Challacombe scale

{{short description|Medical scale measuring mouth dryness}} {{Infobox diagnostic | name = Challacombe scale | image = Xerostomia - Dry Mouth.jpg | alt = | caption = Dry mouth | synonyms = | ICD10 =  | ICD9 = | MeshID = | OPS301 =  | MedlinePlus =  | eMedicine =  | reference_range = | LOINC =  | purpose = To identify and quantify dryness of the mouth | test of = | based on = | calculator = | DiseasesDB =  | ICDO = }} 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.<ref name="bsdht">{{Cite web|url=http://www.bsdht.org.uk/resources-app/the-challacombe-scale|title=The Challacombe Scale|website=www.bsdht.org.uk|access-date=22 June 2019}}{{subscription required}}</ref><ref name=Meurman2018>{{Cite book|url=https://books.google.com/books?id=JnJgDwAAQBAJ&dq=scoring+dry+mouth+cods&pg=PA15|title=Translational Oral Health Research|last=Meurman|first=Jukka H.|date=2018|publisher=Springer|isbn=978-3-319-78204-1|pages=15|language=en}}</ref>

The scale can be used to assess salivary flow and therefore calculate a risk of dental caries.<ref name="Wilson2018">{{Cite book|url=https://books.google.com/books?id=cKJFDwAAQBAJ&dq=challacombe+scale+dry+mouth&pg=PA296|title=Manual of Clinical Procedures in Dentistry|last1=Wilson|first1=Nairn|last2=Dunne|first2=Stephen|date=2018|publisher=John Wiley & Sons|isbn=9780470670521|language=en}}</ref><ref name="Banerjee2015">{{Cite book|url=https://books.google.com/books?id=JvGpCQAAQBAJ&dq=Challacombe+Scale&pg=PA30|title=Pickard's Guide to Minimally Invasive Operative Dentistry|last1=Banerjee|first1=Avijit|last2=Watson|first2=Timothy F.|date=2015|publisher=Oxford University Press|isbn=9780198712091|pages=30–55|language=en}}</ref> In addition, it has a particular use in the assessment of dry mouth in Sjögren syndrome.<ref name=Odell2017>{{Cite book|url=https://books.google.com/books?id=QnfODgAAQBAJ&dq=challacombe+scale+dry+mouth&pg=PA346|title=Cawson's Essentials of Oral Pathology and Oral Medicine E-Book|last=Odell|first=Edward W.|date=2017|publisher=Elsevier Health Sciences|isbn=9780702073892|language=en}}</ref>

Based on a 10-point scale of clinical physical findings, a score of one is least severe and 10 most severe.<ref name="Banerjee2015"/>

==Medical use== thumb|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.<ref name=Hellyer2017>{{Cite journal|last=Hellyer|first=Paul|date=January 2017|title=Root Caries and the Older Patient|url=http://www.bsdht.org.uk/publications/DH_Jan_17_lo.pdf|journal=Dental Health; the Journal of the British Society of Dental Hygiene and Therapy|volume=56|pages=27|issn=0011-8605}}</ref> 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.<ref name="Smile">{{Cite web|url=http://www.smile-onnews.com/article/view/the-challacombe-scale|title=The 'Challacombe' Scale|website=www.smile-onnews.com|access-date=22 June 2019}}</ref>

The Challacombe score can be used to assess dry mouth in Sjögren syndrome<ref name=Odell2017/> and to assess salivary flow and therefore calculate a risk of dental caries, which are more likely in drier mouths.<ref name="Wilson2018"/><ref name="Banerjee2015"/>

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.<ref name=Meurman2018/>

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.<ref name="Smile"/>

== 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.<ref name="Wilson2018"/><ref name="ChallacombeScale">{{Cite web|url=http://www.challacombescale.co.uk/Challacombe-Scale-ENG.pdf|title=The Challacombe Scale :: King's College London & A.S Pharma|website=www.challacombescale.co.uk|access-date=22 June 2019}}</ref> As the mouth becomes drier, each feature is often seen in sequence with the score progressively increasing.<ref name=Odell2017/> Scores may change, for better or worse, allowing monitoring.<ref name="Banerjee2015"/> Example images accompany the features.<ref name="Nature2011"/>

{{refbegin|colwidth=30em}} # Dental 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 (i.e. smooth) # Glassy appearance of oral mucosa, especially palate # Tongue lobulated/fissured # Cervical caries (more than two teeth) # Debris on palate or sticking to teeth {{refend}}

{| class="wikitable" |- ! Score !! Severity and management<ref name="ChallacombeScale"/> |- |style='background: #eae1f0;'| 1–3||style='background: #eae1f0;'| A 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. |- |style='background: #d0bedd;'| 4–6||style='background: #d0bedd;'| A 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. |- |style='background: #bc9dca;'| 7–10||style='background: #bc9dca;'| A 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.<ref name="Nature2011">{{Cite journal|date=21 October 2011|title=Dry mouth scale launched|journal=British Dental Journal|language=en|volume=211|issue=8|pages=351|doi=10.1038/sj.bdj.2011.884|issn=1476-5373|doi-access=free}}</ref><ref name="Katz2018">{{Cite book|url=https://books.google.com/books?id=ZsdlDwAAQBAJ&dq=Challacombe+Scale&pg=PA427|title=Rheumatic Diseases in Older Adults, An Issue of Rheumatic Disease Clinics of North America E-Book|last1=Katz|first1=James D.|last2=Walitt|first2=Brian|date=2018|publisher=Elsevier Health Sciences|isbn=9780323613545|pages=426|language=en}}</ref>

==See also== *Dehydration

== References == {{reflist|30em}}

Category:Medical assessment and evaluation instruments Category:Medical scales Category:Medical scoring systems