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Clinical Pharmacy 1 - Term 1 > 10 - Dental Conditions > Flashcards

10 - Dental Conditions Flashcards

1
Q

What are symptoms of teething pain?

A
  • Gum redness, swelling, or tenderness
  • Drooling, flushed cheeks b/c of mild increase of body temperature
  • Irritability, restlessness, crying, insomnia
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2
Q

What ARE NOT symptoms of teething pain?

A

Fever, diarrhea, vomiting, or common cold symptoms

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3
Q

What are some non-pharms for teething pain?

A
  • Massage baby’s gums w/ clean finger or damp washcloth
  • Cool affected area w/ frozen face cloth, or cold pacifier/teether (avoid exposure to extreme cold)
  • Wipe baby’s face often w/ cloth to remove drool and prevent rashes
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4
Q

When is pharmacological treatment used for teething pain?

A

When non-pharms don’t work

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5
Q

What pharmacological treatment is recommended for teething pain?

A
  • Oral analgesics
  • Acetaminophen – 10-15 mg/kg/dose every 4-6 hours PRN (max 65 mg/kg/day)
  • Ibuprofen – 5-10 mg/kg/dose every 6-8 hours PRN (max 40 mg/kg/day)
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6
Q

When do you refer teething pain?

A

No relief w/ treatment for 3-5 days

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7
Q

What pharmacological treatment is not recommended for teething pain and why?

A
  • Topical anesthetics

- Provide relief for maximum 45 minutes and can inactivate the gag reflex if swallowed or cause methemoglobinemia

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8
Q

What are can a toothache?

A
  • Cracked tooth syndrome

- Post-dental procedure discomfort

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9
Q

What is cracked tooth syndrome?

A

Abrupt pain w/ biting but resolves w/ removal of pressure

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10
Q

When do you refer a toothache?

A

Always, but can offer pharmacological treatment until they can see a dentist

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11
Q

What treatment can be offered for a toothache?

A
  • Oral analgesics (NSAIDs, acetaminophen)

- Local anesthetics (benzocaine)

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12
Q

What is tooth hypersensitivity?

A

Short, quick, sharp dental pain due to exposure to a stimulus on exposed dentin

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13
Q

What can cause tooth hypersensitivity?

A
  • Tooth decay
  • Fractured teeth
  • Worn fillings
  • Gum disease
  • Worn enamel
  • Exposed root from gum recession
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14
Q

When do you refer tooth hypersensitivity?

A

Always

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15
Q

What are some non-pharms for tooth hypersensitivity?

A
  • Soft-bristled toothbrush and proper tooth brushing
  • Decrease acidic foods and drinks
  • Avoid brushing w/in 2 hours of acidic foods and drinks
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16
Q

What is a pharmacological option for tooth hypersensitivity?

A

Desensitizing toothpaste (potassium nitrate most common)

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17
Q

What is the most common cause of oral candidiasis?

A

C. albicans

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18
Q

What are the 2 major forms of oral candidiasis?

A
  • Pseudomembranous – most common, appears as white plaques on oral mucosa that are easily wiped off w/ cotton-tipped applicator
  • Atrophic – common in elderly w/ dentures, erythema w/o plaques
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19
Q

What are risk factors for oral candidiasis?

A
  • Diseases that affect immune system and medications that suppress immune system
  • Xerostomia
  • Use of systemic or inhaled corticosteroids
  • Infants and children
  • Use of broad-spectrum antibiotics
  • Local mucosal trauma
  • Poor dental/denture hygiene
  • Pregnant
  • Smoking
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20
Q

What are signs and symptoms of oral candidiasis?

A
  • “Cottage cheese” soft plaques that are white or cream/yellow on buccal mucosa, tongue, gums, and throat
  • Plaques removed w/ vigorous rubbing but can leave red or bleeding sites
  • Red, flat lesions on mucosa under dentures
  • May cause cracked, red, moist areas on skin at corners of mouth
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21
Q

What are some red flags for oral candidiasis?

A
  • Atypical symptoms of mild oral thrush
  • Px on chemotherapy or immunocompromised from drug therapy
  • Systemic symptoms (unexplained weight loss or thirst)
  • Other organ involvement
  • Any lesion lasting longer than 3 weeks
  • Possible symptoms of adverse drug reaction
  • Suspect another type of infection
  • Unable to confirm oral thrush infection
  • Treatment unsuccessful after 14 days
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22
Q

Would you refer oral candidiasis if the patient is on an inhaled corticosteroid?

A

No, just counsel them on the importance of rinsing their mouth after every use

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23
Q

What are the goals of therapy for oral candidiasis?

A
  • Eradicate infection
  • Prevent complications
  • Prevent recurrence
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24
Q

What are some non-pharms for oral candidiasis in infants?

A
  • Sterilize toys, soothers, and feeding bottles/nipples

- If breastfed, mother may have candidal infection on nipples and requires treatment

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25
Q

What are some non-pharms for oral candidiasis in px w/ dentures?

A
  • Remove dentures overnight
  • Wear dentures only for 6 hours
  • Soak and clean dentures when not using
  • Clean oral cavity w/ soft toothbrush
  • Make sure dentures fit properly
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26
Q

What is the pharmacological therapy for oral candidiasis?

A

Prescription = nystatin (for mild cases) or oral azole antifungals

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27
Q

What is the OTC treatment for oral candidiasis and why is it no longer recommended?

A
  • Gentian violet

- Can cause mucosal irritation, ulceration, and staining; also has been linked to carcinogenicity

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28
Q

What treatment can pharmacists prescribe for oral candidiasis?

A

Nystatin oral suspension

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29
Q

Is nystatin fungistatic or fungicidal?

A

Both

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30
Q

What are the directions of use for nystatin oral suspension?

A
  • Shake well
  • Swish and swallow product
  • Instill 1/2 dose into each side of mouth and ensure contact w/ lesions for as long as possible before swallowing
  • Do not eat 5-10 minutes after dose is given
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31
Q

What are some side effects of nystatin?

A
  • Nausea, vomiting and diarrhea w/ high doses

- Rarely rash or irritation

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32
Q

What is the dosing of nystatin for adults and children?

A

4-6 mL of 100,000 unit/mL suspension QID for 7-14 days

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33
Q

What is the dosing of nystatin for infants?

A

1-2 mL of 100,000 unit/mL suspension QID for 7-14 days

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34
Q

How long should treatment w/ nystatin continue once symptoms have cleared?

A

48 hours

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35
Q

What are the monitoring procedures for oral candidiasis?

A
  • After prescribing nystatin, follow up in 7 days

- Can discontinue medication if symptoms have been resolved for 48 hours

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36
Q

What should be done if the px experiences improvement but not resolution of sx w/ nystatin?

A

Continue nystatin for 7 more days

37
Q

What should be done if px does not experience improvement w/in 14 days while using nystatin?

A

Refer

38
Q

Which organism is the primary cause of herpes labialis?

A

HSV-1

39
Q

What are some symptoms of the primary infection of herpes labialis?

A
  • May be asymptomatic

- May have fever, chills, sore throat, ulcerations on lip, malaise

40
Q

What are triggers for herpes labialis?

A
  • Stress
  • Sun exposure
  • Hormonal changes
  • Trauma
  • Viral infection
  • Fever
  • Cold weather
41
Q

What are the various stages of herpes labialis?

A
  • Prodromal (less than 24 h) - pain, itching, tingling at site
  • Erythema (24-48 h) - red, inflamed area
  • Papule (24-48 h) - small, raised lesions
  • Vesicle (1-3 days) - clear, fluid in lesion, swollen w/ red halo
  • Ulcer (1-3 days) - yellow, weeping, moist and painful
  • Crusting (day 5-8) - hard crust, inflamed, some swelling
42
Q

How long can healing take for herpes labialis?

A

7-10 days

43
Q

What are red flags for herpes labialis?

A
  • Lesion not healed w/in 14 days w/ or w/o tx
  • Systemic symptoms
  • Lesion appears infected
  • More than 6 outbreaks per year
  • Pregnant
  • Immunocompromised
44
Q

What are the goals of treatment for herpes labialis?

A
  • Relieve discomfort
  • Reduce duration and severity
  • Prevent secondary infection
  • Prevent spread
  • Prevent recurrences
  • Reduce triggers
45
Q

What is the OTC treatment for herpes labialis?

A
  • Docosanol 10% (Abreva)
  • Local anesthetics (Anbesol, Orajel, Kank-A)
  • Protectants
  • Topical analgesics
  • Oral analgesics
46
Q

What does docosanol do and what is the dosing?

A
  • Prevent migration and replication
  • Applied 5 times/day at first sign (max. 10 days)
  • For 12 years old and over
47
Q

Should heparin sodium/zinc sulfate and hydrocolloid patches be recommended for herpes labialis?

A

Both are lacking safety and efficacy evidence

48
Q

What is a disadvantage to using local anesthetics for herpes labialis?

A

Risk of choking and being burned

49
Q

What do protectants do and what are some examples that can be used for herpes labialis?

A
  • May help decrease cracking and drying of lesion

- Petrolatum, cocoa butter, allantoin

50
Q

What are examples of topical analgesics used for herpes labialis?

A

Camphor, menthol, phenol

51
Q

Which oral analgesics can be used for herpes labialis and for how long?

A
  • Acetaminophen, ibuprofen, naproxen

- Up to 3 days

52
Q

What are some Rx treatments for herpes labialis?

A

Rx antivirals, either oral or topical

53
Q

What are some non-pharms for herpes labialis?

A
  • Lip conditioners and protectants
  • Keep area clean w/ warm water and soap to prevent infection
  • Avoid direct contact w/ others
  • Wash hands often and avoid touching lesion
  • Avoid sharing objects (straws, glasses, cutlery, razors, towels)
  • Stress reduction and rest
54
Q

What are symptoms of aphthous ulcers?

A
  • Last 5-14 days

- Burning, tingling, intense persistent pain

55
Q

What are the 4 appearance related factors for aphthous ulcers?

A
  • Roundish
  • Shallow-cratered
  • Red halo
  • White-yellow interior covering
56
Q

Are aphthous ulcers contagious?

A

No

57
Q

What are common precipitating factors of aphthous ulcers?

A
  • Local trauma
  • Stress
  • Genetic predisposition
  • Medications (NSAIDs, ACE inhibitors, beta-blockers, opioid analgesics)
58
Q

What are red flags for aphthous ulcers?

A
  • Severe pain
  • More than 5 ulcers present
  • Ulcer greater than 1 cm diameter
  • Lasts more than 14 days
  • Recurring 6-12x per year
  • Systemic disease (HIV, inflammatory bowel disease, diabetes, TB)
  • Fever or other systemic symptoms
  • First ulcer later in life (> 30 y/o)
  • Pregnant
  • Vitamin or iron deficiency suspected
59
Q

What are the goals of therapy for aphthous ulcers?

A
  • Relieve pain
  • Decrease ulcer duration
  • Ensure normal oral function and adequate nutrition intake
  • Decrease frequency and severity of recurrences
60
Q

What are some non-pharms for aphthous ulcers?

A
  • Avoid foods that cause pain when ulcer present
  • Avoid oral trauma (use soft bristled toothbrush, oral wax on braces that rub or irritate cheek, repair irregular dental surfaces)
  • Avoid oral products w/ sodium lauryl sulfate
  • Avoid foods that may trigger a flare
  • Treat nutritional deficiencies
  • Dental hygiene
  • Warm saline rinses
61
Q

What is the OTC treatment for aphthous ulcers?

A
  • Oral analgesics - acetaminophen (NSAIDs may cause or worsen sx)
  • Protectants (hydroxypropyl cellulose, carboxymethyl cellulose)
  • Topical analgesics (camphor, menthol, phenol)
  • Local anesthetics (benzocaine 10-20%)
62
Q

How can the duration of local anesthetics be increased?

A

Combine w/ oral analgesics and protectants

63
Q

What can pharmacists prescribe for aphthous ulcers?

A

Triamcinolone 0.1% in orabase

64
Q

What are the prescription products available for aphthous ulcers that can be prescribed by doctors or dentists?

A
  • Antibiotics
  • Pain relief
  • Other agents - dapsone, colchicine, dexamethasone ointment, prednisolone, infliximab, thalidomide
65
Q

What is the benefit of traimcinolone?

A
  • Delivers protective local coating and enables local anti-inflammatory effect of the corticosteroid
  • May be helpful to speed healing and relieve sx of recurrent minor aphthous ulcers
  • Early initiation may result in a more rapid response
66
Q

What is the dosing of triamcinolone 0.1%?

A
  • Apply to ulcer 2-4 times per day until healed
  • Press small dab (~1/4 inch) to lesion until thin film develops
  • For optimal results, use only enough to coat lesion w/ a thin film and do not rub in
  • Apply at bedtime or after meals (do not eat or drink for 30 minutes after application)
67
Q

What are some side effects of triamcinolone?

A
  • Potential development of oropharyngeal candidiasis (b/c of corticosteroid)
  • Burning
  • Irritation
68
Q

What is the monitoring for aphthous ulcers?

A
  • If no significant healing in 7 days or if ulcer worsens refer
  • Refer if ulcer doesn’t heal w/in 14 days
  • Pharmacist should monitor for pain every 3 days for first week, then again in 1 week
69
Q

What is xerostomia?

A
  • Dry mouth

- Not a disease, but a manifestation secondary to a medical condition, drug, or radiation to salivary glands

70
Q

What is xerostomia usually associated w/?

A
  • Hyposalivation
  • The 2 are not synonymous b/c xerostomia is subjective but hyposalivation is objective and they don’t always occur together
71
Q

What are some complications associated w/ xerostomia?

A
  • Increase risk of dental caries
  • Tooth decay and loss
  • Difficulty speaking
  • Decreased ability to chew and swallow
  • Decreased taste sensation
  • Decreased nutritional status
  • Oral conditions (candidiasis, gingivitis)
72
Q

What are the goals of therapy for xerostomia?

A
  • Prevent complications
  • Relieve symptoms
  • Improve mouth comfort
73
Q

What are some non-pharms for dry mouth?

A
  • Dental care
  • Suck on ice chips
  • Frequent sips of water
  • Hard, sugarless candies or gum
  • Humidifier at night
  • Avoid/reduce caffeine intake
  • Avoid tobacco and alcohol
74
Q

What are some OTC products for xerostomia?

A

Salivary substitutes and lubricants (Biotene, Oral Balance, Moi-Stir, Oramoist)

75
Q

What do salivary substituents and lubricants do?

A
  • Replace moisture and provide lubrication
  • Mimic natural saliva, but do not provide all benefits of saliva
  • *Do not stimulate saliva production
76
Q

What is an advantage to Biotene products?

A

Help replace missing salivary enzyme activity in px w/ decreased saliva production

77
Q

What is gingivitis?

A
  • Chronic inflammation of gums
  • Swelling and discolouration of gums, bleeding gums when brushed
  • First stage of peridontal disease
  • Reversible!
78
Q

What causes gingivitis?

A

Build-up of bacterial plaque from insufficient brushing and flossing

79
Q

What are risk factors for gingivitis?

A
  • Medical conditions
  • Medications
  • Poor nutrition
  • Infections
  • Hormonal changes
80
Q

What is periodontitis?

A
  • Progression of gingivitis
  • Loss of connective tissue attachment => resorption of tooth-supporting bone
  • Plaque has spread to roots
  • Gums may pull away from teeth
81
Q

What are symptoms of periodontitis?

A
  • Pain
  • Bleeding of gingival tissue
  • Halitosis
  • Foul taste
  • Increased salivation
82
Q

What are the screening questions for periodontal disease?

A
  • BUG questions (bleeding gums, unsteady/loose teeth, gum recession) – yes to any = refer
  • Signs of infection, bad breath, bad taste, ulcers, pain
  • Ask when last dental visit was
83
Q

What is the pharmacological treatment for periodontal disease?

A

Chlorhexidine 0.12% (Peridex)

84
Q

What schedule is chlorhexidine?

A

1

85
Q

What does chlorhexidine do?

A

Decreased periodontal pathogens in saliva

86
Q

What is the dosing indication for chlorhexidine?

A
  • Swish and spit 10-15 mLs for 30 seconds BID

- Use 5-7 days for mild gingivitis and up to 31 days for chronic periodontitis

87
Q

What are possible side effects of chlorhexidine?

A
  • Tooth and tongue staining

- Taste disturbances

88
Q

What are some non-pharms for periodontal disease?

A
  • Adhere to daily oral hygiene practices
  • Healthy balanced diet
  • Avoid sipping or frequent intake of acidic food/drink
  • Quit smoking and decrease alcohol consumption
  • Regular dental visits

Clinical Pharmacy 1 - Term 1 (18 decks)

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