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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
How are cold sores transmitted?
direct contact
26
How do cold sores appear?
virus lies latent in facial nerve pathways -reactivated by stress, sunlight, trauma -most of us are HSV positive by early adulthood
27
What percent of people experience recurring cold sores (2-6 per year)?
20-40%
28
What are the symptoms of cold sores?
ranges from asymptomatic to painful fluid-filled sores
29
How long do the symptoms of cold sores last?
7-10 days
30
Where do cold sores appear?
lips or even around nostrils they can start in the mouth
31
What is the prodrome phase of a cold sore?
a tingling, itching, or burning feeling roughly half a day before the cold sore appears -critical to treatment
32
Explain the progression of cold sores.
~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
33
What is the condition we are most likely to mix-up with a cold sore?
impetigo
34
What are some characteristics of impetigo that can help us differentiate it from a cold sore?
impetigo is: -common -less painful -clears within 2 weeks -forms yellow crust
35
What is the time period we should be concerned about a lesion on the lips?
2-3 weeks -maybe BCC or SCC
36
What are non-drug treatments of cold sores?
reduce stress (pretty hard to do) protect from sun dont pop or squeeze lip balm (to keep soft)
37
Of the many OTC topicals, which one might actually do something for the cold sore?
docosanol
38
What is the value of the following for cold sores: docosanol, heparin/ZnSO4, benzocaine, Propolis, benzoyl alcohol, camphor/phenol, lysine, ice
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
What is the product that is a non-medicated patch that can cover up cold sores?
Abreva Conceal -very slight therapeutic effect
40
What is lipivir?
non-drug, simply an emollient prevents cold sore outbreaks, not actual cases has to be used all the time
41
How does docosanol work?
helps reduce viral entry into host cell -may reduce how symptomatic you are
42
What are the directions for use of docosanol?
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
How effective is docosanol (based off the fine print)?
not overly effective improved healing time from 4.8 days to 4.1 days (0.7 day improvement)
44
What is the most common condition pharmacists prescribe for?
cold sores
45
When must oral antivirals be started for a cold sore?
before lesions appear (generally 1-2 hours of onset of prodromal symptoms)
46
What can we prescribe for cold sores?
valacyclovir 2g BID for 2 doses -comes as 500mg tabs acyclovir 5%/hydrocortisone 1% crm applied 5x/day for 5 days
47
What is the efficacy of oral antivirals for cold sores?
faster healing by 1-2 days
48
What is the efficacy of acyclovir/HC cream for cold sores?
improved healing time by 1/2 day lesions about 50% smaller
49
When must the acyclovir/HC cream be started for cold sores?
at the earliest sign of cold sore
50
True or false: the hydrocortisone component of Xerese impairs the antiviral properties
false hydrocortisone is a valuable addition, reduces swelling
51
At what point is prophylaxis considered to have value for cold sores?
6 lesions per year
52
What are apthous ulcers?
canker sores
53
What is the appearance of canker sores?
white or cream-colored lesion within red/inflamed borders painful
54
What is the etiology of canker sores?
unknown etiology, could be factors like: -local trauma -stress -allergies -nutritional deficiencies -medicines
55
What are the symptoms of HFM?
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
What is a mucocele?
cyst-like lesion that forms on the lower lip generally painless
57
What are some conditions to keep in mind when a patient presents with what appears to be a canker sore?
drug-induced ulcers (NSAIDs, beta-blockers, cytotoxic agents) stomatitis (radiation or chemotherapy) mouth cancer
58
What is a non-pharmacological treatment for canker sores?
rinse with salt water several times a day (esp after meals) -other mouth rinses such as hydrogen peroxide are not more effective
59
What is the pharmacological treatment for canker sores?
benzocaine
60
What is the directions for use of benzocaine for canker sores?
apply to lesion for short term pain relief (30-45min) can be used in combo with oral analgesics
61
What is Magic Mouthwash?
solution of milk of magnesia and diphenhydramine for canker sores dph might anesthetize lesion
62
What are the protectants for canker sores?
zilactin orabase -have low expectations, concern over adhesion
63
True or false: styptic sticks are great for canker sores
false
64
What is a prescription therapy for canker sores?
Oracort paste (triamcinolone)
65
What are the directions for use of triamcinolone for canker sores?
apply small amount to sore at bedtime and prn after meals dab it over until smooth/slippery do not rub it
66
When do you refer someone using triamcinolone for a canker sore to an MD/dentist?
if no significant healing in 7 days
67
Which organism causes oral thrush?
c.albicans -opportunistic fungal infection
68
What are the symptoms of oral thrush?
creamy white lesions along tongue or cheek can be painful or burning sensation may bleed when scrapped does not easily wipe off
69
What is the association between oral thrush and diaper rash?
if both are present, then its almost guaranteed that the diaper rash is infected
70
What are the risk factors for oral thrush?
disease states (DM, HIV, anemia, leukemia, xerostomia) medications (ICS, antibiotics, chemotherapy, immunosupps) other (poor oral hygiene, dentures, babies)
71
For asthmatics, seniors, and babies, what are steps to help prevent oral thrush?
asthamtics: improved on ICS use (spacer, gargling post-use) seniors: clean dentures overnight babies: cleaner pacifiers, clean bottles
72
What is the place in therapy of gentian violet 1% solution for oral thrush?
*taken off market due to questions on safety* effective low compliance due to mess causes mucosal irritation if breastfeeding, treat mom too
73
What is the verdict on using probiotics to prevent thrush?
we dont know which species to use thus, dont get it into this with patients
74
What is the drug of choice for thrush?
nystatin (Rx)
75
What is the dosing and instructions of nystatin for infants up to 1 yr for oral thrush? What is the dosing for children?
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
How long does it take for nystatin to give relief from oral thrush? Should it be used after the thrush is cured?
relief in 24-48 hours continue for 48 hours after cure to prevent relapse (typically 7d)
77
Would you prescribe nystatin for a low-birth weight baby?
no get MD involved
78
Describe the efficacy of nystatin for thrush.
well tolerated doesnt interact with other medications (minimal systemic absorption) short contact time limits its efficacy but still DOC
79
What are secondary choices that an MD may prescribe for thrush?
miconazole fluconazole
80
What is xerostomia?
dry mouth
81
Which group of patients are commonly effected by xerostomia?
eldery
82
What are the many functions of saliva?
re-mineralize the teeth lubricates oral mucosa local antimicrobial activity part of taste sensation
83
What are some of the causes of xerostomia?
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
What are non-pharmacological treatments of xerostomia? Why should you be careful with these suggestions?
sipping water sugar-free gum, hard candies humidifier during sleep be careful, they probably already tried these
85
What are the pharmacological treatments of xerostomia?
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
What is angular cheilitis?
erythematous fissures at the angles of the mouth pain in the corners of the mouth
87
What are some good questions when trying to differentiate between angular cheilitis and a cold sore?
any tingling? any prodrome symptoms?
88
What are the symptoms of angular cheilitis?
swelling or cracking at the corners of the lips pain and burning at the corners of the mouth
89
What is gingivitis?
gums become red, swollen, bleed easily (esp during brushing and eating)
90
What can untreated gingivitis result in?
periodontitis
91
What are the causes of gingivitis?
most common=inadequate brushing/flossing-->plaque/tartar medical disorders medications (in most cases can be avoided with good hygiene) tobacco
92
Which drug is most commonly associated to gingivitis?
phenytoin
93
What is TMJ?
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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