Effect of salivary stimulation therapies on salivary flow and chemotherapy-induced mucositis: a preliminary study.
OBJECTIVE
The objective of this study was to evaluate the effect of salivary stimulation therapies on the salivary flow, oral mucositis, and salivary cytokine levels in patients receiving allogeneic hematopoietic stem cell transplantation.


METHODS
Thirty-five eligible patients were randomized into 4 groups: control, mechanical sialogogue, transcutaneous electrical nerve stimulation (TENS) sialogogue, and combined mechanical/electrical sialogogue. Saliva was collected from patients before transplantation and at days 3, 7, and 14 after transplantation. The volume was measured and salivary cytokines were assessed using enzyme-linked immunosorbent assay.


RESULTS
By day 14, resting and stimulated salivary flow levels were diminished. Resting salivary flow rates decreased the most in the control and mechanical groups. In contrast, TENS alone or in combination with mechanical stimulatory therapy benefited the patients. TENS-treated patients showed increase in resting salivary flow. Also, the groups treated with TENS had fewer patients affected by grades 3 and 4 mucositis, and less mucositis was associated with better patient survival (P = .027).


CONCLUSIONS
TENS-associated salivary stimulation therapies minimized the reduction of salivary flow and prevented severe chemotherapy-induced oral mucositis.
Department of Oral Pathology, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Tânia Mara
TM
Pimenta Amaral
Camila Cláudia
CC
Campos
Tálita Pollyanna
TP
Moreira dos Santos
Cláudio Rodrigues
CR
Leles
Antônio Lúcio
AL
Teixeira
Mauro Martins
MM
Teixeira
Henrique
H
Bittencourt
Tarcília Aparecida
TA
Silva
D000328:Adult; D000704:Analysis of Variance; D004815:Epidermal Growth Factor / Q000032:analysis; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D016753:Interleukin-10 / Q000032:analysis; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000032:analysis; D020780:Matrix Metalloproteinase 9 / Q000032:analysis; D008875:Middle Aged; D052016:Mucositis / Q000139:chemically induced*; D010812:Physical Stimulation; D011446:Prospective Studies; D012463:Saliva / Q000737:chemistry / Q000378:metabolism*; D012472:Salivation / Q000187:drug effects*; D018709:Statistics, Nonparametric; D013280:Stomatitis / Q000139:chemically induced*; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000032:analysis; D019716:Tissue Inhibitor of Metalloproteinase-2 / Q000032:analysis; D004561:Transcutaneous Electric Nerve Stimulation; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D055815:Young Adult
D019715:Tissue Inhibitor of Metalloproteinase-1; D014409:Tumor Necrosis Factor-alpha; D019716:Tissue Inhibitor of Metalloproteinase-2; D016753:Interleukin-10; D004815:Epidermal Growth Factor; C522361:MMP2 protein, human; D020778:Matrix Metalloproteinase 2; D020780:Matrix Metalloproteinase 9