Oral Dysesthesia Rating Scale: a tool for assessing psychosomatic symptoms in oral regions

Abstract

Background: The concept of cenesthopathy was first introduced by Dupré and Camus in 1907 to describe clinically unexplainable bodily sensations mainly attributed to psychiatric pathology. If it occurs in oral regions, it is termed oral cenesthopathy and it has been of special interest to psychiatrists and dentists. While there is no independently defined criteria for this condition, which is classified as either a delusional or a somatoform disorder, clinical practice and research require a standard scale to measure and rate its symptoms. In this study, we included any types of psychosomatic symptoms in oral regions as oral dysesthesia, and developed an Oral Dysesthesia Rating Scale (Oral DRS) and evaluated its validity and reliability as an assessment tool.

Methods: The scale was developed based on literature review and extensive clinical experience. Twelve reviewers assessed relevancy of each item to oral dysesthesia symptoms by 1-4 scoring scale and item content validity index was computed. To evaluate the inter-rater reliability of Oral DRS, pairs of raters administered the scale to 40 randomly selected patients with complaints of oral dysesthesia symptoms and Cohen's weighted kappa coefficient was determined for each item.

Results: The scale assesses the severity of feelings of foreign body [A1], exudation [A2], squeezing-pulling [A3], movement [A4], misalignment [A5], pain [A6], and spontaneous thermal sensation or tastes [A7], and the degree of impairment in eating [B1], articulation [B2], work [B3], and social activities [B4] on a scale of 0-5. Items A1, A2, A3, A4, B3, and B4 demonstrated acceptable content validity. Inter-rater reliabilities were good or excellent for all items evaluated.

Conclusion: The Oral DRS can help define the nosography of clinically unexplainable oral dysesthesia through further case evaluation and clinical research and facilitate devising of treatment modalities.

Figure 1

Item content validity index for scales [A] and [B]. Item content validity indices for all items are shown. For the Symptom Severity Scale [A], items A1, A2, A3, and A4 demonstrated acceptable content validity (≥0.8), while items A5, A6, and A7 did not reach acceptable values. For the Functional Impairment Scale [B], while items B1 and B2 did not reach acceptable values, items B3 and B4 demonstrated acceptable content validity.

Figure 2

Frequency distribution of the symptoms. To overview the frequency distribution of the symptoms, the cumulative number of patients who were rated as “2: mild” or more for each item in scales [A] and [B] is shown. The distribution pattern tends to be similar to the pattern of I-CVI except for items A4 and A7 whose values are relatively low compared to those of I-CVI (Figure 1).