Females have lower salivary flow than males, before and after radiation therapy for head/neck cancer

Rajesh V Lalla ¹, Erika S Helgeson ², Komal Virk ³

¹Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA.
²Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
³Division of General Dentistry, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA.
⁴Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁵Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
⁶Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA.
⁷Division of Oral Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
⁸Department of Oral & Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University College of Dentistry, New York, New York, USA.
⁹Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA.
¹⁰Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹¹Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA.
¹²Department of Otolaryngology/Head & Neck Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA.

⁰Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA.

Oral Diseases +

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July 15, 2024

View abstract on PubMed

Summary

Females with head and neck cancer (HNC) exhibit lower salivary flow rates than males, both before and after radiation therapy (RT). This reduced salivary flow in females post-RT may increase the risk of tooth failure.

Area Of Science

Oncology
Radiotherapy
Salivary Gland Physiology

Background

Head and neck cancer (HNC) treatment often involves radiation therapy (RT), which can significantly impact salivary gland function.
Xerostomia (dry mouth) is a common side effect of RT, affecting patients' quality of life and oral health.
Understanding sex-based differences in salivary flow post-RT is crucial for personalized patient care and risk assessment.

Purpose Of The Study

To compare salivary flow rates between female and male patients undergoing RT for HNC.
To evaluate the changes in salivary flow before and at various time points after RT.
To investigate the association between salivary flow and tooth failure risk in HNC patients.

Main Methods

A prospective observational multicenter cohort study (OraRad) was conducted.
Stimulated whole salivary flow was measured in 107 females and 391 males before RT and at 6 and 18 months post-RT.
Statistical analyses compared salivary flow rates between sexes and assessed the risk of tooth failure.

Main Results

Females consistently showed lower mean salivary flow rates than males at all measured time points (pre-RT, 6 months, and 18 months post-RT) (p < 0.001).
The median nadir salivary flow after RT was significantly lower in females (0.22 g/min) compared to males (0.35 g/min) (p < 0.001).
A lower nadir salivary flow was associated with an increased risk of tooth failure specifically in female patients (p = 0.02).

Conclusions

Females with HNC experience significantly reduced salivary flow compared to males, both before and after radiation therapy.
Low salivary flow following RT in females is a potential risk factor for subsequent tooth failure.
These findings highlight a sex-specific difference in salivary gland response to RT and its oral health consequences.

Keywords:

head and neck neoplasms radiotherapy saliva sex tooth loss xerostomia