Oral condition Flashcards
What are some Oral conditions
- dry mouth (xerostomia)*
- Halitosis
- Dental caries
- Gingivitis
- Recurrent aphthous stomatitis *
- Cold Sores (herpes simplex labials)*
- Minor gingival and intraoral injury
- Teething pain
- Toothache *
- Dental hypersensitivity
what is saliva
- produced by salivary glands
- regulated by circadian cycle
- alkaline and slightly viscous, clear
- contain enzymes, buffer, albumin, epithelial mucin, immunoglobulin, leukocytes
complications of hyposalivation
- dysphagia (difficulty swallowing)
- dysphonia (difficulty speaking)
- atrophy of oral epithelium
- hypogeusia (lowered taste sensation)
- affects digestion of starch
- prone to formation of dental caries, gingivitis and other periodontal diseases
what is dysphagia
condition that compromises mastication, making it difficult to swallow especially dry food
what is dysphonia
difficult speaking, due to hyposalivation reducing lubrication of oral cavity, which is commonly used to facilitate speech
what is atrophy of oral epithelium
- due to dryness of mucosa
- can lead to mucositis, inflammation, fissuring, cracks at corners of mouth, ulceration and intramural discomfort
- Can also be cause by poor fitting of dentures which increases trauma
what is hypogeusia
- lowered taste sensation
- or even ageusia (inability to taste) and can lead to decrease appetite/ nutrition
what is dry mouth (xerostomia)
- disorder in which salivary flow is limited
- more prevalent among older persons
common complaints of dry mouth
- difficulty talking/ swallowing
- stomatits
- burning tongue
- halitosis
- impaired taste (esp unmoistened food)
causes of dry mouth
- pathological lesions
- infections (mumps, duct obstruction)
- lifestyle (decrease fluids, caffeine, alcohol, nicotine, anxiety)
- secondary to medical condition (cystic fibrosis, diarrhoea, Crohn disease, DM induced polyuria,sjogren syndrome- irreversible dry mouth)
- medication induced
- irradiation
what causes irreversible dry mouth
- Sjogren syndrome (progressive irreversible xerostomia)
- compromised function from head and neck maligancies
tx goals for dry mouth
- relieve discomfort
- prevent and treat oral infection and periodontal disease
- prevent complications (reduce risk of dental caries)
Tx for dry mouth
- use of saliva substitutes
- non-pharmcological strategies (eliminate causes)
artificial saliva
- primary agents for relieving discomfort of drug mouth (PRN use, as often as needed)
- design to mimic natural saliva
- does not contain many naturally occurring protective components present in innate saliva
- does not stimulate natural salivation (not cure)
what does artificial saliva contain
- carboxymethylcellulose and glycerine (lubrication, add viscosity)
- electrolytes (buffering remineralisation of teeth)
- sugar (sweetener)
- flavouring agents (improve palatability and shelf life)
non pharm for dry mouth
- Avoid oral irritants
- caffeine/alc/nicotine (reduce salivation)
- spicy and acidic (burn tissue)
- dry bulky food (injury oral mucosal) - other strategies to relieve symptoms:
- maintain good hydration
- place yogurt, ice, butter, margarine, veg oil in mouth
- sip water after bite of solid food
- avoid breathing from mouth - avoid complications:
- take food and snacks that promotes chewing
- maintain good oral hygiene and dental care
oral hygiene and dental care
- remove plaque
- mechanical removal by brushing and flossing
- mouth rinses may aid as anti-plague/ anti-cavity adjunct to augment brushing and flossing
- clean dentures by physically removing debris
- avoid the use of teeth whitening products
- regular dental visits - diet modification to prevent caries
- reduce repeated and frequent intake of sugar
- take foods that are less cariogenic (fibrous and high water content)
recurrent aphthous stomatitis (mouth ulcers)
- canker sore, mouth ulcer
- manifestation
- minor aphthous ulcer = single
- minor aphthae
- found on intraoral surface (lip, check, tongue)
- none to mod pain
- some experience burning or tingling
- some experience burning or tingling sensation in the area 24-48h prior
- duration 5-7d (minor)
Herpes simplex labialis (cold sores)
- red, fluid filled vesicles, mature lesions may coalesce and become exudative
- several lesions
- 1-4mm lesion
- usually on outer surface of the lips
- none to moderate pain
- burning, itching, tingling, numbness in area of forthcoming lesion
- causes HSV-1
causes of recurrent aphthous stomatitis
- trauma
- chemical irritation
- smoking cessation (gum and membrane thickens up when the person)
- emotional stress
- systemic medical conditions
- medications (phenytoin, aspirin and NSAIDs, immunosuppressant, chemotherapy, corticosteroids)
- radiotherapy
- others (allergy, genetic predisposition, hormonal changes)
when to refer for recurrent aphthous stomatitis
- < 2 yo
- lesion >1cm
- painless ulcer
- raised borders
- frequently recurring
- non-healing ulcer >2weeks
- association with underlyingpatho or prescribed meds
- failure of prior appropriate self-tx
tx goals for recurrent aphthous stomatitis
- reduce symptoms of pain and inflammation
- promote ulcer healing
- prevent recurrence/complications
pharm products for aphthous stomatitis
- corticosteroids (triamcinolone acetonide)
- protective paste (colloidal silica)
how does corticosteroid help recurrent aphthous stomatitis
MOA: anti-inflammatory (brand specific)
Class: POM + exemption
Application: small amt on ulcer, 2-3x a day after meals and at bedtimes; do not rub in; avoid eating and drinking for 30min after application
CI: presence of infection
Precaution: ext. use only, do not swallow large amt, reversible systematic effect
how does protective paste help recurrent aphthous stomatitis
colloidal silica base forms a film over the lesions to release corticosteroid continuously
components: gelatin, pectin, sodium carboxymethylcellulose in plasticised hydrocarbon gel (polyethylene)
serves to protect ulcer from friction, promote healing
p only meds for recurrent aphthous stomatitis
- Oracort E - local anaesthesia
- lidocaine HCL 3%
- Triamcinolone acetonide 0.1%)
- adhesive paste for application to oral mucosa - Difflam mouth gel- pain relief
- benztdamine HCL 10mg/g
- cetylpyridinium chloride 1mg/g
- apply 1cm of gel on affected area, avoid food and drinks 15 min, use 2-3h prn
GSL products for recurrent aphthous stomatitis
- Bonjela
- Choline salicylate BP 8.714% w/w
- Cetalkonium chloride USP 0.01% w/w
- avoid <16 yo reyes syndrome - Medijel
- lidocaine HCL 0.66% w/w
- aminoacridine HCL 0.05% w/w - Soragel
- choline salicylate BP 8.7% w/w
- cetylpyridinium chloride 0.01% w/w - hybenX:
- sulphated phenolics + sulfuric acid +h20
- stings a little
- promote buccal debridement
non-pharmacological for (recurrent) aphthous stomatitis
- symptom relief: avoid spicy and acidic food
- prevent recurrence:
- identify and avoid contributing factor (stress, trauma)
- lifestyle mod: use soft toothbrush; eat well balanced nutritious diet, reduce stress, toothpaste w/o sodium laurel sulfate; avoid triggers
causes of herpes simplex labialis
- infectivity depends on behaviours and circumstances
- infected individuals can transfer virus when symptomatic or symptomatic, via saliva/ mouth to mouth contact or formites
- highest incidence: 6mth to 3yo (decrease after 35yo)
- incubation: 7d (cannot be cured)
common triggers of herpes simplex labialis
- sunlight and use of tanning booth (UV radiation)
- emotional stress, fatigue, chilling, windburn, fever, illness, injury, menstrual cycle, dental work
when to refer for herpes simplex labialis
- lesions >14d
- increase freq of outbreak
- immunocompromised
- symptoms of systemic infection (fever, swollen glands, rash)
tx goals for herpes simplex labialis
- relieve discomfort of lesion
- prevent secondary bacterial infection
- prevent autoinoculation or spread of the virus to other
- prevent recurrence
pharmacological products for (recurrent) aphthous stomatits
- Lidocaine HCL (acts on surface cells, causes numbing, stinging sensation; 5-10min)
- Benzydamine HCL (may cause numbness/ stinging, photosensitivity, may bronchospasm, not used in <6yo)
- Choline Salicylate (CI in salicylate allergy, active peptic ulcers, may bronchospasm/ asthma; Reyes syndrome - not used <16yo)
- Antiseptics (Cetalkonium chloride, cetylpyridinium chloride; aminoacridine HCL; chlorhexidine; sulphonated phenolics)
pharmacological products for herpes simplex labialis
Acyclovir 5% cream (2g)
- anti-viral; shortens healing time by 1-2d
- cream formulation more effective
- does not alter recurrence rate
Administration: apply thin layer 5x a day for 5-10d (min 5d), space out over 3-4h apart
side effects and concern of acyclovir cream
SE: temporary burning and stinging sensation, mild drying and flaking of skin
Precaution: avoid contact with eyes or mucous membrane inside nose, mouth or vagina; consult Dr after 10d
supple regulations of acyclovir
POM exemption for acyclovir 5% not more than 2g at once
non pharm for herpes simplex labialis
- Prevent activation of virus
- avoid triggers: sunlight, tanning booth
- have sufficient sleep, relaxation techniques - Avoid secondary infection
- clean lesions - Prevent spread of infection to others
- do not kiss, share drinking glasses/straws
- avoid touching lesions
- wash hands frequently
main cause of toothaches
Dental Neglect
1. improper plague removal
- calcifies to form calculus (tartar) that promotes progression of periodontal diseases and interferes with local self-cleaning efforts
- caries: bacteria in plague generates acid from dietary carbohydrates
- demineralised tooth enamel causes erosion of enamel
- pain produced when eroded cavity reaches dentin (cold sensitivity)
- pulpitis (constant dull severe throbbing pain, tooth damage may be irreversible)
risk for caries
- orthodontic appliances
- xerostomia
- gum tissue recession with exposure of roots surfaces
- cariogenic food
other causes of toothache
- abscess (swollen area accumulating pus)
- chipped tooth
- bruxism
- temporomandibular joint disorder (R)
- sinus infection/inflammation (R)
- HA (migraine) (R)
- angina pectoris (R)
- lymphoma or other tumours
- herpes zoster of trigeminal nerve third branch
treatment of toothache
see dentist ASAP
Advice against delaying tx; Early treatment can prevent pulpits and irreversible damage of tooth
short term relief for toothache
Topical: mouth gels containing lidocaine, benztdamine, choline salicylate
Oral: par act, NSAIDs (DO NOT use PO aspirin locally on gingival tissues- chem burn)
Ice: cold pack 10min (DO NOT use heat, increase blood flow and can spread bact. infection)
good oral hygiene
remove plaque
- mechanical removal by brushing and flossing after meals and bed time
- mouth rinse may aid anti-plaque/cavities adjunct to augment brushing
- clean dentures by physically removing debris
- avoid use of teeth whitening products
- regular dental visit
diet modification to prevent caries
- reduce repeated and frequent intake of sugar
- take food that are less cariogenic (fibrous, high water content)
