Podcast
Questions and Answers
What is the primary focus of the Challacombe Scale in the context of xerostomia?
What is the primary focus of the Challacombe Scale in the context of xerostomia?
- To identify the specific bacterial species contributing to halitosis.
- To accurately measure the rate of salivary flow using advanced lab equipment.
- To determine the underlying psychological causes of dry mouth.
- To quantify the severity of and allowing for proper treatment. (correct)
Which of the following best describes xerostomia?
Which of the following best describes xerostomia?
- A decrease in saliva production due to the alteration or damage of saliva flow, predisposing to oral conditions. (correct)
- A cosmetic issue without systemic implications.
- A condition that solely affects elderly individuals.
- A permanent and irreversible cessation of saliva production.
How does the Challacombe Scale aid in monitoring patients with xerostomia?
How does the Challacombe Scale aid in monitoring patients with xerostomia?
- By tracking the presence and count of specific oral bacteria.
- By measuring the effectiveness of saliva substitutes accurately.
- By allowing for regular observation of changes in oral dryness, for better or for worse. (correct)
- By providing a subjective evaluation of patient's emotional response.
What does a high score (7-10) on the Challacombe Scale typically indicate?
What does a high score (7-10) on the Challacombe Scale typically indicate?
Why is it essential to differentiate between 'responders' and 'non-responders' in xerostomia management?
Why is it essential to differentiate between 'responders' and 'non-responders' in xerostomia management?
A patient presents with a Challacombe Scale score of 2. What is the most appropriate initial recommendation?
A patient presents with a Challacombe Scale score of 2. What is the most appropriate initial recommendation?
What does a 'glassy appearance of oral mucosa' typically indicate when assessing xerostomia?
What does a 'glassy appearance of oral mucosa' typically indicate when assessing xerostomia?
Which of the following is a clinical sign correlated with xerostomia?
Which of the following is a clinical sign correlated with xerostomia?
If a patient has a Challacombe score of 5, what should be the next step in their management?
If a patient has a Challacombe score of 5, what should be the next step in their management?
According to the Challacombe Scale, which oral condition requires the exclusion of Sjögren’s Syndrome?
According to the Challacombe Scale, which oral condition requires the exclusion of Sjögren’s Syndrome?
What is one of the first steps a clinician should typically take when managing a patient diagnosed with xerostomia?
What is one of the first steps a clinician should typically take when managing a patient diagnosed with xerostomia?
Which factor distinguishes a 'responder' patient from a 'non-responder' when discussing xerostomia?
Which factor distinguishes a 'responder' patient from a 'non-responder' when discussing xerostomia?
What is the relevance of topical fluoride application in managing xerostomia?
What is the relevance of topical fluoride application in managing xerostomia?
Which of the following systemic conditions is associated with persistent xerostomia?
Which of the following systemic conditions is associated with persistent xerostomia?
What is a frequent oral symptom observed as xerostomia progresses?
What is a frequent oral symptom observed as xerostomia progresses?
Aside from prescription medication, what other factor can temporarily cause xerostomia?
Aside from prescription medication, what other factor can temporarily cause xerostomia?
A patient with xerostomia complains of a sore throat. What could be the direct source?
A patient with xerostomia complains of a sore throat. What could be the direct source?
According to the Challacombe Scale, what is given a point in the scoring system?
According to the Challacombe Scale, what is given a point in the scoring system?
What aspect of saliva is possibly altered in xerostomia?
What aspect of saliva is possibly altered in xerostomia?
Aside from using sugar-free gum, what recommendation applies to patients with mild dryness?
Aside from using sugar-free gum, what recommendation applies to patients with mild dryness?
What type of dental caries is more likely to develop in patients with xerostomia?
What type of dental caries is more likely to develop in patients with xerostomia?
Which of the following factors could cause increased periodontitis?
Which of the following factors could cause increased periodontitis?
In 2011, who was the Challacombe Scale named after?
In 2011, who was the Challacombe Scale named after?
According to the Challacombe Scale, which of the following is a possible clinical finding?
According to the Challacombe Scale, which of the following is a possible clinical finding?
According to the Challacombe Scale, which of the following findings indicates severe dryness?
According to the Challacombe Scale, which of the following findings indicates severe dryness?
Why is the use of saliva substitutes a solution for patients with xerostomia?
Why is the use of saliva substitutes a solution for patients with xerostomia?
According to the Challacombe Scale, what score indicates early decay and symptom change?
According to the Challacombe Scale, what score indicates early decay and symptom change?
Which can contribute as an oral problem from xerostomia?
Which can contribute as an oral problem from xerostomia?
According to the Challacombe Scale, what is not needed for patients with mild dryness?
According to the Challacombe Scale, what is not needed for patients with mild dryness?
What is oral candida?
What is oral candida?
Why should oral hygiene instructions be kept at the forefront of a dentist's mind?
Why should oral hygiene instructions be kept at the forefront of a dentist's mind?
According to the Challacombe Scale, which of the following is a component of Clinical Oral Dryness Score (CODS)?
According to the Challacombe Scale, which of the following is a component of Clinical Oral Dryness Score (CODS)?
Flashcards
What is Xerostomia?
What is Xerostomia?
A persistent or temporary reduction or absence of saliva, altering saliva composition and predisposing to oral conditions.
Clinical Signs of Xerostomia
Clinical Signs of Xerostomia
Dry mouth can lead to issues such as fissured tongue, oral candida, dry mucosa and thick saliva.
What are other symptoms can arise from Xerostomia?
What are other symptoms can arise from Xerostomia?
Dry mouth may lead to halitosis, altered taste, sore throat and ulcerations.
Dental problems related to Xerostomia?
Dental problems related to Xerostomia?
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Systemic implications of Xerostomia?
Systemic implications of Xerostomia?
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Examples of persistent causes of Xerostomia?
Examples of persistent causes of Xerostomia?
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Common temporary causes of Xerostomia?
Common temporary causes of Xerostomia?
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What is a Responder in Xerostomia
What is a Responder in Xerostomia
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Define a Non-Responder in Xerostomia
Define a Non-Responder in Xerostomia
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What is the role when treating Xerostomia?
What is the role when treating Xerostomia?
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What is the Challacombe Scale used for?
What is the Challacombe Scale used for?
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Scale origin?
Scale origin?
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How is the Challacombe Scale scored?
How is the Challacombe Scale scored?
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How does the Challacombe Scale work?
How does the Challacombe Scale work?
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What does a Challacombe Scale score 1-3 indicate?
What does a Challacombe Scale score 1-3 indicate?
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What does a Challacombe Scale score of 4-6 indicate?
What does a Challacombe Scale score of 4-6 indicate?
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What does a Challacombe Scale score 7-10 indicate?
What does a Challacombe Scale score 7-10 indicate?
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Challacombe Scale: Score of 1
Challacombe Scale: Score of 1
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Challacombe Scale: Score of 2
Challacombe Scale: Score of 2
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Challacombe Scale: Score of 3
Challacombe Scale: Score of 3
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Challacombe Scale: Score of 4
Challacombe Scale: Score of 4
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Challacombe Scale: Score of 5
Challacombe Scale: Score of 5
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Challacombe Scale: Score of 6
Challacombe Scale: Score of 6
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Challacombe Scale: Score of 7
Challacombe Scale: Score of 7
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Challacombe Scale: Score of 8
Challacombe Scale: Score of 8
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Challacombe Scale: Score of 9
Challacombe Scale: Score of 9
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Challacombe Scale: Score of 10
Challacombe Scale: Score of 10
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Study Notes
- Julie Watson presents the topic "Xerostomia and the Challacombe Scale"
GDC Learning Outcomes
- The presentation lists GDC learning outcomes numbered 1.1.2, 1.1.3, 1.1.4, 1.1.8, 1.1.11, 1.2.1, 1.2.3, 1.2.4, 1.5.3, 1.7.1, 1.9.1, 1.10.2, 1.10.3, 1.10.4, 1.10.5, 1.10.6, 3.2, 5.2, 6.1, and 6.3
Definition of Xerostomia
- Xerostomia is the persistent or temporary reduction/absence of saliva
- This is due to factors altering/damaging the saliva flow in the oral cavity
- It predisposes individuals to certain oral conditions
- The composition of saliva may be altered
Activities
- Activity 1 involves comparing and contrasting the role and clinical findings for a patient with a Challacombe Scale of 1-3, compared to one of 9
- Activity 2 tasks the user with designing a mind map titled "Exploring Xerostomia"
- Activity 3 requires identifying 10 prescription medications that may cause a dry mouth, using the online BNF
Clinical Signs and Problems Associated with Xerostomia
- Fissured tongue
- Oral candida
- Dry mucosa
- Thick saliva
- Halitosis and affected taste can occur
- Sore throat and ulcerations can result
- High caries incidence is also a problem
- Increased periodontitis may be observed
- Systemic manifestations beyond a dry mouth may be present; oral hygiene instruction may not be the patient's priority
Learning Objectives
- Discuss signs and symptoms of xerostomia
- State the causes of xerostomia, both persistent and temporary
- Defining the difference between responders and non-responders to treatment
- Recommending appropriate products to aid non-responders
- Clearly outlining a package of care for patients with xerostomia
- Discuss and use the Challacombe Scale
Persistent Causes of Xerostomia
- HIV
- Sjögren's Syndrome
- Irradiation
- Diabetes
- Sarcoidosis
- Amyloidosis
- Age changes
- Kidney disease
- Absent salivary gland
Temporary Causes of Xerostomia
- Duct obstruction
- Infection/inflammation of the glands
- Psychogenic disorders
- Mouth breathing
- Prescription drugs
- Alcoholism
- Smoking
- Dehydration
Two Types of Patient Care
- Responders still have some salivary gland activity and their flow may be stimulated
- Non-responders have no gland activity and their flow cannot be stimulated
- For non-responders, alternative methods of lubricating the mouth must be used
Role in Managing Xerostomia
- Fluoride treatment
- Oral hygiene instruction
- Dietary advice
- Smoking cessation
- Regular debridement
- Regular examinations
- Performing a Challacombe Scale assessment
The Challacombe Scale
- Developed by King's College London Dental Institute
- It produces a clinical oral dryness score (CODS)
- It enables clinicians to quantify the severity of xerostomia
- This allows the patient to be treated accordingly
- Named after Professor Stephen Challacombe, oral medicine consultant and was introduced in 2011
How the Challacombe Scale Works
- Factors are used to evaluate the mouth's dryness
- The presence of each factor accrues one point
- Referral and further assessment is required for scores of 7 or more
- As the mouth becomes drier, each feature is often seen in sequence with progressively increasing score
- Scores may change, for better or worse and allows monitoring
Procedure & Interpretation of Results using The Challacombe Scale
- Mirror sticks to buccal mucosa
- Mirror sticks to tongue
- Saliva frothy
- No saliva pooling in the floor of the mouth
- Tongue shows generalized shortened papillae
- Altered gingival architecture
- Glassy appearance of oral mucosa, especially palate
- Tongue lobulated/fissured
- Cervical cavitations on more than two teeth
- Debris on palate or sticking to teeth
Severity and Management using The Challacombe Scale
- A score of 1-3 indicates mild dryness, which may not require further management
- A medication history may reveal the cause
- Treatment is twice-daily chewing of sugar-free gum and keeping hydrated, with regular monitoring
- A score of 4-6 indicates moderate dryness and needs sugar-free chewing gum/ simple sialogogues
- Needs investigated, and saliva substitutes and topical fluoride may be helpful, with regular follow-ups
- A score of 7-10 indicates severe dryness and saliva substitutes/topical fluoride
- The reasons for reduced salivation needs assessment and Sjögren syndrome exclusion, with referral if symptoms worsen
Conclusion
- Xerostomia is an increasingly common, debilitating condition
- Many patients will be seen with it
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