CLINICAL CARE FOR DENTAL CONDITIONS

Question 1

What Dx/Tx/Disp
A common, mild, self-limiting, viral infection of the
mouth.
-Prodromal symptoms of fever, cervical lymphadenopathy, and malaise.
-Numerous pin-head vesicles which rupture and ulcer on the perioral skin, vermilion
border, and oral mucosa.
-Severe and painful gingivitis with difficulty eating.

Answer 1

Primary Herpetic Gingivostomatitis
Tx
(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
DISP
Retain. Refer to dental for cleaning if possible.

Question 2

What Dx/Tx/Disp
A common, mild, self-limiting re-manifestation of the Herpes Simplex virus, re-activated in immunocompromised patients.
-Prodromal symptoms of pain, burning, or tingling in areas where vesicles develop.
-1 – 5 mm vesicles with erythematous border that ulcer and may coalesce to form larger
scalloped ulcers.
-Occurs on keratinized and non-keratinized mucosa.

Answer 2

Recurrent Herpes Simplex
Tx
(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
DISP
Retain.

Question 3

What Tx/Dx

• May have prodrome of itching, tingling, or burning at blister sites.
• Primarily found on vermillion border and/or commissure of lips.
• May present on facial epidermis surrounding oral cavity and nose
• Pain usually only present first 2 days, but may be acute for 5.
• Presents as papules, that become pustular and ulcerate before scabbing.

Answer 3

Herpes Labialis (Recurrent Herpes Simplex)
Tx
-Disease is usually self-limiting. Lesions heal spontaneously in 7-14 days.
-Topical Antivirals at first sign of prodrome or lesion
-Systemic Antivirals
-Symptomatic Tx
-Ice
-Warm cloth
-OTC creams
-NSAID

Question 4

What Dx/Tx/Disp
A common, severe, non-contagious bacterial
infection of the gums with sudden onset.
(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.

Answer 4

Necrotizing Ulcerative Gingivitis (NUG)
-Also known as “trench mouth” and “Vincent’s Angina.”
Tx
(1) Patient uses soft toothbrush to wipe teeth.
(2) Oral hygiene and nutrition instruction.
(3) QH rinses with warm saline or BID 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) MAGIC MOUTHWASH
(7) Treat symptoms
If no improvement after 48 hours: Antibiotics
DISP
Retain

Question 5

What Dx/Tx/Disp
An opportunistic fungal overgrowth of the lining of the mouth
-Caused by Candida albicans, part of the normal oral flora, and is an opportunistic yeast/fungus.
-May result from improper wear or cleaning of oral appliances
-Can be an early warning sign of HIV/AIDS in undiagnosed patients
PE findings
(1) Wet preparation using potassium hydroxide will reveal spores and may show non-septate
mycelia. Biopsy will show intraepithelial pseudomycelia
(2) White “curdled milk” or “cottage cheese” like build up on dorsum of tongue, soft palate, or oropharynx.
(3) Can be easily scraped off with a tongue depressor revealing erythematous and sometimes bleeding tissue.
(4) Higher concentration under appliances.
(5) May present on commissure of lips and cause angular cheilitis.
(6) Uncommon symptoms:
(a) Pain, may feel like burning.
(b) Dysphagia and hoarseness of voice.
(c) Metallic, acidic, salty, or bitter taste.

Answer 5

Oral Candidiasis (Thrush)
Tx
(1) 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.
Disposition
Retain. Refer to dental if does not resolve.

Question 6

What Dx/Tx

• ¼ to 6mm round ulcerations with yellow-gray fibrinoid centers surrounded by red halos, found on non-keratinized tissue
• Manifests after malnutrition, disease, trauma, or stress.
• May have prodrome of burning or itching. Painful, especially when aggravated by physical contact or spicy food

Answer 6

Aphthous ulcers are commonly known as “canker sores” and also known as Recurrent Aphthous Stomatitis (RAS).
Tx
(1) Self healing, 10-14 days.
(2) Treatment is nonspecific, and aimed at treating symptoms.
(3) Topical corticosteroids in an adhesive base do appear to provide symptomatic relief:
(a) triamcinolone acetonide, 0.1%
(b) fluocinonide ointment, 0.05%
(4) Thalidomide has been used selectively in recurrent aphthous ulcerations in HIV-positive
patients.