The study was designed to evaluate the influence of hyperbaric oxygenation (HBO) therapy on salivary gland function and the growth of salivary Streptococcus mutans, Lactobacillus and Candida albicans in patients with head and neck tumours who had undergone radiation therapy. Sixteen patients were included, with radiation doses from 58 to 70 Gy. The first examination was performed at baseline before the first HBO therapy (33.7 ± 9 months after radiation therapy), and the second after 20 daily HBO therapies in a hyperbaric chamber at 2.5 ATA (absolute atmospheres), where patients breathed 100% oxygen for 90 min each day. Measurements of salivary flow, buffer capacity, saliva pH and colony density of S. mutans, Lactobacillus and C. albicans in stimulated saliva were conducted, and xerostomia grade was assessed. Salivary flow increased from 0.20 ± 0.1 to 0.39 ± 0.2 ml/min at the end of HBO therapy (p < 0.001). Salivary pH also increased from 6.0 ± 0.2 to 6.5 ± 0.1 (p < 0.05). The colony density decreased from the time at baseline to the end of HBO therapy for S. mutans (p < 0.001), Lactobacillus (p < 0.05) and the fungus C. albicans (p < 0.05). The xerostomia grade decreased from 2.63 ± 0.2 to 1.94 ± 0.2 after HBO (p < 0.001). There was no significant change in buffer capacity. The increased salivary secretion rate and salivary pH, and decreased S. mutans and Lactobacillus colony density that were observed after HBO therapy may reduce caries progression in those patients.

Keywords:
Hyperbaric oxygenation, Radiation therapy, Saliva, Xerostomia
1.
Almståhl A, Wikström M: Electrolytes in stimulated whole saliva in individuals with hyposalivation of different origins. Arch Oral Biol 2003;48:337–344.
2.
Almståhl A, Wikström M, Stenberg I, Jakobsson A, Fagerberg-Mohlin B: Oral microbiota associated with hyposalivation of different origins. Oral Microbiol Immunol 2003;18:1–8.
3.
Annane D, Depondt J, Aubert P, Villart M, Géhanno P, Gajdos P, Chevret S: Hyperbaric oxygen therapy for radionecrosis of the jaw: a randomized, placebo-controlled, double-blind trial from the ORN96 study group. J Clin Oncol 2004;22:4893–4900.
4.
Arsenian MA: Cardiovascular sequelae of therapeutic thoracic radiation. Prog Cardiovasc Dis 1991;33:299–311.
5.
Bennett MH, Feldmeier J, Hampson N, Smee R, Milross C: Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst Rev 2005;20:CD005005.
6.
Buras JA, Reenstra WR: Endothelial-neutrophil interactions during ischemia and reperfusion injury: basic mechanisms of hyperbaric oxygen. Neurol Res 2007;29:127–131.
7.
Burlage FR, Coppes RP, Meertens H, Stokman MA, Vissink A: Parotid and submandibular/sublingual salivary flow during high dose radiotherapy. Radiother Oncol 2001;61:271–274.
8.
Chambers MS, Garden AS, Kies MS, Martin JW: Radiation-induced xerostomia in patients with head and neck cancer: pathogenesis, impact on quality of life, and management. Head Neck 2004;26:796–807.
9.
Dawes C: A mathematical model of salivary clearance of sugar from the oral cavity. Caries Res 1983;17:321–334.
10.
Dawes C: How much saliva is enough for avoidance of xerostomia? Caries Res 2004;38:236–240.
11.
Dirix P, Nuyts S, Vander Poorten V, Delaere P, van den Bogaert W: The influence of xerostomia after radiotherapy on quality of life: results of a questionnaire in head and neck cancer. Support Care Cancer 2008;16:171–179.
12.
Eisbruch A, ten Haken RK, Kim HM, Marsh LH, Ship JA: Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys 1999;45:577–587.
13.
Eliasson L, Carlén A, Almståhl A, Wikström M, Lingström P: Dental plaque pH and micro-organisms during hyposalivation. J Dent Res 2006;85:334–338.
14.
Finderle Z, Cankar K: Delayed treatment of frostbite injury with hyperbaric oxygen therapy: a case report. Aviat Space Environ Med 2002;73:392–394.
15.
Fox PC: Salivary enhancement therapies. Caries Res 2004;38:241–246.
16.
Gerlach NL, Barkhuysen R, Kaanders JHAM, Janssens GORJ, Sterk W, Merkx MAW: The effect of hyperbaric oxygen therapy on quality of life in oral and oropharyngeal cancer patients treated with radiotherapy. Int J Oral Maxillofac Surg 2008;37:255–259.
17.
Gupta A, Epstein JB, Sroussi H: Hyposalivation in elderly patients. J Can Dent Assoc 2006;72:841–846.
18.
Jham BC, Reis PM, Miranda EL, Lopes RC, Carvalho AL, Scheper MA, Freire AR: Oral health status of 207 head and neck cancer patients before, during and after radiotherapy. Clin Oral Investig 2008;12:19–24.
19.
Kam MK, Teo PM, Chau RM, Cheung KY, Choi PH, Kwan WH, Leung SF, Zee B, Chan AT: Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: the Hong Kong experience. Int J Radiat Oncol Biol Phys 2004;60:1440–1450.
20.
Konings AW, Coppes RP, Vissink A: On the mechanism of salivary gland radiosensitivity. Int J Radiat Oncol Biol Phys 2005;62:1187–1194.
21.
Lee N, Xia P, Quivey JM, Sultanem K, Poon I, Akazawa C, Akazawa P, Weinberg V, Fu KK: Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys 2002;53:12–22.
22.
Lefebvre JL: Current clinical outcomes demand new treatment options for SCCHN. Ann Oncol 2005;16(suppl 6):vi7–vi12.
23.
Meng L, Liu J, Peng B, Fan M, Nie M, Chen Z, Gan Y, Bian Z: The persistence of Streptococcus mutans in nasopharyngeal carcinoma patients after radiotherapy. Caries Res 2005;39:484–489.
24.
Möller P, Perrier M, Ozsahin M, Monnier P: A prospective study of salivary gland function in patients undergoing radiotherapy for squamous cell carcinoma of the oropharynx. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:173–189.
25.
Mychaskiw G 2nd, Pan J, Shah S, Zubkov A, Clower B, Badr A, Zhang JH: Effects of hyperbaric oxygen on skin blood flow and tissue morphology following sciatic nerve constriction. Pain Physician 2005;8:157–161.
26.
Nauntofte B, Tenovuo JO, Lagerlöf F: Secretion and composition of saliva; in Fejerskov O, Kidd E (eds): Dental Caries. The Disease and Its Clinical Management. Oxford, Blackwell Munksgaard, 2003, pp 7–27.
27.
Neovius EB, Lind MG, Lind FG: Hyperbaric oxygen therapy for wound complications after surgery in the irradiated head and neck: a review of the literature and a report of 15 consecutive patients. Head Neck 1997;19:315–322.
28.
Palme CE, Gullane PJ, Gilbert RW: Current treatment options in squamous cell carcinoma of the oral cavity. Surg Oncol Clin N Am 2004;13:47–70.
29.
Plafki C, Carl UM, Glag M, Hartmann KA: The treatment of late radiation effects with hyperbaric oxygenation (HBO). Strahlenther Onkol 1998;174(suppl 3):66–68.
30.
Roesink JM, Moerland MA, Hoekstra A, van Rijk PP, Terhaard CH: Scintigraphic assessment of early and late parotid gland function after radiotherapy for head-and-neck cancer: a prospective study of dose-volume response relationships. Int J Radiat Oncol Biol Phys 2004;58:1451–1460.
31.
Shiboski CH, Hodgson TA, Ship JA, Schiødt M: Management of salivary hypofunction during and after radiotherapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:S66e1–S66e19.
32.
Stephens LC, Schultheiss TE, Price RE, Ang KK, Peters LJ: Radiation apoptosis of serous acinar cells of salivary and lacrimal glands. Cancer 1991;67:1539–1543.
33.
Teguh DN, Levendag PC, Noever I, Voet P, van der Est H, van Rooij P, Dumans AG, de Boer MF, van der Huls MP, Sterk W, Schmitz PI: Early hyperbaric oxygen therapy for reducing radiotherapy side effects: early results of a randomized trial in oropharyngeal and nasopharyngeal cancer. Int J Radiat Oncol Biol Phys 2009;75:711–716.
34.
Thom SR, Bhopale VM, Velazquez OC, Goldstein LJ, Thom LH, Buerk DG: Stem cell mobilization by hyperbaric oxygen. Am J Physiol Heart Circ Physiol 2006;290:H1378–H1386.
35.
van Nieuw Amerongen A, Bolscher JG, Veerman EC: Salivary proteins: protective and diagnostic value in cariology? Caries Res 2004;38:247–253.
36.
van Nieuw Amerongen A, Veerman EC: Current therapies for xerostomia and salivary gland hypofunction associated with cancer therapies. Support Care Cancer 2003;11:226–231.
37.
Vissink A, Jansma J, Spijkervet FK, Burlage FR, Coppes RP: Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med 2003;14:199–212.
38.
World Health Organisation: Oral Health Surveys. Basic Methods, ed 4. Geneva, WHO, 1997.
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2011
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