Salivary hypofunction: an update on aetiology, diagnosis and therapeutics.

Saliva is of paramount importance for the maintenance of oral and general homeostasis. Salivary hypofunction predispose patients to disorders such as dysgeusia, pain and burning mouth, caries and other oral infectious diseases, dysphagia and dysphonia. The aim of this study was to provide an update on the aetiology, diagnostic methods and therapeutic strategies for the management of hyposalivation and xerostomia. The present paper describes subjective and objective methods for the diagnosis of salivary dysfunctions; moreover a number of drugs, and systemic disorders associated with decreased salivary flow rate are listed. We also focused on the underlying mechanisms to radiotherapy-induced salivary damage. Therapeutics for hyposalivation and xerostomia were discussed and classified as preventive, symptomatic, topical and systemic stimulants, disease-modifying agents, and regenerative. New therapeutic modalities have been studied and involve stem cells transplantation, with special attention to regeneration of damage caused by ionizing radiation to the salivary glands. More studies in this area are needed to provide new perspectives in the treatment of patients with salivary dysfunctions.

Effect of low-level laser therapy on radiotherapy-induced hyposalivation and xerostomia: a pilot study.

OBJECTIVE: The present pilot study aimed to assess the effect of low-level laser therapy (LLLT) on hyposalivation and xerostomia as a consequence of head and neck radiotherapy. BACKGROUND DATA: The benefits of LLLT in salivary flow have been shown; however, there are no studies investigating its effects on patients who have already undergone radiotherapy and present hyposalivation and xerostomia as a sequela. METHODS: Twenty-three patients with a history of head and neck malignancy, who were treated by fractioned teletherapy (dosimetry ranging from 45 to 70 Gy) in the cervicofacial region were selected. They all presented with xerostomia and severe hyposalivation. Patients were randomly distributed into a laser group (n=12) and a control group (n=11). A GaAlAs laser (830 nm, 100 mW, illuminated area 0.028 cm2, 3.57 W/cm2, 20 sec, 2.0 J, 71 J/cm2) was used punctually in the major salivary glands, twice a week for 6 weeks, with a 12 session total. Stimulated and unstimulated salivary flow rate (SFR) were assessed, as well as the xerostomia and quality of life related to oral health (QLROH). RESULTS: The analysis did not show any significant difference between the groups with regards to the SFR and xerostomia, and the QLROH. However, at the end of the treatment, the xerostomia and the QLROH showed significant improvement in both groups compared with assessments performed at baseline, highlighting the importance of advice given to the irradiated patients, and their follow-up. CONCLUSIONS: With the parameters used, LLLT was not able to increase SFR or decrease xerostomia. The results may be associated with the late effects of radiotherapy on glandular structure, such as fibrosis and acinar atrophy.