Comparative evaluation of the effectiveness of desensitizing agents in xerostomic patients with head and neck cancer.

Xerostomia as well as hypersensitivity (DH) are common complications in patients who need radiotherapy for head and neck cancer (HNC). Thus the aim of the present study was to evaluate the clinical effectiveness of fours desensitizing agents in xerostomic patients due to radiotherapy for HNC, in comparison to a non-xerostomic healthy group. Methods: The study was conducted as a split-mouth randomized clinical trial. A total of 50 patientsneeded to be treated with radiotherapy for HNC were subjected to dental check up and treatment,if needed before, during and after the therapy. 17 patient begane to complaing DH few months later after the end of radioesposition. Basal and stimulated salivary flow was recorded for each patient according to European classification criteria (1993). The materials used as desensitizing agents were: 1) Vertise FlowTM (VF), 2) Universal Dentine Sealant (UDS), 3) Clearfil Protect Bond (CPB), and 4) Flor-Opal® Varnish (FOV). The inclusion criteria were: 1) relatively good general health status; 2) clinical reduction of the salivary flow 3) two or three teeth hypersensitive to the stimulation with a blast of air; 4) abrasion, erosion or recession with the exposure of the cervical dentine. All the patient met the inclusion criteria and were selected for the study (group A). They were compared to a group of 46 patients suffering for DH who met the same inclusion criteria except for the clinical reduction of salivary flow (group B). In both the groups, the pain experience was generated by a cold stimulus directly to a sensitive tooth surface and assessed using the Visual Analogue Scale (VAS) of pain. The response was recorded before the application of the materials (PRE-1), immediately after (POST-1), at 1 week (POST-2), 4 weeks (POST-3) and 12 week controls (POST-4). Result: the mean basal salivary flow rate was 0.24 ml/min (minimum 0.06 – maximum 0.42), while the stimulated rate was 0.54 ml/min (minimum 0.29 – maximum 0.86). In the control group the salivary flow rate was >0,2 ml/min while the stimulated rate was > 0,5 ml/min. In xerostomic group, data demonstrated that VF and CPB significantly reduced VAS scores at POST -1 and POST-2. However, after 12-weeks controls, both VF and CPB decreased their performance with an increase of the VAS scores. UDS produced a slow but continuos decrease of the VAS. However, after the 12-week controls UDS VAS decreased showing similar values to those noted at PRE-1, similarly to VF and CPB. As regard to FOV, it demonstrated the lower efficacy in DH when compared to the other materials. Conclusion: after 12-week controls, there was no statistically significant hypersensitivity reduction using any of the materials tested in xerostomic group. Exept in the case of UDS, which produced a statistically decrease of the VAS value at post 4 in group B, any other statistical differences in the efficacy of the materials were noted between the two groups.