Lecture 4 - Oral Health & Infections Flashcards
Recurrent aphthous stomatitis (RAS)
canker sores
Risk Factors canker sores
Stress
local injury
non-smoker
hormonal changes
genetics
certain diseases
Vit/mineral deficiencies
non-infectious
signs and symptoms of canker sores
ulcers form on moveable parts of mouth
painful
look like craters
minior canker sores
85% incidence
usually ~ 1 lesions
none to moderate pain
< 1 cm
duration 5-7days
Major canker sores
5% incidence
2-10 lesions
none-moderate pain
0.5- 2cm
duration 7-14 days
Herpetiform
~10% incidence
multiple crops
severe pain
1-4cm
Any intraoral area no self care
duration ~60 days
Self-treatment exclusions ulceres
present > 2 weeks
Frequent recurrent
Systemic illness or other Identifiable cause of ulcers
prior unsuccessful treatment
Major risk factors oral cancer
tobacco use
Heavy alcohol drinking
Other risk factors for oral cancer
HPV infection
male
> 55yrs old
Exposure to sunlight
Poor nutrition
Immunsuppresion
Non-pharm canker sore treatment
Apply ice for 10min
Rinse warm salt water or mouthwash
apply baking soda to ulcer
Avoid exacerbating factors
OTC oral debriding/wound cleaners
Carbide peroxide or Hydrogen peroxide (each has specific directions)
MOA: release O2 to mechanically cleanse the ulcer
Topical oral anesthetics
Benzocaine products
MOA: block conduction of nerve impulses to reduce pain
use ~4 times per day
Precaution/warnings of topical oral anesthetics
hypersensitivity reactions
Can be irritating
Methemoglobinemia = V rare
OTC topical oral protectants
MOA: provide protective barrier over canker to limit friction and irritation
place over sore for 10-20sec and stays on until dissolved
Prevention of canker sores
Avoid foods that can use it
stiff toothbrush
SLS toothpaste
Cold sore trigger of reactivation
Fatigue
Windburn
Stress
Fever
Immunosuppression
Common cold
injury
UV radiation
Self treat exclusions of cold sore
> 14 days present
increasing rate of recurrence
Infection
Immunosuppression
non-pharm cold sore treatment
wash hand frequently
clean lesson with gentle soap and water
keep lesions to prevent cracking
avoid identified triggers
OTC cold sore option
Docosanol 10% (Abreva)
Only FDA approved OTC, 12yrs+
reduces severity and duration
Docosanol 10%
MOA: inhibit fusion between HSV and human cells
use 5 times per day
ADE: mild burning/stinging
Cold sore supplements
Lysine
Lemon balm
Tea tree oil = similar to acyclovir cream efficacy
Vitamin E
Systemic antivirals
Acyclovir
Valacyclovir
Famciclovir
Dosing for -clovirs
Initial treatment usually different than dosing for recurrence
MOA & adjustments for -clovirs
MOA: inhibit viral DNA synthesis and replication
have to be renal dose adjusted
counseling points
maintain hydration
start first sign of prodrone
Famciclovir contains lactose*
Indications for chronic suppressive treatment of cold sores
frequent recurrence, no clear prodrome
recurrences affect quality of life
recurrences associated w/ serious systemic complication
can use episodically, such as triggeres
Options for suppressive old sore treatment
Acyclovir 400mg BID
Valacyclovir 500-1000mg QD
Famciclovir 500mg BID
Xerostomia
Dry mouth
Risk factors for dry mouth
Medications***
anticholinergic**
TCA**
Anti-psych**
Anti-hist 1st gen**
Antihypertensive
Benzo
opioids
muscle relaxants
Risk factors for dry mouth
Depression
DM
Crohns
Soren’s = most common
HIV
substance use
Hx of radiation
prevention of caries
thorough brushing/flossing
use fluoride-enriched products
toothpaste w/o SLS
avoid high sugar/acid food+drink
regular dental care
self treatment exclusions for dry mouth
periodontal disease
damage,decay,etc
Signs of infection
Evidence of mouth trauma
Gums bleeding w/o identifiable cause
Use dentures dont fit right
dry mouth therapeutic lifestyle changes
Avoid alc, caffeine, tobacco, hard to chew food
sip water throughtday + while eating
chew sugar free gum
take suspected meds before eating
risk factors tooth hypersensitivity
Erosion of enamel = brush to hard/stiff bristles
Acidic food/drink
Gum disease
Gridning teeth
whitening products
signs & symptoms of tooth hypersensitivity
Sharp pain caused by temp or sugary food/drink
Varies in severity
How does tooth hypersensitivity vary from toothache
toothache is not self treatable
hypersensitivity occurs in response to stimuli
self treatment exclusions for tooth hypersensitivity
constant dull pain = indicative of toothache
damage or loosening of teeth
signs of infection
evidence of mouth trauma
gums bleeding w/o identifiable cause
use of dentures that dont fit correctly
Therapeutic lifestyle changes for tooth hypersensitivity
avoid acid food/bev
avoid whitening toothpastes/products
Proper toothbrushing
Desensitizing toothpaste info
MOA: decrease excitability of neurons in dentin (Potassium nitrate 5% active ingredient)
age 12+
takes 2-4 weeks, use instead of regular toothpaste
viral pharyngitis
conjunctivitis
Rhinorrhea+cough
Oral ulcer
Hoarseness
Diarrhea
Rash
bacterial pharyngitis
abrupt onset of sore throat
fever
HA
GI upset
Patch exudates
Palatal petichiae
Scarlatiniform rash
Anterior cervical adenitis
Exposure to GAS pharyngitis
Screening Culture
Advantages: 90-95% sensitivity/sepcigicity
Disadvantages: 18-24hrs incubation
Screening Rapid Antigen Detection Test
Advantage: immediate results
Disadvantage: 70-90% sensitivity
Drugs to avoid for bacterial pharyngitis
Tetracyclines: prevalent resistance in GAS
Sulfonamides: not effective elim GAS
Fluoroquinolone: more adverse effects
Symptoms management pharyngitis
Tylenol= 10-15mg/kg q4/6hrs,max 5doses/24hrs
ibuprofen = 10mg/kg (400max) q4/6hrs, max 40mg/kg or 2400mg/day
Symptoms management pharyngitis
Tylenol= 10-15mg/kg q4/6hrs,max 5doses/24hrs
ibuprofen = 10mg/kg (400max) q4/6hrs, max 40mg/kg or 2400mg/day
phenol 1.4% spray = topical
Avoid aspirin
1st line penicillin ADE
common: stomach discomfort, N, V
Serious: C.diff, Hypersensitivity
1st line penicillin pt counseling
take w/ or w/o food
shake suspension before using
store in fridge, throw away after 14 days
1st line amoxicillin ADE
Common: N/V/D, HA, rash
Serious: hypersensitivity, SJS, TEN, eryhtema multiforme
1st line amoxicillin Pt counseling
Take w/ or w.o food
shake suspension before using
store in fridge, throw away after 14 days
non-anaphylactic PCN allergy Cephalexin + cefadroxil
Cephalexin: common = D, serious - SJS,TEN, Hypersensitivity
Cefadroxil: Common = N/D, Serious = SJS, multiform, C.diff, hypersensitivity, thrombocytopenia
anaphylactic PCN allergy Clinda,Clarith,Azith- thromycin
Clinda/Clarith = dont refridge
Azith = store room temp or fridge, discard 10 days
