Salivary Gland Dysfunction Secondary to Cancer Treatment

Abstract

The number of cancer survivors are increasing and so are the oral toxicities from cancer therapy. Most patients receiving treatment for cancer develop some form of oral adverse events including, but not limited to, mucositis, opportunistic infections, dry mouth, and/or osteonecrosis of the jaw. One of the most common complications from head and neck cancer radiation therapy is salivary gland dysfunction (SGD). SGD is an umbrella term that includes the subjective sensation of dry mouth (xerostomia) and hyposalivation (objective reduction of the salivary flow rate). Dry mouth in cancer patients may lead to functional defects (e.g., eating, speaking, and swallowing), increase the risk of dental caries and oral candidiasis, and can have a negative effect on the nutritional and psychological status of the patients. The aim of this mini review was to summarize the current criteria for diagnosis and management of SGD associated with cancer treatment.

Trehalose versus carboxymethylcellulose oral spray for relieving radiation-induced xerostomia in head and neck cancer patients: a randomized controlled trial

“…Nonetheless, the CMC group had mean duration time after radiation and number of cases with concomitant chemotherapy higher than the trehalose group. The longer duration after radiation may reflect to lower effect on salivary gland function while the higher number of ongoing chemotherapy cases suggested higher effect on salivary gland function [ 38 ]. Despite the data being collected from different post-treatment periods, the mean pH and salivary flow rate were similar among the CMC and trehalose group.…”

Prosthodontic implications of saliva and salivary gland dysfunction

“…Salivary gland dysfunction secondary to antineoplastic cytotoxic treatment is common 32,33 . Therapeutic doses of ionizing radiation induce apoptosis and oxidative stress of acinar cells, with serous acini demonstrating more radiosensitivity as compared to mucinous acini 34 .…”

“…Other factors contributing to sialorrhea are the presence of a foreign object (e.g., initial use of dentures and intraoral prostheses), frequent vomiting (e.g., during pregnancy), gastroesophageal reflux disease, heavy metal intoxication, rabies, and certain medications (e.g., cholinergic agonists, lithium) 11,42,44 . Clozapine has been reported to cause sialorrhea in experimental models, and sialorrhea due to chemotherapy‐induced dysphagia has been reported as well 33,45 . Sialorrhea may cause diminishment in quality of life to affected individuals and is thus challenging to manage.…”

“…31 Salivary gland dysfunction secondary to antineoplastic cytotoxic treatment is common. 32,33 Therapeutic doses of ionizing radiation induce apoptosis and oxidative stress of acinar cells, with serous acini demonstrating more radiosensitivity as compared to mucinous acini. 34 This makes the parotid glands the most prone to radiation-induced dysfunction and fibrosis, followed by the submandibular glands and the sublingual glands, where some regeneration may occur post-radiotherapy depending on the dose received.…”

“…11,42,44 Clozapine has been reported to cause sialorrhea in experimental models, and sialorrhea due to chemotherapy-induced dysphagia has been reported as well. 33,45 Sialorrhea may cause diminishment in quality of life to affected individuals and is thus challenging to manage. Like xerostomia, sialorrhea may also be detrimental to denture retention and stability.…”