Kolnick Leanne, Deng Jie, Epstein Joel B, Migliorati Cesar A, Rezk Julie, Dietrich Mary S, Murphy Barbara A
Dept of Medicine, Vanderbilt University, United States.
School of Nursing, Vanderbilt University, United States.
Oral Oncol. 2014 Feb;50(2):135-40. doi: 10.1016/j.oraloncology.2013.10.019. Epub 2013 Nov 14.
The Vanderbilt Head and Neck Symptom Survey (VHNSS) version 2.0 oral symptom subscale addresses underreported oral health issues. We report the associations of xerostomia, dental health, dentures and trismus questions with oral examination findings.
Between May 2011 and April 2012, fifty head and neck cancer (HNC) patients treated with chemoradiotherapy completed the 50-item VHNSS survey, an oral health assessment by a dentist, salivary flow, and inter-incisal opening (IIO) measurements.
Patient reported "problems with dry mouth" correlated with unstimulated salivary flow (-0.43, p=0.002). "Cracked teeth" (0.55, p=<0.001) or "difficulty chewing due to teeth" (0.43, p=0.004) correlated with urgent/emergent dental issues identified on clinical exam. Scores of >4 on any dental question identified 83% of patients with urgent or emergent needs. The ROC curve separated routine from urgent/emergent dental issues (0.89, p<0.001). IIO correlated with reported jaw movement "limitations" (-0.43, p=0.002). Small numbers of patients with dentures precluded meaningful analysis of this subsample.
Clinically significant oral health issues pertaining to xerostomia, dental health and trismus may be identified using the oral health subscale of the VHNSS version 2.0. MASCC guidelines should be followed by patients with xerostomia. The observation that a score of >4 is highly predictive of dental issues is important and needs further validation. If confirmed, this would be a useful screening tool for identifying and referring HNC patients for dental care. Patients with trismus should receive physical therapy.
范德比尔特头颈症状调查问卷（VHNSS）2.0版的口腔症状子量表涉及未得到充分报告的口腔健康问题。我们报告口干、牙齿健康、假牙和牙关紧闭问题与口腔检查结果之间的关联。
2011年5月至2012年4月期间，50名接受放化疗的头颈癌（HNC）患者完成了50项VHNSS调查、牙医进行的口腔健康评估、唾液流量测量和切牙间开口度（IIO）测量。
患者报告的“口干问题”与非刺激性唾液流量相关（-0.43，p=0.002）。“牙齿破裂”（0.55，p<0.001）或“因牙齿导致咀嚼困难”（0.43，p=0.004）与临床检查中发现的紧急/急诊牙科问题相关。任何牙科问题得分>4可识别出83%有紧急或急诊需求的患者。ROC曲线区分了常规牙科问题与紧急/急诊牙科问题（0.89，p<0.001）。IIO与报告的下颌运动“受限”相关（-0.43，p=0.002）。佩戴假牙的患者数量较少，无法对该亚组进行有意义的分析。
使用VHNSS 2.0版的口腔健康子量表可识别出与口干、牙齿健康和牙关紧闭相关的具有临床意义的口腔健康问题。口干患者应遵循MASCC指南。得分>4对牙科问题具有高度预测性这一观察结果很重要，需要进一步验证。如果得到证实，这将是一种用于识别和转诊HNC患者进行牙科护理的有用筛查工具。牙关紧闭患者应接受物理治疗。
