Table 7.1: Scales Used for Assessing Oral Mucositis Source Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 WHO No Changes Soreness with erythema Erythema, ulcers, can eat solids Ulcers, liquid diet only Alimentation not possible WCCNR No Changes Slight erythema, 1-4 ulcers, moist mucosa, no bleeding or infection, mild edema, avoids harsh, hot or spicy foods due to oral sensitivity and experiences mild discomfort or burning sensation Moderate erythema, >4 lesions that are not coalescing, bleeding of mucosa with probing,, mild xerostomia, moderate edema, evidence of mild infection, able to drink fluids and eat soft bland foods, moderate continual pain with use of intermittent analgesics Severe erythema, >1 confluent ulcer, spontaneous bleeding, marked xerostomia, severe edema, infection, alimentation not possible, constant severe pain requiring systemic analgesics N/A NCI CTC(For Bone Marrow Transplantation) No changes Painless ulcer or mild soreness without a lesion Painful erythema, edema or ulcers, but can swallow Painful erythema, edema or ulcers preventing swallowing or requiring hydrations or nutritional support Severe ulcerations requiring prophylactic intubation or resulting in documented aspiration pneumonia NCI CTC v.2 (For Radiation Treatment) No changes Erythema Patchy pseudomembranous reaction (patches generally < or = to 1.5cm in diameter) Confluent pseudomembranous reaction (> or = to 1.5cm in diameter) Necrosis or deep ulceration NCI CTC (For Chemotherapy) No changes Painless ulcers, erythema, or mild soreness in the absence of lesions Painful erythema, edema, or ulcers, but can eat or swallow Painful erythema, edema, or ulcers requiring IV hydration Severe ulcerations or requires parenteral or enteral nutrional support or prophylactic intubation OMAS Ulceration Normal Less than 1 cm sq. Between 1-3 cm sq. Greater than 3 cm sq. N/A OMAS Erythema Normal Not severe Severe N/A N/A