The use of radiation therapy in the treatment of head and neck cancer often destroys salivary function. This results in a condition known as xerostomia, or dry mouth. This condition is usually permanent, with little chance for recovery on its own. According to the Oral Cancer Foundation, dry mouth can have a devastating impact on the quality of life in patients who receive radiation treatment for head and neck cancer. It can destroy oral health by promoting dental cavities and oral infections. Dry mouth also may result in chronic oral pain, may prevent or limit wearing of dentures, and makes chewing, swallowing and speaking difficult.
Medications
There are several different medications used to treat dry mouth. Two common medications are pilocarpine, sold under the brand name Salagen, and cevimeline, sold under the brand name Evoxac. You take these medications three to four times a day. Their effect should help from two to four hours. There are some side effects of these medications. They may include sweating, nausea, diarrhea, frequent urination and runny nose. To be effective, these medications usually need the salivary glands to be partially working. According to Dr. Henk-Jan Guchelaar from the University of Amsterdam in the Netherlands, these medications are effective in approximately 50 percent of patients when some salivary gland function is evident.
Saliva Substitutes and Moistening Agents
Saliva substitutes function to duplicate the properties of normal saliva. According to Dr. Padraig Warde and colleagues from the Princess Margaret Hospital in Toronto, Ontario, Canada, in research published in the March 2000 issue of "Supportive Care in Cancer," saliva substitutes provide relief for approximately 40 percent of patients who use them. Over-the-counter products include solutions, sprays, gels and lozenges. Some examples are Saliva Substitute made by Roxane Labs, Moi-Stir Oral Swabsticks made by Kingswood Labs, Optimoist spray made by Colgate-Palmolive, MouthKote spray made by Parnell, Biotent Oralbalance Long-Lasting Moisturizing Gel made by GlaxoSmithKline, and Salix tablets made by Scandinavian Natural Health & Beauty.
Moistening agents include chewing gum, sips of water and candy. Recommended chewing gums are those with artificial sweeteners, or ones that are made especially for dry mouth. GlaxoSmithKline makes a product called Biotene Dry Mouth Gum. There are some disadvantages to these methods to treat dry mouth. According to Dr. Henk-Jan Guchelaar and colleagues from the University of Amsterdam in the Netherlands in research published in "Supportive Care in Cancer" in July 1997, these methods usually provide only temporary relief of dry mouth. Further, the constant intake of water over the course of a day may result in needing to urinate frequently, especially at night. Finally, the use of candies is associated with increased dental cavities.
Non-traditional Treatments
Two non-traditional treatments for dry mouth are acupuncture and electrical stimulation. Drs. Maria Blom and Thomas Lundeberg from the Karolinska Institute in Stockholm, Sweden conducted a study that was published in "Oral Diseases" in January 2000. They found that patients produced more saliva after 12 and 24 acupuncture treatments. Similar results were found by Dr. Braga and his colleagues from the University of Sao Paulo in Sao Paulo, Brazil. Their study, published in "Minerva Stomatologica" in July 2008, showed that patients had more salivary flow after 12 acupuncture treatments. Their patients also reported the feeling of more saliva in their mouths.
Raimond Wong, and his colleagues from McMaster University in Hamilton, Ontario, Canada, used electrical stimulation on traditional acupuncture points related to saliva flow. Their study was published in the "International Journal of Radiation Oncology, Biology, Physics" in October 2003. They found that salivary flow increased after treatment. However, no changes in patient reports of quality of life were found.
References
- "Supportive Care in Cancer"; Radiation-induced Xerostomia: Pathophysiology, Clinical Course and Supportive Treatment; HJ Guchelaar, A Vermes, JH Meerwaldt; Jul.1997
- "Supportive Care in Cancer"; A Phase II Study of Biotene in the Treatment of Postradiation Xerostomia in Patients with Head and Neck Cancer; P Warde, B Kroll, B O’Sullivan, J Aslandis, E Tew-George, G Waldron, et al; Mar. 2000
- "Oral Diseases"; Long-term Follow-up of Patients Treated with Acupuncture for Xerostomia and the Influence of Additional Treatment; M Blom, T Lundeberg; Jan. 2000
- "Minerva Stomatologica"; The Effect of Acupuncture on Salivary Flow Rates in Patients with Radiation-induced Xerostomia; FP Braga, NN Sugaya, SK Hirota, I Weinfeld, MH Magalhaes, DA Migliari; July 2008.
- "International Journal of Radiation Oncology, Biology, Physics"; A Phase I-II Study in the Use of Acupuncture-like Transcutaneous Nerve Stimulation in the Treatment of Radiation-induced Xerostomia in Head-and-neck Cancer Patients Treated with Radical Radiotherapy;RK Wong, GW Jones, SM Sagar, AF Babjak, T Whelan; Oct. 2003
