Dental Care and Mouth Conditions Flashcards
Teething
pathophys
how many complete permanent teeth do adults have?
- Around 6 months lower central incisors erupt first
- Continue to 2-3 years of age
- 5-6 start to fall out
32 teeth
- 4 incisors
- 2 canines
- 4 premolars
- 6 molars in each arch
Teething
symptoms
2/3 of children experience
- gingival irritation (87%)
- irritability (68%) and drooling (56%)
- a decrease in appetite for solid food
- an increase in thirst
- a mild increase in body temperature (up to 37.7°C)
- loose stools
- ear rubbing and nasal congestion
Symptoms may appear up to 4 days prior to tooth eruption and resolve 3 days post eruption
Teething
Non-pharm
- chew and bite on a frozen face cloth or coolted teether
- rubbing with back of cold spoon
- avoid long term contact with very cold items
- teething biscuits not recommended (sugar) and amber necklaces lack evidence
Teething
Pharm
- Oral analgesics (e.g., acetaminophen or ibuprofen) can be used
Dental Care
when to brush teeth?
when to see dentists
Brush teeth after every meal and at bedtime (with toothpaste)
- soft bristles, replace every 3 months
- powered toothbrushes are better
- See Dentist/Dental Hygienist q 6 months
- The Canadian Dental Association recommends dental assessments for infants within 6 months of the first tooth erupting and at least by the age of 1 year
Dental Care
Dentifrices (toothpaste) functions (4)
- minimize plaque and tartar
- strengthen enamel with dluoride
- remove stains
- freshens mouth
- look for Canadian Dental Association seal
mouthwashes suggested as an adjunct
Chlorhexidine is common prescription dispensed used once or twice daily
can cause staining, discoloration, taste disturbances
Dental Care
Fluoride function?
what happens with excess intake (4)
- Locally reduces demineralization and promoting remineralization of early caries
- children < 3 rice sized amount, 3-6, pea- sized amount
- Most toothpastes contain 0.243%
- excess leads to Gastric distress, headache, weakness, can cause skeletal fluorosis (joint pain)
Aphthous Ulcers/Canker sores
describe (1)
greater freq in who?
inflammatory, non-infectious lesions
- Can be painful, leading to difficulties eating, speaking, and swallowing
- 50% of indiv have recurrences
- Greater frequency of occurrence in those aged <40, female sex, family history, and higher socioeconomic class
- freq and severity decreases with age
Aphthous Ulcers/Canker sores
pathophys (1)
unknown cause, multifactorial
potential risk factors: local trauma, stress, allergies, genetic, systemic disease, hormone change, preservatives, NSAIDs, nutritional deficiencies, foods (chocolate, coffee, strawberries, tomatoes, citrus)
Aphthous Ulcers/Canker sores
Minor aphthae (70-87%)
- describe characteristics
- location
- Single or multiple (1-5) lesions with whitish-grey pseudomebraneous centers,
erythromatous halos, and defined, raised margins - Commonly <1cm in size
- Found on lips, cheeks, under the tongue, floor of mouth, or soft palate
- Localized discomfort may precede appearance of lesion(s)
- Usually heal spontaneously within 7-10 days without scarring
Aphthous Ulcers/Canker sores
Major aphthae (7-20%)
- describe characteristics
- location
- Similar in appearance to minor aphthae, but are more severe, numerous (1-10), and larger in size (>1cm).
- Can be found on the salivary glands and throat (and therefore make swallowing
difficult) - Common in patients infected with HIV
- Can persist for weeks or months and often scar
Aphthous Ulcers/Canker sores
Herpetiform aphthae (5-10%)
- describe characteristics
- location
- Multiple clusters of pinpoint ulcers that may coalesce into a widespread, irregular
lesion (2-3mm in diameter but 10-100 in number) - Usually heal in 7-30 days and may scar
- More common in women and have a later age of onset
Aphthous Ulcers/Canker sores
Other conditions with similar presentation (name a few)
Fever, vesicles, lesions elsewhere on the body, or other systemic symptoms (e.g., diarrhea) may indicate \_\_\_\_\_\_\_?
- infections, GI disease (Crohn’s), autoimmune (lupus), vit deficiencies (iron, folate, B-vitamins), cancer/pre-cancerous lesions (white thickened patches on the oral mucosa may indicate pre-cancerous lesions associated with tobacco use)
non-oral issue from other conditions
Aphthous Ulcers/Canker sores
Red Flags
size, duration, number
- Pain is debilitating Ulcer size > 1 cm Duration > 14 days > 5 ulcers present Multiple clusters that are coalescing Reoccurring history (6-12 times/year) of ulcers that last > 14 days and scar Systemic symptoms present Ulcers on gums or hard palate Immunocompromised (e.g. HIV) Ulcers and blisters present on other parts of the body (e.g. skin, eye, genitalia)
Aphthous Ulcers/Canker sores
Goals of Therapy (5)
- Control local pain Reduce duration of ulcers Restore normal oral function Ensure adequate food and fluid intake Decrease frequency and severity of recurrences
Aphthous Ulcers/Canker sores
Non-pharm treatment (4)
Avoid foods which cause pain
- e.g. hard or salty foods
Address sources of oral trauma
- e.g., use soft toothbrushes, fit dentures properly
Maintain regular daily oral hygiene
Cleanse mouth with salt and water
- Dissolve ½ to 1 teaspoonful of table salt in 250mL warm water. Rinse / swish after each meal.
Aphthous Ulcers/Canker sores
pharm treatment (3 types)
(first 3)
Protectants
- Hydroxypropyl cellulose or carboxymethyl cellulose patches placed over lesions may provide pain relief and protection during healing
Local anaesthetics
- Benzocaine or lidocaine applied with a finger or cotton swab QID (or more often) provides temporary pain relief
- Should be used cautiously or avoided in children <2 due to risk choking and increased absorption leading to methemoglobinemia.
Systemic therapy (OTC or prescription)
- Aside from acetaminophen for pain relief, reserve for severe cases, or those due to underlying conditions
- Colchicine, montelukast, dapsone, infliximab, thalidomide
