Maxillary reservoir denture to overcome radiation-induced xerostomia – Light at the end of the tunnel

An adequate supply of saliva is critical to the preservation and maintenance of oral tissue. Clinicians often do not value the many benefits of saliva until quantities are decreased. Much is written on the subject of salivary hypofunction, but little attention is paid to normal salivary flow and function. This article is a brief, up-to-date overview of the literature on the basics of normal salivary composition, flow, and function. A review of the literature was conducted using MEDLINE and Healthstar (1944 through 1999); articles were selected for inclusion on the basis of relevance and significance to the clinician.

Oral complications are the most frequent and debilitating sequelae of radiation treatment for patients with head and neck cancer. Impaired salivary function and consequent xerostomia can persist for years after radiation treatment, significantly increasing the risk of oral and dental disease and negatively affecting patients' quality of life. Current evidence indicates that many patients undergoing radiation treatment do not receive adequate oral and dental care and follow-up and that patients' compliance with oral care recommendations is frequently poor. Topical lubricants, coating agents,and saliva substitutes or lozenges may provide transient relief from xerostomia. Cholinergic stimulants such as pilocarpine improve salivary flow but have had mixed results in improving patients' assessments of symptoms or other quality-of-life measures. Advances in radiotherapy techniques, such as intensity-modulated radiation therapy, have enabled increased delivery of therapeutic doses of radiation to tumors while limiting exposure to normal tissues, thereby reducing the incidence, duration, and severity of xerostomia in some patients with head and neck cancers. Additionally, radioprotective agents such as amifostine have been shown to reduce radiation-induced toxicity to normal tissues within the radiation field. Studies are ongoing to determine the optimal approaches for these techniques and agents to maximize clinical response while improving the overall quality of life for patients with head and neck cancer.

Xerostomia (dry mouth) is one of the serious complications of head and neck irradiation and has a strong influence on a patient's activities of daily living. MR sialography with salivary secretion stimulation provides additional functional information (salivary secretion reserve) and may contribute to the evaluation of the severity of xerostomia and predict the risk of developing a radiation-induced xerostomia. This aim of the study was to analyze MR sialography as an objective tool to evaluate radiation-induced salivary injury.