title: Xerostomia induced by radiotherapy: an overview of the physiopathology, clinical evidence, and management of the oral damage.
abstract: BACKGROUND
  The irradiation of head and neck cancer (HNC) often causes damage to the salivary glands. The resulting salivary gland hypofunction and xerostomia seriously reduce the patient's quality of life.
  
  
  OBJECTIVE
  To analyze the literature of actual management strategies for radiation-induced hypofunction and xerostomia in HNC patients.
  
  
  METHODS
  MEDLINE/PubMed and the Cochrane Library databases were electronically evaluated for articles published from January 1, 1970, to June 30, 2013. Two reviewers independently screened and included papers according to the predefined selection criteria.
  
  
  RESULTS
  Sixty-one articles met the inclusion criteria. The systematic review of the literature suggests that the most suitable methods for managing the clinical and pathophysiological consequences of HNC radiotherapy might be the pharmacological approach, for example, through the use of cholinergic agonists when residual secretory capacity is still present, and the use of salivary substitutes. In addition, a modified diet and the patient's motivation to enhance oral hygiene can lead to a significant improvement.
  
  
  CONCLUSIONS
  Radiation-induced xerostomia could be considered a multifactorial disease. It could depend on the type of cancer treatment and the cumulative radiation dose to the gland tissue. A preventive approach and the correct treatment of the particular radiotherapeutic patient can help to improve the condition of xerostomia.
authors.affiliation: Department of Biomedical Science, University of Sassari, Sassari, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pinna
authors.affiliation: Department of Surgery, Microsurgery and Medicine, University of Sassari, Sassari, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Campus
authors.affiliation: Department of Dental Science, University of Palermo, Palermo, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Cumbo
authors.affiliation: Department of Biomedical Science, University of Sassari, Sassari, Italy.
authors.forename: Ida
authors.initials: I
authors.lastname: Mura
authors.affiliation: Department of Surgery, Microsurgery and Medicine, University of Sassari, Sassari, Italy.
authors.forename: Egle
authors.initials: E
authors.lastname: Milia
keywords: management strategies; radiation-induced xerostomia; salivary gland hypofunction