Xerostomia and the Challacombe Scale 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 Activity 1 Compare and contrast your role and clinical findings for a patient presenting with a Challacombe Scale of 1-3 with a patient presenting with a Challacombe Scale of 9 Please submit your work to Mrs Watson  Activity 2 Design a Mind Map titled Exploring Xerostomia Please submit your work to Mrs Watson! Activity 3 Identify 10 prescription medications 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 patients Define the difference Discuss and use the between responders and non Challacombe Scale responders Definition Xerostomia is a persistent or temporary reduction or absence of saliva due to factors that may alter or damage the flow of saliva in the oral cavity predisposing to certain oral conditions The resulting saliva may be altered in its composition  Clinical Signs and Problems Fissured Oral Dry Thick Tongue Candida Mucosa Saliva  Affected Halitosis Taste And they go on! Sore Throat Ulcerations foundahttps://www.mouthcancertion.org/wp-content/uploads/2020/06/the-cracker- challenge.pdf And on! High Caries Incidence And On! Increased Periodontitis Systemic Manifestations Your 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. Persistent Causes of Xerostomia HIV Amyloidosis Sjorgrens Syndrome Age Changes Irradiation Kidney Disease Diabetes Absent salivary gland Sarcoidosis Temporary Causes of Xerostomia Duct Obstruction Prescription drugs Infection/Inflammation of Alcoholism the glands Smoking Psychogenic Disorders Dehydration Mouth Breathing Two Types of Patient Care The Responder These patients still have some salivary gland activity It may be possible to stimulate their flow The Non Responder These patients have no gland activity It is not possible to stimulate their flow For these patients alternative methods of lubricating the mouth have to be found. Our Role Fluoride Oral Hygiene Dietary Advice Smoking Treatment Instruction Cessation Regular Regular Complete a Debridement Examinations Challacombe Scale The Challacombe Scale Developed by King's College London Dental Institute. Produces a clinical oral dryness score (CODS). Enables the clinician to quantify the severity of xerostomia. Allows the patient to be treated accordingly. Named after 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 often seen in mouth. sequence with the score The presence of each accrues one progressively increasing. point. Scores may change, for better or Further referral and assessment worse is required for scores of 7 or Allows monitoring more. Procedure & Interpretation of Results 1.Mirror sticks to buccal mucosa 7. Glassy appearance of oral 2.Mirror sticks to tongue mucosa especially palate 3. Saliva frothy 8. Tongue lobulated/fissured 4. No saliva pooling in the floor of 9. Cervical cavitations on more the mouth than two teeth 5. Tongue shows generalised 10. Debris on palate or sticking to shortened papillae teeth 6. Altered gingival architecture  Thank You For Your Attention Finally, to reiterate, Xerostomia is an increasingly common debilitating condition. You will see many patients suffering with this during your career. Look after 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 http://www.challacombescale.co.uk/index.html Wolff A, Fox PC, Ship JA, Atkinson JC, Macynski AA, Baum BJ. Oral mucosal status and major salivary gland function. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1990;70:49–54. Dawes C. Physiological factors affecting salivary flow rate, oral sugar clearance and the sensation 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 hypofunction. J Dent Res. 1992;71:1363–1369. Gerdin EW, Einarson S, Jonsson M, Aronsson K, Johansson I. Impact of dry mouth conditions on oral health-related quality of life in older people. Gerodontol. 2005;22;219–226. Rhodus NL, Moller K, Colby S, Bereuter J. Articulatory speech performance in patients with salivary gland dysfunction: a pilot study, Quintessence Int. 1995;26:805–812. Liu B, Dion MR, Jurasic MM, Gibson G, Jones JA. Xerostomia and salivary hypofunction in vulnerable elders: prevalence and etiology. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114:52–60. Atkinson JC, Grisius M, Massey W. Salivary hypofunction and xerostomia: diagnosis and treatment. Dent Clin North Am. 2005;49:309–326. Croog SH, Elias MF, Colton T, et al. Effects of antihypertensive medication 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. Effects of compliance with fluoride gel application on caries and caries risk in patients after radiation 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 diagnostic techniques. Am J Dent. 2008;21:199–209. Scully C, Epstein JB. Oral health care for the cancer patient. Eur J Cancer B Oral Oncol. 1996;32B:281–292. Singh N, Scully C, Joyston-Bechal S. Oral complications of cancer therapies: prevention and management. Clin Oncol (R Coll Radiol). 1996;8:15–24. Chuangqi Y, Chi Y, Lingyan Z. Sialendoscopic findings in patients with obstructive sialadenitis: 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 Arthritis Rheum. 1984;14:77–105. Dawson IJ, Fox PC, Smith Sjögren’s syndrome-the non-apoptotic model of glandular hypofunction. Rheumatology (Oxford). 2006;45;792–798. Navazesh M, Brightman VJ, Pogoda JM. Relationship of medical status, medications, and salivary flow rates in adults of different ages. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81:172–176. Wu AJ, Ship JA. A characterization of major salivary gland flow rates in the presence of medications 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 irradiation by conformal and intensity modulated irradiation of head and neck cancer. World J Surg. 2003;27:832–837. Rades D, Fehlauer F, Bajrovic A, Mahlmann B, Richter E, Alberti W. Serious adverse effects of amifostine during radiotherapy in head and neck cancer patients. Radiother Oncol. 2004 Mar;70(3):261-264. Alves MB, Motta AC, Messina WC, Migliari DA. Saliva substitute in xerostomic patients with primary Sjögren’s syndrome: a single-blind trial. Quintessence Int. 2004;35:392–396