Written by Tabish Mehraj, PhD Science Writer. This study evaluated the effectiveness of honey and aloe vera in management of xerostomia over a 4-week period (p=0.002). Both interventions significantly reduced xerostomia symptoms, increased salivary flow rate and improved quality of life as compared to saline (p<0.001), moreover salivary nitric oxide levels were highest in thyme group followed by aloe vera, resulting in enhanced function of the salivary gland. 

Xerostomia is a dry-mouth condition that occurs in patients with type 2 diabetes. This condition is often accompanied by reduced saliva production and a sensation in the mouth. It causes speech impairment, changes in the oral mucosa, and alterations in taste, which may lead to malnourishment and weight loss. Currently, various pharmacological treatments and non-drug dependent alternatives such as low laser therapy, acupuncture, and electrostimulation present certain side effects, highlighting the need for alternative, viable, and long-term treatment options aimed to compare the clinical efficacy of aloe vera versus thyme honey mouthwash in individuals with type 2 diabetes suffering from xerostomia. Aloe vera and thyme honey possess properties such as moisturizing, antibacterial, hypoglycemic, wound healing, and antioxidant, making them prospective therapeutic agents for the management of xerostomia.

This study, conducted by Susan S. and her team at the Oral Medicine and Periodontology Department outpatient clinic at Ain Shams University, used a randomized, single-blinded, controlled clinical trial design with biochemical analysis. A total of 45 type 2 diabetic patients diagnosed with xerostomia were enrolled, while patients with other systemic diseases resulting in xerostomia were not included. The adults were distributed into 3 equal groups (n=15 each) with a 1:1:1 ratio.

Aloe Vera Group: Receiving aloe vera mouthwash (50% concentration), made by diluting with water.

Thyme Honey Group: Receiving thyme honey mouthwash (20% concentration), made by diluting with water.

Control Group: Receiving saline mouthwash (20 mL saline).

Participants used their designated mouthwash 3 times a day for 4 weeks. The outcomes were assessed at baseline, 2, and 4 weeks; the assessed parameters included:

Unstimulated salivary flow rate: assessed by the spitting method for 5 minutes, with samples collected at various time points, baseline, 2, and 4 weeks. Patients with a flow rate <0.2 mL/min were included. Subjective xerostomia scores, salivary nitric oxide (NO) levels, xerostomia-related quality of life questionnaire (XeQoLS) analyzed at baseline, 2,4 weeks. Statistical analysis was performed as well.

The results/significant findings are as follows:

XeQoLS scores: Following 4 weeks, scores decreased in all groups, with the greatest reduction observed in the thyme honey group (63% reduction), followed by the aloe vera group (59% reduction while the control group showed a smaller reduction (18%). At baseline, no significant differences were noted between groups regarding XeQoLS scores.

Xerostomia Symptoms (4 weeks): Thyme honey demonstrated the greatest reduction in dry mouth symptoms (63%), followed by aloe vera (59%), while the control group showed only a modest improvement (18%).

Unstimulated Salivary Flow Rate: Salivary flow was highest with thyme honey (2.3-fold higher than saline), followed by aloe vera (2.0-fold higher than control), while the lowest flow was observed in the saline group.

Salivary Nitric Oxide (NO): Thyme honey showed the highest levels representing an approximately 5.9-fold increase compared with control group, followed by aloe vera 5.4-fold higher than saline, while the saline group showed the lowest levels indicating improved salivary gland function in the intervention groups.

Aloe vera and thyme honey, and aloe vera alone, showed promising results in relieving xerostomia symptoms in T2D patients. Significant improvements were observed in salivary flow rate, quality of life, and subjective dryness. Aloe vera and thyme honey have a moisturizing effect due to their mucopolysaccharides and higher water content.

This randomized, controlled study evaluated subjective symptoms, objective salivary flow, and biochemical markers, providing a comprehensive assessment of treatment effects. The findings demonstrated that natural agents such as thyme honey and aloe vera significantly improved xerostomia symptoms, salivary flow rate, and quality of life, highlighting their potential as cost-effective and easily accessible treatment options. However, the study had several limitations, including a short duration of four weeks, a single-center and single-blinded design, and a relatively small sample size (n = 45). Additionally, the bitter aftertaste associated with aloe vera rinses may affect patient acceptability.

This study concludes that both aloe vera and thyme honey mouthwashes are safe, cost-effective, and clinically effective options for managing xerostomia in patients with type 2 diabetes. Thyme honey, in particular, demonstrated a noteworthy advantage over aloe vera and saline, suggesting its potential as a primary natural intervention for this condition. Further research with larger cohorts and extended durations is warranted to solidify these findings and explore optimal formulations.

Click here to read the full text study.

This study was registered in clinicaltrials.gov with the identifier NCT05885906. This article is available in open access under Creative Commons Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license.

Posted March 13, 2026.

Dr. Tabish Mehraj is a pharmaceutical scientist with expertise in pharmaceutics, drug delivery, and formulation development. She earned her PhD in Pharmaceutical Sciences from the University of Mississippi, where her research focused on the formulation, optimization, and characterization of lipid-based nanocarriers for targeted liver delivery of antimalarial therapeutics. Dr. Mehraj has also served as an ORISE Fellow at the U.S. Food and Drug Administration (FDA), where she evaluated the effects of formulation and process design on the quality and performance of intravaginal drug delivery systems and developed bio-relevant in vitro drug release testing methods. She has teaching experience in pharmaceutical and life sciences courses and has authored peer-reviewed publications, book chapters, and conference presentations. Dr. Mehraj is an active member of the American Association of Pharmaceutical Scientists and has been recognized by honor societies including Rho Chi and Gamma Beta Phi.

References:

1. Ibrahim, S. S., Elkhouly, D. B., & Hussein, R. R. (2025). A randomized controlled trial of Aloe vera versus thyme honey oral rinse in the management of xerostomia in type 2 diabetes. Clinical Diabetology, 14(2), 81-87.