A mouth rinse based on a tea solution of Salvia officinalis for oral discomfort in palliative cancer care: a randomized controlled trial

Ragnhild Elisabeth Monsen, Bente Brokstad Herlofson, Caryl Gay, Katrine Gahre Fjeld, Lene Hystad Hove, Karl Egil Malterud, Elisabeth Saghaug, Joran Slaaen, Tone Sundal, Anita Tollisen, Anners Lerdal, Ragnhild Elisabeth Monsen, Bente Brokstad Herlofson, Caryl Gay, Katrine Gahre Fjeld, Lene Hystad Hove, Karl Egil Malterud, Elisabeth Saghaug, Joran Slaaen, Tone Sundal, Anita Tollisen, Anners Lerdal

Abstract

Background: Few clinical studies evaluate interventions to reduce oral discomfort among patients in palliative care.

Aim: This study examines the efficacy of a Salvia officinalis (SO) based herbal mouth rinse compared to conventional normal saline (NS) in order to improve oral health.

Design: A block-randomized controlled trial. Data were collected before and after a 4-day intervention with either SO (n=44) or NS (n=44). Numerical rating scales (NRS, 0-10) and 12 items from the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Oral Health 17 (EORTC QLQ-OH17) measured patient-reported oral symptoms. An oral examination was performed before and after the intervention.

Setting/participants: This study included adult patients with late-stage cancer in an inpatient hospice unit.

Results: Of the 88 patients included (mean age=63.9 years, SD=10.6), 73 (83%) completed the study. At baseline, 78% reported dry mouth on the EORTC QLQ-OH17, and 80% rated dry mouth ≥4 on the NRS. Total oral health scores based on the 12 EORTC QLQ-OH17 items improved similarly in both groups (p<0.001). However, dry mouth ratings on both the EORTC QLQ-OH17 (p=0.036) and NRS (p=0.045) improved more in the SO group than in the NS group. Plaque on the teeth improved in both the SO (p=0.008) and NS (p=0.018) groups, but plaque on the tongue and erythema only improved with NS.

Conclusions: This study did not detect an overall significant difference between SO and NS. Both mouth rinses improved oral health parameters, indicating that systematic assessment and oral care may reduce oral discomfort.

Trial registration: NCT02067572.

Keywords: Mouth rinse; Oral care; Oral health; Palliative care; Randomized controlled trial; Salvia officinalis.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Participant flow chart
Fig. 2
Fig. 2
Patient-reported oral symptoms at baseline (12 items from the EORTC QLQ-OH17)
Fig. 3
Fig. 3
Changes in EORTC QLQ-OH17 and NRS ratings based on dry mouth by treatment group (group-by-time interaction p=0.036 and 0.045, respectively). For the EORTC QLQ-OH17, the effect size for the difference between groups on day 5 is Cohen’s d=0.45; the effect size for improvement over time was d=0.33 for the saline group and 0.75 for the salvia group. For the NRS, the effect size for the difference between groups on day 5 is Cohen’s d=0.31; the effect size for improvement over time was d=0.39 for the saline group, and 0.63 for the salvia group

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