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PHAR154 > Dental Health > Flashcards

Dental Health Flashcards

1
Q

What is the association between tetracyclines and teeth?

A

tetracyclines deposit in teeth
-not to be used in 2nd or 3rd trimester of pregnancy
-not to be used in kids younger than 8 (developing teeth)

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2
Q

What are the possible causes of toothache?

A

tooth decay
abscess/infected gums
damaged filling
repetitive motions (chewing gum, Bruxism)

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3
Q

What is Bruxism?

A

teeth grinding at night

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4
Q

What are the red flags for tooth ache?

A

fever
pus
swelling
headache

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5
Q

What are the OTC analgesics for toothache?

A

acetaminophen (including T1s-T3s)
-T1s are pharm prescribing territory, T3s are MD territory
NSAIDs (ibuprofen, naproxen, ASA)
-go ibu or naproxen

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6
Q

What is the max OTC dose of ibuprofen?

A

1200mg

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7
Q

Would you go for the acet(250mg)+ibu(125mg) 2 caplets Q8H combo product for a tootache?

A

no
go for separate products, the combo product is pretty subtherapeutic

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8
Q

Aside from analgesics, what are OTC treatments for toothache?

A

heat or cold packs (outside on cheek)
topical benzocaine
clove oil (questionable value)

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9
Q

For a toothache, where does the pain have to originate for benzocaine to provide relief?

A

the gums

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10
Q

True or false: if the pain of a toothache originates on a tooth then benzocaine will provide great relief

A

false
zero value for benzocaine if pain originates on teeth

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11
Q

What is the best strength of benzocaine for a toothache?

A

we dont care about the strength

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12
Q

What is the order of tooth appearance during teething?

A

6-10 months: bottom middle teeth (lower central incisors)
8-12 months: upper middle teeth (upper central incisors)
25-33 months: rear molars (upper second molar)

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13
Q

Which teeth tend to be easier on the baby during teething? Which are harder on the baby?

A

easier: upper and lower central incisors
hard on baby: molars

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14
Q

What is a non-pharmacological option for teething pain?

A

teething rings
-or stuff that acts like a teething ring (toys, cold facecloth)

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15
Q

What is a pharmacological option for teething pain?

A

oral analgesics
topical benzocaine 7.5-10%
-grape and other flavours

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16
Q

What are the directions for use of topical benzocaine for teething pain?

A

apply thin layer to gums up to QID
avoid feeding for 1 hour after use

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17
Q

How long does the effect of topical benzocaine last for teething pain?

A

30-45min

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18
Q

What is the age recommendation for topical benzocaine?

A

not recommended for children under 2 years old
-original concern=disabled gag reflex if swallowed
-new concern=rare, acute blood disorder

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19
Q

What is the rare disorder that got linked to topical benzocaine?

A

methemoglobinemia
-less oxygen-carrying capacity of blood

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20
Q

What are the symptoms of methemoglobinemia?

A

pale, gray, blue skin or lips, SOB, fatigue

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21
Q

How long does it take for the symptoms of methemoglobinemia to appear after use of topical benzocaine?

A

minutes to hours of use
after first application or repeated use

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22
Q

True or false: methemoglobinemia is most commonly seen in adults, and is rare in infants

A

false
vice versa

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23
Q

What will you recommend for an infant younger than 2 years who is experiencing teething pain?

A

teething ring (remember the age guideline for benzocaine)

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24
Q

What is the primary cause of cold sores?

A

HSV-1

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25
Q

How are cold sores transmitted?

A

direct contact

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26
Q

How do cold sores appear?

A

virus lies latent in facial nerve pathways
-reactivated by stress, sunlight, trauma
-most of us are HSV positive by early adulthood

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27
Q

What percent of people experience recurring cold sores (2-6 per year)?

A

20-40%

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28
Q

What are the symptoms of cold sores?

A

ranges from asymptomatic to painful fluid-filled sores

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29
Q

How long do the symptoms of cold sores last?

A

7-10 days

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30
Q

Where do cold sores appear?

A

lips or even around nostrils
they can start in the mouth

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31
Q

What is the prodrome phase of a cold sore?

A

a tingling, itching, or burning feeling roughly half a day before the cold sore appears
-critical to treatment

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32
Q

Explain the progression of cold sores.

A

~1/2 day: prodrome phase (itching, tingling, burning)
1-2 days after tingle: cold sore appears
day 4: blister bursts
days 5-8: scab formation

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33
Q

What is the condition we are most likely to mix-up with a cold sore?

A

impetigo

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34
Q

What are some characteristics of impetigo that can help us differentiate it from a cold sore?

A

impetigo is:
-common
-less painful
-clears within 2 weeks
-forms yellow crust

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35
Q

What is the time period we should be concerned about a lesion on the lips?

A

2-3 weeks
-maybe BCC or SCC

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36
Q

What are non-drug treatments of cold sores?

A

reduce stress (pretty hard to do)
protect from sun
dont pop or squeeze
lip balm (to keep soft)

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37
Q

Of the many OTC topicals, which one might actually do something for the cold sore?

A

docosanol

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38
Q

What is the value of the following for cold sores: docosanol, heparin/ZnSO4, benzocaine, Propolis, benzoyl alcohol, camphor/phenol, lysine, ice

A

docosanol: some effect
heparin/ZnSO4: zinc is drying, heparin is no value
benzocaine: anesthetic, can be helpful
propolis: from bees and likely unhelpful
benzoyl alcohol: might be drying
camphor/phenol: mild anesthetics
lysine: amino acid with iffy value
ice: anti-inflammatory and can be helpful

39
Q

What is the product that is a non-medicated patch that can cover up cold sores?

A

Abreva Conceal
-very slight therapeutic effect

40
Q

What is lipivir?

A

non-drug, simply an emollient
prevents cold sore outbreaks, not actual cases
has to be used all the time

41
Q

How does docosanol work?

A

helps reduce viral entry into host cell
-may reduce how symptomatic you are

42
Q

What are the directions for use of docosanol?

A

has to be applied at first sign of cold sore (prodromal tingling)
apply to lesion 5x/day until healed
can use Qtip for application to prevent autoinoculation

43
Q

How effective is docosanol (based off the fine print)?

A

not overly effective
improved healing time from 4.8 days to 4.1 days (0.7 day improvement)

44
Q

What is the most common condition pharmacists prescribe for?

A

cold sores

45
Q

When must oral antivirals be started for a cold sore?

A

before lesions appear (generally 1-2 hours of onset of prodromal symptoms)

46
Q

What can we prescribe for cold sores?

A

valacyclovir 2g BID for 2 doses
-comes as 500mg tabs
acyclovir 5%/hydrocortisone 1% crm applied 5x/day for 5 days

47
Q

What is the efficacy of oral antivirals for cold sores?

A

faster healing by 1-2 days

48
Q

What is the efficacy of acyclovir/HC cream for cold sores?

A

improved healing time by 1/2 day
lesions about 50% smaller

49
Q

When must the acyclovir/HC cream be started for cold sores?

A

at the earliest sign of cold sore

50
Q

True or false: the hydrocortisone component of Xerese impairs the antiviral properties

A

false
hydrocortisone is a valuable addition, reduces swelling

51
Q

At what point is prophylaxis considered to have value for cold sores?

A

6 lesions per year

52
Q

What are apthous ulcers?

A

canker sores

53
Q

What is the appearance of canker sores?

A

white or cream-colored lesion within red/inflamed borders
painful

54
Q

What is the etiology of canker sores?

A

unknown etiology, could be factors like:
-local trauma
-stress
-allergies
-nutritional deficiencies
-medicines

55
Q

What are the symptoms of HFM?

A

begins with fever, malaise, sore throat
1-2 days after fever, painful sores in mouth
skin rash develops after 1-2 days
generally happens once

56
Q

What is a mucocele?

A

cyst-like lesion that forms on the lower lip
generally painless

57
Q

What are some conditions to keep in mind when a patient presents with what appears to be a canker sore?

A

drug-induced ulcers (NSAIDs, beta-blockers, cytotoxic agents)
stomatitis (radiation or chemotherapy)
mouth cancer

58
Q

What is a non-pharmacological treatment for canker sores?

A

rinse with salt water several times a day (esp after meals)
-other mouth rinses such as hydrogen peroxide are not more
effective

59
Q

What is the pharmacological treatment for canker sores?

A

benzocaine

60
Q

What is the directions for use of benzocaine for canker sores?

A

apply to lesion for short term pain relief (30-45min)
can be used in combo with oral analgesics

61
Q

What is Magic Mouthwash?

A

solution of milk of magnesia and diphenhydramine for canker sores
dph might anesthetize lesion

62
Q

What are the protectants for canker sores?

A

zilactin
orabase
-have low expectations, concern over adhesion

63
Q

True or false: styptic sticks are great for canker sores

A

false

64
Q

What is a prescription therapy for canker sores?

A

Oracort paste (triamcinolone)

65
Q

What are the directions for use of triamcinolone for canker sores?

A

apply small amount to sore at bedtime and prn after meals
dab it over until smooth/slippery
do not rub it

66
Q

When do you refer someone using triamcinolone for a canker sore to an MD/dentist?

A

if no significant healing in 7 days

67
Q

Which organism causes oral thrush?

A

c.albicans
-opportunistic fungal infection

68
Q

What are the symptoms of oral thrush?

A

creamy white lesions along tongue or cheek
can be painful or burning sensation
may bleed when scrapped
does not easily wipe off

69
Q

What is the association between oral thrush and diaper rash?

A

if both are present, then its almost guaranteed that the diaper rash is infected

70
Q

What are the risk factors for oral thrush?

A

disease states (DM, HIV, anemia, leukemia, xerostomia)
medications (ICS, antibiotics, chemotherapy, immunosupps)
other (poor oral hygiene, dentures, babies)

71
Q

For asthmatics, seniors, and babies, what are steps to help prevent oral thrush?

A

asthamtics: improved on ICS use (spacer, gargling post-use)
seniors: clean dentures overnight
babies: cleaner pacifiers, clean bottles

72
Q

What is the place in therapy of gentian violet 1% solution for oral thrush?

A

taken off market due to questions on safety
effective
low compliance due to mess
causes mucosal irritation
if breastfeeding, treat mom too

73
Q

What is the verdict on using probiotics to prevent thrush?

A

we dont know which species to use
thus, dont get it into this with patients

74
Q

What is the drug of choice for thrush?

A

nystatin (Rx)

75
Q

What is the dosing and instructions of nystatin for infants up to 1 yr for oral thrush? What is the dosing for children?

A

infants up to 1 yo: 100,000-200,000U suspension QID
sweep around mouth area with Q-tip
children: 500,000U suspension QID
retain in mouth as long as possible, then
swallow

76
Q

How long does it take for nystatin to give relief from oral thrush? Should it be used after the thrush is cured?

A

relief in 24-48 hours
continue for 48 hours after cure to prevent relapse (typically 7d)

77
Q

Would you prescribe nystatin for a low-birth weight baby?

A

no
get MD involved

78
Q

Describe the efficacy of nystatin for thrush.

A

well tolerated
doesnt interact with other medications (minimal systemic absorption)
short contact time limits its efficacy but still DOC

79
Q

What are secondary choices that an MD may prescribe for thrush?

A

miconazole
fluconazole

80
Q

What is xerostomia?

A

dry mouth

81
Q

Which group of patients are commonly effected by xerostomia?

A

eldery

82
Q

What are the many functions of saliva?

A

re-mineralize the teeth
lubricates oral mucosa
local antimicrobial activity
part of taste sensation

83
Q

What are some of the causes of xerostomia?

A

radiation/chemo
mouth-breathing (terminally ill, allergic rhinitis)
chronic disease (HIV, Alzheimers)
medications (diuretics, TCAs, 1st gen AH, opioids)
short-term causes (anxiety, dehydration, viral infections)

84
Q

What are non-pharmacological treatments of xerostomia? Why should you be careful with these suggestions?

A

sipping water
sugar-free gum, hard candies
humidifier during sleep
be careful, they probably already tried these

85
Q

What are the pharmacological treatments of xerostomia?

A

saliva substitutes (Moi-Stir, Oralbalance, Biotene)
-trial and error
-short duration of action (due to swallowing)
-cant completely replicate saliva, but has to be tried

86
Q

What is angular cheilitis?

A

erythematous fissures at the angles of the mouth
pain in the corners of the mouth

87
Q

What are some good questions when trying to differentiate between angular cheilitis and a cold sore?

A

any tingling?
any prodrome symptoms?

88
Q

What are the symptoms of angular cheilitis?

A

swelling or cracking at the corners of the lips
pain and burning at the corners of the mouth

89
Q

What is gingivitis?

A

gums become red, swollen, bleed easily (esp during brushing and eating)

90
Q

What can untreated gingivitis result in?

A

periodontitis

91
Q

What are the causes of gingivitis?

A

most common=inadequate brushing/flossing–>plaque/tartar
medical disorders
medications (in most cases can be avoided with good hygiene)
tobacco

92
Q

Which drug is most commonly associated to gingivitis?

A

phenytoin

93
Q

What is TMJ?

A

clicking, popping sounds in jaw joint
pain and discomfort (temporary or chronic)
most commonly between 20-40 yr olds

PHAR154 (18 decks)

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