Dry Mouth, Ulcers, Carcinomas, Candida ☺️

Question 1

Causes of dry mouth

Answer 1

Medications

• recent changes to diuretics
• antimuscarinics, antihistamines
• antidepressants, antiHTN

Comorbidities

• DM
• Sjogrens
• Head, neck radio/chemo

Intrinsic

• dehydration
• anxiety

Question 2

Assessment of dry mouth severity

-management ideas

Answer 2

Challacombe scale
-assess 10 points, each positive finding given a point

1-3 - mild => hydrate, good dental hygiene, sugar free gum
4-6 - moderate => sugar free gum, saliva stimulants, topical fluoride
7-10 - severe => saliva stimulants, topical fluorides, assess for cause

Question 3

Complications of dry mouth

Answer 3

Caries
Periodontitis
Candida

Question 4

Causes of ulcers

Pathophysiology

Answer 4

Trauma
Infection
Anemia/haematinic deficiency
Cancer

Damage to mucosa and lamina propria

Question 5

Management of ulcers

-safety netting

Answer 5

Saline mouth rise
Topical antiinflammatory spray/rinse
-benzydamine hydrochloride or chlorhexidine

Remove cause of trauma (dentures, sharp teeth)
Maintain oral intake

REFER if present for 2wk+ for cancer?

Question 6

Types of oral carcinoma

• presentation
• risk factors

Answer 6

Squamous cell carcinoma - inside mouth
Basal carcinoma - outside mouth

Smoking, alcohol, malnutrition, stress
Male

White plaques, red speckles
Early, painless
Late, painful but have a poorer prognosis

Question 7

Oral candida

• pathophysiology
• risk factors

Answer 7

IC
Steroid/ABx use
Poor fitting dentures, hygiene
Dry mouth

Fungal infection

Question 8

Oral candida presentation

Answer 8

Discomfort, pain => swallowing problems

Question 9

Oral candida management

Answer 9

Topical antifungal rinse (nystatin)
Systemic antifungal tablet (fluconazole)

Denture hygeine or replacement
-soak in chlorhexidine for 15mins TDS

Question 10

Angular cheilitis

• presentation
• risk factors
• management

Answer 10

Mouth corners become painful, inflammed, crusted and cracked

Common in

• inadequate/lost dentures that don’t support the lip
• Fe, vitaminB deficiency
• DM, immunocompromised

Can get infected by candida or staph aureus

Symptom management
-lubricate inflammed area with lip balm

Bacterial causes
-fusidic acid and hydrocortisone

Fungal causes

• nystatin or micronazole gel
• rinse mouth after using inhaled steroids