evaluated with the help of questionnaire related to oral dryness. These subjects were divided into case group and control group on the basis of response to questionnaire of oral dryness. Unstimulated saliva samples were obtained and analyzed for estimation of salivary estradiol levels by enzyme linked immune sorbent assay technique. After analyzing the result of salivary estradiol levels, case group was subjected to hormone replacement therapy (HRT). The patients were followed up for their response towards oral dryness as well as salivary estradiol levels after the therapy. Results The mean salivary estradiol level before HRT was significantly more among control group as compared to case group (p value < 0.001). Most of the patients complained of dry mouth (26 out of 30); reduced amount of saliva in the mouth (25 out of 30); dry mouth at night (28 out of 30); dry mouth during the day (25 out of 30) before HRT. These complains were significantly reduced after the therapy. The mean salivary estradiol in the case group levels increased significantly after HRT (p value < 0.001). Conclusion The salivary estradiol levels were reduced in post menopausal women with the complain of xerostomia as compared to those without the complain of xerostomia. Further these levels can be recovered with the help of hormone replacement therapy.

Minimizing Complications of Aging That Lead to Dry Mouth and Poor Oral Health

Poor oral health causes severe pain and untreated infections to spread throughout the body. For older adults, the prevalence of root decay exceeds that of any other medical condition. Our research shows tooth loss and edentulousness were associated with increased mortality and inversely associated with BMI, waist circumference, blood pressure, and fasting blood glucose. Our Stop-it study found people who lost bone density had fewer teeth, problems chewing, and involuntary weight loss and frailty. 88% of the elderly take medications that cause loss of saliva. Sjögren’s and radiation therapy for head and neck cancer patients heighten risk. Without saliva, patients have increased tooth decay, periodontal disease and fungal infections, salivary gland blockage, and problems swallowing and speaking. Dry mouth leads people to suck on candy that further increase caries. Substituting sugarfree gum for candy increases salivary flow and reduces dental caries. Brushing, flossing, and limiting sugar also lessen tooth decay.