The Challacombe Scale

CCMed showcases dry mouth solution

Dry mouth is a condition that can go unnoticed by clinicians yet it can have a hugely detrimental impact on patients’ quality of life. This was the message that CCMed, which supplies A.S Saliva Orthana products, was giving to clinicians who visited their stand at AGM.

A.S Saliva Orthana is uniquely formulated from naturally occurring mucin which provides a protective barrier in the mouth against desiccation, tooth decay and infection and acts as an effective lubricant.

Apart from making life miserable, dry mouth, also known as xerostomia, can lead to a rapid increase in dental decay and an increased risk of mouth infection.

“Dry mouth is most commonly a side effect of medication or treatment. Each xerostomia-related medication will reduce saliva flow by 25%. So if you have an elderly patient taking three types of medication that’s a 75% reduction in saliva flow and that is really going to have a huge effect on their quality of life,” says Ellie Channell, CCMed’s National Account Manager.

“We know doctors are aware of the problem but it can be overlooked because these patients often have more serious underlying health concerns which are higher up the list of priorities. A lot of patients might not mention they have a dry mouth because they are not aware there is a treatment available, they just think that’s the way life is just one of those side-effects thy have got to live with.”

CCMed was exhibiting at AGM for the first time this year. “AGM is a great conference. All the delegates we spoke to were interested to find out how they can help their patients who suffer from a dry mouth. We had a steady footfall at our stand and saw a range of clinicians from different therapeutic areas which was very useful for us,” said Ms Channell.

December 2014

The long and winding road – November 2012, Liverpool

732 miles across some the UK’s most congested motorways, we (Niki and Ellie) travelled over 4 days to attend 3 conferences in a row. Although exhausting the conferences proved to be some of the best yet, confirming DRY MOUTH to be the buzz word everyone is talking about and not just in the South.

Day 1: Maidstone Head and Neck Cancer Study day – Firstly the A.S Saliva Orthana pop up banner refused to come out of its metal case, which is an exhibiting nightmare! However it only made us all the more determined to put on our best smiles and witty banter to attract people to our stand. At first delegates were a little nervous venturing into the trade room for fear of being the first trade victim, as it is well known we sale reps drink blood. However by morning coffee break we were all chatting away and friends. The highlight of the day for us was speaking with Head and Neck cancer sufferers all of which were battling with their dry mouths. One lady stood out in mind the most, she was initially very adamant that she had tried everything and nothing worked for her dry mouth. After listening to her we discussed how she had been applying the products and gave her a sample of A.S Saliva Orthana to try straight away. We carefully advised her to spray where the saliva glands exit, so firstly she sprayed under her tongue, she immediately looked up at us and commented on how nice that felt. After applying A.S Saliva Orthana under the tongue, into the cheeks, roof of the mouth and the top of tongue she was amazed at the difference it made. She came back a little later to tell us she was still noticing the relief.

After lunch we packed up and headed 366 miles to Liverpool. On arrival we were excited, however our Sat Nav promptly lead us into the Liverpool tunnel dashing our hopes of seeing some more of the city. After a minute or two in the tunnel it was apparent that it was much longer than we first thought and the sat nav had conveniently lost its satellite signal. When finally emerging back above ground we paid the toll and drove on, the Sat Nav however had other plans...! When coming back to life it re-directed us round and back into the tunnel, then once again lost signal abandoning us to our fate. We repeating this pattern of going back and forth through the tunnel a few more times, until Niki, unable to take it any more upon emerging from our 4th trip underground pleaded with the toll man for help. We eventually made it to our hotel.

Day 2: Quality of Life Conference – Based at the Hard Days Night Hotel, we were at the funkiest function to date. However we were determined not to be distracted by the multi-coloured carpet or Beatle memorabilia hung all over the walls and got down to the serious business of the day; dry mouth. The responses from delegates were great, from CNS Nurses and Speech & Language Teams to Dieticians and Dentists everyone knew someone with a dry mouth and wanted to help. They were keen to learn that A.S Saliva Orthana had been clinically proven to have stronger film forming properties than CMC based alternatives, making it last longer. Delegates were keen to take samples back to patients and get their feedback.

After a hard day’s work we headed on over to the Liverpool ACC to set up our stand for the BSDHT (British Society for Dental Hygiene and Therapy) conference the following day. Following on from the death of our pop up banner we were pulling out the big guns and erected the A.S Pharma spider stand.

Day 3: BSDHT Liverpool ACC – The quiet before the storm, all stands look fantastic, samples lined up in rows with labels facing forwards, pots full of pens, leaflet holders packed full of literature, sales reps eagerly awaiting the first sign of interest or eye contact. Then it begins, registration! At first there are a few delegates, then there are more than you think you can handle, but the sales rep in us takes over and nobody leaves the stand uninformed. Delegates hungry for information and ‘freebies’ descend upon our immaculate stand, pots of pens knocked over, samples are stuffed into bags. Without a doubt it is the exciting and fast moving conversation that makes it so much fun.

Rhiannon Jones presented a great interactive lecture on Xerostomia and the problems it causes in people’s lives. We all felt especially sorry for the 82 yr old lady in the case study she presented, who suffers terribly with dry mouth, after the removal of the salivary glands on one side of her face. This lady was especially affected by the fear of choking on food or medication as a result of her dry mouth, which she had been battling with for over 10 yrs. It made me want to track her down and give her a never ending supply of A.S Saliva Orthana.

Delegates after Rhiannon’s lecture flooded to the A.S Pharma stand to receive copies of The Challacombe Scale and learn about A.S Saliva Orthana and how it can help by lubricating the mouth and protecting against dental infections.

Towards the evening of Friday (day 3) began the champagne and nibbles, which of cause it would be rude to refuse. Once everyone had had one or two glasses of champagne, we were lucky enough to be able to dance the evening away to the Mersey Beatles. Having had so much fun dancing to the Band and motivated by the champagne many headed out to The Cavern to continue the evening. That is all I have to say about that....

Day 4: BSDHT Saturday – Some had a slower start to the day than others. We however ate a good breakfast and got ready to make the final day the best day.

Following on from the success of the day before, everyone was talking about dry mouth and seeking out the A.S Pharma stand. The Challacombe Scale was very popular as many Hygienists and Therapists wanted a way to quantify Xerostomia in their patients. Once they had diagnosed dry mouth they were keen to explore therapy options and A.S Saliva Orthana was by far the best one available. Delegates loved that their patients could get A.S Saliva Orthana on prescription or could buy it over the counter at pharmacies nationwide.

At the end of a long 4 days and a long drive home we were tired but pleased we made the trip and were lucky enough to meet so many wonderful people. We can’t wait to go back to Liverpool in December for the Aintree Head and Neck study day.

Written by Ellie Arthur, Regional Account Manager, CCMed Ltd.

If you would like a sample of A.S Saliva Orthana or The Challacombe Scale please email your enquiry to Ellie and Niki at or call 01264 332172.

November 2012

CCMed Ltd contribute to radio show... The Importance of Saliva – October 2012

Saliva is needed for lubrication, you won’t be driving your car home tonight on water alone – it will need oil – the difference being lubrication.

So you have noticed some changes in your mouth.  Perhaps your lips are always dry, you have a constant thirst? Maybe you have noticed that it is difficult to chew and swallow food, possibly you are waking through the night with your tongue stuck to the roof of your mouth and you are desperate for a sip of water?  Any of these symptoms, and there are many more, are signs that you could be suffering with  or Dry Mouth.

If you are taking medications, it is more than likely that one or more of your prescribed drugs will list dry mouth as a side effect.  In fact over 1000 regularly prescribed medications will cause this painful and detrimental condition.

Painful, because trying to swallow food, or even just talking can be agony in extreme cases.  The mouth can become sore with ulcers and simple pleasures in life, such as sharing a cup of tea and a biscuit with friends will seem impossible.  A fundamental part of our wellbeing as humans is to socialise with friends, colleagues and family. Detrimental, because a lack of saliva will leave the mouth open to attack from bacteria.  The teeth will have lost their protective coating and will be exposed to plaque acids. A rapid increase in cavities will ensue, as the loss of saliva means there is no remineralisation of the tooth enamel. Without the lubricating properties of saliva, abrasive foods will cause cuts to the mouth’s soft tissues which may then ulcerate.  Chronic dry mouth will also lead to bad breath.

An already vulnerable patient taking xerostomic medications can undoubtedly become withdrawn, depressed and suffer low self esteem.  If they are already poorly and uncomfortable and then feel unable to eat sufficiently nutritious meals, they will lose weight and not recover as well or as quickly as they perhaps could have done if the dry mouth had been diagnosed and treated.  Disturbed sleep caused by regular waking for sips of water and then the inevitable toilet visits will inhibit coping strategies.  We all know that a lack of regular sleep is the equivalent to torture!

So which drugs should we be looking out for, and what can we do to help? Many of the medications for Stroke, Alzeihmer’s, Parkinsons and Cancer Treatments will cause dry mouth along with all the ‘anti’s’ such as Antidepressants, Antihistamines, Decongestants and Beta Blockers. The list is extensive and worth discussing with the Prescribing Clinician.

If the medication is the cause of your dry mouth, then one simple measure that can be taken is to change the time that the drug is taken. For example, if taken in the evening, switch to taking it in the morning although this may not always be possible.

If medication is NOT the cause then a visit to a doctor is essential because a lack of saliva could indicate a more serious underlying condition which needs to be looked into.

Other methods to improve the symptoms would be to keep hydrated by drinking plenty of fluids but avoiding alcohol and coffee as these lead to dryness as does smoking, mouth breathing, and anxiety.

Use a high fluoride toothpaste and mouth wash to protect the teeth and gums and keep regular appointments with the dentist so that any changes can be monitored.  Stimulate saliva flow by sucking on sugar free sweets and chewing gum.

For those with a low salivary flow, the use of artificial saliva is recommended.  Choose one that is pH neutral and sweetened naturally with xylitol.  Mucin based artificial salivas such as AS Saliva Orthana have been proven to be more effective than the chemically formulated products offering a more efficient and longer lasting coating to the teeth and gums.  Saliva Orthana is available from all chemists and is available on prescription.

Written by Niki Smith, Regional Account Manager, A.S Pharma part of CCMed Ltd

October 2012

Royal College of Speech and Language Therapy – 11th & 12th September 2012, Manchester

CCMed Ltd took the battle against dry mouth to Manchester for the Royal College of Speech & Language Therapy two day conference. Amongst the delegates was The Lord Mayor of Manchester who showed an interest in the subject of Xerostomia at the CCMed stand.

CCMed standMany speech and language therapists found dry mouth to be a common complaint affecting a wide variety of their patients and attention focused upon the difficulties many of these patients faced.

Dry mouth can be caused by many factors including:

  • Stroke
  • Cancer
  • Elderly
  • Respiratory conditions
  • Dysphasia
  • Neurology
  • Mental health
  • Therapists were keen to get their hands on The Challacombe Scale to help diagnose patients with dry mouth and be able to monitor their progress after treatment has started.

    Speech and language therapists were delighted to learn that after diagnosis, fast and effective relief from dry mouth was easily available. The A.S Saliva Orthana products are pH neutral so will not sting or irritate already sore mouths, and the non sticky formulation makes it even more effective than alternatives. Most importantly Speech and Language Therapists took special care to learn how to advise their patients to correctly apply A.S Saliva Orthana. When spraying inside the mouth a patient must aim for where the salivary glands exit, this would include; under the tongue, each cheek and into the palate to make sure the full benefit of using A.S Saliva Orthana is received. Many speech and language therapists were excited to learn that in addition to the A.S Saliva Orthana liquid spray, a gel will soon be released in the U.K and pleased to be amongst the first to hear about it.

    To pre order your free sample of A.S Saliva Orthana Gel email:

    October 2012


    The Challacombe Scale Patient Review Form now makes it even easier to diagnose Dry Mouth, allowing clinicians to score symptoms observed directly onto The Scale during patient examination.

    The Challacombe Scale works using an additive scoring system of 1- 10. Each feature, which can now be marked directly onto The Scale, scores 1 point. Symptoms may not necessarily progress in the order shown, but when added together will indicate a patients likely needs. Scores may change over time and can be used to monitor progression or regression.

    August 2012


    CCMed’s fight against dry mouth took Niki & Ellie to Glasgow, supporting the British Association of Dental Therapists at their 49th National Conference.

    Professor Stephen Challacombe stole the show with a presentation on The Challacombe Scale which was described as ‘balanced, informative and relative’₁. Therapists are among some of the biggest supporters of The Challacombe Scale and champion its global progress. As therapists see many cases of dry mouth, they use The Challacombe Scale widely to assess, monitor and refer patients and recommend A.S Saliva Orthana to help manage symptoms.

    Many delegates were keen to take further information on A.S Saliva Orthana, as they had patients in mind who are in need of effective management for their dry mouths. Whilst others were very keen to talk about their patients, who have told them that A.S Saliva Orthana has had a positive impact on their lives, and very effectively relieves their symptoms of dryness.

    Many Dental Health Practitioners now regularly recommend A.S Saliva Orthana to their patients which is available through prescription, over the counter or directly from CCMed Ltd.

    CCMed have a produced a ‘Prescription Request Pad’ which is available free of charge to all Clinicians. Clinicians assess the patient and enter, on a tear-off sheet, which AS Saliva Orthana products they believe the patient needs. The patients can then take this to their GP’s (or other prescribers)or directly to the pharmacy.

    CCMed would like to say a special thank you to Sally Reid & Sandy Kowkabzadeh whose excellent organisational skills made the event so special.

    ₁ Deborah Ryan BADT

    June 2012


    Challacombe Scale Launch Challacombe Scale

    Top: Professor Challacombe gives his presentation.

    Bottom: The A.S Saliva Orthana stand


    I have been very encouraged by the number of practitioners, therapists, hygienists and nurses who have come up to me on various academic and social occasions and said how useful they have found the scale. They tell me that just having the scale up on the wall of the surgery or waiting room reminds everyone of the importance of recognising clinical dryness and at last there is something which gives them useful clinical guidance, especially about when they can treat or give advice, and when they should refer. From my perspective, I am delighted that the scale is proving to be as useful as we had hoped. It was designed not as a distant academic tool, but something that everyone who is concerned with oral health could use.

    June 2012


    The dentists and hygienists have all recommended A.S Saliva Orthana and the patients have reported back that it is the best product thay have tried. It did not foam as alternative products have a tendancy to do. The lozenges were a favourite for all patients as they were easy to use and fitted into a handbag for convenience.

    14 June 2012 Rose Cox, Hart Dental Practice

    I was in the middle of radiotherapy and tried the tabs (AS Saliva Orthana lozenges) myself with a good result!

    12 June 2012 Ruth Lovering, Dental Therapist

    My dad is suffering with dry mouth due to cancer treatment and I gave him a couple of your samples (AS Saliva Orthana).  He said it definitely made a difference and made him more comfortable.

    11 June 2012 Lynda Taylor, Dental Therapist


    Dental and other healthcare professionals, along with leading academics and clinicians attended the official launch of The Challacombe Scale at Tylney Hall in Hampshire.

    The eponymous scale, developed by Professor Stephen Challacombe of King’s College will make it far easier to asses the severity of dry mouth or xerostomia which is believed to affect as many as 1 in 4 people. Using a simple numeric system to register the Clinical Oral Dryness Score (CODS), the scale will enable health care professionals to develop treatment plans for dry mouth patients and raise awareness of this debilitating condition.

    The four speakers, from King’s College and Guy’s and St Thomas’ NHS Foundation Trust at the launch event covered in detail the causes, effects and treatment of dry mouth, starting with Dr Pepe Shirlaw, consultant in oral medicine who underlined the role of prescription drugs in causing xersotomia with nine of the 20 most commonly prescribed medication in the USA having dry mouth as a known side effect.

    Dr Suzie Moore looked at radiotherapy versus disease-induced hyposalivation, dental diseases and prevention and discussed particular problems relating to patients undergoing treatment for head and neck cancers while Professor Tim Newton spoke about the potentially devastating psychological impact of dry mouth.

    Professor Newton stressed that patients do not come to see him about their decreased saliva - they are concerned with the limitations on their body and the pain and discomfort that it causes. The impact on their lives is huge which is why raising awareness among health professionals, carers and the general public is so vital. To help encourage that, CCMed who hosted the event are offering all dental practices a free poster of the Challacombe Scale to display on practice walls. CCMed supply A.S Saliva Orthana, a natural mucin based saliva substitute that is similar to natural human saliva.

    So to the highlight of the day, Professor Challacombe himself who pointed to research that has reinforced the importance of saliva as a diagnostic fluid;
    Periodontal disease markers, bone disease markers, cancer markers – all can be detected using saliva, breast cancer and antibodies of systemic disease can be detected using saliva and of course, Olympic athletes will be drug tested using saliva.

    Those attending the official launch of the Challacombe Scale were left in no doubt about the importance of saliva, the significant physical and psychological impact of dry mouth and the need to raise awareness of a very common but under diagnosed problem. The Challacombe Scale will be a major resource in helping achieve that and Professor Challacombe spoke of the need for it to be generally available and proven as a useful tool. The scale looks at ten key signs, chosen because they are the most easily reproducible but is by no means exhaustive and there is no doubt that there is scope for expanding the use of the scale to GPs, care assistants and others.

    Professor Challacombe hopes to see practices embrace the information, put posters in the waiting room and make sure the score is used and recorded in patients’ notes and made the point that is often the rest of the dental team to move practices forward, particularly in terms of patient education and awareness.

    For more information or to get your copy of the Challacombe Scale please visit

      Challacombe Scale Launch Challacombe Scale
    Challacombe Scale Launch Challacombe Scale

    Top left: Ellie Arthur - Regional Account Manager CCMed, Professor Challacombe - Kings College London, and Tanya Brown - Business Development Manager CCMed

    Top right: Ellie Arthur - Regional Account Manager CCMed, Professor Challacombe - Kings College London, Dr Pepe Shirlaw - Kings College London, Professor Newton - Kings College London, and Tanya Brown - Business Development Manager CCMed

    Bottom left: Speakers from Kings College London at The Challacombe Scale Launch: Dr Suzie Moore, Professor Challacombe, Dr Pepe Shirlaw, and Professor Newton

    Bottom right: CCMed Staff who all helped make the day a success!