Comment on “Assessment of a New Tool to Monitor Oral Hydration and Dry Mouth: FishburneTabs”

We found the innovative study from Giacaman et al. evaluating FishburneTabs as an assessment tool of oral hydration and hyposalivation in a cohort of elderly care home residents (Giacaman et al. 2026) to be of immense interest. The authors set out to develop a simple and user-friendly alternative to conventional sialometry. This is very much needed and can help vulnerable populations with cognitive impairment. The pioneering work of the article is commended, but several recommendations are provided that would improve the clinical usefulness and accuracy of this promising device. Findings of the study showed moderate sensitivity (62.2%) and specificity (61.9%) when comparing FishburneTabs with stimulated salivary flow. Nonetheless, we propose that future validation studies may benefit from having unstimulated salivary flow as the reference standard in the FishburneTabs comparison. Lee et al. (2024) have shown that unstimulated flow more reliably reflects properties at baseline oral hydration status and provides diagnostic parameters for xerostomia prediction more meaningfully. Because FishburneTabs depend upon passive absorption of pooled saliva instead of stimulated secretion, their agreement with measurements of unstimulated flow may produce better correlations and improve the observed diagnostic accuracy. The writers determined differences between T1 and T2 readings. The T2 speed values were judged to be higher due to continuing capillary action. We suggest looking at an intermediate timepoint; for instance, 1 min after placement may offer a good compromise between sufficient diffusion and overestimation. Furthermore, due to the rheological differences that exist in hyposalivation, in particular the change in mucin glycosylation and extensional viscosity recently reported by (Mishra et al. 2025) and (Rereddy et al. 2022), we propose investigating whether saliva viscosity measurements can be used as a complementary measure. Such phenomena can be helpful for clinicians to interpret the results of FishburneTabs in patients with altered salivary rheology, where absorption patterns might significantly differ. In addition, despite the inclusion of polypharmacy as a recognized risk factor for hyposalivation, no analyses of medicine profiles were conducted. Specific classes of drugs, particularly anticholinergic, antidepressants, and cardiovascular drugs, are known to produce varying degrees of xerogenicity. For future studies, we recommend characterizing participants by medication class and dosage to test which patient subgroups would benefit from FishburneTabs monitoring. Can facilitate targeted implementation in settings where prescription of certain medications is common, such as psychiatric or geriatric facility. The authors are transparent about the limitations of the study and of FishburneTabs being complementary to sialometry, and not a replacement for it. To enhance clinical applicability, longitudinal validation studies assessing test–retest associations at multiple timepoints are recommended. Through such studies, it will be established whether FishburneTabs can reliably determine the changes in oral hydration over time that can be used to measure interventions. Furthermore, it would also be interesting for the FishburneTabs to be compared to other point-of-care devices such as the BokaFlo device validated by (Kessler et al. 2021) in order to position FishburneTabs within the diagnostic arena and clarify their specific advantages in different clinical scenarios. In short, Giacaman et al. have developed a potentially useful tool for hyposalivation assessment that could greatly enhance care for the elderly and dependents. The FishburneTabs has the potential to be a valuable tool for the evaluation of oral dryness, provided there are refined measurement protocols, validation against relevant reference standards and stratification by clinical factors. We recommend further research for the optimization of this device and evidence-based guidelines for its use in various settings. Chenglu Ruan: conceptualization, writing – review and editing, writing – original draft. Lin Wang: conceptualization, writing – original draft, writing – review and editing. The authors have nothing to report. The authors declare no conflicts of interest.