The effect of chewing gum on dry mouth, interdialytic weight gain, and intradialytic symptoms: A prospective, randomized controlled trial (original) (raw)

Abstract

Introduction: The major salivary glands can be stimulated by chewing gum to increase saliva flow and decrease xerostomia. The aim of this study was to investigate the effect of chewing gum on dry mouth, interdialytic weight gain, and intradialytic symptoms in hemodialysis (HD) patients. Methods: This prospective randomized controlled single-blind study was conducted with patients who had been treated for at least 6 months with sessions 3 days a week for 4 hours at two HD units. Patients were randomly allocated to chewing gum group or the control group. In the chewing gum group, gum was chewed for 10 minutes six times a day, and when the patients felt mouth dryness or were thirsty. In the nonchewing gum group, gum was not chewed. The patients were followed-up for 3 months. A total of three saliva samples were taken before starting treatment at the first, 12th, and 36th HD session. Data were collected with the "Visual Analogue Scale (VAS)," "Hemodialysis Patients Fluid Control Scale," "Dialysis Symptom Index," and "Hospital Anxiety and Depression Scale" at baseline, week 4, week 8, and week 12. Findings: The study was completed with a total of 44 patients consisting of 22 patients in the each group. The second and third month VAS values (xerostomia) of the patients in the chewing gum groups were statistically significantly lower than those in the control group (P = 0.014, P < 0.001, respectively). The third month salivary flow rate in the chewing gum group was higher than the values in the control group patients (P < 0.001). Discussion: It is anticipated that this study will raise nurses' awareness of dry mouth and encourage future studies on interventions to increase the salivary flow rate to prevent or treat dry mouth.

Figures (5)

Loading...

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

References (33)

  1. Bossola M, Tazza L. Xerostomia in patients on chronic hemodialysis. Nat Rev Nephrol. 2012;8:176-182. https:// doi.org/10.1038/nrneph.2011.218.
  2. Bossola M. Xerostomia in patients on chronic hemodial- ysis: An update. Semin Dial. 2019;32:467-474. https:// doi.org/10.1111/sdi.12821.
  3. Lindley EJ. Reducing sodium intake in hemodialysis patients. Semin Dial. 2009;22:260-263. https://doi.org/ 10.1111/j.1525-139X.2009.00570.x.
  4. Kurita N, Hayashino Y, Yamazaki S, et al. Revisiting interdialytic weight gain and mortality association with serum albumin interactions: The Japanese dialysis out- comes and practice pattern study. J Ren Nutr. 2017;27: 421-429. https://doi.org/10.1053/j.jrn.2017.05.003.
  5. Ozen N, Cinar FI, Askin D, Mut D, Turker T. Non- adherence in hemodialysis patients and related factors: A multicenter study. J Nurs Res. 2019;27:e36. https:// doi.org/10.1097/jnr.0000000000000309.
  6. Gibson EL, Held I, Khawnekar D, Rutherford P. Differ- ences in knowledge, stress, sensation seeking, and locus of control linked to dietary adherence in hemodialysis patients. Front Psychol. 2016;7:1864.
  7. Bots CP, Brand HS, Veerman EC, et al. Interdialytic weight gain in patients on hemodialysis is associated with dry mouth and thirst. Kidney Int. 2004;66: 1662-1668. https://doi.org/10.1111/j.1523-1755.2004\. 00933.x. Chewing gum and dry mouth Hemodialysis International 2020
  8. 8 Jagodzi nska M, Zimmer-Nowicka J, Nowicki M. Three months of regular gum chewing neither alleviates xerostomia nor reduces overhydration in chronic hemo- dialysis patients. J Ren Nutr. 2011;21:410-417. https:// doi.org/10.1053/j.jrn.2010.08.002.
  9. Duruk N, Eser I. The null effect of chewing gum during hemodialysis on dry mouth. Clin Nurse Spec. 2016;30: E12-E23. https://doi.org/10.1097/NUR.000000000000 0234.
  10. Bots CP, Brand HS, Veerman EC, et al. The management of xerostomia in patients on haemodialysis: Comparison of artificial saliva and chewing gum. Palliat Med. 2005;19: 202-207. https://doi.org/10.1191/0269216305pm1009oa.
  11. Said H, Mohammed H. Effect of chewing gum on xerostomia, thirst and interdialytic weight gain in patients on hemodialysis. Life Sci J. 2013;10: 1767-1777.
  12. Dehghanmehr S, Piri F, Roohi R, Nooraeen S, Salarzaei M. Investigating the effect of sugar-free candies on the intensity of thirst and dry mouth in patients undergoing hemodialysis. J Pharm Sci Res. 2017;9: 1993-1996.
  13. Fan WF, Zhang Q, Luo LH, Niu JY, Gu Y. Study on the clinical significance and related factors of thirst and xerostomia in maintenance hemodialysis patients. Kidney Blood Press Res. 2013;37:464-474. https://doi.org/10\. 1159/000355717.
  14. Navazesh M, Kumar SK. Measuring salivary flow: Chal- lenges and opportunities. J Am Dent Assoc. 2008;139: 35S-40S. https://doi.org/10.14219/jada.archive.2008.0353.
  15. Jones JM, Watkins CA, Hand JS, Warren JJ, Cowen HJ. Comparison of three salivary flow rate assessment methods in an elderly population. Commun Dent Oral Epidemiol. 2000;28:177-1784. https://doi.org/10.1034/j. 1600-0528.2000.280303.x.
  16. Ericsson Y, Hardwick L. Individual diagnosis, prognosis and counselling for caries prevention. Caries Res. 1978; 12:94-102. https://doi.org/10.1159/000260369.
  17. Sreebny L. Saliva-Salivary gland hypofunction (SGH). FDI working group 10. J Dent Assoc S Afr. 1992;47: 498-501.
  18. Daugirdas JT. Second generation logarithmic estimates of single-pool variable volume Kt/V: An analysis of error. J Am Soc Nephrol. 1993;4:1205-1213.
  19. Albayrak CA. A scale development study: fluid control in hemodialysis patients (Unpublished master thesis). Marmara University Institute Health Sciences. Istanbul, Turkey: 2012.
  20. Weisbord SD, Fried LF, Arnold RM, et al. Development of a symptom assessment instrument for chronic hemo- dialysis patients: The dialysis symptom index. J Pain Symptom Manage. 2004;27:226-240. https://doi.org/10\. 1016/j.jpainsymman.2003.07.004.
  21. Önsöz HB, Usta Yes ¸ilbalkan O. Reliability and validity of the Turkish version of the dialysis symptom index in chronic hemodialysis patients. Turk Neph Dial Transpl. 2013;22:60-67. https://doi.org/10.5262/tndt.2013\. 1001.08.
  22. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67: 361-370. https://doi.org/10.1111/j.1600-0447.1983\. tb09716.x.
  23. Aydemir Ö, Güvenir T, Küey L, Kültür S. Validity and reliability of Turkish version of hospital anxiety and depression scale. Turk J Psychiatr. 1997;8:280-287. (Original work published in Turkish).
  24. Kho HS, Lee SW, Chung SC, Kim YK. Oral manifesta- tions and salivary flow rate, pH, and buffer capacity in patients with end-stage renal disease undergoing hemo- dialysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88:316-319. https://doi.org/10.1016/ s1079-2104(99)70035-1.
  25. Simons D, Brailsford SR, Kidd EA, Beighton D. The effect of medicated chewing gums on oral health in frail older people: A 1-year clinical trial. J Am Geriatr Soc. 2002;50:1348-1353. https://doi.org/10.1046/j.1532- 5415.2002.50355.x.
  26. Marshall MR, Vandal AC, de Zoysa JR, et al. Effect of low-sodium versus conventional sodium dialysate on left ventricular mass in home and self-care satellite facility hemodialysis patients: A randomized clinical trial. J Am Soc Nephrol. 2020;31:1078-1091. https://doi.org/10\. 1681/ASN.2019090877.
  27. Kugler C, Maeding I, Russell CL. Nonadherence in patients on chronic hemodialysis: An international com- parison study. J Nephrol. 2011;24:366-375. https://doi. org/10.5301/JN.2010.5823.
  28. Mellon L, Regan D, Curtis R. Factors influencing adher- ence among Irish haemodialysis patients. Patient Educ Couns. 2013;92:88-93. https://doi.org/10.1016/j.pec. 2013.01.023.
  29. Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis. 2006;48:S2-S90. https://doi.org/ 10.1053/j.ajkd.2006.03.051.
  30. Bruzda-Zwiech A, Szczepa nska J, Zwiech R. Sodium gra- dient, xerostomia, thirst and inter-dialytic excessive weight gain: A possible relationship with hyposalivation in patients on maintenance hemodialysis. Int Urol Nephrol. 2014;46:1411-1417. https://doi.org/10.1007/ s11255-013-0576-y.
  31. Mistiaen P. Thirst, interdialytic weight gain, and thirst- interventions in hemodialysis patients: A literature review. Nephrol Nurs J. 2001;28:601-615.
  32. National Kidney Foundation. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis. 2015;66:884-930. https://doi.org/10\. 1053/j.ajkd.2015.07.015.
  33. Abdel-Kader K, Unruh ML, Weisbord SD. Symptom burden, depression, and quality of life in chronic and end-stage kidney disease. Clin J Am Soc Nephrol. 2009;4: 1057-1064. https://doi.org/10.2215/CJN.00430109.