DEAR MAYO CLINIC: I was diagnosed with oral cavity cancer and will need surgery. I spoke to another patient who underwent a similar procedure, and he said he had many issues afterward with hyposalivation, which affected his eating, speaking and oral health. Can you explain what this is and how do I prevent it?

ANSWER:

While they are being treated, patients with head and neck cancer often experience xerostomia, or dry mouth, which may be caused by a condition known as hyposalivation or reduced saliva production. Though it is not necessarily a side effect of surgery, it is often associated with other treatments to the head and neck, such as radiation therapy. This condition can significantly affect a person's oral health and overall quality of life.

The standard of care for patients with head and neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy or a combination of these treatments. Unfortunately, about 70% of patients may experience damage to healthy tissue adjacent to the treatment area. This includes the salivary glands responsible for producing and secreting saliva into the mouth.

Saliva plays a crucial role in maintaining oral health by helping to break down food, neutralize acids and prevent bacterial overgrowth in the mouth. Also, saliva aids in swallowing and keeps the mouth moist, preventing discomfort and speaking difficulties. Any change to the salivary gland disrupts the normal saliva flow, causing dry mouth.

As your friend pointed out, several challenges can arise from hyposalivation, including oral health concerns, since saliva helps protect teeth and gums from decay and infections. Reduced saliva flow can increase the risk of dental cavities, gum disease and oral infections.

A lack of saliva also can alter your taste. Saliva is essential for carrying taste molecules from food to our taste buds. With reduced saliva production, taste may be altered, which can lead to less enjoyment while eating and drinking. Also, saliva is necessary to create a comfortable environment for dentures. Dry mouth can make wearing dentures uncomfortable and may cause irritation.

Recognizing the number of people affected by hyposalivation, research is occurring to try to find new alternatives for patients. At Mayo Clinic, researchers are looking at whether stem cells can restore salivary gland function. This research is ongoing, but initial results look very promising. Between now (when you need to be treated for your head and neck cancer) and the time stem cell research can provide definitive treatments, talk with your care team to determine the risk for hyposalivation. This can help you be aware of potential changes and create a plan to manage the condition if it arises. Consider speaking with a dietitian for easy-to-chew foods you can swallow and enjoy during recovery to maintain adequate nutrition. This is particularly important if you have specific dietary restrictions or concerns outside your cancer.

Other tips to help manage hyposalivation:

• Maintain excellent oral hygiene. Regular brushing, flossing and rinsing with fluoride mouthwashes can help prevent dental problems. It is important to continue with regular dental visits after surgery to ensure your mouth and teeth remain healthy.
• Stay hydrated. Sipping water regularly can help keep the mouth moist. Avoiding sugary and acidic beverages is recommended, as they can contribute to dental issues.
• Use saliva substitutes. Over-the-counter saliva substitutes can temporarily alleviate dry mouth. There are sprays, gels and lozenges available.
• Chew gum or candy. Chewing on gum or sucking on candy can stimulate saliva flow. Be sure to choose the sugarless variety to limit the risk of cavities or other concerns.
• Select moist or softer food. Things like eggs, oatmeal, cottage cheese, yogurt, avocado, canned fruit in natural juices, hummus or tofu are all great options that easily can be incorporated into many dishes.
• Be mindful of the temperature. Ensure that foods are not too hot or spicy, as heat can worsen mouth discomfort.
• Avoid dry air. Depending upon where you live, dry air can be a way of life. But consider using a humidifier at night to add moisture to the air and reduce dryness.
• Avoid tobacco and alcohol. Both tobacco and alcohol can exacerbate dry mouth.

Though hyposalivation is common for patients who have received multimodality therapy for oral cancer, with advanced preparation, you can hopefully alleviate the discomfort it causes to maintain a good quality of life and easier recovery. — Dr. Jeffrey Janus, M.D., Otolaryngology, Mayo Clinic, Jacksonville, Florida 

****************************

Related Articles