Skip to main content
SpringerLink
Log in

Xerostomia and Dental Problems in the Head and Neck Radiation Patient

  • Chapter
  • First Online:
The MASCC Textbook of Cancer Supportive Care and Survivorship

Abstract

Head and neck radiotherapy is accompanied by deleterious effects of radiation to healthy tissues. The clinical consequences of the effects of radiotherapy on the salivary glands include a reduced salivary secretion (hyposalivation) and accompanying sensation of oral dryness (xerostomia) due to damage to the salivary glands, taste loss, and the lifelong threat of developing caries, oral infections, and osteoradionecrosis. While taste loss is a reversible consequence that usually subsides early in postirradiation, hyposalivation is normally irreversible. This chapter focuses on the long-term effects of radiotherapy on the salivary glands and dentition. The clinical picture of xerostomia and hyposalivation-related dental caries is described, and guidelines are given on how to manage xerostomia and how to prevent hyposalivation-related sequelae such as dental caries.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Sreebny LM, Vissink A, editors. Dry mouth. The malevolent symptom: a clinical guide. Wiley-Blackwell: Ames, IA; 2010.

    Google Scholar 

  2. Dawes C, Pedersen AM, Villa A, Ekström J, Proctor GB, Vissink A, et al. The functions of human saliva: a review sponsored by the world workshop on oral medicine VI. Arch Oral Biol. 2015;60:863–74.

    Article  CAS  PubMed  Google Scholar 

  3. Javaid MA, Ahmed AS, Durand R, Tran SD. Saliva as a diagnostic tool for oral and systemic diseases. J Oral Biol Craniofac Res. 2016;6:66–75.

    PubMed  Google Scholar 

  4. Ship JA, Fox PC, Baum BJ. Normal salivary gland function: how much saliva is enough? J Am Dent Assoc. 1991;122:63–9.

    Article  CAS  PubMed  Google Scholar 

  5. Dawes C, Odlum O. Salivary status in patients treated for head and neck cancer. J Can Dent Assoc. 2004;70:397–400.

    PubMed  Google Scholar 

  6. Jensen SB, Vissink A, Limesand KH, Reyland ME. Salivary gland hypofunction and xerostomia in head and neck radiation patients. J Natl Cancer Inst. 2018; (in press).

    Google Scholar 

  7. Vissink A, Jansma J, Spijkervet FK, Burlage FR, Coppes RP. Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med. 2003;14:199–212.

    Article  CAS  PubMed  Google Scholar 

  8. Sciubba JJ, Goldenberg D. Oral complications of radiotherapy. Lancet Oncol. 2006;7:175–83.

    Article  PubMed  Google Scholar 

  9. Beetz I, Schilstra C, Visink A, van der Schaaf A, Bijl HP, van der Laan BF, et al. Role of minor salivary glands in developing patient-rated xerostomia and sticky saliva during day and night. Radiother Oncol. 2013;109:311–6.

    Article  PubMed  Google Scholar 

  10. Berthrong M. Pathologic changes secondary to radiation. World J Surg. 1986;10:155–70.

    Article  CAS  PubMed  Google Scholar 

  11. Konings AW, Coppes RP, Vissink A. On the mechanism of salivary gland radiosensitivity. Int J Radiat Oncol Biol Phys. 2005;62:1187–94.

    Article  CAS  PubMed  Google Scholar 

  12. Dardick I, Byard RW, Carnegie JA. A review of the proliferative capacity of major salivary glands and the relationship to current concepts of neoplasia in salivary glands. Oral Surg Oral Med Oral Pathol. 1990;69:53–67.

    Article  CAS  PubMed  Google Scholar 

  13. Burlage FR, Coppes RP, Meertens H, Stokman MA, Vissink A. Parotid and submandibular/sublingual salivary flow during high dose radiotherapy. Radiother Oncol. 2001;61:271–4.

    Article  CAS  PubMed  Google Scholar 

  14. Coppes RP, Vissink A, Konings AW. Comparison of radiosensitivity of rat parotid and submandibular glands after different radiation schedules. Radiother Oncol. 2002;63:321–8.

    Article  PubMed  Google Scholar 

  15. Nagler RM. The enigmatic mechanism of irradiation-induced damage to the major salivary glands. Oral Dis. 2002;8:141–6.

    Article  CAS  PubMed  Google Scholar 

  16. Vissink A, van LP, Langendijk JA, Coppes RP. Current ideas to reduce or salvage radiation damage to salivary glands. Oral Dis. 2015;21:e1–10.

    Article  CAS  PubMed  Google Scholar 

  17. Murdoch-Kinch CA, Kim HM, Vineberg KA, Ship JA, Eisbruch A. Dose-effect relationships for the submandibular salivary glands and implications for their sparing by intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72:373–82.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dijkema T, Raaijmakers CPJ, Ten Haken RK, Roesink JM, Braam PM, Houweling AC, et al. Parotid gland function after radiotherapy: the combined Michigan and Utrecht experience. Int J Radiat Oncol Biol Phys. 2010;78:449–53.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jensen SB, Pedersen AML, Vissink A, Andersen E, Brown CG, Davies AN, et al. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer. 2010;18:1039–60.

    Article  CAS  PubMed  Google Scholar 

  20. Jen YM, Lin YC, Wang YB, Wu DM. Dramatic and prolonged decrease of whole salivary secretion in nasopharyngeal carcinoma patients treated with radiotherapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:322–7.

    Article  PubMed  Google Scholar 

  21. Lombaert IM, Brunsting JF, Wierenga PK, Kampinga HH, de HG, Coppes RP. Keratinocyte growth factor prevents radiation damage to salivary glands by expansion of the stem/progenitor pool. Stem Cells. 2008;26:2595–601.

    Article  CAS  PubMed  Google Scholar 

  22. Coppes RP, Stokman MA. Stem cells and the repair of radiation-induced salivary gland damage. Oral Dis. 2011;17:143–53.

    Article  CAS  PubMed  Google Scholar 

  23. van Luijk P, Pringle S, Deasy JO, Moiseenko VV, Faber H, Hovan A, Baanstra M, et al. Sparing the region of the salivary gland containing stem cells preserves saliva production after radiotherapy for head and neck cancer. Sci Transl Med. 2015;7:305ra147.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Fox PC, Busch KA, Baum BJ. Subjective reports of xerostomia and objective measures of salivary gland performance. J Am Dent Assoc. 1987;115:581–4.

    Article  CAS  PubMed  Google Scholar 

  25. Mizutani S, Ekuni D, Tomofuji T, Azuma T, Kataoka K, Yamane M, et al. Relationship between xerostomia and gingival condition in young adults. J Periodontal Res. 2015;50:74–9.

    Article  CAS  PubMed  Google Scholar 

  26. Schuurhuis JM, Stokman MA, Roodenburg JL, Reintsema H, Langendijk JA, Vissink A, et al. Efficacy of routine pre-radiation dental screening and dental follow-up in head and neck oncology patients on intermediate and late radiation effects. A retrospective evaluation. Radiother Oncol. 2011;101:403–9.

    Article  PubMed  Google Scholar 

  27. Schuurhuis JM, Stokman MA, Witjes MJ, Langendijk JA, van Winkelhoff AJ, Vissink A, et al. Head and neck intensity modulated radiation therapy leads to an increase of opportunistic oral pathogens. Oral Oncol. 2016;58:32–40.

    Article  PubMed  Google Scholar 

  28. Jongebloed WL, ‘s-Gravenmade EJ, Retief DH. Radiation caries. A review and SEM study. Am J Dent. 1988;1:139–46.

    CAS  PubMed  Google Scholar 

  29. Jansma J, Vissink A, Jongebloed WL. Natural and induced radiation caries. A SEM study. Am J Dent. 1993;6:130–6.

    CAS  PubMed  Google Scholar 

  30. Kielbassa AM, Hinkelbein W, Hellwig E, Meyer-Lückel H. Radiation-related damage to dentition. Lancet Oncol. 2006;7:326–35.

    Article  PubMed  Google Scholar 

  31. Lieshout HF, Bots CP. The effect of radiotherapy on dental hard tissue--a systematic review. Clin Oral Investig. 2014;18:17–24.

    Article  CAS  PubMed  Google Scholar 

  32. AAOM Clinical Practice Statement: subject: clinical management of cancer therapy-induced salivary gland hypofunction and xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122(3):310–2.

    Google Scholar 

  33. Mouly S, Salom M, Tillet Y, et al. Management of xerostomia in older patients: a randomised controlled trial evaluating the efficacy of a new oral lubricant solution. Drugs Aging. 2007;24:957–65.

    Article  CAS  PubMed  Google Scholar 

  34. Mouly SJ, Orler JB, Tillet Y, et al. Efficacy of a new oral lubricant solution in the management of psychotropic drug-induced xerostomia: a randomized controlled trial. J Clin Psychopharmacol. 2007;27:437–43.

    Article  CAS  PubMed  Google Scholar 

  35. Vissink A, De Jong HP, Busscher HJ. Wetting properties of human saliva and saliva substitutes. J Dent Res. 1986;65:1121–4.

    Article  CAS  PubMed  Google Scholar 

  36. Johnson JT, Ferretti GA, Nethery WJ, et al. Oral pilocarpine for post-irradiation xerostomia in patients with head and neck cancer. N Engl J Med. 1993;329:390–5.

    Article  CAS  PubMed  Google Scholar 

  37. Vivino FB, Al-Hashimi I, Khan Z, et al. Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjögren’s syndrome: a randomized, placebo-controlled, fixed-dose, multicenter trial. P92-01 study group. Arch Int Med. 1999;159:174–81.

    Article  CAS  Google Scholar 

  38. Petrone D, Condemi JJ, Fife R, et al. A double-blind, randomized, placebo-controlled study of cevimeline in Sjögren’s syndrome patients with xerostomia and keratoconjunctivitis sicca. Arthritis Rheum. 2002;46:748–54.

    Article  CAS  PubMed  Google Scholar 

  39. Fife RS, Chase WF, Dore RK, et al. Cevimeline for the treatment of xerostomia in patients with Sjögren’s syndrome: a randomized trial. Arch Intern Med. 2002;162:1293–300.

    Article  CAS  PubMed  Google Scholar 

  40. Jensen SB, Pedersen AML, Vissink A, et al. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer. 2010;18:1061–79.

    Article  CAS  PubMed  Google Scholar 

  41. Chambers MS, Jones CU, Biel MA, et al. Open-label, long-term safety study of cevimeline in the treatment of postirradiation xerostomia. Int J Radiat Oncol Biol Phys. 2007;69:1369–76.

    Article  CAS  PubMed  Google Scholar 

  42. Wiseman LR, Faulds D. Oral pilocarpine: a review of its pharmacological properties and clinical potential in xerostomia. Drugs. 1995;49:143–55.

    Article  CAS  PubMed  Google Scholar 

  43. Jedel E. Acupuncture in xerostomia – a systematic review. J Oral Rehabil. 2005;32:392–6.

    Article  CAS  PubMed  Google Scholar 

  44. Wu X, Chung VC, Hui EP, Ziea ET, Ng BF, Ho RS, et al. Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews. Sci Rep. 2015;5:16776. https://doi.org/10.1038/srep16776.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Brennan MT, Shariff G, Lockhart PB, et al. Treatment of xerostomia: a systematic review of therapeutic trials. Dent Clin N Am. 2002;46:847–56.

    Article  PubMed  Google Scholar 

  46. Alajbeg I, Falcão DP, Tran SD, Martín-Granizo R, Lafaurie GI, Matranga D, et al. Intraoral electrostimulator for xerostomia relief: a long-term, multicenter, open-label, uncontrolled, clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113:773–81.

    Article  PubMed  Google Scholar 

  47. Regelink G, Vissink A, Reintsema H. Efficacy of a synthetic polymer saliva substitute in reducing oral complaints of patients suffering from irradiation-induced xerostomia. Quintessence Int. 1998;29:383–8.

    CAS  PubMed  Google Scholar 

  48. Epstein JB, Emerton S, Le ND, Stevenson-Moore P. A double-blind crossover trial of oral balance gel and Biotene toothpaste versus placebo in patients with xerostomia following radiation therapy. Oral Oncol. 1999;35:132–7.

    Article  CAS  PubMed  Google Scholar 

  49. Zero DT. Dentifrices, mouthwashes, and remineralization/caries arrestment strategies. BMC Oral Health. 2006;6(Suppl 1):S9.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Ship JA, McCutcheon JA, Spivakovsky S, et al. Safety and effectiveness of topical dry mouth products containing olive oil, betaine, and xylitol in reducing xerostomia for polypharmacy-induced dry mouth. J Oral Rehabil. 2007;34:724–32.

    Article  CAS  PubMed  Google Scholar 

  51. Turner MD. Hyposalivation and Xerostomia: etiology, complications, and medical management. Dent Clin North Am. 2016;60:435–43.

    Article  PubMed  Google Scholar 

  52. Hahnel S, Behr M, Handel G, Bürgers R. Saliva substitutes for the treatment of radiation-induced xerostomia – a review. Support Care Cancer. 2009;17:1331–43.

    Article  PubMed  Google Scholar 

  53. Fox PC, Brennan M, Pillemer S, et al. Sjögren’s syndrome: a model for dental care in the 21st century. J Am Dent Assoc. 1998;129:719–28.

    Article  CAS  PubMed  Google Scholar 

  54. Atkinson JC, Wu A. Salivary gland dysfunction: causes, symptoms, treatment. J Am Dent Assoc. 1994;125:409–16.

    Article  CAS  PubMed  Google Scholar 

  55. Fox PC. Management of dry mouth. Dental Clin N Am. 1997;41:863–76.

    CAS  Google Scholar 

  56. Gupta N, Pal M, Rawat S, Grewal MS, Garg H, Chauhan D, et al. Radiation-induced dental caries, prevention and treatment - a systematic review. Natl J Maxillofac Surg. 2015;6:160–6.

    Article  PubMed  PubMed Central  Google Scholar 

  57. American Dental Association Council on Scientific Affairs. The use of dental radiographs: update and recommendations. J Am Dent Assoc. 2006;137:1304–12.

    Article  Google Scholar 

  58. Jansma J, Vissink A, ‘s-Gravenmade EJ. In vivo study on the prevention of post-radiation caries. Caries Res. 1989;23:172–8.

    Article  CAS  PubMed  Google Scholar 

  59. Chalmers JM. Minimal intervention dentistry: part 1. Strategies for addressing the new caries challenge in older patients. J Can Dent Assoc. 2006;72:427–33.

    PubMed  Google Scholar 

  60. Anusavice KJ. Dental caries: risk assessment and treatment solutions for an elderly population. Compend Contin Educ Dent. 2002;23(10 Suppl):12–20.

    PubMed  Google Scholar 

  61. Walsh L. Lifestyle impacts on oral health. In: Mount G, Hume W, editors. Preservation and restoration of tooth structure. Middlesbrough: Knowledge Books and Software Ltd; 2005. p. 83–110.

    Google Scholar 

  62. Van Loveren C. Sugar alcohols: what is the evidence for caries-preventive and caries-therapeutic effects? Caries Res. 2004;38:286–93.

    Article  PubMed  Google Scholar 

  63. Guggenheimer J, Moore PA. Xerostomia: etiology, recognition and treatment. J Am Dent Assoc. 2003;134:61–9.

    Article  PubMed  Google Scholar 

  64. Tanida T, Okamoto T, Okamoto A, et al. Decreased excretion of antimicrobial proteins and peptides in saliva of patients with oral candidiasis. J Oral Pathol Med. 2003;32:586–94.

    Article  CAS  PubMed  Google Scholar 

  65. Daniels TE, Fox PC. Salivary and oral components of Sjogren’s syndrome. Rheum Dis Clin N Am. 1992;18:571–89.

    CAS  Google Scholar 

  66. Jha N, Seikaly H, Harris J, Williams D, Liu R, McGaw T, et al. Prevention of radiation induced xerostomia by surgical transfer of submandibular salivary gland into the submental space. Radiother Oncol. 2003;66:283–9.

    Article  PubMed  Google Scholar 

  67. Seikaly H, Jha N, Harris JR, Barnaby P, Liu R, Williams D, et al. Long-term outcomes of submandibular gland transfer for prevention of postradiation xerostomia. Arch Otolaryngol Head Neck Surg. 2004;130:956–61.

    Article  PubMed  Google Scholar 

  68. Jha N, Seikaly H, Harris J, Williams D, Sultanem K, Hier M, et al. Phase III randomized study: oral pilocarpine versus submandibular salivary gland transfer protocol for the management of radiation-induced xerostomia. Head Neck. 2009;31:234–43.

    Article  PubMed  Google Scholar 

  69. Sood AJ, Fox NF, O'Connell BP, Lovelace TL, Nguyen SA, Sharma AK, et al. Salivary gland transfer to prevent radiation-induced xerostomia: a systematic review and meta-analysis. Oral Oncol. 2014;50:77–83.

    Article  PubMed  Google Scholar 

  70. Hagen R, Scheich M, Kleinsasser N, Burghartz M. Two-stage autotransplantation of human submandibular gland: a novel approach to treat postradiogenic xerostomia. Eur Arch Otorhinolaryngol. 2016;273:2217–22.

    Article  PubMed  Google Scholar 

  71. Delporte C, O’Connell BC, He X, Lancaster HE, O'Connell AC, Agre P, et al. Increased fluid secretion after adenoviral-mediated transfer of the aquaporin-1 cDNA to irradiated rat salivary glands. Proc Natl Acad Sci U S A. 1997;94:3268–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Preston GM, Agre P. Isolation of the cDNA for erythrocyte integral membrane protein of 28 kilodaltons: member of an ancient channel family. Proc Natl Acad Sci U S A. 1991;88:11110–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Shan Z, Li J, Zheng C, Liu X, Fan Z, Zhang C, et al. Increased fluid secretion after adenoviral-mediated transfer of the human aquaporin-1 cDNA to irradiated miniature pig parotid glands. Mol Ther. 2005;11:444–51.

    Article  CAS  PubMed  Google Scholar 

  74. Baum BJ, Zheng C, Alevizos I, Cotrim AP, Liu S, McCullagh L, et al. Development of a gene transfer-based treatment for radiation-induced salivary hypofunction. Oral Oncol. 2010;46:4–8.

    Article  CAS  PubMed  Google Scholar 

  75. Baum BJ, Alevizos I, Zheng C, Cotrim AP, Liu S, McCullagh L, et al. Early responses to adenoviral-mediated transfer of the aquaporin-1 cDNA for radiation-induced salivary hypofunction. Proc Natl Acad Sci U S A. 2012;109:19403–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Aure MH, Konieczny SF, Ovitt CE. Salivary gland homeostasis is maintained through acinar cell self-duplication. Dev Cell. 2015;33:231–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Nanduri LS, Maimets M, Pringle SA, van der Zwaag M, van Os RP, Coppes RP. Regeneration of irradiated salivary glands with stem cell marker expressing cells. Radiother Oncol. 2011;99:367–72.

    Article  CAS  PubMed  Google Scholar 

  78. Nanduri LS, Baanstra M, Faber H, Rocchi C, Zwart E, de HG, et al. Purification and ex vivo expansion of fully functional salivary gland stem cells. Stem Cell Rep. 2014;3:957–64.

    Article  CAS  Google Scholar 

  79. Lombaert IM, Brunsting JF, Wierenga PK, Faber H, Stokman MA, Kok T, et al. Rescue of salivary gland function after stem cell transplantation in irradiated glands. PLoS One. 2008;3:e2063.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Nanduri LS, Lombaert IM, van der Zwaag M, Faber H, Brunsting JF, van Os RP, et al. Salisphere derived c-kit+ cell transplantation restores tissue homeostasis in irradiated salivary gland. Radiother Oncol. 2013;108:458–63.

    Article  CAS  PubMed  Google Scholar 

  81. Feng J, van der Zwaag M, Stokman MA, van OR, Coppes RP. Isolation and characterization of human salivary gland cells for stem cell transplantation to reduce radiation-induced hyposalivation. Radiother Oncol. 2009;92:466–71.

    Article  CAS  PubMed  Google Scholar 

  82. Pringle S, van OR, Coppes RP. Concise review: adult salivary gland stem cells and a potential therapy for xerostomia. Stem Cells. 2013;31:613–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands

    A. Vissink & F. K. L. Spijkervet

  2. Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, USA

    Michael T. Brennan

Authors
  1. A. Vissink
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. K. L. Spijkervet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael T. Brennan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Vissink .

Editor information

Editors and Affiliations

  1. University of South Australia, Adelaide, SA, Australia

    Ian Olver

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Vissink, A., Spijkervet, F.K.L., Brennan, M.T. (2018). Xerostomia and Dental Problems in the Head and Neck Radiation Patient. In: Olver, I. (eds) The MASCC Textbook of Cancer Supportive Care and Survivorship. Springer, Cham. https://doi.org/10.1007/978-3-319-90990-5_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90990-5_24

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90989-9

  • Online ISBN: 978-3-319-90990-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation