Oral Disorders

Question 1

Cold sore clinical presentation

Answer 1

• 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

Question 2

Cold sores: when to refer

Answer 2

if lesions last longer than 2 weeks

Question 3

Cold sore tx

Answer 3

• treat as soon as possible

- treat when prodrome sx appear (tingling, burning, itching, etc)

Question 4

Cold sore first line tx

Answer 4

Abreva (doconasol) or Zilactin (benzyl alcohol)

• can effectively inhibit development of cold sores
• suppress sensory receptors and offer relief from pain/itching

Question 5

Cold sore second line tx

Answer 5

Anbesol, Blistex, Campho-phenique, Carmex, Orabase, Orajel

Question 6

Cold sore NON-pharmacologic tx

Answer 6

• cornstarch may be soothing
• petrolatum and cocoa butter keep area moist
  DO NOT USE astringents such as tannic acid or zinc sulfate

Question 7

Cold sore prevention

Answer 7

• Lysine or balanced aa
• Herpecin-L
• Vitamin C
• Probiotics

Question 8

Canker sore presentation

Answer 8

• 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

Question 9

Canker sore - when to refer

Answer 9

• 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

Question 10

Canker sore tx

Answer 10

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

Question 11

Canker sore non-pharmacologic tx

Answer 11

saline rinse
avoid spicy or salty foods
avoid citrus

Question 12

Dry mouth (xerostomia) causes

Answer 12

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

Question 13

Dry mouth clinical presentation

Answer 13

• 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

Question 14

Dry mouth NON-pharmacologic tx

Answer 14

• chewing gum with xylitol
• using sugar-free hard candy to increase saliva flow
• drink small sips of water
• avoid caffeine, alcohol, and smoking

Question 15

long term effects of dry mouth

Answer 15

• 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

Question 16

Dry mouth pharmacologic tx

Answer 16

• focus on using artificial saliva

- does not contain natural protective mechanisms as saliva –> replacement, not a cure

Question 17

Dry mouth OTC products

Answer 17

ACT total care dry mouth lozenge, biotene, MedActive, Orajel, Oasis, Salivart, etc

Question 18

Dry mouth counseling points

Answer 18

• remind pt of importance of proper oral hygiene
• recommend non-pharmacologic tx as well as referral to xerostomia resources
• if sx worsen, see dentist

Question 19

Dry mouth resources

Answer 19

American Dental Assoc
Nat’l Institute of Dental and Craniofacial Research
Amer Acad Oral Medicine
Sjogren’s Syndrome Foundation

Question 20

Teething clinical presenation

Answer 20

mild pain, irritation, reddening, excessive drooling, mouth biting, gum rubbing, low-grade fever, slight swollen gums, sleep disturbances, bumps on gums

Question 21

When do teeth usually begin to erupt

Answer 21

as early as 6 months, sx can appear before eruption

Question 22

Teething tx - NON-pharmacologic

Answer 22

• massage gums
• cold teething ring/rag
• dry toast to chew on

Question 23

Teething pharmacologic tx *** (this may be wrong; wait for response from Dr. Wong)

Answer 23

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

Question 24

Teething pt referral

Answer 24

• 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