Xerostomia: prevalence and pharmacotherapy. With special reference to beta-adrenoceptor antagonists. A prospective randomized trial to reduce oral Candida spp. colonization in patients with hyposalivation. The efficacy of pilocarpine and bethanechol upon saliva production in cancer patients with hyposalivation following radiation therapy. 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. Effect of low-level laser therapy on radiotherapy-induced hyposalivation and xerostomia: a pilot study. Pilocarpine in the prevention of postirradiation xerostomia. Radiation-induced hyposalivation and its treatment with oral pilocarpine. Pilocarpine treatment of salivary gland hypofunction and dry mouth (xerostomia). Major salivary gland function in patients with radiation-induced xerostomia: flow rates and sialochemistry. Hypnosis for postradiation xerostomia in head and neck cancer patients: a pilot study. Quantifying Radioxerostomia: Salivary Flow Rate, Examiner’s Score, and Quality of Life Questionnaire Phase III randomized study: oral pilocarpine versus submandibular salivary gland transfer protocol for the management of radiation-induced xerostomia. [Usefulness of pilocarpine in the prevention of xerostomia in patients with head and neck cancer treated with radiotherapy. Assessment with gammagraphy and salivary flow]. Hyperthermic, supersaturated humidification in the treatment of xerostomia. ARIX: a randomised trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer. Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Protection of salivary function by concomitant pilocarpine during radiotherapy: a double-blind, randomized, placebo-controlled study.
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 Low salivary flow rates are associated with higher oral C and ida spp . counts , which may predispose to oral c and idiasis . The aim of this study was to compare the effect of stimulating salivary flow rates with that of a regimen of chlorhexidine mouth rinse on the intensity of C and ida colonization in patients with reduced salivary flow rates . Thirty-one out patients were r and omized to stimulate salivary output ( group 1 ) or to receive chlorhexidine mouth rinses ( group 2 ) . Evaluations were performed at baseline ( T0 ) , at end of treatment ( T1 ) , and 15 days after last day of treatment ( T2 ) . Chewing-stimulated whole saliva sample s were collected at each visit . Group 1 showed a constant reduction in median cfu counts , although the difference was significant only between T0 and T2 ( p = 0.004 ) . Group 2 showed a reduction in median C and ida cfu counts between T0 and T1 ( p = 0.01 ) , but the counts increased at T2 ( p = 0.01 ) , and the difference between T0 and T2 was not significant ( p = 0.8 ) . In conclusion , patients who received salivary stimulation showed reductions of C and ida cfu counts in saliva and a trend for increasing salivary flow rates between baseline and end of study evaluations . The use of chlorhexidine mouth rinses dramatically reduced C and ida cfu counts , but when patients discontinued treatment , intensity of colonization rose again PURPOSE Pilocarpine and bethanechol have been reported as potentially effective sialogogues for xerostomic patients . The purpose of the present study was to compare the efficacy of bethanechol to that of pilocarpine in patients with dry mouth following cancer therapy . STUDY DESIGN Patients with documented hyposalivation were provided pilocarpine or bethanechol for 2 - 3 weeks in an open-label r and omized crossover study . Baseline and weekly whole resting saliva ( WRS ) and whole stimulated saliva ( WSS ) were obtained for 5 minutes . Subjective response and side effects were recorded . RESULTS Forty-two xerostomic patients who had received radiation therapy to the head and neck participated . The increase in the WRS and WSS with each medication independently was limited . Statistically significant increase in WRS was seen for both medications when all patients using either agent were analyzed , but no statistically significant increase in WSS was found . Twenty-seven patients completed the crossover protocol . No significant difference in the effect was noted between each of the 2 drugs whether they were prescribed as the first or second drug in the crossover . Statistically significant improvement in subjective report of saliva production/mouth wetness was seen for patients on either medication . This study suggests that subjective improvement in symptoms of dry mouth may be related to resting saliva production , and not to stimulated saliva production . No statistically significant differences in adverse side effects were reported between the medications prescribed . The most common side effects were minor and included frequent urination , dizziness , and increased sweating . CONCLUSIONS The findings indicate that head and neck radiation-treated patients with established hyposalivation will respond minimally to systemic sialagogues and while they may experience an increase in resting saliva little change in stimulated saliva may occur . It is not known whether relatively small increases in saliva are beneficial in maintaining oral health ; however , subjective improvement suggests improved quality of life . While it is not known if prolonged use of a sialagogue will have increased effects , the limited increase in saliva seen following the second drug of the crossover suggests that prolonged use of a sialagogue may further increase saliva production 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 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 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 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 We studied the effects of pilocarpine hydrochloride , a para-sympathomimetic agent , on major salivary gl and output and subjective responses in 31 patients with salivary hypofunction .  Pilocarpine hydrochloride ( 5-mg capsules , three times daily ) was given for 5 months and a placebo was r and omly assigned for 1 month in a double-blind fashion . Objective measurements of major salivary gl and output , subjective impressions of oral moisture , treatment-related side effects , and a number of physiologic measures were assessed monthly . Pilocarpine significantly increased salivary output in 21 of the 31 patients . Subjective improvement in the feeling of oral dryness , speaking , chewing , and swallowing were reported by 27 individuals . Side effects , while common , generally were mild and tolerable . There were no significant alterations in cardiovascular or other physiologic measures . We conclude that pilocarpine is an effective and safe treatment for salivary gl and hypofunction and xerostomia in selected patients . The increase in major gl and output provides beneficial natural secretions and relief of oral dryness 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 Xerostomia , the sensation of dry mouth , affects almost all patients who undergo radiotherapy for cancer in the head and neck area . Current therapies for xerostomia are inadequate , and the condition negatively impacts the quality of life . This prospect i ve observational pilot study aim ed to evaluate whether hypnosis could improve salivation and decrease xerostomia .  Twelve patients with xerostomia after radiotherapy for head and neck cancer were assessed for severity of xerostomia symptoms and sialometry . They then received a single hypnosis session with specific suggestions to increase salivation . The session was recorded on a compact disk ( CD ) , and the participants were instructed to listen to it twice a day for one month . Sialometry was repeated immediately after hypnosis . Vali date d xerostomia question naires were completed at one , four , and 12 weeks after hypnosis . A substantial overall improvement was reported by eight patients at 12 weeks ( 66 % ) . The saliva flow rate increased on sialometry in nine patients following hypnosis ( 75 % ) . There was no correlation between the magnitude of changes in the measured saliva flow rate and changes in subjective measures ( Spearman 's correlation coefficient r=0.134 ) . Symptomatic improvement significantly correlated with the number of times the patients listened to the hypnosis CD ( r=0.714 , P=0.009 ) . No adverse events were reported . The data from this small observational trial suggest that hypnosis may be an effective treatment for xerostomia . Confirmation in a larger r and omized and controlled investigation is warranted Background and Purpose : Salivary flow rates alone are not sufficient to quantify all aspects of radioxerostomia . This is a problem in studies aim ing to reduce radioxerostomia . The aim of this study was to evaluate the association between objective ly measured salivary flow rate and subjective xerostomia ratings by the physician ( RTOG scale ) or the patients ( quality of life [ QoL ] question naire ) . Patients and Methods : In a case-control study patients who underwent recall for oral cancer were screened . Inclusion criteria for this diagnostic , noninterventional study were : history of oral carcinoma , surgical and radiation therapy , time interval from start of radiation therapy > 90 days , salivary gl and s within the radiation field . The control group consisted of patients , who had not received radiotherapy .  RTOG salivary gl and score , quality of life ( EORTC QLQ-C30 and H&N35 ) , and sialometry were recorded . Results : Patients with RTOG score 0 had mean salivary flow rates of 0.3 ml/min , those with RTOG 1 0.12 ml/min , RTOG 2 0.02 ml/min , and RTOG 3 < 0.01 ml/min . RTOG score 4 ( total fibrosis ) did not occur . Based on salivary flow rates , all patients were grouped into xerostomia < 0.2 ml/min ( 30 patients ) and nonxerostomia ( twelve patients ) . QoL results revealed significant differences between patients with xerostomia and nonxerostomia for physical function , dyspnea , swallowing , social eating , dry mouth , nutritional support , and a tendency to higher values for appetite loss . Conclusion : The correlation between “ subjective ” QoL parameters and salivary flow was confirmed . The different subjective aspects of radioxerostomia seem to be better differentiated by the EORTC QoL question naire . Hintergrund und Ziel : Die Speichelfließrate allein reicht nicht aus , um alle Aspekte der Radioxerostomie zu erfassen . Dies stellt ein Problem für Studien dar , die auf die Reduktion der Radioxerostomie abzielen . Ziel dieser Studie war die Evaluation der Zusammenhänge zwischen objektiv gemessener Speichelfließrate und subjektiven Xerostomiebewertungen durch den Untersucher ( RTOG-Score ) oder den Patienten (Lebensqualitätsfragebogen).Patienten und Method ik : In einer Fall-Kontroll-Studie wurden Patienten i m Rahmen des onkologischen Recalls untersucht . Einschlusskriterien für diese nichtinterventionelle , diagnostische Studie waren : chirurgische und Strahlentherapie nach Oropharynxkarzinom , Zeit nach Beginn der Strahlentherapie > 90 Tage , Speicheldrüsen i m Strahlenfeld . Die Kontrollgruppe best and aus Patienten ohne Strahlentherapie .  Der RTOG-Speicheldrüsenscore , Lebensqualität ( EORTC QLQ-C30 und H&N35 ) und Sialometrie wurden erfasst . Ergebnisse : Patienten mit RTOG 0 wiesen eine mediane Speichelfließrate von 0,3 ml/min auf , mit RTOG 1 0,12 ml/min , RTOG 2 0,02 ml/min und RTOG 3 < 0,01 ml/min . RTOG 4 ( vollständige Fibrose ) kam nicht vor . Basierend auf der Speichelfließrate wurden alle Patienten in die Gruppen „ Xerostomie “ < 0,2 ml/min ( 30 Patienten ) und „ Nichtxerostomie “ ( zwölf Patienten ) eingeteilt . Die Ergebnisse der Lebensqualität erbrachten signifikante Unterschiede für diese beiden Gruppen für folgende Dimensionen : „ physische Funktion “ , Dyspnoe , Schlucken , Essen in Gesellschaft , trockener Mund , Zusatznahrung und eine Tendenz für höhere Werte bei Appetitverlust . Schlussfolgerung : Die Korrelation zwischen „ subjektiven “ Lebensqualitätsparametern und der Speichelfließrate konnte bestätigt werden . Die verschiedenen subjektiven Aspekte der Xerostomie scheinen mit dem EORTC-Fragebogen deutlicher differenzier- und quantifizierbar 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 AIM To assess the utility of salivary gl and scintigraphy and salivary flow to quantify salivary function and to evaluate the usefulness of pilocarpine in the treatment of radiation-induced xerestomia in head and neck cancer patients . METHOD Thirty two patients with head and neck tumor treated with radiotherapy ( RDT ) were studied . Patients were classified into two groups : pilocarpine group ( P ) , that received prophylactic pilocarpine before RDT and during the first year after treatment . No pilocarpine group ( NP ) that received RDT without pilocarpine .  Salivary gl and scintigraphy and salivary flow were performed before RDT and during one year after treatment . Parotid and submaxillary uptake and excretion were calculated . Salivary flow after stimulation during five minutes was also obtained . RESULTS Uptake and excretion in both salivary gl and s decreased after RDT . There were no statistical differences comparing P and NP groups ( p < 0.001 ) . However , in group P a trend to recovery was observed in parotid uptake values at 12 months after treatment , but it was not statistically significant . In both groups the salivary flow decreased after RDT and a good correlation ( r = 0.8 ) between salivary flow and submaxillary excretion and parotid excretion was found . CONCLUSIONS Salivary gl and scintigraphy and salivary flow could be useful to evaluate salivary gl and function in patients with head and neck irradiated tumors . Although better results on the salivary uptake at 12 months were noted , pilocarpine did not significantly improve salivary gl and function OBJECTIVES To investigate the role of hyperthermic , supersaturated humidification in the treatment of radiation-induced xerostomia . STUDY DESIGN A r and omized , controlled , crossover pilot study of patients with symptomatic xerostomia following radiotherapy for head and neck cancer . Patients compared a st and ard bedside humidifier with a new device delivering hyperthermic , supersaturated humidification through a nasal cannula . METHODS The patients were r and omized to a 2-week course of st and ard , cool air bedside humidification or to hyperthermic , supersaturated humidification through a nasal cannula  ( Vapotherm Inc. , Annapolis , MD ) . After a 1-week washout period , patients were crossed over to the opposite device for another 2 weeks . The patients underwent physical examination initially and after each trial period using an objective xerostomia scale , and then completed a question naire quantifying their symptoms . Patients additionally rated their symptoms at home , twice daily , using a visual analogue scale . RESULTS Using the Oral Assessment Guide , lip scores went from 1.67 initially to 1.67 after control and 1.67 after Vapotherm . Tongue scores were 1.67 , 1.5 , and 1.83 , respectively . Saliva scores were 1.67 , 1.5 , and 1.5 , respectively . Mucous membranes scores were 1.5 , 1.67 , and 1.5 , respectively . The physical examination scores at these four sites were not significantly different between control and Vapotherm ( P = .78,.78,.72 , and .37 , respectively ) . The patient symptom question naire and visual analogue scores also revealed no significant difference between the two devices . CONCLUSION The Vapotherm MT-3000 device appears to provide minimal or no additional relief from radiation xerostomia over st and ard bedside humidifiers . Further investigation may be warranted with newer models of the device and with disorders of mucociliary clearance BACKGROUND Radiation treatment of head and neck cancer can cause chronic xerostomia which impairs patients ' quality of life . The study reported here examined the efficacy of acupuncture in alleviating xerostomia symptoms especially dry mouth . PATIENTS AND METHODS A total of 145 patients with chronic radiation-induced xerostomia > 18 months after treatments were recruited from seven UK cancer centres . The study employed a r and omised crossover design with participants receiving two group sessions of oral care education and eight of acupuncture using st and ardised methods . Patient-reported outcome ( PROs ) measures were completed at baseline and weeks 5 , 9 , 13 , 17 , and 21 . The primary outcome was improvement in dry mouth . OBJECTIVE saliva measurements were also carried out . RESULTS Acupuncture compared with oral care , produced significant reductions in patient reports of severe dry mouth ( OR = 2.01 , P = 0.031 ) sticky saliva ( OR = 1.67 , P = 0.048 ) , needing to sip fluids to swallow food ( OR = 2.08 , P = 0.011 ) and in waking up at night to drink ( OR = 1.71 , P = 0.013 ) . There were no significant changes in either stimulated or unstimulated saliva measurements over time . CONCLUSION Eight sessions of weekly group acupuncture compared with group oral care education provide significantly better relief of symptoms in patients suffering from chronic radiation-induced xerostomia 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 PURPOSE To investigate the effect of concomitant administration of pilocarpine during radiotherapy for head- and -neck squamous cell carcinoma ( HNSCC ) on postradiotherapy xerostomia . METHODS AND MATERIAL S A prospect i ve , double blind , placebo-controlled r and omized trial including 170 patients with HNSCC was executed to study the protective effect of pilocarpine on radiotherapy-induced parotid gl and dysfunction . The primary objective endpoint was parotid flow rate complication probability ( PFCP ) scored 6 weeks , 6 months , and 12 months after radiotherapy . Secondary endpoints included Late Effects of Normal Tissue/Somatic Objective Management Analytic scale ( LENT SOMA ) and patient-rated xerostomia scores . For all parotid gl and s , dose-volume histograms were assessed because the dose distribution in the parotid gl and s is considered the most important prognostic factor with regard to radiation-induced salivary dysfunction . RESULTS Although no significant differences in PFCP were found for the two treatments arms , a significant ( p = 0.03 ) reduced loss of parotid flow 1 year after radiotherapy was observed in those patients who received pilocarpine and a mean parotid dose above 40 Gy . The LENT SOMA and patient-rated xerostomia scores showed similar trends toward less dryness-related complaints for the pilocarpine group . CONCLUSIONS Concomitant administration of pilocarpine during radiotherapy did not improve the PFCP or LENT SOMA and patient-rated xerostomia scores . In a subgroup of patients with a mean dose above 40 Gy , pilocarpine administration result ed in sparing of parotid gl and function . Therefore , pilocarpine could be provided to patients in whom sufficient sparing of the parotid is not achievable
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 .