Dental Health Flashcards
What is the reason for not prescribing tetracyclines in children?
Tetracyclines can cause permanent tooth staining
What are some possible causes for toothaches?
Tooth decay
Abscess/infected gums
Damaged fillings
Repetitive motions (grinding teeth)
Our main concern us that they do not have an infection
What can pharmacists do for toothaches?
Analgesics can help patient get to an appointment with a dentist
ex. Acetaminophen (including T1 and T3), NSAIDs (ibuprofen, naproxen)
What are some red flags associated with toothaches?
Fever, pus, swelling, headaches
Is acetaminophen + ibuprofen combo therapy useful?
It is a standard practice by dentists, acet. works more centrally while ibu. works peripherally to decrease prostaglandins
Are OTC acet/ibu combo products indicated for toothaches?
Currently available OTC combos do not have high enough doses. Better to use separate OTC products
What are some topical treatments for toothaches?
Heat or cold packs on the outside of the cheek
Benzocaine (relief if pain is from the gums, but will not help pain from inside the tooth)
Clove oil
Why do children start to become more fussy at 6 months?
Teething pain (especially molar eruptions)
But it could also be due to the following:
extra drooling
irritable
facial rash
mild fever
What is usually used to help with teething pain?
Teething rings or objects that act like a teething ring(toys, cold face cloth)
Is topical benzocaine useful to manage teething pain?
Not reccomended
It washes off and there is worry about numbing of throat(inhibited gag reflex)
Also associated with blue baby syndrome
What is methemoglobinemia (blue baby syndrome)?
It is the reduction of the blood’s oxygen-carrying capacity.
Topical benzocaine use in infants is associated with methemoglobinemia.
What is the efficacy of natural teething pain gel?
Next to nothing, they are effectively unmedicated gels
Go with teething ring instead
Are cold sores a condition commonly seen by pharmacists?
Yes, it is the most common condition that pharmacists prescribe for
What pathogen causes cold sores and what factors induce it’s reactivation?
Primarily caused by HSV-1 (oral herpes). This virus is usually dormant in everyone, but it can activate in some people and cause cold sores
Reactivated by stress, sunlight, trauma, etc.
What are cold sores?
It is a condition characterized by painful fluid-filled sores. These sores are located on the lips and around the nostrils
Symptoms usually last 7-10 days
What are the stages of a cold sore?
Stage 1 (prodromal): Tingling, itching, or burning (pharmacists can prescribe effective therapy at this stage) (0.5 days)
Stage 2: blister formation (1-2 days after tingling)
Stage 3: blister bursts (pharmacists cannot prescribe something effective at this stage, need MD prescription) (day 4)
Stage 4: scab formation (days 5-8)
Stage 5: healing stage
What condition can cold sores be confused with?
Impetigo
How to differentiate between cold sores and impetigo?
Impetigo is…
less painful
no prodromal phase
seen in younger children (cold sores can still happen in kids)
Can be difficult to diagnose, so we might have to resort to diagnosis by treatment
Can cold sores last for longer than 7 days?
No, it could be something worse (basal/squamous) especially if the lesion remain for 2-3 weeks
What are some non-drug options for cold sore treatment?
Reduce stress (easier said than done)
Protect from the sun
Don’t squeeze or pop
Lip balm (keep soft)
What are some OTC products used in cold sore treatment?
Docosanol (might actually treat cold sore directly)
Other options either dry or moisturize skin:
benzocaine
lysine
benzoyl alcohol
Does covering a cold sore with an unmedicated patch help reduce recovery time?
It seems like they slightly reduce duration. Not really a mainstay of cold sore therapy?
What is the efficacy of lipivir?
Not medicated, simply an emollient
prevents outbreaks, not to actually treat cases.
The emollient in lipivir is made of a mixture of polyethylene glycols (PEGs), a substance that interferes with the herpes simplex virus
What is the efficacy of Abreva (docosanol 10%)?
It helps reduce viral entry into host cell
Apply at first sign of cold sore (prodromal tingling)
Apply to lesion 5x/day until healed
How to reduce auto-innoculation of cold sores?
Use a q-tip to apply agents like abreva (docosanol)
Does docosanol reduce duration significantly?
Not really, it marginally reduces duration
ex. 4.8 days (without docosanol) vs. 4.1 days (with docosanol)
What are some prescribed agents used in cold sore treatment?
Oral antivirals must be started before lesions appear (during prodromal stage) or will be ineffective
oral:
Valacyclovir 2g BID
topical:
Acyclovir/HC cream applied 5 times per day x 5 days (25 applications)
What is the efficacy of acyclovir/HC cream?
This combination combines pros of both agents. These are secondary to oral agents, but they are still fairly effective
What should a patient with fully developed cold sores do to help with cold sores?
Anesthetics could help with the pain, but nothing that will treat cold sores directly
What should people with recurrent cold sore episodes do to help reduce frequency ?
An MD could prescribe an antiviral for regular use. This can decrease the probability of a cold sore coming back by 1/3
What are canker sores?
Apathous ulcers
They are characterized by white or cream-coloured lesion within red/inflamed bodies.
Painful
Often have an unknown etiology
ex. local trauma, stress, allergies, nutritional deficiencies
How to differentiate between mouth sores seen in hand-foot-mouth disease vs. canker sores?
Mouth sores from hand-foot-mouth disease only happen once
Canker sores can be recurrent
What are mucoceles?
Mucoceles often result from trauma and are are characterized by a cyst-like growth
They are also less painful vs. canker sores
Can drugs induce canker sores?
Canker sores can be aggravated by many things, and drugs like NSAIDs, beta blockers, and cytotoxic agents are commonly blamed for inducing canker sores
What is stomatitis?
These are ulcers that form in the mouth following radiation or chemotherapy. Patients will be aware that this can develop
What are some non-drug options to help prevent canker sores?
Prevent local trauma
Reduce stress
Nutritional deficiencies
ex. iron, folic acid, zinc, Vit B
Are hydrogen peroxide rinses more effective vs. saline?
Saline is just as effective, hydrogen peroxide also has a metallic taste
What are some drug therapy options for canker sores?
Benzocaine
Protectants like Zilactin and Orabase
Magic mouthwash
How to use benzocaine for canker sores?
Apply directly to the lesion (can apply q2h)
Short term pain relief
Do not use in children under 2 die to concerns with methemoglobemia
How to protectants work in canker sores?
They act by adhering to mucosal tissue and protecting canker sore from impact
What is magic mouthwash?
Milk of magnesia + diphendyramine
Swish around in the mouth QID for pain relief
Should pharmacists recommend AgNO3/styptic sticks for canker sores?
No, this is usually used on shaving cuts
Don’t apply on canker sore
What is a prescribed agent for canker sores?
Oracort (triamcinolone) paste. This is an topical steroid paste
Apply small amount at bedtime
If no improvement in 7 days, see dentist or MD
What is oral candidiasis (thrush)?
It is an oral infection of C. albicans
Creamy white lesions along tongue or cheek
Can be painful or have a burning sensation
What is a common cause for oral thrush?
This is commonly seen in people that use inhalers (opportunistic infection)
(rinse mouth after administration to prevent oral candidiasis)
How to differentiate between milk residue and oral candidiasis?
Milk residue is easily brushed off compared to the white residue associated with oral candidiasis
If a child has oral candidiasis and a diaper rash, is it justifiable to assume their diaper rash is infected?
Yes, this child has a yeast infection
What are some risk factors associated with thrush (oral candidiasis)?
Disease states:
Diabetes, HIV, Anaemia, Leukemia
Medications:
Inhaled corticosteroids, broad spectrum antibiotics, chemo/radio therapy
Other:
Poor oral hygiene, dentures, babies
How can people prone to oral candidiasis do to prevent them from developing?
Asthmatics:
improve inhaled corticosteroid use (use spacer and rinse out mouth after use)
Seniors:
clean dentures at night
Babies:
clean pacifiers and bottles
Is Gentian Violet 1% solution effective in oral candidiasis?
It is a herbal product and its efficacy is lower than the DOCs covered earlier
causes mucosal irritation
Safety is questionable
What is angular cheilitis?
It is irritation of the edges around the corners of the patient’s mouth
Can shingles on the face be easily mistaken for cold sore?
No, these shingles are rare on the face. They also can cause scarring once cleared up. The areas affected are not limited to the lips alone, but can affect surrounding skin
When should mouth ulcers be referred to an MD?
Last longer than 3 weeks
Suspected adverse drug reaction (ex. NSAIDs)
Crops of 5-10 or more ulcers
Rash
How many people have an oral Candidiasis colonization?
Approx 30-60% of healthy individuals
What is leukoplakia?
An asymptomatic and often well-demarcated white-plaque that cannot be wiped away or characterized clinically or pathologically as any other disease
Usually found in older men (40-70)
Smokers are 6x more likely to develop leukoplakia
What are some symptoms associated with thrush (oral candidiasis)?
Creamy white lesions along tongue or cheek
Can be painful or a burning sensation
May bleed slightly when scraped during removal
Infants will be more fussy and could also develop candidial diaper rash
