Oral Medicine Specialists Research Articles

Epidermolysis Bullosa Oropharyngeal Severity (EBOS) score: A multicenter development and reliability assessment

Epidermolysis bullosa (EB) is a genetic mucocutaneous disorder characterized by blister formation upon mild trauma. All 4 EB types may show oropharyngeal lesions involving either hard or soft tissues. Currently, there are very few data on EB scoring that include the oropharyngeal cavity. We sought to develop an oropharyngeal severity score that was objective, valid, reliable, reproducible, easy to perform, and appropriate for all EB types. In this study, oral medicine specialists developed a new score, the EB Oropharyngeal Severity (EBOS) score. This measured oropharyngeal disease activity (erythema, atrophy, blisters, erosion/ulceration) and structural damage (microstomia, ankyloglossia, scarring phenotype beyond microstomia and ankyloglossia, enamel hypoplasia). It was tested on 92 patients with different types/subtypes of EB, and interobserver and intraobserver reliability were assessed. The EBOS mean total score was 12.9 ± 10.9 (range: 0-34). Both interobserver and intraobserver reliability for total score on all patients with EB were considered excellent (intraclass correlation coefficient 0.94; 95% confidence interval 0.90-0.96 and intraclass correlation coefficient 0.90; 95% confidence interval 0.84-0.94, respectively). Even analyzing each single parameter of the disease activity and structural damage, a substantial to excellent correlation was found in the interobserver (except for 4 sites) and intraobserver reliability. A significant correlation was found between EB types/subtypes and the EBOS median score (P<.001), but not between age and the EBOS mean total score in each group. The sample size was small and the number of EB subtypes was limited. The EBOS score seems to represent an instrument capable of truly quantifying the oropharyngeal severity in different types/subtypes of EB, demonstrating excellent interobserver and intraobserver reliability.

Mucosal Disorders with Oral Epithelial Dysplasia risk – Development of a simple screening tool for general health care setting

Oral visual screening can avert oral cancer mortality. Oral premalignancies are currently considered as separate, individual disorders. The objective was to develop a simple clinical screening tool to detect oral premalignancies in general health care setting and validate diagnostic accuracy against Oral Medicine specialist examination as gold standard. All steps in development of new tool, from item generation to item selection and item reduction were carried out. Item generation was done using qualitative methods. After pre-testing and piloting, junior dental house surgeon administered the refined tool, to patients attending dental outpatient department (n=255). Subsequent evaluation by an Oral Medicine specialist using consensus clinical criteria, detected 59 screen positive cases. Each case was recoded as per scores assigned by binary logistic regression coefficients and total score computed. The Receiver Operator Characteristic (ROC) was performed against specialist examination as gold standard. Performance ability and reliability coefficient of final tool was assessed. A simple score was assigned to indicate stage and clinical severity. Screening Tool for Oral Premalignancies (STOP) has sensitivity 96.6%, specificity 99.0% and accuracy 98.4% with reliability coefficient 0.874. Scores detect clinical signs and staging reflect clinical severity alerts. Oral Potentially Malignant Disorders need to be evaluated as single entity, under a common umbrella - Mucosal Disorders with Oral Epithelial Dysplasia risk (MD-OEDr). STOP is a simple tool for opportunistic general health care screening of MD-OEDr.

Gerodontology - Orodental care for elderly

AbstractChanging demographics, including an increase in life expectancy and the growing numbers of elderly, has recently focused attention on the need for geriatric dental care. Ageing affects oral tissues in addition to other parts of the human body, and oral health (including oral mucosa, lips, teeth and associated structures, and their functional activity) is an integral component of general health. Oral disease can cause pain, difficulty in speaking, mastication, swallowing, maintaining a balanced diet, not to mention aesthetical considerations and facial alterations leading to anxiety and depression. Certain strategies should be adopted for improving oral health of the elderly, including the management and maintenance of oral conditions, which are necessary for re-establishing effective masticatory function. Oral health is often neglected in the elderly and oral diseases associated with aging are complex, adversely affecting the quality of life. Although majority of oral health problems are not usually associated with mortality, nearly more than half of the deaths due to oral cancer occur at an age of 65 years plus. This review of geriatric dentistry, which is dedicated to geriatric physicians, geriatric dentist and specialists in oral medicine, emphasizes on age-related oral changes in elderly patients and efforts to summarize the effects of aging in hard and soft oral tissues.

Abstract B27: Influence of fluorescence visualization on screening decisions in the general dental office

Abstract Oral cancer is a substantial, often unrecognized issue globally, with close to 300,000 new cases reported annually. It is a management conundrum: a cancer site that is easily examined, yet &amp;gt;40% of oral cancers are diagnosed at a late stage when prognosis is poor and treatment can be devastating. Opportunistic screening within the dental office could lead to earlier diagnosis and intervention with improved survival. With an increasing number of screening tools commercially available it is vital to validate these tools within the general dental office amongst clinicians who are not as experienced as specialists in high-risk clinics. One such tool, fluorescence visualization (FV), is used to assess alterations to tissue fluorescence. The goal of this study was to determine how clinicians made decisions about referral based on the risk classification of the lesion, how FV was integrated and how it affected the decision to refer. Information on FV rates in private practice and how FV affects decision making is vital to determine the feasibility of using this tool in a general practice setting. Methods: 15 dental offices participated in a 1-day workshop on oral cancer screening, including an introduction to and use of FV. Participants then screened patients (medical history, convention oral exam, fluorescent visualization exam) in-office for 11 months. Participants were asked to triage lesions by apparent risk: low, intermediate and high. Low-risk (LR) lesions were common and benign conditions including geographic tongue, candidiasis and known trauma. Intermediate risk (IR) lesions were lichenoid in appearance and high-risk (HR) lesions were white or red lesions or ulcers without apparent cause. Clinicians then made the decision on which lesions to reassess in 3 weeks based on risk assessment and clinical judgment. Lesions of concern were seen by a community facilitator or referred to an oral medicine specialist. Results: 2542 patients were screened with 389 (15%) low, intermediate or high-risk lesions detected. Of the 389 lesions, FV data was available for 357. Of 325 LR lesions, 175 (54%) were FV+. 93 were recalled (primarily trauma), 86 complied and at 3 weeks only 18 were FV+ and 2 were FVE (equivocal). 22 lesions were seen by a facilitator/referred resulting in 2 biopsies with benign findings. 89% of low-risk FV+ lesions were transient. Eight of the 16 IR lesions were FV+, 10 lesions were recalled (6 FV+, 1 FVE, 3 FV−) and all complied. 4 of 6 FV+ lesions remained positive and were referred. Status of FV− and FVE lesions remained the same and were referred/seen by a facilitator. One FV− IR lesion was reassessed as FV+ and referred for biopsy (lichenoid mucositis). Of the 16 lesions assessed HR at baseline, 9 were FV+, 1 FVE and 6 FV−; 1 FV+ lesion was referred directly, biopsied -&amp;gt; low grade dysplasia. Of the 8 FV+ lesions, 5 were FV+ and 1 FVE at follow-up, 4 were referred resulting in 1 biopsy of low grade dysplasia. 1 FVE lesion was FV− at recall. 4 of the 6 FV− lesions were recalled, 1 was FV+ at recall and referred. 25 FV+ sites had no visible clinical lesion. 9 were recalled, 8 complied and 1 was referred directly to a specialist with no reassessment. None were found to be of concern; FV+ was associated with denture sore spots, scar tissue, vascularities, etc. Conclusions: A 3 week reassessment appointment is invaluable to reduce the proportion of FV+ lesions attributed to trauma and prevent the unnecessary referral due to confounders. Patient compliance for the 3 week reassessment was high. Not surprisingly, FV status of intermediate and high risk lesions did not alter as much at reassessment. FV played a role in the decision to reassess and refer lesions as lesions with persisting FV+ were more apt to be referred. Clinicians relied on their own judgment and referred if a lesion was FV− if they were concerned. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B27.

Dentists’ preferences for diagnosis, management and referral of chronic oro-facial pain: Results from a national survey

Aim: To explore the diagnosis, treatment and referral patterns of chronic oro-facial pain patients by generalist primary care dentists (GDPs) in the UK. Methods: A cross-sectional survey was conducted using a non-stratified random sample of 500 GDPs who were selected from the General Dental Council register. A self-complete postal questionnaire with four hypothetical clinical case scenarios describing sub-types of chronic oro-facial pain (COFP) was used to investigate diagnosis, treatment and referral options of GDPs. Results: Two hundred and twenty (44%) GDPs responded. The majority correctly diagnosed temporomandibular disorder (TMD; 88%) and burning mouth syndrome (BMS; 92%). There was more variation in the diagnosis of the other cases related to persistent oro-facial pain. For TMD there was a clear preference for treatment with occlusal splint therapy, and referral to a temporomandibular joint (TMJ) specialist. The BMS scenario showed drug therapy and referral to an oral medicine specialist to be most popular. The chronic oro-facial pain cases had greater variation in management and choice of psychotherapy was related to duration of pain symptoms. Conclusions: The greater variation in responses to scenarios based on patients with chronic oro-facial pain may reflect the difficulty clinicians face in diagnosing and treating this condition. Management appears to follow a biomedical model and most clinicians chose to refer patients for treatment. There are few specialist services to cater for such referrals, indicating a need to train primary care practitioners in management of chronic COFP, along with the establishment of evidence-based guidelines.

Orale Medizin

Oral medicine is a dental specialty that bridges the traditional areas of health between dentistry and medicine. International descriptions reflect this and oral medicine is defined as "the dental speciality placed at the interface between medicine and dentistry and is concerned with the diagnosis and management of (non-dental) pathology affecting the oral and maxillofacial region." Oral medicine specialists provide clinical care to patients with a wide variety of orofacial conditions, including oral mucosal diseases, orofacial pain syndromes, salivary gland disorders, and oral manifestations of systemic diseases. There is a growing need to implement this specialty globally: due to the rapid progress in both medicine and dentistry, and to the growing percentage of senior citizens in many countries, the adequate diagnosis and treatment of oral diseases will become even more complex in the future. In this article, the authors' intention is to point out that oral medicine is neither a recognized specialty nor a distinct field of study in Germany, Austria, or Switzerland; thus, the need for postgraduate training in this field in countries where oral medicine is not a specialization is emphasized.

Evaluation of oral mucosal diseases: inter‐ and intra‐observer analyses

Essential to the diagnosis and management of oral mucosal diseases are visual evaluation and monitoring of the oral cavity. Digital photography has recently become an important clinical tool. The aims of this study were to (i) evaluate inter- and intra-observer differences between oral medicine and other dental specialists when assessing changes in oral mucosal pathology and (ii) assess the influence of calibration labels incorporated into the clinical images on the reliability and consistency of evaluation. Ten oral medicine specialists (OM) and 10 other dental specialists (DS) participated in the study. Pairs of images captured with an intraoral camera at two time points from 17 cases of mucosal diseases were presented to the participants. Each pair of photographs was presented with a calibration label (showing length and white to black hues) and again without one. The participants were asked to respond to a questionnaire evaluating changes in size, color, location, and severity for each image pair. Oral medicine specialists had better absolute agreement and consistency than DS when evaluating the changes in the images; however, these parameters did not exceed 52% in either group. The incorporation of a calibration label in the images increased agreement and consistency of evaluations in both groups. Follow-up evaluations of oral mucosal lesions are performed better by oral medicine practitioners compared to other dental specialists. The incorporation of a calibration label in the clinical images seems to enhance evaluation.

The treatment of oral cancer: an overview for dental professionals

Oral cancer is a serious life-threatening disease. Dental professionals may be the first individuals to identify/suspect these lesions before referring to oral and maxillofacial surgeons and oral medicine specialists. Because the general dentist will likely follow on with the patient's future oral health, it is important that he or she has a basic understanding of the various treatments involved in treating oral malignancies and their respective outcomes. The four main modalities discussed in this review include surgery alone, radiotherapy alone, surgery with radiotherapy, and chemotherapy with or without surgery and radiotherapy. Chemotherapy has become an area of great interest with the introduction of new 'targeted therapies' demonstrating promising results in conjunction with surgery. Despite these results, the toxicities associated with chemotherapy regimens are frequent and can be severe, and therefore may not be suitable for all patients. Treatment modalities have improved significantly over the decades with overall decreases in recurrence rates, improved disease-free and overall survival, and an improved quality of life. Prognosis, however, is still ultimately dependent on the clinical stage of the tumour at the initial diagnosis with respect to size, depth, extent, and metastasis as recurrence rates and survival rates plummet with disease progression.

Numb Chin Syndrome as a Manifestation of Possible Breast Cancer Metastasis Around Dental Implants

Numb chin syndrome, sometimes called numb lip syndrome, is an uncommon but well-recognized symptom in medical oncology. It may be a metastatic neurologic manifestation of malignancy, often with no clinically visible pathologic finding. The authors report a numb chin syndrome as a manifestation possible breast cancer metastasis around dental implants in a 69-year-old woman. The patient was presented with complaint of numbness in the lower jaw. Medical anamnesis revealed a metastatic breast carcinoma (CA). Radiographic imaging with conventional panoramic radiography and cone beam computed tomographic examination, revealed a moth-eaten shape, radiolucent, and radiopaque mixed appearance around the dental implants that was related with possible metastasis of the breast cancer. Numb chin syndrome is almost unknown within the dental and oral and maxillofacial community, despite being well reported in the medical literature. General dentists, oral medicine specialists, and oral and maxillofacial surgeons must be aware of this condition to consider metastatic cancer in patients with unexplained facial hypoesthesia. Moreover, although the development of metastatic lesions around implants is an uncommon pathologic finding, the examination of peri-implant lesion should be performed carefully considering the entire pathologic situations.

Tumor Markers: An Overview

Oral cancer is a potentially fatal disease that has been the bane of clinicians throughout the world. Though various modalities of management exist, early detection still provides the best hope for any cancer patient Advances in molecular diagnosis have led to a plethora of choices being available in the fight against cancer. Abnormal cellular products elucidated from malignant cells can be detected and measured in various body tissues and fluids and constitute tumor markers. The various clinical applications and their limitations are covered in the brief overview to help the oral medicine specialist understand the relevant advances made in the field of tumor markers.

Provision of oral medicine in departments of oral and maxillofacial surgery in the UK: national postal questionnaire survey 2009

We investigated the current provision of oral medicine in oral and maxillofacial (OMF) departments in the UK. We examined the number of specialists in oral medicine in OMF departments, the training given to OMF consultants in oral medicine, and the estimated time dedicated to treating patients with oral medical conditions in outpatient clinics. We also examined the pattern and reasons for onward referrals to departments of oral medicine. A postal questionnaire was sent to 300 OMF consultants and was returned by 183 (61%). Sixteen (9%) of the responding consultants had a registered specialist qualification in oral medicine with the General Dental Council (GDC), 15 (8%) had a degree in oral medicine, and 4 (2%) had a diploma. One hundred and eighteen (64%) consultants had been given formal training in oral medicine during their training as registrars. Time dedicated to oral medicine in outpatient clinics varied between less than 20% and more than 40% of total outpatient time. Sixteen surgeons (9%) referred 1–2 patients/week to departments of oral medicine, and 19 (10%) referred 2–4/month. Reasons for referral included need for specialist expertise, failure of treatment, and lack of time in outpatients. The proposal for a dentally qualified consultant-led oral medicine service was supported by 70 responding surgeons (38%).

Guest Editorial

Oral medicine is the dental specialty extending beyond the areas of health traditionally regarded as “dentistry” and bridging to those covered by the umbrella of “medicine”. International descriptions reflect this and oral medicine is defined as “the dental specialty placed at the interface between medicine and dentistry and is concerned with the diagnosis and management of (non-dental) pathology affecting the oral and maxillofacial region”. In Australia, oral medicine has existed comfortably within the fold of oral pathology and oral medicine over many years but this is historical and oral pathology (a diagnostic, laboratory based specialty) is now clearly a separate specialty with both specialties having defined training programmes, specialist registration requirements and career pathways. The Oral Medicine Society of Australia and New Zealand is the representative body and membership is open to general practitioners and specialists. This supplement on contemporary oral medicine is compiled as an aid to dental and medical practitioners, as well as undergraduate and postgraduate students. It presents papers provided by specialist practitioners in Australia, and the Journal gratefully acknowledges their contributions. All papers were invited and they reflect a small part of the contribution of oral medicine specialists to the oral and general health of Australian patients. It does not show the great contribution that specialists have made to science and knowledge within oral medicine over the past 50 years. Some readers will recall with gratitude the opportunity to study under scholars of the standing of Peter Reade, Ken Adkins, Ken Sutherland and Mark Jolly. The first paper in the supplement identifies papers published in the Australian Dental Journal over the past 10 years with relevance to oral medicine. It is only a thumbprint but it shows the strong activity in the discipline and the willingness of authors to publish for the Australian dental profession rather than internationally in specialty journals where access to Australian practitioners is difficult. Oral medicine is like most of the specialty areas of dental science in general practice. It provides an opportunity to enhance the routine health services to patients. It also provides the opportunity to add value to patient health with both surveillance, treatments and referrals that bridge from cautious clinical management to life-saving situations. Oral medicine specialists have a significant load of premalignant and malignant disease, and this reflects what is being seen and recognized in general practice. A single malignancy recognized in a practising lifetime is very likely a life saved. It makes all the effort worthwhile. A follow-on question examines the boundaries of responsibility of the dental practitioner and how these should be included in general dental practice. The focus of this supplement is exclusively on non-dental pathology but that does not make surveillance any different from periodontal examinations or mixed dentition analyses. The dental practitioner is in the ideal situation with a large volume of patients who attend in regular cycles for oral examination under excellent conditions not found elsewhere in health facilities. Reasonably, the current author, and many others, feel the dental practitioner should include all visible cervico-facial skin surfaces in the examination and a full examination of cervical lymph node chains. The aim is not to become an expert diagnostician but to become skilled in the recognition of abnormality and then the decision to watch, treat or refer can be made. Many practices already undertake this level of examination and it is one of the aims of this supplement to provide assistance in this “additional” level of care.

Oral fungal infections: an update for the general practitioner

Oral candidosis is the most common fungal infection encountered in general dental practice. It manifests in a variety of clinical presentations which may mimic more sinister diseases, and can occasionally be refractory to treatment requiring the attention of an oral medicine specialist. Management of oral candidosis should always include a thorough investigation of underlying predisposing conditions, as the disease often presents when the patient is systemically compromised. This update highlights the pathogenesis, clinical presentation, and management strategies of oral Candidal lesions commonly encountered in dental practice.

Multiple Odontogenic Keratocysts

ABSTRACTOdontogenic keratocyst is a cyst of odontogenic origin that exhibits a keratinized epithelial lining. Odontogenic keratocyst has been the topic of numerous investigators and is known for its potentially aggressive behavior and significant rate of recurrences.1OKC cyst often occurs as a solitary lesion at the angle of the mandible, however in some instances, multiple such cysts may occur in association with a syndrome called “Nevoid basal cell syndrome”.1These patients have propensity to develop multiple neoplasm including basal cell carcinoma and medulloblastoma. Hence early diagnosis and treatment is of utmost importance in reducing the severity of long-term sequelae of this syndrome. Here we present a case of multiple odontogenic keratocysts with nevi and narrowed ribs which has profound relevance to specialist in Oral Medicine and Radiology and Oral and Maxillofacial Surgery.

Oro-facial aspects of leprosy: Report of two cases with literature review

Leprosy is a chronic infectious disease affecting primarily the skin, peripheral nerves, respiratory system and the eyes. Leprosy induces various types of clinical presentation affecting the patient's immune response. Cell-mediated immunity is considered to be the crucial defence against the disease and the magnitude of this immunity defines the extent of the disease. The article presents two case reports of manifestations of leprosy in the oro-facial region, with a brief review of various other important oro-facial manifestations of leprosy. The first report deals with granulomatous nodules in the palate while the second report presents bilateral facial palsy in leprosy patients. Both the reports gain importance due to rare oral manifestation in a borderline leprosy patient in the first case, while the second case presents a rare bilateral Bell's sign. The role of the dental profession and especially the Oral Medicine specialist is of great importance in early diagnosis of oral lesions.

Nasal-type NK/T-cell Lymphoma with Palatal Ulcer as the Earliest Clinical Manifestation: A Case Report with Literature Review

Extranodal nasal natural killer (NK)/T-cell lymphoma is a very rare kind of lymphoma, Oral cavity involvement of extranodal natural killer/T-cell lymphoma, nasal type is extremely rare, and its clinicopathologic features are also poorly understood. Recently, we experienced an unusual case of Epstein-Barr virus-associated, extranodal NK/T-cell type with a unhealed palatal ulcer as the earliest clinical feature. It is a challenge for oral medicine specialists to make the early diagnosis for this special type of tumor.

Oral white lesions: pitfalls of diagnosis

General practitioners are often the first point of contact for patients with oral white lesions, which represent a wide spectrum of diagnoses of varying seriousness. Some clinical features are classical and others overlap between different diagnoses; they should be correlated with patient history, and sometimes other investigations, for diagnosis. Leukoplakia is a clinical term, and is a diagnosis of exclusion with no histopathological connotation. It has been redefined to describe a predominantly white lesion with premalignant potential. Patients with lesions that are potentially malignant should be referred to an oral medicine specialist or oral maxillofacial surgeon for systematic management.

Email for distance diagnosis of oral diseases: a preliminary study of teledentistry

We examined the feasibility of distance diagnosis of oral diseases, using transmission of digital images by email. Twenty-five cases of oral lesions were documented during a 12-month study in a primary care public health clinic in Paraná in Southern Brazil. Clinical electronic charts and images were produced and sent by email to two oral medicine specialists with a median of 10 years experience in the field. The consultants provided a maximum of two clinical hypotheses for each case. In 15 of the 25 cases (60%) both consultants made a correct diagnosis; in seven cases (28%) only one consultant made a correct diagnosis; and in three cases (12%) neither consultant made a correct diagnosis. Thus in 88% of cases, at least one consultant was able to provide the correct diagnosis. The results suggest that distant diagnosis can be an effective alternative in the diagnosis of oral lesions and that the using two distant consultants improves diagnostic accuracy. Primary care public health clinics may benefit from the use of email and digital cameras for telehealth in remote areas where oral medicine specialists are not available.

Oral lesions in HIV and HCV co‐infected individuals in HAART era

During recent years, a new population of HIV and HCV co-infected subjects has emerged presenting particular oral problems. The aim of our study was to determine the prevalence of oral lesions in HIV+ subjects and HIV and HCV co-infected subjects, to assess whether co-infection is a risk factor for the presence of oral lesions. 200 HIV+ subjects were consecutively enrolled, divided into two groups: Group 1 (130 HIV+ subjects) and Group 2 (70 HIV-HCV co-infected subjects) and visited by two oral medicine specialists. Epidemiological, laboratory and clinical parameters were gathered to determine the possible risk factors for oral lesions. 52 on 200 subjects (26%) presented oral lesions: in Group 1, 25 on 130 subjects (19.23%) presented oral lesions, whereas in Group 2, 27 on 70 subjects (38.57%) presented oral lesions. Multivariate analysis showed that the following variables are statistically associated with the presence of oral lesions: HIV-HCV co-infection (OR = 2.32; 95% CI = 1.01-5.33: P < 0.05) and the use of drugs for the treatment of systemic diseases not associated with HIV (OR = 4.34; 95% CI = 1.78-5.33: P = 0.005). It is possible to assess, on the basis of our results, that co-infected patients are more prone than HIV mono-infected patients to develop oral lesions and thus should undergo strict oral medicine monitoring.

The Sjogren's Syndrome Damage Index--a damage index for use in clinical trials and observational studies in primary Sjogren's syndrome

To validate a tool for assessment of accumulated damage in patients with Primary SS (PSS). Of the total 114 patients fulfilling American-European Consensus Group (AECG) criteria for PSS 104 were included in the study and assessed by rheumatologists at T (time) = 0 months and T = 12 months. On each occasion, damage and activity data, and autoantibody status were collected. SF-36 and Profile of Fatigue and Discomfort-Sicca Symptoms Inventory (PROFAD-SSI) questionnaires were completed. Cross-sectional analysis of this data was subject to a process of expert validation by 11 ophthalmologists, 14 oral medicine specialists and 8 rheumatologists. Items were removed from the index if >or= 50% of respondents recommended exclusion. Statistical validation was performed on remaining items. Spearman's rank analysis was used to investigate associations between damage scores and other disease status measures and Wilcoxon matched-pair analysis to assess sensitivity to change in the damage score. Based on the expert validation, a 29-item damage score was agreed incorporating ocular, oral and systemic domains. Total damage score correlated with disease duration at study entry (r = 0.436; P < 0.001), physical function as measured by SF-36 (r = 0.250, T = 0 months; r = 0.261 T = 12 months) and activity as measured by the Sjögren's Systemic Clinical Activity Index (r = 0.213, T = 0 months; r = 0.215, T =12 months). Ocular damage score correlated with the 'eye dry' domain of PROFAD-SSI (r = 0.228, T = 0 months; r = 0.365, T = 12 months). Other associations not present on both assessments were considered clinically insignificant. On Wilcoxon analysis, the index was sensitive to change over 12 months (z = -3.262; P < 0.01). This study begins validation of a tool for collection of longitudinal damage data in PSS. We recommend further trial in both the experimental and clinical environment.