Management of salivary hypofunction during and after radiotherapy.
Salivary hypofunction, the most common complication of high-dose radiation therapy (RT) to the head and neck, has a significant impact on quality of life, and requires careful planning of long-term dental and oral care. This report documents the results and conclusions of an evidence-based literature review on multidisciplinary team management of salivary hypofunction during and after RT. An update is provided on the pathophysiology of salivary hypofunction during and after RT, and recommendations for clinical management. The paper presents aspects managed by dental professionals (use of cholinergic agonists and other saliva stimulants, prevention of hyposalivation-induced rampant caries, and use of saliva substitutes), as well as the role of the radiation oncologist in minimizing salivary gland damage (parotid-sparing RT; cytoprotectants). This summary includes basic science, translational and clinical research topics with respect to radiation-induced salivary hypofunction, and provides an evidence-based management algorithm.
Shiboski
Caroline H
CH
Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA 94143-0422, USA. caroline.shiboski@ucsf.edu
Hodgson
Tim A
TA
Ship
Jonathan A
JA
Schiødt
Morten
M
D004999:Amifostine / Q000009:adverse effects / Q000627:therapeutic use; D003731:Dental Caries / Q000517:prevention & control; D006801:Humans; D018721:Muscarinic Agonists / Q000627:therapeutic use; D010862:Pilocarpine / Q000627:therapeutic use; D011832:Radiation Injuries / Q000628:therapy*; D011837:Radiation-Protective Agents / Q000627:therapeutic use; D011878:Radiotherapy / Q000009:adverse effects; D012464:Saliva, Artificial / Q000627:therapeutic use; D012469:Salivary Glands / Q000528:radiation effects* / Q000637:transplantation; D014987:Xerostomia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
D018721:Muscarinic Agonists; D011837:Radiation-Protective Agents; D012464:Saliva, Artificial; D010862:Pilocarpine; D004999:Amifostine