9. Mucosal ulceration and inflammation Flashcards
What can be used to provide temporary relief in mucosal ulceration and inflammation?
Topical, symptomatic therapy involves simple mouthwashes, antimicrobial mouth washes, local analgesics and topical corticosteroids.
What should you do if any ulcer persists for more than three weeks?
Must refer for biopsy
What simple mouthwashes can be used for mucosal ulceration and inflammation?
- Rinse mouth with salt solution prepared by dissolving half a teaspoon of salt in a glass of warm water to relieve pain and swelling.
- Alternative: compound sodium chloride mouthwash made with warm water.
How can you prescribe sodium chloride mouthwash for mucosal ulceration and inflammation?
Sodium chloride mouthwash, compound.
Send: 300ml
Label: Dilute with an equal volume of warm water
NB: advise pt to spit out mouthwash after rinsing.
What do antimicrobial mouthwashes do for mucosal ulceration and inflammation?
Antimicrobial mouthwashes can reduce secondary infection and are particularly useful when pain limits other oral hygiene measures.
What antimicrobial mouthwashes are available?
- Chlorhexidine mouthwash - 0.2% - rinse mouth for 1 minute with 10ml twice daily.
- Hydrogen peroxide mouthwash - 6% - rinse for 2 minutes with 15ml diluted in half a glass of warm water three times daily.
What advise should be given to pts with chlorhexidine mouthwash for mucosal inflammation/swelling? (3)
Advise pt to spit out mouthwash after rinsing and use until lesions have resolved and patient can carry out good oral hygiene.
Chlorhexidine gluconate might be incompatible with some ingredients in toothpaste; advise pt to leave an interval of at least 30 minutes between mouthwash and toothpaste.
Advise pt that chlorhexidine MW can be diluted 1:1 with water with no loss in efficacy.
What advise do you give to a patient with hydrogen peroxide mouthwash, 6%?
Advise pt to spit out MW after rinsing, and use until lesions have resolved and patient can carry out good oral hygiene.
Hydrogen peroxide mouthwash can be used as a rinse for up to 3 minutes, if required.
When is a tetracycline mouthwash useful?
A tetracycline mouthwash is effective in some patients with recurrent aphthous stomatitis. Doxycycline can be used as a rinse and is usually given for three days. Enough medication to treat several episodes of ulceration can be provided.
What is an appropriate prescription of doxycycline mouthwash in a patient with recurrent aphthous stomatitis?
Doxycycline dispersible tablets, 100mg. 1 tablet to be dissolved in water and rinsed around the mouth for 2 minutes 4x/day for 3 days at the onset of ulceration.
Advise pt to spit out mouthwash after rinsing.
In what pts do you need to be cautious when prescribing doxycycline tablets for mouthwash?
Use with caution in patients with hepatic impairment or those receiving potentially hepatotoxic drugs.
In which patient do you not prescribe doxycycline tablets for mouth wash?
- Pregnant women
- Nursing mothers
- Children under 12 years, as it can deposit on growing bone and teeth (by binding to calcium) and cause staining, and occasionally, dental hypoplasia.
- The anticoagulant effect of warfarin might be enhanced by doxycycline.
Why is doxycycline not recommended for children under 12?
It causes intrinsic staining of developing teeth.
How effective are local analgesics in relieving pain for mucosal ulceration and inflammation?
Local analgesics can’t relieve pain continuously, but are helpful in severe pain (e.g. major apthae) to enable eating or sleeping.
What local analgesics can be prescribed for mucosal ulceration and inflammation? (4)
- Benzydamine hydrochloride mouthwash, 0.15%. (Difflam) Rinse or gargle 15ml every 1.5 hours PRN.
- Benzydamine hydrochloride spray 0.15%. (Difflam). 4 sprays to affected area every 1.5 hours.
- Lidocaine ointment, 5%. Rub sparingly and gently onto affected area.
- Lidocaine spray, 10%. Apply as necessary with a cotton bud.
How can benzydamine mouthwash be prescribed for mucosal ulceration and inflammation?
Benzydamine hydrochloride mouthwash, 0.15%
Send: 300ml
Label: Rinse or gargle using 15ml every 1.5 hours as required.
What advice should be given for benzydamine mouthwash, 0.15%?
Advise pt that benzydamine mouthwash can be diluted with an equal volume of water if stinging occurs.
Advise patient to spit out mouthwash after rinsing.
The mouthwash is usually given for not more than 7 days.
In which age groups can benzydamine mouthwash 0.15% be used?
Adults
13-17 years - as for adults
<=12 years - not recommended for use because of local anaesthetic properties.
How can benzydamine oromucosal spray, 0.15% be prescribed?
Benzydamine hydrochloride oromucosal spray, 0.15%.
Send: 30ml
Label: 4 sprays onto affected area every 1.5 hours.
In adults and children of 12 years and over, up to 8 sprays of benzydamine oromucosal spray can be applied at any one time.
Can be used in children
Can benzydamine oromucosal spray, 0.15% be used in children?
Yes!
6 months - 5 years = 1 spray per 4 kg body-weight (max. 4 sprays) every 1.5 hours.
6-17 years - 4 sprays every 1.5 hours.
How can you prescribe lidocaine ointment, 5%?
Lidocaine ointment, 5%.
Rub sparingly and gently on affected areas.
Advise pt to take care when the application to avoid producing anaesthesia of the pharynx before meals as this might lead to choking.
What advise should be given to a patient with lidocaine ointment, 5%?
Advise pt to take care with the application to avoid producing anaesthesia of the pharynx before meals as this might lead to choking.
Can Lidocaine ointment, 5% be prescribed for children?
Yes - instructions as for adults
How can you prescribe lidocaine spray, 10%?
Lidocaine spray, 10%
Apply as necessary with a cotton bud.
What advise should you give to pts with lidocaine spray, 10%?
Advise pt to take care with the application to avoid producing anaesthesia of the pharynx before meals as this might lead to choking.
Can lidocaine spray, 10% be prescribed for children?
Yes - as for adults
What 3 types of topical corticosteroids can be prescribed to treat mucosal ulceration and inflammation?
- Clenil Modulite, 50 micrograms/metered inhalation (beclometasone diproprionate). 1-2 puffs directed onto ulcers, 2x/day.
- Betamethasone soluble tablets, 500 micrograms. (Betnesol). 1 tablet dissolved in 10ml water as a mouthwash.
- Hydrocortisone oromucosal tablets 2.5mg. 1 tablet dissolved next to lesion 4 times daily.
How can the topical corticosteroid beclometasone dipropionate inhaler be prescribed for mucosal ulceration and inflammation?
Clenil Modulite (Beclometasone dipropionate), 50 micrograms/metered inhalation.
1-2 puffs directed onto ulcers twice daily.
Can be used in children 2+ as for adults.
How can the topical corticosteroid betamethasone soluble tablets be prescribed for mucosal ulceration and inflammation?
Betamethasone soluble tablets, 500 micrograms. (Betnesol)
1 tablet dissolved in 10ml water as a mouthwash four times daily.
Advise pt to spit out MW after rinsing.
Can be used in children 12+ - as for adults.
(<12 years not appropriate for use because of risk of swallowing)
How can the topical corticosteroid, hydrocortisone oromucosal tablets be prescribed for mucosal ulceration and inflammation?
Hydrocortisone Oromucosal Tablets, 2.5mg.
1 tablet dissolved next to lesion four times daily.
<12 prescribe only on medical advise.
> = 12 - as for adults.
