Effect of low-level laser therapy on radiotherapy-induced hyposalivation and xerostomia: a pilot study. Xerostomia: prevalence and pharmacotherapy. With special reference to beta-adrenoceptor antagonists. Radiation-induced hyposalivation and its treatment with oral pilocarpine. Pilocarpine in the prevention of postirradiation xerostomia. Pilot study of subcutaneous amifostine in patients undergoing postoperative intensity modulated radiation therapy for head and neck cancer: preliminary data. The effect of acupuncture on salivary flow rates in patients with xerostomia. Manual acupuncture improved quality of life in cancer patients with radiation-induced xerostomia. Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Stimulation of salivary flow with a powered toothbrush in a xerostomic population. Acupuncture treatment of patients with radiation-induced xerostomia. Effects of furosemide on the oral cavity. Effects of furosemide and bendroflumethiazide on saliva flow rate and composition. Cevimeline for the treatment of xerostomia in patients with Sjögren syndrome: a randomized trial. Acupuncture for the prevention of radiation-induced xerostomia in patients with head and neck cancer. Influence of parotid-sparing radiotherapy on xerostomia in head and neck cancer patients. Toxicity and compliance of subcutaneous amifostine in patients undergoing postoperative intensity-modulated radiation therapy for head and neck cancer. Efficacy of pilocarpine lozenge for post-radiation xerostomia in patients with head and neck cancer. Major salivary gland function in patients with radiation-induced xerostomia: flow rates and sialochemistry. Effectiveness of pilocarpine in postradiation xerostomia Phase III quality-of-life study results: impact on patients' quality of life to reducing xerostomia after radiotherapy for head-and-neck cancer--RTOG 97-09. Phase III randomized study: oral pilocarpine versus submandibular salivary gland transfer protocol for the management of radiation-induced xerostomia. Assessment of xerostomia and its impact on quality of life in head and neck cancer patients undergoing radiotherapy, and validation of the Taiwanese version of the xerostomia questionnaire. Evaluation of radioprotective effect of pilocarpine ingestion on salivary glands.
OBJECTIVE The present pilot study aim ed 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 r and omly 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 gl and s , 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 assessment s 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 gl and ular structure , such as fibrosis and acinar atrophy The main objective of this thesis was to estimate the prevalence of subjectively perceived dry mouth , xerostomia , in a representative general adult population , and the possible co-morbidity between xerostomia and on-going pharmacotherapy . Further , to evaluate the effects of beta-adrenoceptor antagonists on saliva flow rate and composition . The prevalence of xerostomia was evaluated by means of a question naire mailed to a r and om sample of 4.200 adult subjects living in the southern part of the province of Hall and , Sweden . Three hundred men and equally many women aged 20 , 30 , 40 , 50 , 60 , 70 and 80 years were selected from the national census register . From 3311 ( 81 % ) evaluable question naires was concluded that , in the studied population , 21.3 % of the men and 27.3 % of the women reported xerostomia . The difference between the sexes was statistically significant , women reporting higher prevalence of dry mouth than men . It was also found that xerostomia was significantly age-related . Further , it was demonstrated that there was a strong co-morbidity between reported prevalence of dry mouth and on-going pharmacotherapy . Generally , no specific drug or drug-group proved to be especially xerogenic , rather , polypharmacy was strongly correlated to reported symptoms of dry mouth , and it was also a significant correlation between increasing xerostomia and the number of medications taken . The effects of beta-adrenoceptor antagonists on saliva flow rate and composition were evaluated both in healthy volunteers and in hypertensive patients . The effects of one week of treatment with the non-selective ( propranolol ) and the beta 1-selective ( atenolol ) adrenoceptor antagonists were compared with that of placebo in three different clinical trials , including 38 , 11 and 19 healthy volunteers , respectively . Two of these studies were focused on the effects on whole saliva secretion rate and composition and the third study on the secretions from the parotid and the subm and ibular-sublingual gl and s. Salivary composition but not saliva flow rates were affected by the beta-adrenoceptor antagonists , and the most pronounced effects were observed for total protein composition and amylase activity , both being significantly decreased during treatment with any of the antagonists , however , more accentuated during treatment with atenolol .  Twelve hypertensive patients who were well-controlled in their blood-pressure by means of monotherapy with metoprolol , a beta 1-selective adrenoceptor antagonist , were observed during four weeks of withdrawal and after re-exposure to this antihypertensive treatment . The observed effects on salivary composition were essentially the same as those found in healthy volunteers . In the hypertensive group , however , whole saliva flow rates increased significantly on drug withdrawal and decreased again on re-exposure to metoprolol OBJECTIVE The aim of this study was to determine the effects of radiation on the secretion of saliva from mucous salivary gl and s in comparison with serous salivary gl and s. STUDY DESIGN The minor salivary gl and s of the palate were used as an example of mucous gl and s , while the parotid gl and s were used as an example of a serous secretion organ . Serial flow rate measurements of the parotid and palatal gl and s were taken over a period of approximately 9 months in 13 patients who suffered from malignancies of the head and neck region . Twelve patients consented to take part in a second study in which salivary flow was stimulated by oral pilocarpine before and at the conclusion of radiotherapy and 7 months later . Complaints and symptoms were recorded at each time of measurement . RESULTS After radiotherapy , the secretory performance of the parotid gl and s dropped off rapidly and irreversibly . Salivary secretion from the palatal gl and s was not totally diminished as a result of radiation . Clinical complaints and histologic findings indicate a serious alteration of the tissues irradiated ; however , residual secretion from the remaining parenchyma of the mucous gl and s still remains . Pilocarpine produced a clinical ly significant increase of salivary flow from the palatal gl and s before and 7 months after radiation . Secretory performance of the parotid gl and s could not be sufficiently increased by stimulation with pilocarpine after radiotherapy . Clinical side effects and risks for the treatment of symptomatic postradiation xerostomia with pilocarpine were minimal . CONCLUSIONS These findings emphasize the greater resistance and recoverability of the mucous secreting minor palatal gl and s in comparison with the serous secreting parotid gl and s. They also indicate the significant postradiation ability of the mucous secreting gl and s to be stimulated by pilocarpine During radiation therapy to the head and neck region , salivary gl and hypofunction commonly develops . The aim of our study was to evaluate whether the sialogogue pilocarpine given during radiation therapy may reduce the severity of xerostomia and salivary dysfunction . Our results showed the  pilocarpine-treated group to have a lower frequency of oral symptoms during the treatment than the  placebo-treated group . Although salivary flow decreased in all patients , the pilocarpine-treated group had smaller flow reductions . No drug effect was observed in the gl and s that were completely irradiated . Thus , pilocarpine appeared to stimulate salivary tissues outside the radiation field The major salivary gl and s produce about 90 % of salivary secretions ; the minor salivary gl and s produce the remainder . St and ard conventional radiation therapy for advanced oropharyngeal tumors typically involves administering high radiation dose to the major salivary gl and s bilaterally . In most cases , this causes a marked reduction in oral saliva output . Xerostomia is the most prevalent late side effect of radiation for head and neck malignancies and is cited by patients as the major cause of decreased quality of life . The degree of xerostomia has been reported to depend on the radiation dose and salivary gl and volume irradiated . Several studies show dose volume response relationships in the salivary gl and s , suggesting the possibility of significant improvement in saliva production post radiation as well as quality of life if radiation techniques can spare the salivary gl and s. In recent years , conformal radiation techniques have evolved , which may allow radiation of tumor targets in the head and neck area while sparing substantial portions of salivary gl and s. It has been shown that in using these techniques , adequate irradiation of the targets while sparing major salivary gl and s is feasible . Early clinical experience showed substantial sparing of salivary flow following radiation and suggested an improvement of tumor control and of xerostomia over that achieved with st and ard radiation techniques . We hypothesize that the addition of a radioprotector may further improve salivary function over that obtained with intensity modulated radiation therapy alone . To test this hypothesis , we initiated a pilot clinical trial whose principal objective is to compare measurements of unstimulated and stimulated salivary flow rates 6 months after intensity modulated radiation therapy plus amifostine ( Ethyol ; MedImmune , Inc , Gaithersburg , MD ) ( study patients ) with those obtained in historical controls treated with intensity modulated radiation therapy alone Of 21 patients with severe xerostomia , 11 were treated with acupuncture and 10 patients received placebo acupuncture . Those patients who received acupuncture treatment showed increased salivary flow rates during and after the acupuncture treatment . The improved salivary values persisted during the observation year , whereas the patients who received placebo acupuncture showed some improvement of salivary flow rates only during the actual treatment . The results of the present study indicate that acupuncture may be a useful adjunct for the stimulation of salivary flow in some patients with xerostomia PURPOSE Radiotherapy-induced xerostomia seriously reduces the quality of life ( QOL ) for patients with head and neck cancer . This study aim ed to investigate the effects of manual acupuncture on objective and subjective assessment of symptom changes in patients with cancer who have with radiation-induced xerostomia . MATERIAL S AND METHODS Twelve ( 12 ) patients with radiation-induced xerostomia were r and omized into 2 groups ( real or sham acupuncture ) . Acupuncture was conducted twice weekly for 6 weeks in a single-blind setting . The effect was evaluated by measuring whole salivary flow rates ( stimulated and unstimulated ) and question naire-based assessment of subjective symptoms pre- and post-treatment ( 3 and 6 weeks after acupuncture treatment ) . RESULTS Both groups showed a slight increase in whole salivary flow rates , with no significant difference between them . However , real acupuncture markedly increased unstimulated salivary flow rates , and improved the score for dry mouth according to the xerostomia question naire , by 2.33 points versus 0.33 in the controls . CONCLUSIONS Our results showed the significantly meaningful amelioration of the subjective sensation of xerostomia closely associated with QOL in patients with head and neck cancer treated with irradiation PURPOSE To assess long-term xerostomia in patients receiving parotid-sparing radiation therapy ( RT ) for head- and -neck cancer , and to find the patient and therapy-related factors that affect its severity . PATIENTS AND METHODS From March 1994 through January 2000 , 84 patients received comprehensive bilateral neck RT using conformal and multisegmental intensity-modulated RT ( IMRT )  aim ing to spare the major salivary gl and s. Before RT and periodically through 2 years after the completion of RT , salivary flow rates from each of the major salivary gl and s were selectively measured . At the same time intervals , each patient completed an 8-item self-reported xerostomia-specific question naire ( XQ ) . To gain a relative measure of the effect of RT on the minor salivary gl and s , whose output could not be measured , the surfaces of the oral cavity ( extending to include the surface of the base of tongue ) were outlined in the planning CT scans . The mean doses to the new organ ( " oral cavity " ) were recorded . Forty-eight patients receiving unilateral neck RT  were similarly studied and served as a benchmark for comparison . Factors predicting the XQ scores were analyzed using a r and om-effects model . RESULTS The XQ was found to be reliable and valid in measuring patient-reported xerostomia . The spared salivary gl and s which had received moderate doses in the bilateral RT group recovered to their baseline salivary flow rates during the second year after RT , and the spared gl and s in the unilateral RT group , which had received very low doses , demonstrated increased salivary production beyond their pre-RT levels . The increase in the salivary flow rates during the second year after RT paralleled an improvement in xerostomia in both patient groups . The improvement in xerostomia was faster in the unilateral compared with the bilateral RT group , but the difference narrowed at 2 years . The major salivary gl and flow rates had only a weak correlation with the xerostomia scores . Factors found to be independently associated with the xerostomia scores were the pre-RT baseline scores , the time since RT , and the mean doses to the major salivary gl and s ( notably to the subm and ibular gl and s ) and to the oral cavity . CONCLUSION An improvement over time in xerostomia , occurring in t and em with rising salivary production from the spared major salivary gl and s , suggests a long-term clinical benefit from their sparing . The oral cavity mean dose , representing RT effect on the minor salivary gl and s , was found to be a significant , independent predictor of xerostomia . Thus , in addition to the major salivary gl and s , sparing the uninvolved oral cavity should be considered as a planning objective to further reduce xerostomia The purpose of this study was to determine if using a Sonicare toothbrush was a beneficial treatment of  xerostomia . Sixty-one subjects with medication-induced xerostomia were r and omly assigned a Sonicare ( SC ) or manual toothbrush ( MTB ) . Subjects were followed for four visits ( one month apart ) ; after two months , the MTB group crossed over to using a SC . At each visit , saliva flow was measured by subjects expectorating for five minutes at four collection periods . For the first sample subjects were asked to spit while brushing for three minutes and for two minutes after brushing . Five-minute saliva collection s were taken at 15- , 30- and 45-minute intervals . Question naires were administered at the end of the study period and three years later . Paired analysis on the MTB group that crossed over to SC showed significant increase in salivary flow at all post-brushing collection s ( p < 0.01 ) . The end-of- study question naire showed that 96.4 % of subjects found the SC comfortable to use , 98.2 % had enhanced salivary flow , and 92.7 % would use it to increase salivary flow . After three years , subjects rated the cleaning effect of the SC more than 4.5 ( where 5 = excellent ) . The Sonicare toothbrush may help in the treatment of xerostomia . The use of a Sonicare result ed in a statistically significant increase in post-brushing salivary flow rates in persons with medcation-induced xerostomia Xerostomia is a common and usually irreversible side effects in patients receiving radiation therapy ( > 50 Gy ) for head and neck cancer . Of 38 patients with radiation-induced xerostomia , 20 in the experimental group were treated with classical acupuncture and 18 patients in the control group received superficial acupuncture as placebo . Within both groups the patients showed significantly increased salivary flow rates after the acupuncture treatment . In the experimental group 68 % and in the control group 50 % of the patients had increased salivary flow rates at the end of the observation period . Among those patients who had had all their salivary gl and s irradiated , 50 % in both groups showed increased salivary flow rates ( > 20 % ) by the end of the observation period of 1 year . The study indicates that among the patients who had increased salivary flow rates already after the first 12 acupuncture sessions , the majority had high probability of continual improvement after the completion of acupuncture treatment . The improved salivary flow rates usually persisted during the observation year . The changes observed in the control group were somewhat smaller and appeared after a longer latency phase . Significant differences for salivary flow rates could be observed only within each group , and there were no statistically significant differences between the groups . There were no differences in the improvement of salivary flow rates between those patients who were irradiated within a year before the acupuncture treatment and those who had received radiation therapy several years earlier . The results indicate that acupuncture might be a useful method for the treatment of radiation-induced xerostomia , and that superficial acupuncture should preferably not be used as placebo acupuncture Furosemide , a potent loop diuretic , has been reported to cause  xerostomia  , a sensation of oral dryness . We obtained urine and salivary secretions from five normal males after oral intake of either 0.5 mg/kg body weight of furosemide or placebo . The experimental treatment result ed in a five-fold increase in urinary output . In contrast , analysis of salivary secretions indicated there were no significant differences in flow rates , total output , total protein , or Na+ , K+ , or Cl- concentrations following drug or placebo . Subjectively , xerostomia was experienced 10 times more frequently after ingestion of furosemide . These data suggest that , in vivo , furosemide had a greater effect on the kidney than on the salivary gl and and that the sensation of oral dryness is not solely a function of the quantitative salivary output Aim of this study was to evaluate the effect on saliva flow rate and composition and on perceived xerostomia . The study used a Latin square design , all subjects being once daily ( at 7.00 a.m. ) taking the bendroflumethiazide ( 2.5 mg ) , furosemide ( 40 mg ) , or placebo , in a r and omised order . Each treatment period of 7 days was separated by wash-out periods of 14 days . Unstimulated and paraffin chewing stimulated whole saliva , and 3 % citric acid stimulated parotid and subm and ibular-sublingual secretion were collected twice daily , at 7.30 a.m. , with the patients in a fasting condition ( morning values ) , and at 10.30 a.m. , about 2 h after intake of a st and ard breakfast ( lunchtime values ) , on day 0 ( baseline ) , day 1 ( acute treatment ) , and day 7 ( chronic treatment ) . Saliva flow rates were measured and all four secretions were analysed for the concentration of sodium , potassium , chloride , and total protein . Xerostomia was assessed by means of a Visual Analogue Scale . Statistical analysis used the Wilcoxon signed rank test . For flow rate , only that of subm and ibular-sublingual secretion was affected , significantly so in the morning during chronic treatment with both drugs . In resting whole saliva the output of both sodium and chloride tended to decrease especially during treatment with bendroflumethiazide , while in subm and ibular-sublingual secretion the output of all the electrolytes was decreased , especially for potassium and chloride and during treatment with furosemide . Further , xerostomia tended to increase during treatment with furosemide , statistically significant at lunchtime during chronic treatment . In conclusion , this study has demonstrated a modest effect on salivary flow rate and a more pronounced effect on saliva composition , especially in subm and ibular-sublingual secretion during treatment of healthy volunteers with therapeutic doses of two different diuretics , encouraging clinical studies in hypertensive patients and basic research as to the presence of a thiazide sensitive Na-Cl cotransporter in human salivary gl and BACKGROUND Cevimeline hydrochloride is a cholinergic agent with muscarinic agonist activity prominently affecting the M1 and M3 receptors prevalent in exocrine gl and s. We evaluated the safety and efficacy of cevimeline in the treatment of xerostomia in patients with Sjögren syndrome . METHODS Seventy-five patients with Sjögren syndrome and associated salivary gl and dysfunction were enrolled in a double-blind , r and omized , placebo-controlled trial at 8 university- and office-based outpatient clinical facilities in the United States . Eligible study participants were r and omized to receive 30 mg of cevimeline 3 times daily , 60 mg of cevimeline 3 times daily , or placebo for 6 weeks . Subjective responses were determined using global patient evaluation and visual analog scales . Salivary flow was measured objective ly . RESULTS Sixty-one participants completed the study . Patients in both cevimeline groups had significant improvements in dry mouth , as indicated by symptoms , salivary flow , and use of artificial saliva , compared with the placebo group . The drug was generally well tolerated , with expected adverse events result ing from the drug 's muscarinic agonist action . Fourteen patients withdrew from the study because of adverse events , the most frequent being nausea . CONCLUSIONS Therapy with cevimeline , 30 mg 3 times daily , seems to be well tolerated and to provide substantive relief of xerostomia symptoms . Although both dosages of cevimeline provided symptomatic improvement , 60 mg 3 times daily was associated with an increase in the occurrence of adverse events , particularly gastrointestinal tract disorders . Use of 30 mg of cevimeline provides a new option for the treatment of xerostomia in Sjögren syndrome The aim of this study was to evaluate the effectiveness of  acupuncture  in minimizing the severity of radiation-induced xerostomia in patients with head and neck cancer . A total of 24 consecutive patients receiving > 5000 cGy radiotherapy ( RT ) involving the major salivary gl and s bilaterally were assigned to either the preventive acupuncture group ( PA , n = 12 ) , treated with acupuncture before and during RT , or the control group ( CT , n = 12 ) , treated with RT and not receiving acupuncture . After RT completion , clinical response was assessed in all patients by syalometry , measuring the resting ( RSFR ) and stimulated ( SSFR ) salivary flow rates , and by the visual analogue scale ( VAS ) regarding dry mouth-related symptoms . Statistical analyses were performed with repeated- measures using a mixed-effect modeling procedure and analysis of variance . An alpha level of 0.05 was accepted for statistical significance . Although all patients exhibited some degree of impairment in salivary gl and functioning after RT , significant differences were found between the groups . Patients in the PA group showed improved salivary flow rates ( RSFR , SSFR ; p < 0.001 ) and decreased xerostomia-related symptoms ( VAS , p < 0.05 ) compared with patients in the CT group . Although PA treatment did not prevent the oral sequelae of RT completely , it significantly minimized the severity of radiation-induced xerostomia . The results suggest that acupuncture focused in a preventive approach can be a useful therapy in the management of patients with head and neck cancer undergoing RT Radiotherapy ( RT ) for head and neck cancers causes permanent salivary gl and dysfunction ( SGD ) and xerostomia . We have previously demonstrated the effectiveness of parotid-sparing RT on salivary function . The aim of this was to characterize the relationship between radiation dosages to parotid gl and s , SGD , xerostomia , and impaired quality of life ( QOL ) .  Ninety-three patients received unilateral ( n=38 ) and bilateral ( n=44 ) neck RT with parotid-sparing techniques , or st and ard three-field technique RT  ( n=11 ) . Unstimulated and stimulated parotid saliva was collected pre-RT and 1 year post-RT . Assessment of QOL and xerostomia was conducted with three question naires . The results demonstrated that reduced radiation dosages to parotid gl and s were strongly associated with percentage of baseline parotid flow rates measured at 1 year post-RT . Unilateral and bilateral neck RT with parotid-sparing techniques were successful in preserving salivary output , compared to st and ard three beam RT techniques . Lower radiation dose to contralateral parotid gl and s was associated with greater percentage of baseline salivary flow rates at 1 year post-RT , fewer xerostomic complaints , and an enhanced QOL St and ard conventional radiation therapy for advanced head and neck tumors typically involves administering high radiation dose to the major salivary gl and s bilaterally . In most cases , this causes a marked reduction in oral saliva output . Xerostomia is one of the most prevalent late side effects of radiation for head and neck malignancies , and patients cite it as the major cause of decreased quality of life . The degree of xerostomia has been reported to depend on the radiation dose and volume of salivary gl and irradiated . Several studies show dose-volume-response relationships in the salivary gl and s , suggesting the possibility of significant improvement in saliva production postradiation , as well as quality of life , if radiation techniques can spare the salivary gl and s. A growing body of literature supports the premise that intensity-modulated radiation therapy ( IMRT ) allows irradiation of tumor targets in the head and neck while sparing substantial portions of salivary gl and s. Early clinical experience has shown substantial sparing of salivary flow following IMRT , and suggests at least equal tumor control but improved xerostomia compared with patients receiving st and ard radiation techniques . We hypothesize that the addition of a radiation protector , such as amifostine ( Ethyol ; Medimmune Inc , Gaithersburg , MD ) may further improve salivary function over that obtained with IMRT alone . To test this hypothesis , we have initiated a pilot clinical trial to compare unstimulated and stimulated salivary flow rates 6 months and 1 year after IMRT + amifostine with historic controls treated with IMRT alone . Twenty-seven patients have been accrued onto this trial , and the toxicity and compliance data are reported herein BACKGROUND Patients with radiation-induced xerostomia produce little or no saliva . Several studies have demonstrated the efficacy of systemic administration of pilocarpine hydrochloride in individuals with post-radiation xerostomia . However , analysis of pilocarpine lozenges for treatment of post-radiation xerostomia in patients with head and neck cancer has not been reported . METHODS The aim of this study was to quantify improvement in clinical symptoms and salivary function after treatment of post-radiation xerostomia with pilocarpine lozenges . In a double-blinded , placebo-controlled trial , 33 head and neck cancer patients were assigned r and omly to receive Salagen tablet , pilocarpine hydrochloride lozenge ( 3 or 5 mg ) or placebo lozenge every 10 days . At each visit , a subjective evaluation was undertaken through the use of visual analog scales before and at 180 minutes after treatment . Whole resting saliva was collected before and at 0 , 30 , 60 , 90 , 120 , 150 and 180 minutes after treatment . RESULTS The percentage of patients with decreased feeling of oral dryness , sore mouth or speaking difficulties after taking 5-mg pilocarpine lozenge was greater than Salagen or placebo . There were statistically significant increases in salivary production in pilocarpine treatment groups vs. placebo ( P < 0.05 ) . CONCLUSION The 5-mg pilocarpine lozenge produced the best clinical results , but further investigation with a larger group of patients is required Radiation therapy for cancer of the head and neck region often causes salivary gl and dysfunction and xerostomia . Several reports suggest that the subm and ibular/sublingual ( SM/SL ) gl and s may be less radiosensitive than the parotid . The purpose of this study was to evaluate differential radiation effects on the major salivary gl and s. Fifty patients with radiation-induced xerostomia were evaluated ( 33 males , 17 females ; mean age 52.7 ) . The average total tumor dose was 6034 cGy . Major salivary gl and function was compared with that of 50 non-irradiated controls . Salivary flow rates included unstimulated and stimulated flows of both the parotid and SM/SL gl and s. Sialochemical analyses included total protein , lysozyme , lactoferrin , sodium , chloride , and potassium . All four measures of salivary flow were significantly reduced in patients as compared to controls ( p = .0001 ) . Like the parotid , subm and ibular/sublingual gl and dysfunction appears to be radiation dose- and field-dependent . Patients in the lowest radiation dose quartile ( < or = 5000 cGy ) had significantly increased salivary flow compared to those in the highest dose quartile ( > or = 6800 cGy ; p = .025 ) . Gl and s that were partially irradiated were more likely to have some residual function than fully irradiated gl and s ( p = .003 ) . Lactoferrin content was increased in parotid saliva of radiation patients ( p = .0001 ) . Chloride content was significantly increased also ( p = .0001 ) . The SM/SL gl and s are clearly dysfunctional in post-irradiation xerostomia patients compared to controls , in terms of both flow rates and sialochemistry Pilocarpine and placebo tablets were administered for 90 day periods in a double‐blind , sequential crossover trial to 12 patients with postradiation xerostomia .  Salivary flow was measured by two techniques , symptomatic change and adverse side effects were also recorded . Nine of the 12 patients showed marked improvement by two or more criteria while taking pilocarpine . None of the 12 patients showed meaningful improvement while on placebo .  Side effects were minimal and easily controlled . These results show that pilocarpine is effective in relieving the signs and symptoms of postradiation xerostomia . Cancer 59:1123‐1125 , 1987 PURPOSE To determine whether prevention of hyposalivation after  curative radiotherapy ( RT ) to the head and neck improves patients ' quality of life ( QOL ) . METHODS AND MATERIAL S Patients were to receive at least 50 Gy to 50 % of the volume of the major salivary gl and s , provide unstimulated and stimulated saliva sample s , and complete the University of Washington head- and -neck QOL tool before RT and 3 and 6 months after RT . Patients were r and omized to receive pilocarpine 5 mg or placebo q.i.d . RESULTS A total of 249 patients was r and omized between March 1998 and January 2000 . Of these , 214 were eligible for QOL analysis . Patients were evenly distributed between arms by race , gender , tobacco use , tumor site , T stage ( 50 % T2-T3 ) , and salivary function . A Karnofsky performance status of 90 % was more common in the pilocarpine arm . Twenty percent of the patients on the pilocarpine arm and 29 % of the patients on the placebo arm were taking nutritional supplements . The placebo arm patients had greater mouth pain and chewing difficulties . Compliance for the QOL tool at 3 and 6 months was 65 % and 50 % , respectively . Despite statistically significant ( p = 0.047 and p = 0.049 , respectively ) preservation of salivary function in the pilocarpine arm , patients on the pilocarpine arm reported difficulties with swallowing ( 75 % ) , activity ( 80 % ) , hyposalivation ( 64 % ) , and taste ( 81 % ) . No difference was noted between arms at 3 months in mucositis scores , with both arms demonstrating increased requirement for oral nutrients . CONCLUSION Objective prevention of hyposalivation did not affect patients ' assessment of salivary function or QOL because of the greater impact mucositis plays in QOL after RT BACKGROUND Xerostomia is a serious morbidity of radiation treatment in head and neck cancer . METHODS We conducted a prospect i ve phase III multicenter r and omized study comparing subm and ibular salivary gl and transfer ( SGT ) procedure with pilocarpine during and for 3 months after XRT .  Salivary flow ( baseline , stimulated ) and University of Washington Quality of Life Question naire ( U of W QOL ) scores were measured . RESULTS . : An interim intent to treat analysis ( 120 patients ) at 6 months shows superior results in SGT arm : median baseline salivary flow for SGT ( 0.04 mL/minute ) versus pilocarpine ( 0.01 mL/minute ) , p = .001 ; median stimulated salivary flow ( 0.18 mL/minute ) for SGT versus ( 0.05 mL/minute ) for pilocarpine , p = .003 . Scores ( U of W QOL ) for amount ( p = .017 ) and consistency of saliva ( p = .005 ) in favor of SGT leading to premature closure of study . CONCLUSIONS Subm and ibular SGT procedure is superior to pilocarpine in management of radiation-induced xerostomia The purpose s of this study were to ( a ) explore the impact of xerostomia and saliva flow on quality of life and ( b ) vali date the Taiwanese version of the Xerostomia Question naire ( XQ ) for patients undergoing radiotherapy ( RT ) for head and neck cancer in Taiwan . This was a prospect i ve longitudinal study . Instruments consisted of the Xerostomia Question naire-Taiwan version ( XQ-T ) and the Medical Outcomes Study Short Form-36 Taiwan Version .  Salivary output was measured by collecting unstimulated whole saliva . The question naires and measurements of salivary output were completed before RT was initiated and at two , four , six , and eight weeks after RT had started . Changes in xerostomia scores , quality of life , saliva flow , and predictors of quality of life over time were examined by using general estimating equations . The XQ-T is the first xerostomia measurement instrument developed for use with Taiwanese cancer patients and demonstrated excellent reliability and validity . Saliva flow was significantly correlated with  XQ-T scores at two , four , six , and eight weeks after RT had started , but not before RT had begun . Saliva flow and quality -of-life scores significantly diminished and xerostomia scores significantly increased over the eight-week period . Saliva flow and XQ-T scores significantly predicted quality of life , after adjusting for the maturation effect . The results of this study show that the XQ-T is the first xerostomia measurement instrument to be developed for Taiwanese cancer patients and demonstrates excellent reliability and validity There is controversy concerning the effect of pilocarpine in the reversal of radio-induced xerostomia ; however , the tests are usually performed at the end of radiotherapy . The present study evaluated the radioprotective effects of pilocarpine when ingested during radiation treatment . Eleven patients ( recently diagnosed with head and neck cancer who were not undergoing radiotherapy ) were divided into two groups : the control group ( saline solution intake n=6 ) and the pilocarpine-treated ( 5 mg pilocarpine three times daily , n=5 ) group , in a prospect i ve and double-blinded study . For five weeks , oral conditions , unstimulated salivary flow and stimulated saliva flow were collected weekly , with the first collection occurring prior to radiation therapy . As early as the second week , the control group exhibited oral complications and greater reduction in salivary flow rate . At the end of the study , the pilocarpine-treated group presented mean values of salivary flow greater than those of the control group . Pilocarpine intake applied simultaneously with radiotherapy demonstrated encouraging results with regard to lowering salivary flow reduction and incidence of xerostomia , as well as of oral complications
The results of the included studies did not provide evidence to state that patients taking  antihypertensives suffer more xerostomia or hyposalivation than patients not taking them .
The case-control studies showed great variability in salivary flow , but in this case most studies showed how salivary flow is lower in patients medicated with antihypertensive drugs .
The aims of this systematic review are ( 1 ) to compare the prevalence of xerostomia and hyposalivation between patients taking antihypertensive drugs with a control group ( CG ) , ( 2 ) to compare salivary flow rate between patients treated with a CG , and ( 3 ) to identify which antihypertensives produce xerostomia .