Radiotherapy plays an important role in the treatment of patients with head and neck cancer, but the therapy often results in the loss of some salivary gland function, causing hyposalivation and xerostomia.
Recent advances, such as proton radiotherapy and intensity- modulated radiotherapy, and the addition of radioprotectors such as amifostine, spare some salivary gland function. In addition, research has shown that prescribing pilocarpine or pure cholinergic sialogogues stimulates residual salivary gland function after radiotherapy, as does the use of acupuncture.
When these methods are insufficient to help the patient, oncologists manage the symptoms with oral lubricants and saliva substitutes. A recent Cochrane Review, “Interventions for the Management of Dry Mouth: Topical Therapies,” found that integrated mouth care systems, such as Biotène Oral Balance, “may be effective in reducing symptoms of dry mouth” (2011;12: CD008934).
The Biotène system includes a gel, antibacterial toothpaste, alcohol-free oral rinse, moisturizing spray, and dry mouth liquid.
The committee reviewed 5 studies (Epstein 1999; Gil- Montoya 2008; Nagy 2007; Shahdad 2005; and Ship 2007) that looked at integrated systems by Biotène, BioXtra, and Xerostom. Bioxtra contains similar ingredients to Biotène (hydroxyethylcellulose, polyglycerylmethacrylate, lactoperoxidase, glucose oxidase, xylitol, lactoferrin, lysozyme, and monofluorophosphate); Xerostom contains olive oil, betaine, xylitol, fluoride, vitamin E, and vitamin B5.
The review committee classified all 5 trials as head-to-head trials and found that all of the mouth care systems showed a positive effect on the symptoms of dry mouth. However, each study evaluated different comparisons and outcomes, so the committee could not determine if one was better than another at reducing dry mouth.
Overall, the Cochrane group reviewed 36 randomized, controlled trials of saliva stimulants and substitutes that were compared with either placebo or another intervention. They looked at lozenges, sprays, mouth rinses, gels, oils, chewing gum, and toothpastes. The review found that oxygenated glycerol trimester saliva substitute spray showed evidence of effectiveness.
The committee added that more research in this area is needed, but that there are promising interventions for patients that suffer from xerostomia.