Dental Flashcards
Avoid Tetras with who?
-2nd & 3rd TM (Pregnancy)
-Kids < 8yrs
What causes tooth aches?
-Tooth Decay
-Abscess or Infected Gums
-Damaged Fillings
-Repetitive Motions (tooth grinding, chewing gum)
Common agents given for tooth aches?
-Ace (incl. T1-T3s)
-NSAIDs (Ibu, Nap, ASA)
Common agents given for tooth aches?
-Ace (incl. T1-T3s)
-NSAIDs (Ibu, Nap, ASA)
What is the Rx daily limit for Ibu intake? OTC?
Rx: 2400mg (400-600mg Q4-6hrs)
OTC: 1200mg
Daily Rx limit for Ace intake?
4000mg (650-1000mg Q6hrs)
Topical Benzocaine… Good for pain originating from a tooth?
Nope… Only provides relief of pain if it originates from the Gums.
Teething pains are common for infants between 1-2yrs of age… What other conditions might it be?
-Ear Infection
-RSV
-Food Allergies
-Colic
What signs indicate an infant is going through teething pains?
-Extra Drooling
-Irritable
-Facial Rash
-Mild Fever
What can we give infants for teething pain?
-Teething Rings or other things to gnaw on (toys, cold facecloth, etc.)
-Topical Benzocaine (QID application & avoid feeding for 1hr after use due to throat numbing)
Name of rare, acute blood disorder associated with Topical Benzocaine (<2yrs)?
Methemoglobinemia (or “Blue Baby Syndrome”)
How does Methemoglobinemia present?
-Within mins to hrs
-1st app or repeat use
-Less O2 carrying capacity in the blood (Pale, Gray or Blue Skin & Lips)
-Can also present in adults during Surgical / Tracheal Applications
Best Topical Benzocaine product for teething?
Orajel Medicated Teething Relief
Why is Baby Orajel shit?
Lacks Benzocaine (is unmedicated… jump straight to teething rings).
1 Pharmacist prescribing scenario?
Cold Sores
What virus primarily causes cold sores?
HSV-1
What is recurrence rate for cold sores?
20-40% people (2-6 episodes / yr)
What re-activates dormant HSV-1 virus in cold sore patients?
Stress, Sunlight, Trauma
How do cold sores present?
Painful, fluid-filled sores that linger around for 7-10d
Can cold sores start in the mouth?
Yes (but canker sores can as well)
In what phase of cold sore infection are meds beneficial?
During the “Prodrome Syndrome” phase (ie. Day 1-2)… Must catch infection early.
Progression of cold sores?
Day 0.5: Tingling, Itching, Burning
Days 1-2: Blister Formation
Day 4: Blister Bursting
Days 5-8: Scab Formation
Progression of cold sores?
Day 0.5: Tingling, Itching, Burning
Days 1-2: Blister Formation
Day 4: Blister Bursting
Days 5-8: Scab Formation
Differential conditions that may present similarly to cold sores?
-Angular Cheilitis (cracking around corners of lip creases)
-Impetigo (brown, crusty lesions & painless)
What differentials can be used to distinguish cold sores from impetigo?
-Less painful
-Vesicles present within lesions themselves (occasionally w cold sores but more Impetigo)
-Age (Impetigo more common in kids)
Non-Pharmacological measures for cold sore management?
-Reduce stress
-Protect from sun
-No popping / squeezing
-Lip Balm
Is Heparin / ZnSO4 good for cold sores?
Nope… Sulfate present dries lesions out & could lead to cracking.
Propolis or Lysine good to use for cold sores?
Not therapeutically helpful
One OTC product that may actually help treat cold sores?
Docosanol
Preventative lip gel that can be used to prevent cold sores (doesn’t actually treat).
Lipivir
How does Docosanol actually help treat cold sores?
-Reduces viral entry into host cells
Application instructions for Docosanol?
-Apply at 1st sign (ie. During Prodromal Phase).
-Apply 5x / day until healed.
Given Docosanol is 2nd best topical product for cold sores, what are some other options?
Valacyclovir 2g BID (8tabs)
or
Acyclovir 5% / HC 1% crm (5x daily for 5d)
Referral cases that might present cold sore-ish would be what?
Basal / Squamous Cell infiltration with the Elderly (pre-cancerous?)
What will you say to someone who has already blistered over cold sores?
-AV’s of no use (didn’t catch early enough).
-Lip Balms & Benzocaine for numbing!
A younger patient (4yrs) comes in with his mom & presents painful sores in the mouth. She tells you he had a fever, malaise & sore throat 1.5d ago. He also presents with a light skin rash. What might be his condition?
HFM Disease
Johnny comes in with complaints of painful, white ulcers within the inside of his mouth. He is otherwise asymptomatic & healthy. What might he have?
Canker Sores (Aphthous Ulcers)
Kimmy recently went in for chemo treatments & comes to your Pharmacy complaining of internal mouth ulcers. What might she have developed from the chemo?
Stomatitis
Are Sodium Perborate or Hydrogen Peroxide rinses more effective anti-septic treatments for Canker Sores than Regular Saline?
Nope
Is Orabase Paste better than Zilactin Gel for intra-oral applications in Canker Sore treatments?
Yes, paste better (slightly better adherence to mucosal tissues but tamper pt. expectations).
Rx Therapy option for Canker Sores?
Oracort (Triamcinolone Paste)… Apply to sore HS & prn after meals.
-No healing within 7d = Referral to Dentist or MD.
What does Oral Thrush (C. albicans) sometimes present as in young babies?
Milk Residue (wipes off much easier though… C. albicans much grabbier).
How does Thrush present?
-Creamy white lesions along tongue or cheek
-Painful or burning sensation
-Slight bleeding when scraped
-Potential accompanying diaper rash (infants)
Predispositions for Oral Thrush infections?
-Disease States (DM / HIV / Anemia / Leukemia / Xerostomia)
-Meds (ICS / BS AB’s / Chemo)
-Poor Oral Hygiene, Dentures, Babies…
If I wanted a Holistic fix for Oral Thrush for my baby, what product might I try?
Gentian Violet 1% Sol’n (very messy)
NO LONGER ON MARKET!!!
Rx Therapy for Oral Thrush?
Nystatin Oral Suspension… Typically relief in 1-2d but carry out therapy for 4-7d to prevent relapse.
<1yr: 100-200 000 U applied QID
> 1yr: 500 000 U applied QID
Secondary Rx Therapies for Oral Thrush?
Miconazole & Fluconazole (MD Prescription)
Xerostomia is commonly seen with what pt. demographic?
Elderly
Other causes of dry mouth?
-Radiation / Chemo
-Mouth Breathing
-Chronic Disease
-Meds (ie. TCA’s / 1st gen AH’s / Opioids)
-Anxiety / Dehydration / Viral Infections
Pharmacological agents to treat Xerostomia?
Saliva Subs (Moi-Stir, Oralbalance, Biotene)
What medications can potentially induce Gingivitis?
-Phenytoin
-Cyclosporine
-Ca2+ Channel Blockers
Name of condition associated with clicking or popping sounds & pain or discomfort around the jaw joint?
TMJ
