Review Article ISSN 2277-3657 Available online at www.ijpras.com Volume 4, Issue 3 (2015):35-47 International Journal of Pharmaceutical Research & Allied Sciences 35 Xerostomia: Post Radiation Management Strategies Ayesha Tariq*, Muhammad Jamshaid, Imtiaz Majeed University of central Punjab, Lahore, Punjab, Pakistan *Email: ayeshatariq592@gmail.com Subject: Pharmacology Abstract Xerostomia is clinically denoted by feeling of dryness in the mouth due to decreased production of saliva. Prevalence of this condition is about 20% in the general population with highest rate of incidence in females and elderly people. Xerostomia (feeling of dryness) can impair the patient’s ability of speaking, swallowing and chewing, but the extent of dysfunction is dependent on the dose of radiation and the size of irradiated tissues. Average radiation dose of 10 to 15 Grays is associated with minimum dysfunction of salivary glands. But when the radiation dose is greater than 40 Gray, then maximal dysfunction (approx 75%) is observed in the salivary glands which are radiosensitive in nature. When radiotherapy induced in xerostomia, patients they are at highest risk of developing oral infections like gingivitis, periodontitis, viral and as well as fungal infections. Xerostomia can be managed by various means such as intensity modified radiation therapy (IMRT), transplantation of salivary glands, sialagogues (saliva stimulants), oral hygiene and by different salivary substitutes or artificial saliva. This brief study give explanation about different management approaches for radiotherapy induced xerostomia. Keywords: Xerostomia, Xerostomia management, salivary substitutes, artificial saliva 1. Introduction In head and neck treatment, radiotherapy is generally used as definitive treatment either alone or concomitantly with surgery and chemotherapy. One of the most alarming side effects associated with radiation therapy is mouth dryness[1, 2]. The term dry mouth was first time described by bartley as medical symptom in 1868. According to him, clinical manifestation of this condition was based on dryness of buccal mucosa and abolition of salivary ducts[3]. After 21 years, In 1889, Hutchinson was the person, who gave the name ‘xerostomia’ to this condition[4]. Xerostomia is usually defined as subjective feeling of dryness in the mouth [5]due to the reason of having viscous, decreased or lack of salivary secretions[[6, 7]. According to the National Institute of Dental and Craniofacial Research-National Institutes of Health (NIDCR), it is a medical condition in which patient is unable to moist his mouth normally due to absence of sufficient saliva[8]. Parotid, submandibular, sublingual and some minor salivary glands(lingual, labial, buccal, palatine, glossopalatine) are mainly involved in saliva production which can be unstimulated(resting) and stimulated[9, 10]. Along with other glands, about 60-70% of stimulated saliva is produced mainly by parotid gland( with flow rate 0.2-0.7ml/min) but for the most part of submandibular and sublingual glands and minor salivary glands are involved in unstimulated saliva production( approx 65% with flow rate of >0.1ml/min).While rest of the unstimulated saliva is contributed by parotid gland(20%) and the sublingual gland(7-8%)[11, 12].In healthy person, normal saliva flow is about 500ml-1.5L per day[9, 13]but in xerostomic condition, salivary flow rate is less than 0.1ml/min[14]. Xerostomia may be expected from the hypo functioning of salivary glands in which composition and quantity of saliva is changed[15]. Acinar atrophy and persistent swelling of salivary glands are hallmarks of radiation associated injury(resultant effects of radiation-induced apoptosis and necrosis)[1] that leads to dysfunction of salivary secretions[16]. Xerostomia has a negative effect on