Xerostomia and Challacombe Scale Overview

Xerostomia and the Challacombe Scale

• Xerostomia is a persistent or temporary reduction or absence of saliva.
• Factors that can alter or damage saliva flow in the oral cavity can lead to xerostomia, predisposing to certain oral conditions.
• The resulting saliva might change in composition.
• Learning outcomes include discussing the signs and symptoms of xerostomia, stating the causes (persistent and temporary), defining the difference between responders and non-responders, recommending products to help non-responders, clearly outlining a care package for patients, and using the Challacombe scale.
• Activities include comparing and contrasting clinical findings for patients with different Challacombe Scale scores (1-3 and 9), creating a mind map outlining xerostomia, and identifying 10 prescription medications linked to dry mouth, needing the online BNF.

GDC Learning Outcomes

• A list of GDC learning outcomes is provided.

Activities

• Activity 1 requires comparing and contrasting patient roles and clinical findings for patients with Challacombe scores of 1-3 versus 9.
• Activity 2 involves creating a mind map on xerostomia.
• Activity 3 asks to identify 10 prescription drugs that cause dry mouth, using an online BNF.

Clinical Signs and Problems

• Images displaying clinical signs include a fissured tongue, oral candidiasis, dry mucosa, and thick saliva.

Causes of Xerostomia

Persistent Causes

• HIV
• Sjögren's Syndrome
• Irradiation
• Diabetes
• Sarcoidosis
• Amyloidosis
• Age Changes
• Kidney Disease
• Absent salivary gland

Temporary Causes

• Duct Obstruction
• Infection/inflammation of glands
• Psychogenic disorders
• Mouth breathing
• Prescription drugs
• Alcoholism
• Smoking
• Dehydration

Types of Patient Care

• Responder patients exhibit some salivary gland activity, and their flow might be stimulated.
• Non-responder patients have no gland activity, requiring alternative methods for mouth lubrication.

Our Role

• Responsibilities include fluoride treatment, oral hygiene instruction, dietary advice, smoking cessation, regular debridement, and regular examinations, completing the Challacombe Scale.

The Challacombe Scale

• Developed by King's College London Dental Institute.
• Provides a clinical oral dryness score (CODS).
• Enables clinicians to quantify xerostomia severity.
• Allows patients to be treated accordingly.
• Named after Professor Stephen Challacombe.
• Introduced in 2011.

How the Challacombe Scale Works

• The scale considers features of the dryness of the mouth.
• As the mouth dries, the score progressively increases.
• The presence of each feature adds a point.
• Further referral and assessment are required if the score reaches 7 or higher.
• Scores may change for better or worse, and monitoring is essential

Procedure and Interpretation of Results

• Specific features and how they translate to the interpretation of Challacombe Scale scores are outlined.

Severity and Management

• A score of 1-3 suggests mild dryness, potentially managing via hydration and sugar-free chewing gum, followed by regular monitoring.
• A score of 4-6 indicates moderate dryness, requiring sugar-free gum or sialogogues, further investigations, and saliva substitutes.
• A score of 7-10 indicates severe dryness that requires saliva substitutes, fluoride, investigation, and potentially a referral.

Thank You

• Xerostomia is an increasing, debilitating condition often observed in dental practice.
• Dental professionals should support patients well during their careers.

Further Reading

• Relevant resources and links for further information on xerostomia and related topics are listed.

Additional Information (Potential Systemic Manifestations)

• Patients might have multiple underlying issues beyond just dry mouth.
• Recognizing this is crucial for providing appropriate oral hygiene instructions.