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.
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
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 .