## 4 Discussion
Thus, it is consolidated as an efficient alternative that is less invasive and more convenient for the management of xerostomia. TENS is generally safe and well tolerated, and none of the patients experienced significant secondary effects. Although our study was not initially centered on exploring immediate effects, the results highlight a notable impact immediately after the first session. After the comparison between the treatment and sham groups, it was observed that after a single intervention, the reduction in the scores was significantly more pronounced in the treatment group. This finding underlines that even a single session can have a considerable effect, which is fundamental for understanding the immediate efficacy of the treatment. The treatment through TENS was also effective in post-radiotherapy xerostomia. [PERSON] et al. (2003) [24] conducted one of the first controlled randomized assays where ALTENS (Acupuncture-Like Transcutaneous Electrical Nerve Stimulation, low-amplitude TENS) was compared with pilocarpine in 37 patients. The results demonstrated that ALTENS was more effective in improving salivary flow and alleviating xerostomia, laying the foundations for considering TENS as a viable alternative to pharmacological treatment. Afterwards, [PERSON] et al. (2014) [26] assessed the application of TENS in 30 patients, showing that it doubled the production of saliva measured through the spitting method. However, this study did not assess the impact on quality of life, limiting its perspective on the comprehensive effect of the treatment. In 2015 [25], [PERSON] et al. expanded the findings of their previous study with a controlled randomized trial with 96 patients, once again comparing ALTENS with pilocarpine. This study confirmed that ALTENS was not only superior in terms of efficacy, but also showed less toxicity. For their part, [PERSON] et al. (2015) [27] investigated the impact of the daily application of TENS in 40 patients, finding a significant increase in salivary flow. [PERSON] et al. (2019) [28] complemented this evidence with a controlled randomized assay with 15 patients, where they showed that the effects of TENS, aside from increasing salivary production, were maintained until after six months, improving the quality of life perceived. TENS may modulate the activity of sympathetic and parasympathetic nerves innervating the salivary glands, promoting saliva secretion through the regulation of neuronal excitability and synaptic plasticity in the somatosensory pathways involved in salivation control [13; 30; 31; 32]. Drainage salometry is the gold standard for hyposalivation evaluation, yet its prolonged measurement time and difficulty in vulnerable populations limit its clinical use. As a validated alternative, the Oral Schirmer Test is rapid, accessible, and objective, overcoming the practical challenges of siolometry. Its integration in dental and medical practice enables early xerostomia detection, ensuring timely diagnosis and improved management [18,19]. Despite the limitations inherent to the unequal number of sessions between the treatment and sham groups, this methodological decision was crucial for our study. The design intentionally limited the sessions of the sham group to a single session, due to the ethical and logistical considerations, thus allowing us to focus the assessment on the cumulative effects of the treatment exclusively in the treatment group. Additionally, a further limitation was the lack of diversity in the types of medications administered, which could have influenced the outcomes and the generalizability of the findings. Extending the intervention period in future studies could provide more conclusive data on long-term efficacy and sustained treatment benefits. Furthermore, incorporating follow-ups at 3 or 6 months would allow for the assessment of enduring effects and the retention of benefits such as salivary gland function, essential aspects for validating the clinical relevance of the interventions.