CLINICAL CARE FOR DENTAL CONDITIONS Flashcards
What would you suspect
Inflammation of the oral mucosa and gingiva.
(1) Prodromal symptoms of fever, cervical lymphadenopathy, and malaise.
(2) Numerous pin-head vesicles which rupture and ulcer on the perioral skin, vermilion
border, and oral mucosa.
(3) Severe and painful gingivitis with difficulty
eating.
(4) Occasionally through oral-genital contact with HSV-2.
Herpetic Gingivostomatitis
Oral Herpes.
True/False
Oral Herpes Treatment
Disease is usually self-limiting. Lesions heal spontaneously in 7-14 days.
True
Oral Herpes Treatment
(1) Disease is usually self-limiting. Lesions heal spontaneously in 7-14 days.
(2) Acyclovir 200-800 mg five times daily for 7-14 days may speed recovery time.
(3) Treat symptoms
(a) Hydration
(b) Systemic analgesia
(c) Antipyretics
(d) Soft bland diet
(4) Provide oral hygiene instruction
(5) MAGIC MOUTHWASH, 1:1:1 ratio of
(a) 2% viscous lidocaine
(b) Liquid diphenhydramine
(c) Kaopectate or Maalox
DDx for oral herpes
(1) Mononucleosis (Epstein-Barr virus)
(2) Herpangina (Coxsackie A virus)
(3) Necrotizing Ulcerative Gingivitis
Disposition for oral herpes
Retain. Refer to dental for cleaning if possible.
__________ is a common, mild, self-limiting re-manifestation of the Herpes Simplex virus, re-activated in immunocompromised patients.
Recurrent Herpes Simplex
What would you suspect
(1) Prodromal symptoms of pain, burning, or tingling in areas where vesicles develop.
(2) 1 – 5 mm vesicles with erythematous border that ulcer and may coalesce to form larger
scalloped ulcers.
(3) Occurs on keratinized and non-keratinized mucosa.
Recurrent Herpes Simplex
Treatment (intraoral herpes simplex)
(1) Disease is usually self-limiting. Lesions heal spontaneously in 7-14 days.
(2) Acyclovir 200-800 mg five times daily for 7-14 days may speed recovery time.
(3) Treat symptoms
(a) Systemic analgesia
(b) Hydration
(c) Antipyretics
(d) Soft bland diet
(4) Provide oral hygiene instruction
(5) MAGIC MOUTHWASH, 1:1:1 ratio of
(a) 2% viscous lidocaine
(b) Liquid diphenhydramine
(c) Kaopectate or Maalox
______________ is a common, severe, non-contagious bacterial infection of the gums with sudden onset.
Necrotizing Ulcerative Gingivitis (NUG)
Necrotizing Ulcerative Gingivitis (NUG) is also known as
“trench mouth” and “Vincent’s Angina.”
What would you suspect?
(1) Ulcerations present on dental papillae and marginal gingiva. These have a
characteristically punched-out appearance and are covered by a grey pseudo membrane.
(2) Overwhelming foul breath.
(3) Rapid onset may be accompanied by malaise or fever.
(4) Acutely painful, bleeding gingiva.
(5) Excessive salivation.
(6) Odynophagia.
(7) Regional lymphadenopathy.
NUG
Treatment for NUG
(1) Patient uses soft toothbrush to wipe teeth.
(2) Oral hygiene and nutrition instruction.
(3) Hourly rinses with warm saline or twice daily rinses with hydrogen peroxide or
chlorhexidine.
(4) Remove factors contributing to disease.
(5) After improvement in 24-48 hours, debride gently with a hand scaler or ultrasonic device.
(6) If no improvement after 48 hours:
(a) Penicillin VK 500mg qid or
(b) Erythromycin 250mg qid or
(c) Tetracycline 250mg qid
(7) MAGIC MOUTHWASH
(8) Treat symptoms
MAGIC MOUTHWASH, is a 1:1:1 ratio of
(a) 2% viscous lidocaine
(b) Liquid diphenhydramine
(c) Kaopectate or Maalox
What do you debride NUG with after After improvement in 24-48 hours?
and scaler or ultrasonic device.
Complications of NUG
(1) Necrotizing periodontitis and tooth loss.
(2) Necrotizing stomatitis.
Differential Diagnosis NUG
(1) Herpetic Gingivostomatitis.
Disposition NUG
Retain. Refer to dental if does not resolve.
______is an opportunistic fungal overgrowth of the lining of the mouth.
- White material is made up of debris, fibrin, and desquamated epithelial cells that have been invaded by yeast cells.
- Can be easily scraped off with a tongue depressor revealing erythematous and sometimes bleeding tissue.
- Can be an early warning sign of HIV/AIDS in undiagnosed patients
- May result from improper wear or cleaning of oral appliances.
Oral Candidiasis (Thrush)
Treatment for Oral Candidiasis (Thrush)
Antifungal therapy:
(a) Fluconazole 100 mg x 7 days
(b) Ketoconazole 200-400 mg x 7-14 days with breakfast.
(c) Clotrimazole troches 10 mg 5 x daily
(d) Nystatin mouth rinse TID
(2) HIV infected patients may need longer anti-fungal therapy, and require newer drugs
such as voriconzole.
(3) 0.12% chlorhexidine and half-strength hydrogen peroxide rinses.
(4) Clean dentures with Nystatin powder.
DDx for Thrush
(1) Leukoplakia.
(2) Lichen planus
(3) Geographic tongue
(4) Hairy tongue
(5) Poor oral hygiene
Disposition for thrush
Retain. Refer to dental if does not resolve.
_________ is an umbrella term for conditions
producing dysfunction of the jaw joint or pain in the jaw and face, often in or around the temporomandibular joint (TMJ), including masticatory and other muscles of the head and neck, the fascia, or both.
temporomandibular disorders (TMD)
What dis?
when jaw is opened >10 mm, a click or pop is heard or a catch is felt as the disk pops back over the head of the condyle. Usually another click is heard during closing when the condyle slips over the posterior rim of the disk and the disk slips forward.
Internal joint derangement
WHAT DIS?
often results from trauma or infection, but may be congenital or a result of RA. Chronic, painless limitation of motion occurs. When ankylosis leads to arrest of condylar growth, facial asymmetry is common.
Ankylosis
Crossbite malocclusion, facial asymmetry, and shifting of the midpoint of the chin to the unaffected side. Lower border of mandible is often convex on the affected side
Condylar hyperplasia
WHAT DIS???
Deviation of chin to affected side, elongated mandible, flatness of face on unaffected side. Malocclusion
Condular hypoplasia
WUT DIS?
Symptoms include bruxism, headaches, pain and tenderness in and around the masticatory apparatus or referred to other locations in the head and neck. Possible limitations to mobility. Placing tongue blades 2-3 thick between molars on both sides may ease symptoms when patient bites down
Myofascial pain syndrome
Benign migratory glossitis, or _________ results from changing patterns of hyperkeratosis and erythema on dorsum and edges of tongue.
geographic tongue
What would you suspect?
(1) Desquamated filiform papillae in irregular circinate pattern, often with an inflamed
center and white or yellow border.
(2) Often resembles a map, and may migrate over time.
(3) No known cause.
(4) Affects 2-3% of population.
(5) May be associated with crenated tongue.
geographic tongue
Treatment for geographic tongue
(1) No treatment. Assure patient condition is benign.
(2) Advise patients not to consume irritating foods. Patient is usually already aware of
condition.
(3) May disappear over time, but usually permanent
What DIS????
Dark, elongated filiform papillae, stained by chromeogenic microorganisms, giving the appearance of hair.
Hairy tongue
Treatment for Hairy tongue
(1) Good oral hygiene including scrubbing tongue.
(2) Resolving predisposing factors.
WHAT DIS???
(1) Soft nodule; if superficial, covered by thin epithelium; appears bluish, most common on
lips and floor of the mouth (ranula).
(2) Occurs as a result of a ruptured or obstructed minor salivary gland.
(3) Presents similar to an abscess, but often bluish or semi-translucent.
(4) Usually fluctuant, but can be firm.
(5) 1 mm to several cm.
Mucocele
Mucocele tx
(1) Some spontaneously resolve. Instruct patient to rinse with salt water 6 times a day for
several days.
(2) May require surgical removal
(3) Does not resolve with incision and drainage.
ddx for mucocele
(1) Cyst
(2) Abscess
mucocele disposition
Retain. Referral to dental
