Podcast
Questions and Answers
A patient presents with xerostomia secondary to alcohol abuse. Which of the following is the MOST appropriate initial intervention?
A patient presents with xerostomia secondary to alcohol abuse. Which of the following is the MOST appropriate initial intervention?
- Fabrication of custom fluoride trays.
- Prescription of a saliva stimulating medication.
- Referral for surgical intervention to correct salivary gland dysfunction.
- Counseling on alcohol cessation. (correct)
A patient with a history of Sjogren's Syndrome is diagnosed with xerostomia. Which of the following represents the MOST appropriate long-term management strategy?
A patient with a history of Sjogren's Syndrome is diagnosed with xerostomia. Which of the following represents the MOST appropriate long-term management strategy?
- Providing oral hygiene education and fluoride treatment. (correct)
- Prescribing antibiotics to prevent secondary infections.
- Initiating speech therapy to address articulation difficulties.
- Recommending a diet high in acidic foods to stimulate saliva production.
A patient's Challacombe Scale score improves from an 8 to a 5 following intervention. What does this change indicate?
A patient's Challacombe Scale score improves from an 8 to a 5 following intervention. What does this change indicate?
- The patient should be monitored for oral cancer.
- The patient's xerostomia has improved. (correct)
- The patient requires immediate referral to an oral medicine consultant.
- The patient's xerostomia has worsened.
A patient with diabetes presents with xerostomia. Which of the following is the MOST likely underlying mechanism contributing to the patient's dry mouth?
A patient with diabetes presents with xerostomia. Which of the following is the MOST likely underlying mechanism contributing to the patient's dry mouth?
After radiation therapy, a patient experiences severe xerostomia with minimal salivary gland function. Which approach is MOST suitable?
After radiation therapy, a patient experiences severe xerostomia with minimal salivary gland function. Which approach is MOST suitable?
A patient complains of a sticky mirror during oral examination. Which of the following Challacombe Scale findings does this correlate with?
A patient complains of a sticky mirror during oral examination. Which of the following Challacombe Scale findings does this correlate with?
Which of the following Represents appropriate advice concerning diet for xerostomia?
Which of the following Represents appropriate advice concerning diet for xerostomia?
A patient who is a smoker reports a dry mouth. What etiological factor is MOST likely contributing to this?
A patient who is a smoker reports a dry mouth. What etiological factor is MOST likely contributing to this?
A patient diagnosed with Amyloidosis exhibits signs of xerostomia. What underlying mechanism is MOST likely responsible for this?
A patient diagnosed with Amyloidosis exhibits signs of xerostomia. What underlying mechanism is MOST likely responsible for this?
Which of the following methods are MOST useful in monitoring the condition of a patient with xerostomia?
Which of the following methods are MOST useful in monitoring the condition of a patient with xerostomia?
Which factor is LEAST likely to directly influence salivary flow rates in adults?
Which factor is LEAST likely to directly influence salivary flow rates in adults?
In the context of head and neck cancer treatment, what is the primary goal of using conformal and intensity-modulated irradiation techniques?
In the context of head and neck cancer treatment, what is the primary goal of using conformal and intensity-modulated irradiation techniques?
Why is it important to pay close attention to patients who suffer from xerostomia?
Why is it important to pay close attention to patients who suffer from xerostomia?
Which of the following is the MOST likely long-term consequence of altered gingival architecture?
Which of the following is the MOST likely long-term consequence of altered gingival architecture?
What is a primary characteristic of Sjögren’s syndrome concerning glandular function, as suggested by the 'non-apoptotic model'?
What is a primary characteristic of Sjögren’s syndrome concerning glandular function, as suggested by the 'non-apoptotic model'?
A patient reports experiencing a persistent dry mouth. What is the MOST appropriate initial step a dental professional should take?
A patient reports experiencing a persistent dry mouth. What is the MOST appropriate initial step a dental professional should take?
Which of the following best describes the purpose of sialendoscopy in patients with obstructive sialadenitis?
Which of the following best describes the purpose of sialendoscopy in patients with obstructive sialadenitis?
If a patient is experiencing dry mouth, what is the MOST important advice to give them regarding fluoride?
If a patient is experiencing dry mouth, what is the MOST important advice to give them regarding fluoride?
How does aging generally affect the secretory reserve capacity of major salivary glands?
How does aging generally affect the secretory reserve capacity of major salivary glands?
How does xerostomia impact speech according to Rhodus, Moller, Colby, and Bereuter's 1995 study?
How does xerostomia impact speech according to Rhodus, Moller, Colby, and Bereuter's 1995 study?
What is the primary purpose of using saliva substitutes for xerostomic patients with primary Sjögren’s syndrome?
What is the primary purpose of using saliva substitutes for xerostomic patients with primary Sjögren’s syndrome?
What is a potential adverse effect associated with the use of amifostine during radiotherapy in head and neck cancer patients?
What is a potential adverse effect associated with the use of amifostine during radiotherapy in head and neck cancer patients?
What is the MOST significant factor affecting salivary flow rate, as highlighted by Dawes (1987)?
What is the MOST significant factor affecting salivary flow rate, as highlighted by Dawes (1987)?
Which of the following is LEAST likely to be a contributing factor to xerostomia in elderly patients?
Which of the following is LEAST likely to be a contributing factor to xerostomia in elderly patients?
In managing primary Sjögren’s syndrome, what is the significance of understanding its clinical and immunopathological features?
In managing primary Sjögren’s syndrome, what is the significance of understanding its clinical and immunopathological features?
How might specific medications contribute to reduced salivary flow rates?
How might specific medications contribute to reduced salivary flow rates?
According to the information provided, what is the primary focus of the Challacombe Scale?
According to the information provided, what is the primary focus of the Challacombe Scale?
Epstein, van der Meij, Lunn, and Stevenson-Moore's study (1996) primarily investigated the impact of fluoride gel on caries in which patient population?
Epstein, van der Meij, Lunn, and Stevenson-Moore's study (1996) primarily investigated the impact of fluoride gel on caries in which patient population?
Which of the following best describes the relationship between medical conditions, medication use, and salivary flow rates?
Which of the following best describes the relationship between medical conditions, medication use, and salivary flow rates?
Why might certain antihypertensive medications contribute to xerostomia?
Why might certain antihypertensive medications contribute to xerostomia?
Which of the following best describes the primary difference between temporary and persistent xerostomia?
Which of the following best describes the primary difference between temporary and persistent xerostomia?
A patient presents with a Challacombe Scale score of 2. Which of the following clinical findings is MOST likely?
A patient presents with a Challacombe Scale score of 2. Which of the following clinical findings is MOST likely?
Which of the following oral conditions is LEAST likely to be associated with xerostomia?
Which of the following oral conditions is LEAST likely to be associated with xerostomia?
What should be the initial step in managing a patient presenting with xerostomia?
What should be the initial step in managing a patient presenting with xerostomia?
A patient with xerostomia also reports a sore throat and difficulty swallowing. What could be a potential underlying systemic manifestation?
A patient with xerostomia also reports a sore throat and difficulty swallowing. What could be a potential underlying systemic manifestation?
How does xerostomia contribute to an increased risk of dental caries?
How does xerostomia contribute to an increased risk of dental caries?
When should an alcohol-containing mouthwash be avoided in patients with xerostomia?
When should an alcohol-containing mouthwash be avoided in patients with xerostomia?
What is the main purpose of using the Challacombe Scale in assessing patients with suspected xerostomia?
What is the main purpose of using the Challacombe Scale in assessing patients with suspected xerostomia?
In providing oral hygiene instructions to a patient with xerostomia, why is it important to consider potential systemic manifestations?
In providing oral hygiene instructions to a patient with xerostomia, why is it important to consider potential systemic manifestations?
Which of the following strategies is MOST appropriate for managing halitosis in a patient with xerostomia?
Which of the following strategies is MOST appropriate for managing halitosis in a patient with xerostomia?
Flashcards
Persistent Xerostomia
Persistent Xerostomia
Dry mouth caused by ongoing factors.
Temporary Xerostomia
Temporary Xerostomia
Dry mouth caused by temporary factors.
Responder (Xerostomia)
Responder (Xerostomia)
Patients with some salivary gland activity.
Non-Responder (Xerostomia)
Non-Responder (Xerostomia)
Signup and view all the flashcards
Challacombe Scale
Challacombe Scale
Signup and view all the flashcards
CODS
CODS
Signup and view all the flashcards
Challacombe Scale Indicators
Challacombe Scale Indicators
Signup and view all the flashcards
Oral Mucosa Appearance in Xerostomia
Oral Mucosa Appearance in Xerostomia
Signup and view all the flashcards
Frothy Saliva
Frothy Saliva
Signup and view all the flashcards
Abnormal Tongue Xerostomia
Abnormal Tongue Xerostomia
Signup and view all the flashcards
Xerostomia
Xerostomia
Signup and view all the flashcards
Xerostomia
Xerostomia
Signup and view all the flashcards
Sjögren's Syndrome
Sjögren's Syndrome
Signup and view all the flashcards
Fissured Tongue
Fissured Tongue
Signup and view all the flashcards
Oral Candida
Oral Candida
Signup and view all the flashcards
Dry Mucosa
Dry Mucosa
Signup and view all the flashcards
Causes of Xerostomia
Causes of Xerostomia
Signup and view all the flashcards
Thick Saliva
Thick Saliva
Signup and view all the flashcards
Complications of Dry Mouth
Complications of Dry Mouth
Signup and view all the flashcards
Management of Xerostomia
Management of Xerostomia
Signup and view all the flashcards
Halitosis
Halitosis
Signup and view all the flashcards
Affected Taste
Affected Taste
Signup and view all the flashcards
Diagnosing Salivary Hypofunction
Diagnosing Salivary Hypofunction
Signup and view all the flashcards
Sore Throat
Sore Throat
Signup and view all the flashcards
Antihypertensive Medications
Antihypertensive Medications
Signup and view all the flashcards
Ulcerations
Ulcerations
Signup and view all the flashcards
Fluoride Gel Application
Fluoride Gel Application
Signup and view all the flashcards
High Caries Incidence
High Caries Incidence
Signup and view all the flashcards
Salivary gland dysfunction
Salivary gland dysfunction
Signup and view all the flashcards
Obstructive Sialadenitis
Obstructive Sialadenitis
Signup and view all the flashcards
Primary Sjögren’s Syndrome
Primary Sjögren’s Syndrome
Signup and view all the flashcards
Glandular Hypofunction
Glandular Hypofunction
Signup and view all the flashcards
Salivary Flow Factors
Salivary Flow Factors
Signup and view all the flashcards
Medication-Related Salivary Changes
Medication-Related Salivary Changes
Signup and view all the flashcards
Salivary Gland Aging
Salivary Gland Aging
Signup and view all the flashcards
Salivary Gland Sparing Irradiation
Salivary Gland Sparing Irradiation
Signup and view all the flashcards
Amifostine Side Effects
Amifostine Side Effects
Signup and view all the flashcards
Saliva Substitute
Saliva Substitute
Signup and view all the flashcards
Single-blind Trial
Single-blind Trial
Signup and view all the flashcards
Study Notes
- Xerostomia is the sensation of dry mouth
- This presentation discusses Xerostomia and the Challacombe Scale
- Julie Watson is the presenter
Learning Outcomes
- By the end of the session you will be able to:
- Discuss the signs and symptoms of xerostomia
- State the causes of xerostomia, both persistent and temporary
- Define the difference between responders and non responders
- Recommend appropriate products to aid non responders
- Clearly outline a package of care for these patients
- Discuss and use the Challacombe Scale
Definition of Xerostomia
- Xerostomia consists of a persistent or temporary reduction or absence of saliva
- This results from factors that may alter or damage the flow of saliva in the oral cavity, predisposing it to certain oral conditions.
- The composition of the resulting saliva may also be altered.
Clinical Signs and Problems
- Fissured Tongue
- Oral Candida
- Dry Mucosa
- Thick Saliva
- Halitosis
- Affected Taste
- Sore Throat
- Ulcerations
- High Caries Incidence
- Increased Periodontitis
Systemic Manifestations
- Patients may be suffering with more than just a dry mouth, keep this in mind when giving oral hygiene instruction
- It may not be their number one issue
Examples of Persistent Causes of Xerostomia
- HIV
- Sjorgrens Syndrome
- Irradiation
- Diabetes
- Sarcoidosis
- Amyloidosis
- Age Changes
- Kidney Disease
- Absent salivary gland
Examples of 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
- Non Responders
The Responder
- Responder patients still have some salivary gland activity
- It may be possible to stimulate their flow to assist with reducing xerostomia
The Non Responder
- Non Responder patients have no gland activity
- It may be not possible to stimulate their flow
- Alternative methods of lubricating the mouth have to be found for these patients
Our Role in Treating Xerostomia
- Fluoride Treatment
- Oral Hygiene Instruction
- Dietary Advice
- Smoking Cessation
- Regular Debridement
- Regular Examinations
- Completing a Challacombe Scale
The Challacombe Scale
- The Challacombe Scale was developed by King's College London Dental Institute
- It produces a clinical oral dryness score (CODS)
- CODS enables clinicians to quantify the severity of xerostomia and allows the patient to be treated accordingly
- The scale is named after Professor Stephen Challacombe, oral medicine consultant
- The Challacombe Scale was introduced in 2011
How the Challacombe Scale Works
- The following factors are used to evaluate the dryness of the mouth.
- The presence of each factor accrues one point.
- As the mouth becomes drier, each feature is often seen in sequence with the score progressively increasing.
- An increasing score indicates increased monitoring is needed
- Scores may change, for better or worse
- Further referral and assessment is required for scores of 7 or more.
Challacombe Scale Components
- Mirror sticks to buccal mucosa
- Mirror sticks to tongue
- Saliva frothy
- No saliva pooling in floor of mouth
- Tongue shows generalised shortened papillae (mild depapillation)
- Altered gingival architecture (ie. smooth)
- Glassy appearance of oral mucosa, especially palate
- Tongue lobulated / fissured
- Cervical caries (more than two teeth)
- Debris on palate or sticking to teeth
Challacombe Score Severity
-
A score totalling 1-3 indicates mild dryness
-
Management may not be required
-
Sugar-free chewing gum for 15 mins, twice daily, and attention to hydration is needed
-
Routine checkup monitoring is required.
-
A score totalling 4-6 indicates moderate dryness
-
Sugar-free chewing gum or simple sialogogues may be required.
-
Further investigation happens if reasons for dryness remains unclear
-
Saliva substitutes and topical fluoride may be helpful.
-
Monitor at regular intervals especially for early decay and symptom change.
-
A score totalling 7 - 10 indicates severe dryness.
-
Saliva substitutes and topical fluoride are usually needed.
-
Exclude the cause of hyposalivation and Sjogren's Syndrome, with a referral for investigation and diagnosis.
-
Patients may need further specialist input if worsening, and need to be monitored for changing symptoms and signs.
-
Xerostomia is an increasingly common debilitating condition.
-
Clinicians will likely see many patients battling xerostomia throughout their career.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.