Effect of aloe vera and coconut in the management of xerostomia in patients with Sjogren’s syndrome: a crossover randomized clinical trial

Aim: This study aimed to evaluate the efficacy of carboxymethyl cellulose (CMC)-based natural mixture of aloe vera gel and coconut oil as a salivary substitute in comparison to the conventional CMC for the management of xerostomia in a sample of patients with Sjogren’s syndrome (SS). Methods: This crossover randomized clinical trial included 24 patients diagnosed with SS. Half the patients started with the study treatment (A-Gel) for 2 weeks, then went through a 7-day washout period, then received the control treatment (B-Gel), while the other half had the order reversed. The measured outcomes were subjective oral dryness (Bother 1’ xerostomia index), modified xerostomia quality of life scale (XeQoLS), clinical oral dryness (CODs), and salivary candidal load. Results: With a mean age of 46.96 ± 11.86 years, all patients were female and suffered from mouth dryness for 16.58 ± 25.32 months. In light of our findings, both groups’ Bother 1’ xerostomia index values recorded at different intervals showed significant improvements. There was a p < 0.001 difference between the mean value for groups A and B at baseline (7.33 ± 2.39 and 7.29 ± 2.66), one week later (4.17 ± 2.24 and 4.25 ± 2.57), and two weeks later (2.83 ± 2.08 and 2.88 ± 2.07). However, there was no significant difference between the groups. Likewise, for CODs and modified XeQoLS, no significant difference was found between groups; however, both groups showed a statistically significant improvement (p < 0.001). Improvement in the modified XeQoLS was observed in all domains (physical functioning, pain & clinical acceptance). Regarding candidal load, there was no statistically significant difference between groups or even within groups (p > 0.05). Conclusions: As salivary substitutes, the CMC natural mixture (aloe vera, coconut oil) and the conventional CMC-based oral gel are equally efficient at minimizing xerostomia symptoms and enhancing SS patients’ quality of life with minimal side effects. Saliva’s natural effect might be substituted with a natural mixture of coconut oil, aloe vera gel, and CMC. The trial is registered on clinicaltrials.gov, identifier: NCT04252209.