Conventional radiation therapy is often used in the treatment of head and neck cancer.  This type of radiation therapy has been known to result in a condition known as xerostomia.  Xerostomia literally means dry mouth.  Xerostomia occurs when the cells in the salivary glands have been damaged. The result is that the glands don’t produce a normal amount of saliva.  When patients undergo radiation therapy for head and neck cancer, xerostomia develops quickly.  Xerostomia can be permanent.

Xerostomia can impact quality of life.  Xerostomia destroys oral health by promoting severe dental cavities and oral infections.  This may require removal of all the teeth. It also results in chronic oral pain, and may prevent or limit wearing of dentures. In addition, patients tell us that xerostomia alters taste and makes chewing, swallowing and speaking difficult.

Treatment for xerostomia can either be supportive or preventive. 

Supportive care includes the use of saliva substitutes and moistening agents.  Saliva substitutes temporarily duplicate the properties of normal saliva, and provide relief for approximately 40% of patients who use them. Temporary moistening agents include chewing gum, candy and sips of water.  Other supportive care may involve the use of drugs that can stimulate any remaining salivary function.  Many of these drugs have side effects.  You should talk to your doctor to see if using them is right for you.

Preventive care may be either surgical or radiological. The surgical option is known as the submandibular gland transfer (SGT). The SGT is a surgical treatment that has been shown to prevent xerostomia in 83% of patients. The surgery must happen before radiation therapy.  During surgery, one gland is transferred under the chin.  This gland is then shielded during post-operative radiation therapy.  This protects the gland. However, there are certain people for whom this treatment is not feasible because of the location of their cancer.  A discussion with your surgeon or oncologist is recommended to see if you would be a candidate for this treatment.

The second type of preventative treatment is the use of a new type of radiation therapy.  Intensity modulated radiation therapy (IMRT) is one of these.   During IMRT, radiation beams are directed to the tumor while sparing normal surrounding tissue (such as the salivary glands). Studies have shown preservation of salivary flow when the parotid salivary gland is spared via IMRT.