Drugs for oral and dental conditions 2

Question 1

Explain the process of periodontal disease progression
7 points

Answer 1

• Gingivitis is reversible with professional treatment and good oral hygiene.
• Untreated gingivitis can advance to periodontitis, the destruction of the tissues and bone that support the teeth.
• Bacterial plaque hardens the teeth, forming calculus.
• An inflammatory host response against the microorganisms of the bacterial plaque and their toxins occurs. The intense inflammatory reaction results in gums separating from the teeth and the creation of
  pockets that become infected.
• Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans bacteria have been indicated in the pathogenesis of adult periodontitis.
• As the pockets deepen, more gum tissue and bone is destroyed.
• Often only mild symptoms are present throughout progression of the disease, until the teeth become loose, and sometimes must be removed.

Question 2

List the risk factors for Periodontal disease

Answer 2

• Poor oral hygiene
• Smoking
• Poorly controlled diabetes mellitus
• Stress
• Underlying immunodeficiencies
• Dry mouth

Question 3

Explain the uncomplicated gingivitis

Answer 3

• An inflammation of the gum margin causing the gums to separate from the teeth.
• Pockets (recesses) form between the gums and the teeth.
• Pus and bacteria can collect in these pockets, eventually causing periodontitis.

Question 4

List the characterists of the uncomplicated gingivitis

Answer 4

• Pain
• Redness
• Bleeding
• Swollen gums
• Gum recession may occur

Question 5

Explain the prophylaxis and general measures for gingivitis

Answer 5

Oral hygiene is usually adequate to prevent superficial mouth and gum infection:
* Oral hygiene after each meal to remove plaque and food debris.
* Brush teeth twice daily.
* Floss teeth at least once daily.
* Rinse mouth with homemade salt mouthwash for one minute twice daily (i.e. ½ medicine measure of table salt in a glass of lukewarm water).

Question 6

Explain the Gingivitis treatments and how to use that drug for gingivitis

Answer 6

Brush, floss, rinse mouth with water and then rinse with:
* Chlorhexidine, 15 mL as a mouthwash, twice daily, after brushing teeth, for 5 days.
* Do not swallow.
* Note: Do not eat or drink immediately after this. Chlorhexidine is inactivated by organic material

Question 7

What is periodontitis?

Answer 7

Progressive gingivitis to the point where the underlying bone is eroded. It is characterised by loose teeth and is a cause of tooth loss in adults.

Question 8

Acute or very painful infection of the gingival margin. Name the condition

Answer 8

Necrotising periodontitis

Question 9

Necrotising periodondotitis is characterided by what?

Answer 9

• Foul smelling breath
• Necrosis and sloughing of the gum margin, especially of the interdental papillae
• Loss of gingiva and supporting bone around teeth
  May be associated with underlying disease, e.g. HIV.
  May lead to disease of surrounding lips and cheeks if not adequately treated.

Question 10

Explain the treatment for necrotising periodontitis treatment

Answer 10

Metronidazole
Brush, floss, rinse mouth with water and then rinse with:
* Chlorhexidine 0.2%, 15 mL as a mouthwash, twice daily, for 5 days
Pain:
Paracetamol

Question 11

what is Aphthous ulcers (canker sores)

Answer 11

Painful shallow, round or oval lesions with a white to yellow pseudomembrane and a well-defined erythematous border

Question 12

where do we find the apthous ulcers?

Answer 12

In the mouth on inner oral tissues, including the lips, cheeks, and tongue, not the gums, hard palate and dorsum of the tongue.

Question 13

Differentiates between minor ulcers and major ulcers

Answer 13

• Minor ulcers (< 1 cm diameter) usually heal
  within 10 days.
• Major ulcers (> 1 cm diameter) are very
  painful, often very deep and persist.
• Major ulcers usually indicate advanced HIV
  infection.

Question 14

Explain the general measures for Apthous ulcers

Answer 14

• Avoid substances that can worsen or trigger episodes and on ways to alleviate painful or bothersome symptoms.
• Eliminating nuts, chocolate, acidic food and drink, salty and/or spicy foods, alcoholic and/or carbonated beverages from diet
• Avoiding oral products containing sodium lauryl sulfate (SLS). These may trigger the formation or delay healing.

Question 15

Explain the treatment for minor ulcers.
Explain the goal for treatment of minor ulcers and how to use that treatment

Answer 15

• Goals of treatment: reduce pain, inflammation and frequency of recurrent episodes.
  Paracetamol,
• Children > 6 years of age and adults
• Tetracaine topical, applied every 6 hours.
• Apply a thin layer on the affected areas only (may be used inside mouth).

Question 16

When to refer the ulcers

Answer 16

• Major ulcers for further diagnostic evaluation.
• Ulcers that are not healing within 10 days.

Question 17

1. Explain what is herpes simplex infections of the month and lips
2. Chracterised by what?
3. When does its resolve

Answer 17

Acute, painful vesicular eruptions of the lips or ulcerations of the lips and mouth caused by Herpes
simplex virus and characterised by:
* shallow, painful ulcers on the lips, gingiva, tongue and pharynx
* pain exacerbated by eating It is a self-limiting infection with symptoms subsiding within 10 days.

Question 18

Explain the whole process of herpes simplex infections

Answer 18

Primary infections generally occur when HSV1 is transmitted via nonsexual contact during childhood.
Transmission occurs by direct contact of the virus with mucous membranes or open skin.
HSV enters and replicates within the neurons, epidermis, and dermis.
Recurrent infections occur in 30% to 40% of those exposed to HSV, resulting from the reactivation of HSV, as the virus lays latent in the trigeminal ganglion.
Reactivation appears to be affiliated with stress, extreme
temperatures, direct sunlight, fever, menstruation, and trauma.
Primary infection generally appears within 20 days following exposure to HSV. Cold sore lesions begin on the lips as small vesicles, which rupture and fuse, forming a larger, painful, crusty lesion.
Lesions also may be associated with localized prodromal symptoms such as tingling, burning, pain, or itching.
Refusing food or drink may also be an indicator of an active HSV infection in children.
Healing typically begins within a few days, with complete healing upto 2 weeks

Question 19

Explain the general measures for herpes simplex virus

Answer 19

• Rinse mouth with homemade salt mouthwash for one minute twice daily (i.e. ½ medicine measure of table salt in a glass of lukewarm water).
• Ensure adequate hydration.
• Fluid diet for children.
• Avoid acidic drinks, e.g. orange juice or soft drinks as they may cause pain.

Question 20

Explain the treatment for herpes simplex

Answer 20

• Cover lesions on the lips with petroleum jelly.
• Pain: Paracetamol
  Extensive oral herpes:
• For children > 6 years and adults:
• Tetracaine topical, applied every 6 hours.
• Apply a thin layer on the affected areas only (may be used inside mouth).
• ONLY for
• Children with extensive oral herpes provided treatment can be
  started within 72 hours of onset of symptoms.
• HIV-infected patients with herpes infections of the lips or mouth.
• Antiviral treatment: acyclovir for 7 days

Question 21

When to refer herpes simplex virus

Answer 21

• Severe condition.
• Dehydrated patients.
• No improvement after 1 week of treatment.