______________________________________________ Oral Cancer and Complications of Cancer Therapies
ORAL ASSESSMENT GUIDE (OAG)
Category
Assessment
Finding
Score
Voice
Listen to the patient’s voice
Normal
1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3
Deep or raspy
Unable to speak
Swallow Ask the patient to swallow and test gag reflex with tongue depressor
Swallowing normally
Some pain while swallowing
Too painful to swallow
Lips
Observe and palpate
Smooth, pink, and moist
Cracked and/or dry
Ulcerated or bleeding
Tongue
Observe and palpate
Pink and moist, papillae present
Coated or papillae loss, shiny appearance with or without redness
Blistered or cracked
Saliva
Use depressor to assess the tongue and mucosa for saliva
Watery
Excessive amount of saliva, drooling
Thick, ropey, or absent
Mucous membranes
Observe
Pink and moist
Reddened or coated without ulcerations
Ulcerations with or without bleeding
Gingiva
Observe and gently scrape gingival tissue with depressor
Pink and firm
Oedematous
Spontaneous bleeding
Teeth or dentures
Observe and scrape teeth with depressor
Clean, no debris or plaque
Plaque or debris in some areas
Generalized plaque or debris along gum line
Source: [56]
Table 5
The parotid gland is a purely serous gland (i.e., it releases a watery secretion without a mucous component). The subman- dibular gland has both a serous and a thicker mucus secretion, with the serous component being predominant. The sublingual salivary gland features secretions that are more mucus than serous. The minor salivary glands have secretions that are nearly all mucus in origin. Damage to one or both parotid glands will increase the viscosity of the saliva as the watery component of the saliva decreases. The saliva develops a thick, ropy con- sistency that decreases its function as a lubricating medium. The location of some malignant lesions is such that all of the major salivary glands are damaged. The cells that produce the serous secretions are extremely sensitive to ionizing radiation and can undergo a 50% decrease in output with a cumulative radiotherapy dose of only 1,000 cGy [61]. Salivary glands that are irradiated with a cumulative dose of 4,000 cGy usually have a permanent decrease in output [62].
The resultant condition of xerostomia will usually remain with patients for the remainder of their life. It is the most common persistent radiotherapy side effect [63]. Saliva substitutes and certain cholinergic drugs, such as pilocarpine, may decrease the severity of the xerostomia, but no treatment regimen will return salivary output to the levels prior to radiotherapy [64]. How- ever, a 2011 multicenter randomized controlled trial found that intensity-modulated radiotherapy that spares the parotid glands is significantly less likely to cause severe xerostomia [63]. Xerostomia presents patients with a host of problems that they must confront on a daily basis. Patients who wear complete or partial dentures may have chronic sore spots because the lubrication that saliva produces to lessen the friction against the mucosal tissues is significantly decreased. These prostheses may be difficult to use for mastication and thus complicate the ability to eat. Because the perception of taste is partially
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