Oral Disorders Lecture

Question 1

What is the enamel of the tooth composed of?

Answer 1

Crystalline calcium phosphate salt

Question 2

Purpose and contents of dentin?

Answer 2

Protects the pulp

Contains microscopic tubules which are a direct channel to the nerve pulp

Question 3

What is pulp?

Answer 3

Mostly vascular and neural tissues

Question 4

Define tooth hypersensitivity

Answer 4

Short, sharp pain arising from exposed dentin in response to a stimulus

Question 5

Define lesion localization

Answer 5

Exposed dentin
Loss of enamel
Gingival recession

Question 6

Define lesion initiation

Answer 6

Dentin tubules open to oral cavity and pulp

Question 7

What causes tooth hypersensitivity?

Answer 7

Excessive brushing with abrasive toothpast or medium/hard bristled toothbrush
Extrinsic acid: acidic meds, foods, drinks
Intrinsic acid: gastroesophageal reflux disease or bulimia nervosa
Periodontitis
Dental procedures
Clenching or grinding teeth
Gumline grooves
Tooth whitening

Question 8

What are the signs and symptoms of tooth hypersensitivity?

Answer 8

Short sharp or stabbing pain associated with triggers

• hot/cold solutions
• hot/cold air
• sweet/sour substances
• pressure

Question 9

What are some goals of treatments for tooth hypersensitivity ?

Answer 9

Repair damaged surface area of tooth with the proper toothpaste and or stop abrasive tooth brushing technique

Question 10

Exclusions for self-treatment for tooth hypersensitivity?

Answer 10

Toothache
Mouth soreness (poor fitting dentures)
Fever or swelling
Loose, broke, or knocked out teeth
Bleeding gums
Severe tooth pain triggered or worsened by hot, cold, chewing
Trauma to mouth with bleeding, swelling soreness

Question 11

Nonpharmacologic treatment options for tooth hypersensitivity?

Answer 11

Standard toothpaste
Soft-bristle toothbrush
Avoid acidic foods and beverages
Wait 2-3 hours before brushing teeth if they have been exposed to acidic food or beverages

Question 12

Pharmacologic treatment options for tooth hypersensitivity?

Answer 12

Desensitizing toothpaste (potassium nitrate 5% & fluoride)
Not for children under 12 years old or people using teeth whitening toothpastes

Question 13

MOA of potassium nitrate 5%?

Answer 13

K Nitrate: blocks pain perception by reducing excitability of intradental nerves

Question 14

What is a toothache and what is it caused by?

Answer 14

Prolonged, throbbing pain
Due to inflammatory response to bacteria in pulp
Treatment: NSAIDs, APAP, topical anesthetics
NO hot or sweet foods

Question 15

What is hypersensitivity and what is it caused by?

Answer 15

Short, stabbing pain
Associated with trigger
20-45% spontaneous remission
Treatment: toothpastes, soft bristle brush, avoid acidic food/drinks, proper brushing techniques

Question 16

Define Etiology

Answer 16

Pain caused by the eruption of primary or baby teeth through the gum surface

Question 17

What are the signs and symptoms of etiology?

Answer 17

Drooling, mild pain, irritation, reddening, low grade fever or slight swelling of gums with sleep disturbances
NO vomiting, diarrhea, congestion ,fever, malaise and rashes

Question 18

Treatment goals for etiology?

Answer 18

Relieve gum pain and irritation

Reduce irritability and sleep disturbances

Question 19

What are the nonpharmacologic therapies for etiology?

Answer 19

Gum massage
Chilled/frozen teething rings
Cold wet washcloth
Dry toast

Question 20

What is the topical oral analgesic treatment for etiology?

Answer 20

Benzocain 5-10% or Phenol 0.5%
Not for children less than 4 months old
Avoid with fever or congestion
Avoid high concentrations

Question 21

What are pediatric systemic analgesics treatments?

Answer 21

Acetaminophen

Ibuprofen (6 months +)

Question 22

What is the epidemiology and etiology of recurrent aphthous stomatitis (canker sores)?

Answer 22

Effects 25% of Americans and is more common in females

Unknown etiology but can be triggered by trauma, stress, hormone changes, food allergies, etc

Question 23

What are signs and symptoms of RAS?

Answer 23

Epithelial ulcerations on freely moveable mucous membrane: lips, tongue, buccal mucosa, soft palate, floor of mouth
- Pricking or burning sensation in affected area can occur for 24-48 hours –> ulcer forms

Question 24

What is minor RAS?

Answer 24

85% of cases
Flat, oval ulcer with white-yellow-gray covering and a red border
Prodromal may occur first
Moderate pain
Heals within 5-7 days with no scarring

Question 25

What is major RAS?

Answer 25

``` 10% of cases Large, deep crater form ulcers that are oval and have irregular grayish-yellow border Moderate pain 1-10 lesions Duration 14+ days and leaves scars ```

Question 26

What is herpetiform?

Answer 26

``` 5% of cases Multiple small ulcers Moderate-severe pain VERY small lesions Heals within 10-14 days ```

Question 27

Goals of treatment of RAS are?

Answer 27

Relieve pain/irritation | Prevent secondary infection

Question 28

When to exclude self-treatment of RAS?

Answer 28

Lesions last for more than 14 days Frequently recurring symptoms Symptoms of systemic illness Failure self treat previously

Question 29

What are the nonpharmacologic treatments of RAS?

Answer 29

``` Iron, Folate, Vitamin B12 Avoid triggers Avoid spicy, acidic, sharp foods Ice applied every 10 minutes NO HEAT ```

Question 30

What are the pharmacologic treatments of RAS?

Answer 30

``` Oral debriding and wound cleansing agents Topical oral anesthetics Topical oral rinses Systemic analgesics Topical oral protectants ```

Question 31

What is oral debriding and wound cleansing agents?

Answer 31

Provides temprary relief or discomfort After meals and at bedtime Do not swallow or use for more than 7 days

Question 32

What agents are in oral debriding and wound cleansing agents?

Answer 32

Carbamide peroxide Hydrogen peroxide Sodium bicarbonate

Question 33

What is carbamide peroxide used for in oral debriding and wound cleansing agents?

Answer 33

MOA Breaks down H2O2 in mouth | Not used in children less than 2

Question 34

What is hydrogen peroxide used for in oral debriding and wound cleansing agents?

Answer 34

Breaks down into water and O2

Question 35

What is the most common topical oral anesthetics?

Answer 35

Benzocaine

Question 36

Administration of topical oral anesthetics?

Answer 36

QID Relief seen in seconds of application but only short duration of action Limit to 7 days Less than 2 years old

Question 37

What are the topical oral rinses?

Answer 37

Soothe and hasten healing of lesions - Listerine - Saline rinses - Baking soda paste

Question 38

What are topical oral protectants?

Answer 38

``` Inert substances/coat & protect Use as needed Denture adhesives Canker cover Wax on braces ```

Question 39

What is the epidemiology of herpes simplex labialis (cold sores)?

Answer 39

Mostly caused by HSC-1 Mostly during childhood Virus lays dormant in trigeminlaa ganglia until reactivated (UVR, stress, fatigue, cold/windburn) Highly contagious Fluid filled vesicles usually heal in 10-14 days

Question 40

What are some signs or symptoms of cold sores?

Answer 40

Prodrome --> burning, itching, tingling, or numbness Initial: small, red fluid filled May have pain, fever, bleeding or lymph node involvement Junction of the oral mucosa and skin of lip and nose

Question 41

Goals of treatment for cold sores?

Answer 41

Relieve pain/irritation Prevent secondary infections Prevent spread to others

Question 42

What are some exclusions for self treatment for cold sores?

Answer 42

Lesion there for 14+ days Increased frequency of outbreaks Compromised immunity Symptoms of infection: fever, swollen glands, rash

Question 43

What are the nonpharmacologic treatments for cold sores?

Answer 43

Clean lesions with mild soap solution Wash hand frequently Keep moist with skin topical skin protectants Avoid triggers and factors that delay healing

Question 44

What is the pharmacologic treatment of cold sores?

Answer 44

Docosanol 10% (Abreva) - Only OTC for HSV - MOA: direct fusion inhibitor to prevent viral replication Not in children under 12 years old

Question 45

What are the complementary treatment for cold sores?

Answer 45

Tea Tree oil 6% five time daily Lemon balm 1% lip balm two to four times daily (shorten healing times, prevent infection spread, and reduce symptoms L-lysine LongoVital: dietary supplement with vitamins + herbals

Question 46

Xerostomia (dry mouth) epidemiology and etiology?

Answer 46

Disease states: diabetes, Sjogren's syndrome, depression, Crohn's Lifestyle choices Radiation therapy of head/neck Meds: antihistamines, decongestants, diuretics, antihypertensives, antipsychotics, sedatives

Question 47

Dry mouth signs, symptoms and complications?

Answer 47

``` Difficulty talking or swallowing Stomatitis Halitosis Weight loss Dental caries Gingivitis Periodontal disease ```

Question 48

What are the goals of treatment for dry mouth?

Answer 48

Relieve discomfort Prevent and treat oral infections and disease Reduce risk of dental decay

Question 49

What are the exclusions for self treatment for dry mouth?

Answer 49

``` Tooth erosin, decalcification and decay Candidiasis, gingivitis, periodontitis Reduce denture wearing time Mouth soreness Presence of fever or swelling Loose/broken/knocked out teeth Bleeding gums in the absence of trauma Severe tooth pain ```

Question 50

Nonpharmacologic treatments of dry mouth?

Answer 50

Avoid: tobacco, alcohol, caffeine, antihistamines, CNS stimulants, sugary/acidic foods Increase H2O Sugar free chewing gums or lozenges Soft-bristle toothbrush with fluoride

Question 51

What are the pharmacologic treatments of dry mouth?

Answer 51

Artificial saliva products: mimic natural saliva, does not stimulate salivary glands, use after meals and at bed time

Question 52

What is contained in artificial saliva products?

Answer 52

Carboxymethylcellulose + glycerin Flavoring Sweeteners Fluoride