Xerostomia GN PDF

Xerostomia and the Challacombe Scale Julie Watson GDC learning Outcomes 1.1.2 1.7.1 1.1.3 1.9.1 1.1.4 1.10.2 1.1.8 1.10.3 1.1.11 1.10.4 1.2.1 1.10.5 1.2.3 1...

Xerostomia and the Challacombe Scale Julie Watson GDC learning Outcomes 1.1.2 1.7.1 1.1.3 1.9.1 1.1.4 1.10.2 1.1.8 1.10.3 1.1.11 1.10.4 1.2.1 1.10.5 1.2.3 1.10.6 1.2.4 3.2 1.5.3 5.2 6.1 6.3 2 Ac;vity 1 Compare and contrast your role and clinical ?ndings for a pa1ent presen1ng with a Challacombe Scale of 1-3 with a pa1ent presen1ng with a Challacombe Scale of 9 List form and bullet points Please submit your work to Mrs Watson  Ac;vity 2 Design a Mind Map 1tled Exploring Could be scientific, holistic, products However we would like to Xerostomia Please submit your work to Mrs Watson! Ac;vity 3 Iden1fy 10 prescrip1on medica1ons that may cause a dry mouth. You will need the online BNF to help you with this. Please submit this work to Mrs Watson 6 Learning Outcomes By the end of the session you will be able to: Discuss the signs and Recommend appropriate symptoms of xerostomia products to aid non State the causes of responders xerostomia, both persistent Clearly outline a package of and temporary care for these pa1ents DeKne the diLerence Discuss and use the between responders and non Challacombe Scale responders De?ni;on Xerostomia is a persistent or temporary reduc1on or absence of saliva due to factors that may alter or damage the Pow of saliva in the oral cavity predisposing to certain oral condi1ons The resul1ng saliva may be altered in its composi1on  Clinical Signs and Problems Fissured Oral Dry Thick Tongue Candida Mucosa Saliva  ARected Halitosis Taste And they go on! Sore Throat Ulcera;ons foundahTps://www.mouthcancer;on.org/wp-content/uploads/2020/06/the-cracker- challenge.pdf And on! High Caries Incidence And On! Increased Periodon;;s Systemic Manifesta;ons Your pa1ents may be suLering with more than just a dry mouth. Keep this in mind when giving oral hygiene instruc1on It may not be their number one issue. Persistent Causes of Xerostomia HIV Amyloidosis Sjorgrens Syndrome Age Changes Irradia1on Kidney Disease Diabetes Absent salivary gland Sarcoidosis Temporary Causes of Xerostomia Duct Obstruc1on Prescrip1on drugs Infec1on/InPamma1on of Alcoholism the glands Smoking Psychogenic Disorders Dehydra1on Mouth Breathing Two Types of Pa;ent Care The Responder These pa1ents s1ll have some salivary gland ac1vity It may be possible to s1mulate their Pow Mastication stimuli Chemical stimuli - citric acid Taking of evening primrose oil Electronic devices Medication Acupuncture  Sprays Be aware some products may contain animal products Gels Mouthwashes The Non Responder Gum (unable to use ordinary chewing gum) Olive oil on lips at night These pa1ents have no gland ac1vity It is not possible to s1mulate their Pow For these pa1ents alterna1ve methods of lubrica1ng the mouth have to be found. Our Role Fluoride Oral Hygiene Dietary Advice Smoking Treatment Instruc1on Cessa1on Regular Regular Complete a Debridement Examina1ons Challacombe Scale The Challacombe Scale Developed by King's College London Dental Ins1tute. Produces a clinical oral dryness score (CODS). Enables the clinician to quan1fy the severity of xerostomia. Allows the pa1ent to be treated accordingly. Named a_er Professor Stephen Challacombe, oral medicine consultant. Introduced in 2011. How it Works The following factors are used to As the mouth becomes drier, evaluate the dryness of the each feature is o_en seen in mouth. sequence with the score The presence of each accrues one progressively increasing. point. Scores may change, for beber or Further referral and assessment worse is required for scores of 7 or Allows monitoring more. Procedure & Interpreta;on of Results 1.Mirror s1cks to buccal mucosa 7. Glassy appearance of oral 2.Mirror s1cks to tongue mucosa especially palate 3. Saliva frothy 8. Tongue lobulated/Kssured 4. No saliva pooling in the Poor of 9. Cervical cavita1ons on more the mouth than two teeth 5. Tongue shows generalised 10. Debris on palate or s1cking to shortened papillae teeth 6. Altered gingival architecture  Thank You For Your ATen;on Finally, to reiterate, Xerostomia is an increasingly common debilita1ng condi1on. You will see many pa1ents suLering with this during your career. Look a_er them well! Further Reading Acupuncture for dry mouth: youtube.com/watch? v=DOotx17ZCn8 Sjorgrens Syndrome A Place to Begin: youtube.com/watch?v=Sa7XQ_Hr_8Q If you use Biotene, you must watch this: youtube.com/watch?v=IKvLI9kd-D8 Challacombe-scale-ENG (1) pdf hbp://www.challacombescale.co.uk/index.html WolL A, Fox PC, Ship JA, Atkinson JC, Macynski AA, Baum BJ. Oral mucosal status and major salivary gland func1on. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1990;70:49–54. Dawes C. Physiological factors aLec1ng salivary Pow rate, oral sugar clearance and the sensa1on of dry mouth in man. J Den Res. 1987;66:648–653. Navazesh M, Christensen C, Brightman V. Clinical criteria for the diagnosis of salivary gland hypofunc1on. J Dent Res. 1992;71:1363–1369. Gerdin EW, Einarson S, Jonsson M, Aronsson K, Johansson I. Impact of dry mouth condi1ons on oral health-related quality of life in older people. Gerodontol. 2005;22;219–226. Rhodus NL, Moller K, Colby S, Bereuter J. Ar9culatory speech performance in pa9ents with salivary gland dysfunc9on: a pilot study, Quintessence Int. 1995;26:805–812. Liu B, Dion MR, Jurasic MM, Gibson G, Jones JA. Xerostomia and salivary hypofunc1on in vulnerable elders: prevalence and e1ology. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114:52–60. Atkinson JC, Grisius M, Massey W. Salivary hypofunc1on and xerostomia: diagnosis and treatment. Dent Clin North Am. 2005;49:309–326. Croog SH, Elias MF, Colton T, et al. ELects of an1hypertensive medica1on on quality of life in elderly hypertensive woman. Am J Hypertens. 1994;7:329–339. Epstein JB, van der Meij EH, Lunn R, Stevenson-Moore P. ELects of compliance with Puoride gel applica1on on caries and caries risk in pa1ents a_er radia1on therapy for head and neck cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82:268–275. Scully C, Bagan JV, Hopper C, Epstein JB. Oral cancer: current and future diagnos1c techniques. Am J Dent. 2008;21:199–209. Scully C, Epstein JB. Oral health care for the cancer pa1ent. Eur J Cancer B Oral Oncol. 1996;32B:281–292. Singh N, Scully C, Joyston-Bechal S. Oral complica1ons of cancer therapies: preven1on and management. Clin Oncol (R Coll Radiol). 1996;8:15–24. Chuangqi Y, Chi Y, Lingyan Z. Sialendoscopic Kndings in pa1ents with obstruc1ve sialadeni1s: long-term experience. Br J Oral Maxillofac Surg. 2013;51:337–341. Fox RI, Howell FV, Bone RC, Michelson P. Primary Sjögren’s syndrome: clinical and immunopathologic features. Semin Arthri9s Rheum. 1984;14:77–105. Dawson IJ, Fox PC, Smith Sjögren’s syndrome-the non-apopto1c model of glandular hypofunc1on. Rheumatology (Oxford). 2006;45;792–798. Navazesh M, Brightman VJ, Pogoda JM. Rela1onship of medical status, medica1ons, and salivary Pow rates in adults of diLerent ages. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81:172–176. Wu AJ, Ship JA. A characteriza1on of major salivary gland Pow rates in the presence of medica1ons and systemic diseases. Oral Surg Oral Med Oral Pathol. 1993;76:301–306. Ghezzi EM, Ship JA. Aging and secretory reserve capacity of major salivary glands. J Dent Res. 2003;82:844–848. Eisbruch A, Ship JA, Dawson LA, et al. Salivary gland sparing and improved target irradia1on by conformal and intensity modulated irradia1on of head and neck cancer. World J Surg. 2003;27:832–837. Rades D, Fehlauer F, Bajrovic A, Mahlmann B, Richter E, Alber1 W. Serious adverse eLects of amifos1ne during radiotherapy in head and neck cancer pa1ents. Radiother Oncol. 2004 Mar;70(3):261-264. Alves MB, Moba AC, Messina WC, Migliari DA. Saliva subs1tute in xerostomic pa1ents with primary Sjögren’s syndrome: a single-blind trial. Quintessence Int. 2004;35:392–396