Oral Disorders Lecture Flashcards
What is the enamel of the tooth composed of?
Crystalline calcium phosphate salt
Purpose and contents of dentin?
Protects the pulp
Contains microscopic tubules which are a direct channel to the nerve pulp
What is pulp?
Mostly vascular and neural tissues
Define tooth hypersensitivity
Short, sharp pain arising from exposed dentin in response to a stimulus
Define lesion localization
Exposed dentin
Loss of enamel
Gingival recession
Define lesion initiation
Dentin tubules open to oral cavity and pulp
What causes tooth hypersensitivity?
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
What are the signs and symptoms of tooth hypersensitivity?
Short sharp or stabbing pain associated with triggers
- hot/cold solutions
- hot/cold air
- sweet/sour substances
- pressure
What are some goals of treatments for tooth hypersensitivity ?
Repair damaged surface area of tooth with the proper toothpaste and or stop abrasive tooth brushing technique
Exclusions for self-treatment for tooth hypersensitivity?
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
Nonpharmacologic treatment options for tooth hypersensitivity?
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
Pharmacologic treatment options for tooth hypersensitivity?
Desensitizing toothpaste (potassium nitrate 5% & fluoride) Not for children under 12 years old or people using teeth whitening toothpastes
MOA of potassium nitrate 5%?
K Nitrate: blocks pain perception by reducing excitability of intradental nerves
What is a toothache and what is it caused by?
Prolonged, throbbing pain
Due to inflammatory response to bacteria in pulp
Treatment: NSAIDs, APAP, topical anesthetics
NO hot or sweet foods
What is hypersensitivity and what is it caused by?
Short, stabbing pain
Associated with trigger
20-45% spontaneous remission
Treatment: toothpastes, soft bristle brush, avoid acidic food/drinks, proper brushing techniques
Define Etiology
Pain caused by the eruption of primary or baby teeth through the gum surface
What are the signs and symptoms of etiology?
Drooling, mild pain, irritation, reddening, low grade fever or slight swelling of gums with sleep disturbances
NO vomiting, diarrhea, congestion ,fever, malaise and rashes
Treatment goals for etiology?
Relieve gum pain and irritation
Reduce irritability and sleep disturbances
What are the nonpharmacologic therapies for etiology?
Gum massage
Chilled/frozen teething rings
Cold wet washcloth
Dry toast
What is the topical oral analgesic treatment for etiology?
Benzocain 5-10% or Phenol 0.5%
Not for children less than 4 months old
Avoid with fever or congestion
Avoid high concentrations
What are pediatric systemic analgesics treatments?
Acetaminophen
Ibuprofen (6 months +)
What is the epidemiology and etiology of recurrent aphthous stomatitis (canker sores)?
Effects 25% of Americans and is more common in females
Unknown etiology but can be triggered by trauma, stress, hormone changes, food allergies, etc
What are signs and symptoms of RAS?
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
What is minor RAS?
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
What is major RAS?
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
What is herpetiform?
5% of cases Multiple small ulcers Moderate-severe pain VERY small lesions Heals within 10-14 days
Goals of treatment of RAS are?
Relieve pain/irritation
Prevent secondary infection
When to exclude self-treatment of RAS?
Lesions last for more than 14 days
Frequently recurring symptoms
Symptoms of systemic illness
Failure self treat previously
What are the nonpharmacologic treatments of RAS?
Iron, Folate, Vitamin B12 Avoid triggers Avoid spicy, acidic, sharp foods Ice applied every 10 minutes NO HEAT
What are the pharmacologic treatments of RAS?
Oral debriding and wound cleansing agents Topical oral anesthetics Topical oral rinses Systemic analgesics Topical oral protectants
What is oral debriding and wound cleansing agents?
Provides temprary relief or discomfort
After meals and at bedtime
Do not swallow or use for more than 7 days
What agents are in oral debriding and wound cleansing agents?
Carbamide peroxide
Hydrogen peroxide
Sodium bicarbonate
What is carbamide peroxide used for in oral debriding and wound cleansing agents?
MOA Breaks down H2O2 in mouth
Not used in children less than 2
What is hydrogen peroxide used for in oral debriding and wound cleansing agents?
Breaks down into water and O2
What is the most common topical oral anesthetics?
Benzocaine
Administration of topical oral anesthetics?
QID
Relief seen in seconds of application but only short duration of action
Limit to 7 days
Less than 2 years old
What are the topical oral rinses?
Soothe and hasten healing of lesions
- Listerine
- Saline rinses
- Baking soda paste
What are topical oral protectants?
Inert substances/coat & protect Use as needed Denture adhesives Canker cover Wax on braces
What is the epidemiology of herpes simplex labialis (cold sores)?
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
What are some signs or symptoms of cold sores?
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
Goals of treatment for cold sores?
Relieve pain/irritation
Prevent secondary infections
Prevent spread to others
What are some exclusions for self treatment for cold sores?
Lesion there for 14+ days
Increased frequency of outbreaks
Compromised immunity
Symptoms of infection: fever, swollen glands, rash
What are the nonpharmacologic treatments for cold sores?
Clean lesions with mild soap solution
Wash hand frequently
Keep moist with skin topical skin protectants
Avoid triggers and factors that delay healing
What is the pharmacologic treatment of cold sores?
Docosanol 10% (Abreva)
- Only OTC for HSV
- MOA: direct fusion inhibitor to prevent viral replication
Not in children under 12 years old
What are the complementary treatment for cold sores?
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
Xerostomia (dry mouth) epidemiology and etiology?
Disease states: diabetes, Sjogren’s syndrome, depression, Crohn’s
Lifestyle choices
Radiation therapy of head/neck
Meds: antihistamines, decongestants, diuretics, antihypertensives, antipsychotics, sedatives
Dry mouth signs, symptoms and complications?
Difficulty talking or swallowing Stomatitis Halitosis Weight loss Dental caries Gingivitis Periodontal disease
What are the goals of treatment for dry mouth?
Relieve discomfort
Prevent and treat oral infections and disease
Reduce risk of dental decay
What are the exclusions for self treatment for dry mouth?
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
Nonpharmacologic treatments of dry mouth?
Avoid: tobacco, alcohol, caffeine, antihistamines, CNS stimulants, sugary/acidic foods
Increase H2O
Sugar free chewing gums or lozenges
Soft-bristle toothbrush with fluoride
What are the pharmacologic treatments of dry mouth?
Artificial saliva products: mimic natural saliva, does not stimulate salivary glands, use after meals and at bed time
What is contained in artificial saliva products?
Carboxymethylcellulose + glycerin
Flavoring
Sweeteners
Fluoride
