The effect of cytotoxic therapy on saliva and oral flora

Oral complications of cytotoxic therapy result from direct mucosal damage and, indirectly, occur as a consequence of immunosuppression. Such problems are further exacerbated as a result of associated xerostomia and secondary infection. Therefore, the aims of this study were to examine the salivary volume and composition (amylase, IgA, and lysozyme) together with the oral carriage of potential pathogens in patients receiving cytotoxic therapy. A pilot study comparing healthy controls with patients on chemotherapy for malignant conditions indicated that there were differences between the two groups. Therefore, a longitudinal study was initiated and twelve patients were assessed prior to and 4 and 12 weeks after the start of cytotoxic therapy. The 10-minute forced-spitting salivary volume and amylase and IgA levels all declined significantly over the 12-week period. Lysozyme content did not change. A quantitative increase in the oral carriage of Candida species, coliforms, and Staphylococcus aureus was also observed during therapy. Hence, it is concluded that cytotoxic chemotherapy results in a decreased salivary flow, a reduction in salivary amylase and IgA, and an increase in the oral carriage of opportunistic pathogens.