Sir, we write further to the recent article on dry mouth management/care.1 During oncology treatment, both qualitative and quantitative features of saliva may be impaired leading to long-term compromised maintenance of oral health.2,3,4,5 Without xerostomia management, the risk of caries, dental infections, coronal fractures and dental abscesses is high. Particularly aggressive dental caries (radiation caries [RC]) can be observed in patients treated with head and neck radiotherapy.4 This is similar in patients with salivary gland dysfunction induced by different cancer treatment modalities.2,3,4

RC management is challenging for oral healthcare professionals and the lack of established protocols may lead to high rates of restoration failure, persistent foci of infection and higher risk for osteoradionecrosis development, consequently increasing treatment costs.4 Recent recommendations for RC prevention include daily sodium fluoride application for at least four minutes using custom trays, or regular professional fluoride applications when patients present with special needs (disability, poor compliance, trismus, absence of teeth).2,4

Our cancer centre (Toulouse, France) is creating a service dedicated to dry mouth management for patients undergoing anti-cancer treatment and approximately one-year post-treatment. This results from discussions with co-experts in: France - F. Decup (Montrouge), M. Florimond (Paris) and S. Doméjean (Clermont-Ferrand) for the management of patients with pathological dry mouth; and internationally - A. Banerjee (London, UK) and N. Palmier (São Paulo, Brazil) for cariology management of patients undergoing oncology treatment and xerostomia.6,7

The team is linked to nursing staff trained in oral care/hygiene maintenance and dietary advice recommendations adapted for xerostomia. Patients are then discharged to their general practitioner to ensure long-term, sustainable oral rehabilitation. It is fundamental to support these patients during oncology treatment.8