Sir, the articles by Jawad et al., A review of dental treatment of head and neck cancer patients before, during and after radiotherapy: parts 1 and 2 (BDJ 2015; 218: 65–68 and 69–74), provide a useful overview of the management of patients receiving radiotherapy in the head and neck region. The papers highlighted how the management of these patients can be challenging and a team approach is most effective.

The authors discuss xerostomia and its management, and detail various saliva substitutes. They explain that some preparations are acidic and should be avoided in dentate patients. We feel it would be useful to further expand on this point. For patients attending our oncology support service we have identified several inappropriate prescriptions, mainly from some of our medical colleagues, and feel it would be useful to raise awareness of this issue.

A UK Medicines Information (UKMi) document1 is a good reference and details three preparations as acidic and best avoided in dentate patients: Glandosane synthetic saliva, SST tablets (although it is formulated with a calcium phosphate dibasic buffer to prevent demineralisation) and Biotene Oralbalance gel (although a reformulated version with a pH closer to neutral is now available). Glandosane has been shown, in many in vitro studies, to have detrimental demineralising effects on enamel and dentine.2,3,4 As alternatives are available it would seem appropriate to avoid these preparations in dentate patients.