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How Are the Grades of Oral Mucositis Determined?

Find out how patients are finding relief from oral mucositis caused by chemotherapy

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How Are the Grades of Oral Mucositis Determined?

Among the many side effects that afflict chemotherapy patients, oral mucositis – a condition characterized by painful sores, bleeding, and inflammation inside the mouth – tops many patients’ lists as the worst part of undergoing these treatments. Not only are the symptoms themselves quite unpleasant, but the complications that can arise as a result of mucositis can threaten a patient’s recovery and even endanger their life. For a physician to identify and treat oral mucositis, however, they must first have the means to judge its severity – easier said than done, as it turns out. So how are the grades of oral mucositis determined and what exactly do they mean? Keep reading as the experts at Chemo Mouthpiece™ explain.

Grading Scales for Oral Mucositis Symptoms

As it happens, a wide variety of grading scales have been made to judge the severity of oral mucositis. The most prominent of which include the World Health Organization (WHO) scale, the Oral Mucositis Assessment Scale (OMAS), and the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE). Each attempt to judge oral mucositis based on an objective scale that can be easily used by doctors in a variety of environments and on a variety of patients. Some details about each system are provided below:

World Health Organization (WHO) Scale

The WHO scale for grading mucositis symptoms is straightforward and easy to use because of its very general thresholds, but those same generalizations mean that it leaves out many of the nuances of oral mucositis. The scale reads as follows:

Grade 0 – No signs of oral mucositis
Grade 1 – Redness (erythema) and mild discomfort in the mouth
Grade 2 – Mouth sores present, but the patient can still consume solid foods
Grade 3 – Extensive mouth sores present, requiring the patient to switch to a liquid diet
Grade 4 – Severe mouth sores present, making oral nutrition in any form impossible

As described above, the WHO scale uses the severity of ulcers in the mouth and a patient’s ability to eat certain types of foods to grade mucositis symptoms. However, at least one study has shown that this scale fails to properly take into account the nutritional challenges a patient faces when afflicted with oral mucositis, at least compared with the OMAS scale.

Oral Mucositis Assessment Scale (OMAS)

Sometimes referred to as the “objective scoring system for site assessment,” the OMAS measures the degree of redness and ulceration in nine specific areas of the mouth: the upper and lower lips, left and right cheeks, left and right sides of the tongue, the floor of the mouth, the soft palate, and the hard palate. In each area, any lesions that are present are measured and scored; less than 1 cm2 rates a 1 on the scale, whereas 1-3 cm2 is a 2, and anything larger is a 3 on the scale. Redness is measured from 0-2, with 0 meaning no redness and 2 meaning severe redness. A study published in 1999 judged the OMAS to be especially useful in rating the severity of mucositis symptoms.

Common Terminology Criteria for Adverse Events (CTCAE)

The CTCAE is a scale devised and used by the National Cancer Institute (NCI), which updates the scale with each version of the CTCAE that they publish. Like the OMAS, the CTCAE is split into two parts; rather than addressing different symptoms, however, this scale is divided between clinical symptoms – as measured by a doctor – and functional symptoms – those reported by the patient themselves. The severity of symptoms on both scales is rated from 1-5, as shown below:

Clinical Examination
Grade 1 – Clearly visible redness of the mucous membranes
Grade 2 – Patchy lesions in the mouth
Grade 3 – Larger swaths of lesions or ulcers in the mouth, along with some bleeding
Grade 4 – Life-threatening symptoms, including significant bleeding and necrosis
Grade 5 – Patient has died

Patient Report of Symptoms
Grade 1 – Few signs of mucositis, able to eat normally
Grade 2 – Some symptoms, but able to eat some solid foods
Grade 3 – Severe symptoms, unable to take in food or liquids orally
Grade 4 – Symptoms threaten the patient’s life
Grade 5 – Death

Though this scale is a bit more complicated to implement than the WHO or OMAS systems, it incorporates both objective and subjective interpretations of a patient’s symptoms. Also, the fact that it is backed by the NCI lends the CTCAE significant weight as a tool for combating oral mucositis.

While the variety of grading scales used for oral mucositis gives doctors some flexibility in judging the symptoms of this condition, the lack of a consistent measuring system makes it more difficult to accurately gauge the severity of this illness from patient to patient in many cases. If you receive a judgment from your doctor concerning the extent of your mucositis symptoms, consider asking what scale they used and how best to mitigate any oral issues you may experience.

Reduce Oral Mucositis Symptoms with a Powerful Cryotherapy Device

Cryotherapy – the application of cold temperatures to treat a condition – has been shown to be quite effective at reducing symptoms for many patients who suffer from oral mucositis. If you are forced to deal with this ailment, consider a potent cryotherapy device for mouth sores, the Chemo Mouthpiece™. This preventative tool can chill your entire oral cavity during chemotherapy treatments by as much as 30 degrees, shrinking the blood vessels of your mouth and keeping much of the toxic chemo drug that cause mucositis out of the area. To learn more about how the Chemo Mouthpiece™ can help with your symptoms, visit us online or call (866) 461-7518 today.


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