Healing Pathophysiology of Oral Mucositis

Fig. 11.2 Oral Mucositis Grading Scales. a World Health Organization scoring criteria. b National Cancer Institute Common Terminology Criteria for Adverse Events CTCAE version 4.0. c Oral Mucositis Assessment Scale. d Oral Assessment Guide a World Health Organization WHO Scoring Criteria for Oral Mucositis Grade 1 2 3 4 Description Normal Soreness with or without erythema Ulceration and erythema; patient can swallow a solid diet Ulceration and erythema; patient cannot swallow a solid diet Ulceration and pseudomembrane formation of such severity that alimentation is not possible Adapted from Sonis et al. 2004a With permission from Sonis et al. 1999 b National Cancer Institute Common Terminology Criteria for Adverse Events CTCAE version 4.0 Adverse event Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Oral mucositis definition: a disorder characterized by inflammation of the oral mucosa Asymptomatic or mild symptoms; intervention not indicated Moderate pain; not interfering with oral intake; modified diet indicated Severe pain; interfering with oral intake Life-threatening consequences; urgent intervention indicated Death http:www.acrin.orgPortalsoAdministrationRegulatoryCTACE_4.02_2009-09-15_QuickReference_5x7.pdf c Oral Mucositis Assessment Scale Location UlcerationPseudomembrane circle Erythema circle Upper lip Lower lip Right cheek Left cheek Right ventral and lateral tongue Left ventral and lateral tongue Floor of mouth Soft palatefauces Hard palate 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 Ulcerationpseudomembrane: 0 = no lesion 1 = 1 cm 2 2 = 1 cm 2 –3 cm 2 3 = 3 cm 2 Erythema: 0 = none 1 = not severe 2 = severe d Oral Assessment Guide Numerical and Descriptive Ratings Category Tools for Assessment Methods of Measurement 1 2 3 Swallow Observation Ask patient to swallow. To test gag reflex, gently place blade on back of tongue and depress Normal swallow Some pain on swallow Unable to swallow Voice Auditory Converse with patient Normal Deeper or raspy Difficulty talking or painful Lip Visualpalpation Observe and feel tissue Smooth and pink and moist Dry or cracked Ulcerated or bleeding Tongue Visualpalpation Feel and observe appearance of tissue Pink and moist and papillae present Coated or loss of papillae with a shiny appearance with or without redness Blistered or cracked Saliva Tongue blade Insert blade into mouth, touching the center of the tongue and the floor of the mouth Watery Thick or ropy Absent Mucous membrane Visual Observe appearance of tissue Pink and moist Reddened or coated increased whiteness without ulcerations Ulcerations with or without bleeding Gingiva Tongue blade and visual Gently press tissue with tip of blade Pink and stippled Edematous with or without redness Spontaneous bleeding or bleeding with pressure Teeth Visual Observe appearance of teeth Clean and no debris Plaque or debris in localized area between teeth if present Plaque or debris generalized along gum line Adapted from Eilers et al. 1988