Oral Disorders Flashcards
Cold sore clinical presentation
- lesions first visible as small, red papules or fluid-filled vesicles 1-3mm in diameter
- prodrome sx (early sx of disease)
- usually appear at lower lip or edge of mouth, clear fluids
- can coalesce into single, large lesion. Crust forms over ruptured vesicles
- usually self-limiting and heal within 7-10 days with no scarring
Cold sores: when to refer
if lesions last longer than 2 weeks
Cold sore tx
- treat as soon as possible
- treat when prodrome sx appear (tingling, burning, itching, etc)
Cold sore first line tx
Abreva (doconasol) or Zilactin (benzyl alcohol)
- can effectively inhibit development of cold sores
- suppress sensory receptors and offer relief from pain/itching
Cold sore second line tx
Anbesol, Blistex, Campho-phenique, Carmex, Orabase, Orajel
Cold sore NON-pharmacologic tx
- cornstarch may be soothing
- petrolatum and cocoa butter keep area moist
DO NOT USE astringents such as tannic acid or zinc sulfate
Cold sore prevention
- Lysine or balanced aa
- Herpecin-L
- Vitamin C
- Probiotics
Canker sore presentation
- on the tongue, floor of mouth, soft palate, or inside lining of lips/cheeks
- most lesions last 7 to 14 days and heal spontaneously w/out scarring
- NOT an infection
- likely localized inflammation
Canker sore - when to refer
- when ulcers are severe
- doesn’t heal w/in 10-14 days
- if ulcers are painful or recur frequently
- if ulcers began after starting a medication
Canker sore tx
mild cases: control discomfort and protect sore from irritation
OTC products provide relief but DO NOT heal: contain benzocaine, such as anbesol, orabase, or zilactin-B
- do not use in pt w/hx of benzocaine hypersensitivity
- gel formulation is best
- other products: carmex, gly-oxide, kanka, tanac
- if product releases nascent O2, do not use for more than 7 days
Canker sore non-pharmacologic tx
saline rinse
avoid spicy or salty foods
avoid citrus
Dry mouth (xerostomia) causes
medications: LOTS, antihistamines, anticholinergics, antidepressants, etc
- Medical conditions: DM, HIV/AIDS, HTN, Hep C, lymphoma, menopause, etc
- alcohol/tobacco use
- excessive consumption of caffeine or spicy foods
- Sjogren’s syndrome: major cause
Dry mouth clinical presentation
- sensation of dryness in mouth
- saliva that seems thick and stringy
- difficulty chewing, speaking, swallowing
- altered sense of taste
- discomfort when wearing dentures
- tooth decay and caries
- gum irritation/disease
- mouth sores/dryness
- cracked lips
Dry mouth NON-pharmacologic tx
- chewing gum with xylitol
- using sugar-free hard candy to increase saliva flow
- drink small sips of water
- avoid caffeine, alcohol, and smoking
long term effects of dry mouth
- saliva has protective mechanisms including: controlling pH, antimicrobial, remineralization, etc
- if left untx, can lead to dental caries, periodontal disease, halitosis
- affects 20-50% of elderly pts
Dry mouth pharmacologic tx
- focus on using artificial saliva
- does not contain natural protective mechanisms as saliva –> replacement, not a cure
Dry mouth OTC products
ACT total care dry mouth lozenge, biotene, MedActive, Orajel, Oasis, Salivart, etc
Dry mouth counseling points
- remind pt of importance of proper oral hygiene
- recommend non-pharmacologic tx as well as referral to xerostomia resources
- if sx worsen, see dentist
Dry mouth resources
American Dental Assoc
Nat’l Institute of Dental and Craniofacial Research
Amer Acad Oral Medicine
Sjogren’s Syndrome Foundation
Teething clinical presenation
mild pain, irritation, reddening, excessive drooling, mouth biting, gum rubbing, low-grade fever, slight swollen gums, sleep disturbances, bumps on gums
When do teeth usually begin to erupt
as early as 6 months, sx can appear before eruption
Teething tx - NON-pharmacologic
- massage gums
- cold teething ring/rag
- dry toast to chew on
Teething pharmacologic tx *** (this may be wrong; wait for response from Dr. Wong)
Benzocaine 7.5% and 10%. AVOID 20% - 10% better at night for bedtime relief - 7.5% during the day Systemic analgesics - Acetaminophen: 10-15 mg/kg
Teething pt referral
- if baby is vomiting or has diarrhea, fever, nasal congestion, pain, or other sx
- if tx doesn’t improve sx in 3-5 days, refer
- if sx are not characteristic of teething, refer
