Challacombe scale

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Challacombe scale
Xerostomia - Dry Mouth.jpg
Dry mouth
PurposeTo identify and quantify dryness of the mouth

The Challacombe scale is a widely used diagnostic medical tool designed to produce a clinical oral dryness score (CODS) which quantifies the extent of dryness of the mouth, with the aim of making a decision of whether to treat or not, and to monitor its progression or regression. [1] [2]

Contents

It can be used to assess salivary flow and therefore calculate a risk of dental caries. [3] [4] In addition, it has a particular use in the assessment of dry mouth in Sjögren syndrome. [5]

Based on a 10-point scale of clinical physical findings, a score of one is least severe and ten most severe. [4]

Medical use

Challacombe scale inside a dental hygienist's surgery Inside a dental hygienist surgery.jpg
Challacombe scale inside a dental hygienist's surgery

Dry mouth (xerostomia) is frequently caused by medication and to a lesser extent, by anxiety or Sjögren's syndrome. [6] It can be useful to have the extent of dryness recorded. That is, if a person has a complaint of a dry mouth, the clinician can apply the Challacombe scale to determine its severity and whether treatment is required. The scale also provides a common reference point, allowing progress or deterioration to be monitored. [7]

The Challacombe score can be used to assess dry mouth in Sjögren syndrome [5] and to assess salivary flow and therefore calculate a risk of dental caries, which are more likely in drier mouths. [3] [4]

The score correlates with the rate of salivary flow and with the wetness of the mouth, indicated by the thickness of the mucosal film on the inside of the cheeks, on the palate and on the tongue. [2]

While a high score indicates the need for treatment and investigation, a low score may indicate the need not to intervene, a decision frequently more difficult to make. [7]

Procedure and interpretation of results

The following factors are used to evaluate the dryness of the mouth. The presence of each accrues one point and further referral and assessment is required for scores of 7 or more. [3] [8] As the mouth becomes drier, each feature is often seen in sequence with the score progressively increasing. [5] Scores may change, for better or worse, allowing monitoring. [4] Example images accompany the features. [9]

  1. Dental mirror sticks to buccal mucosa
  2. Mirror sticks to tongue
  3. Saliva frothy
  4. No saliva pooling in floor of mouth
  5. Tongue shows generalised shortened papillae (mild depapillation)
  6. Altered gingival architecture (i.e. smooth)
  7. Glassy appearance of oral mucosa, especially palate
  8. Tongue lobulated/fissured
  9. Cervical caries (more than two teeth)
  10. Debris on palate or sticking to teeth
ScoreSeverity and management [8]
1–3A score totalling 1–3 is indicative of mild dryness and may not require further management. A medication history may reveal the cause, and treatment is with twice daily chewing of sugar-free chewing gum and keeping hydrated. Follow-up is by regular monitoring.
4–6A score totalling 4–6 is indicative of moderate dryness and requires sugar-free chewing gum or simple sialogogues. Further investigation is needed if the cause is unclear, and saliva substitutes and topical fluoride may be helpful. Regular follow-ups to check for early dental decay and symptom change are required.
7–10A score totalling 7–10 is indicative of severe dryness and needs saliva substitutes and topical fluoride. The reasons for reduced salivation needs assessment and Sjögren syndrome needs to be excluded. A referral is required for further investigation and diagnosis, particularly if symptoms and signs worsen.

History

The Challacombe scale was launched on 2 September 2011 and based on research conducted at King's College London Dental Institute under the supervision of professor Stephen Challacombe. [9] [10]

See also

Related Research Articles

Sjögren syndrome Medical condition

Sjögren's syndrome is a long-term autoimmune disease that affects the body's moisture-producing glands, and often seriously affects other organ systems, such as the lungs, kidneys, and nervous system. Primary symptoms are dryness, pain and fatigue. Other symptoms can include dry skin, vaginal dryness, a chronic cough, numbness in the arms and legs, feeling tired, muscle and joint pains, and thyroid problems. Those affected are also at an increased risk (15%) of lymphoma.

Saliva Bodily fluid secreted by saliva glands

Saliva is an extracellular fluid produced and secreted by salivary glands in the mouth. In humans, saliva is 98% water plus electrolytes, mucus, white blood cells, epithelial cells, enzymes, antimicrobial agents such as secretory IgA, and lysozymes.

Salivary gland Exocrine glands that produce saliva through a system of ducts

The salivary glands in mammals are exocrine glands that produce saliva through a system of ducts. Humans have three paired major salivary glands, as well as hundreds of minor salivary glands. Salivary glands can be classified as serous, mucous or seromucous (mixed).

Tooth decay Deformation of teeth made by acids from bacteria

Tooth decay, also known as dental caries or cavities, is the breakdown of teeth due to acids made by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation.

Xerostomia Medical condition

Xerostomia, also known as dry mouth, is dryness in the mouth, which may be associated with a change in the composition of saliva, or reduced salivary flow, or have no identifiable cause.

Meth mouth Tooth decay caused by methamphetamine use

Meth mouth is a colloquial term used to describe severe tooth decay and tooth loss, as well as tooth fracture, acid erosion, and other oral problems that are often symptomatic to extended use of the drug methamphetamine. The condition is thought to be caused by a combination of side effects of the drug and lifestyle factors, which may be present in long-term users. However, the legitimacy of meth mouth as a unique condition has been questioned because of the similar effects of some other drugs on teeth. Images of diseased mouths are often used in anti-drug campaigns.

Stomatitis Medical condition

Stomatitis is inflammation of the mouth and lips. It refers to any inflammatory process affecting the mucous membranes of the mouth and lips, with or without oral ulceration.

Dental plaque is a biofilm of microorganisms that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it is often brown or pale yellow. It is commonly found between the teeth, on the front of teeth, behind teeth, on chewing surfaces, along the gumline (supragingival), or below the gumline cervical margins (subgingival). Dental plaque is also known as microbial plaque, oral biofilm, dental biofilm, dental plaque biofilm or bacterial plaque biofilm. Bacterial plaque is one of the major causes for dental decay and gum disease.

The oral mucosa is the mucous membrane lining the inside of the mouth. It comprises stratified squamous epithelium, termed "oral epithelium", and an underlying connective tissue termed lamina propria. The oral cavity has sometimes been described as a mirror that reflects the health of the individual. Changes indicative of disease are seen as alterations in the oral mucosa lining the mouth, which can reveal systemic conditions, such as diabetes or vitamin deficiency, or the local effects of chronic tobacco or alcohol use. The oral mucosa tends to heal faster and with less scar formation compared to the skin. The underlying mechanism remains unknown, but research suggests that extracellular vesicles might be involved.

An oral medicine or stomatology doctor has received additional specialized training and experience in the diagnosis and management of oral mucosal abnormalities including oral cancer, salivary gland disorders, temporomandibular disorders and facial pain, taste and smell disorders; and recognition of the oral manifestations of systemic and infectious diseases. It lies at the interface between medicine and dentistry. An oral medicine doctor is trained to diagnose and manage patients with disorders of the orofacial region, essentially as a "physician of the mouth."

Burning mouth syndrome (BMS) is a burning sensation in the mouth with no underlying known dental or medical cause. No related signs of disease are found in the mouth. People with burning mouth syndrome may also have a subjective xerostomia, paraesthesia, or an altered sense of taste or smell.

Sialadenitis Medical condition

Sialadenitis (sialoadenitis) is inflammation of salivary glands, usually the major ones, the most common being the parotid gland, followed by submandibular and sublingual glands. It should not be confused with sialadenosis (sialosis) which is a non-inflammatory enlargement of the major salivary glands.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

Oral and maxillofacial pathology refers to the diseases of the mouth, jaws and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral skin. The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.

Remineralisation of teeth

Tooth remineralisation is the natural repair process for non-cavitated tooth lesions, in which calcium, phosphate and sometimes fluoride ions are deposited into crystal voids in demineralised enamel. Remineralisation can contribute towards restoring strength and function within tooth structure.

Biotene is a dental hygiene product originally manufactured by Laclede Inc. but now marketed by GlaxoSmithKline. It comes in a number of forms, including toothpaste, mouthwash and gel.

Human mouth Part of human anatomy

In human anatomy, the mouth is the first portion of the alimentary canal that receives food and produces saliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth.

Salivary gland disease Medical condition

Salivary gland diseases (SGD) are multiple and varied in cause.

Salivary gland aplasia is the congenital absence of salivary glands. Usually the term relates to the absence of some or all of the major salivary glands.

Stephen J. Challacombe

Stephen James Challacombe FRC(Path), FDSRCS, FMedSci, is professor of oral medicine at King's College in London, best known for research in oromucosal immunology and for developing the Challacombe scale for measuring the extent of dryness of the mouth. He led the team that laid out research challenges of global health inequalities and oral health, particularly relating to the oral manifestations of HIV.

References

  1. ↑ "The Challacombe Scale". www.bsdht.org.uk. Retrieved 22 June 2019.(subscription required)
  2. 1 2 Meurman, Jukka H. (2018). Translational Oral Health Research. Springer. p. 15. ISBN   978-3-319-78204-1.
  3. 1 2 3 Wilson, Nairn; Dunne, Stephen (2018). Manual of Clinical Procedures in Dentistry. John Wiley & Sons. ISBN   9780470670521.
  4. 1 2 3 4 Banerjee, Avijit; Watson, Timothy F. (2015). Pickard's Guide to Minimally Invasive Operative Dentistry. Oxford University Press. pp. 30–55. ISBN   9780198712091.
  5. 1 2 3 Odell, Edward W. (2017). Cawson's Essentials of Oral Pathology and Oral Medicine E-Book. Elsevier Health Sciences. ISBN   9780702073892.
  6. ↑ Hellyer, Paul (January 2017). "Root Caries and the Older Patient" (PDF). Dental Health; the Journal of the British Society of Dental Hygiene and Therapy. 56: 27. ISSN   0011-8605.
  7. 1 2 "The 'Challacombe' Scale". www.smile-onnews.com. Retrieved 22 June 2019.
  8. 1 2 "The Challacombe Scale :: King's College London & A.S Pharma" (PDF). www.challacombescale.co.uk. Retrieved 22 June 2019.
  9. 1 2 "Dry mouth scale launched". British Dental Journal. 211 (8): 351. 21 October 2011. doi: 10.1038/sj.bdj.2011.884 . ISSN   1476-5373.
  10. ↑ Katz, James D.; Walitt, Brian (2018). Rheumatic Diseases in Older Adults, An Issue of Rheumatic Disease Clinics of North America E-Book. Elsevier Health Sciences. p. 426. ISBN   9780323613545.
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