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Pharmacy Practice II > Oral Health > Flashcards

Oral Health Flashcards

1
Q

Dental Caries - Etiology and Pathophysiology

A

• Plaque: complex microbial community which adheres to tooth surface, readily removed by brushing/flossing
- Source of microbes causing caries and periodontal disease

  • Calculus (tartar) – hardened deposit due to calcium salts in saliva; removable only by professional
  • Plaque bacteria generate acid - acid demineralizes tooth enamel/dentin - dental plaque attracts more bacteria, promoting decay
  • Prevalent in children!!
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2
Q

Symptoms of Dental Caries

A
  • Enamel: No SX
  • Dentin: Tooth pain/sensitivity
  • Pulp: Pain
  • Systemic: Inflammation/pus
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3
Q

Risk Factors for Caries

A
  1. Poor oral hygiene
  2. Diet
  3. Xerostomia (dry mouth)
  4. Heredity
  5. Gum tissue recession
  6. Limited access to dental care
  7. Orthodontic appliances
  8. Tobacco
  9. Medications and medical disorders (anticholinergic meds; diabetes)
  10. Radiation therapy to head/neck
  11. Baby bottle tooth decay
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4
Q

Prevention of Caries*

A
  • Key to preventing caries is controlling dental plaque

Non-Pharm:

  • Dietary measures
  • Plaque removal devices (toothbrushes, dental floss, oral irrigators)

Pharm:

  • Fluoride
  • Dentifrices (toothpastes)
  • Mouth rinses
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5
Q

Dietary Measures (Prevention)

A

HIGH

  • water content
  • fibrous foods
  • fluids
  • saliva production (sugar free gum)

LOW

  • highly cariogenic food (>15% sugar/clings to teeth/remains in mouth)
  • acidic foods/beverages
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6
Q

Plaque Removal Devices (Prevention)

A

• Toothbrush

  • No standardization (soft bristles less likely to cause damage)
  • Has ADA Seal of Acceptance
  • Replace about every 3mo or when sick/worn out
  • Worn out toothbrush may injure gums
  • Manual vs electric (Orthodontic appliances, manual dexterity)

• Floss

  • Failing to floss leaves up to 35% of tooth surface un- cleaned
  • Considerations: manual dexterity, elderly, tightness of teeth
  • ADA Seal of Acceptance

• Oral Irrigators

  • High-pressure stream of water
  • Not a substitute for toothbrush, floss
  • Useful with orthodontic appliances
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7
Q

Proper Oral Hygiene

A
  • Brush with toothpaste (after each meal or at least 2x/day)
  • Floss (at least 1x per day)
  • Proper selection and timely replacement of toothbrushes
  • Use tongue scrapers
  • Visit dentist at a minimum 2x/year
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8
Q

Dentifrice - Toothpaste (Prevention)

A

• Enhances removal of dental plaque/stains
• Decreases incidence of dental caries/gum disease
• Reduces mouth odors
• Enhances personal appearance
• Commonly contain abrasive, surfactant, humectants, binder, sweetener, flavoring, therapeutic ingredient
- Abrasive (silica, Ca/Al salts) essential in cleaning teeth
- Surfactant (Na lauryl sulfate) causes foaming
• Sweetener (saccharin)
- Available as powders, pastes and gels

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9
Q

Therapeutic Ingredients in Dentifrices

A
  1. Fluoride: preventing AND treating carious lesions
    - Facilitates remineralization of early caries
    - May interfere with bacterial process (decrease plaque adherence and/or inhibit glycolysis)
  2. Triclosan: antigingivitis/antibacterial
    - Still in some toothpastes, although in 2016 the FDA banned
    them in antiseptic hand and body wash products
  3. Potassium nitrate: sensitive teeth
  4. Titanium dioxide, hydrogen peroxide: antistain, whitening
    - Plain baking soda also effective at stain removal
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10
Q

Fluoride

A

• Indicated for both prevention and treating carious lesions
• Maintain overall oral health
• Topical effects facilitate remineralization of early carious lesions
• Three forms effective for anticaries/anticavity effect
- Sodium fluoride
- Sodium monofluorophosphate
- Stannous fluoride*
*May cause slight tooth discoloration (not permanent)

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11
Q

Mouth Rinses

A
  • Adjunct to proper flossing and brushing

• Fluoridated mouthwashes (0.05% sodium fluoride daily or 0.2% weekly)

  • Effective anticaries agents
  • Use after brushing; DO NOT swallow
  • Nothing PO for 30 min after use
  • Not recommended for kids under 6 yo or those with difficulty rinsing

• Gels (stannous fluoride 0.4%)

  • Use after brushing, daily at night
  • Brush 1 minute, swish before expectorating
  • Do not rinse
  • Available via dental professional
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12
Q

Other Ingredients in Mouth Rinses

A

Antigingivitis/Antiplaque effects
• Aromatic oils (eucalyptol, menthol, methyl salicylate, thymol) (eg – Listerine)
- Antibacterial, local anesthetic effect
• Quaternary ammonium compounds (cetylpyridinium) (eg – Crest Pro- Health)
- Antimicrobial
• Phenol oils, methyl salicylate, and alcohol
- Sloughing of the oral epithelium may occur
- Burning sensation
- Disulfiram reaction/alcohol disorders

• Caution in children < 12 yo

  • Labeling includes warning not to swallow
  • Seek care or contact poison control center
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13
Q

Cautions in Children

A

• < 3 yo – begin brushing teeth as soon as they come into mouth using fluoride toothpaste
- Use small amount or ”smear” (size of grain of rice)
• 3 to 6 yo –use small amount (size of a pea)
• Do not use high fluoride concentrated toothpaste in children <6 yo
• Children need supervision with brushing until age 8-9
• Important to provide instruction on proper technique/habits
• All fluoride dentifrice products must contain warning label

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14
Q

Periodontal Disease

A
  • Affects ~46% of U.S. adults 30 yrs and older
  • Main cause of tooth loss in adults > 45 years
  • Inflammation of supporting structures of the teeth
  • Associated with oral hygiene status, not with age

• Types of Periodontal Disease
1. Gingivitis (mildest form, early stages)
• Common, reversible
• Inflammation of the gingiva without loss of epithelial attachment to the tooth
2. Periodontitis (involves bone loss)
• Significant, irreversible
• Periodontal ligament attachment and bone support of tooth have been compromised/lost

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15
Q

Periodontal Disease: Treatment

A

• Refer for:

  • Oral hygiene improvement (same measures as prevention of caries)
  • Debridement
  • Scaling and root planing by dentist/hygienist
  • Chlorhexidine gluconate rinse
  • Gum surgery
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16
Q

Tooth Hypersensitivity

A

• Potential Etiologies
- Gum recession exposing sensitive portions of teeth
~ Extrinsic acid (acidic/soda/wine/sour)
~ Intrinsic acid (GERD/vomit)
~ Xerostomia
~ Incorrect tooth brushing
~ Occupation
• Teeth clenching (can result in referred pain)
• Dental work (may be temporary)
• Damage to pulp/tooth
• Infection (gum, bone)
• Pain from hot, cold, sweet, or sour solutions
• Individual pain thresholds vary
• Self-treatable if due to abrasion or erosion

REFER patient to dentist if: 
• Toothache
• Fracture
• Faulty restoration
• Gingival recession
17
Q

Management of Tooth Hypersensitivity

A

• Identify and eliminate predisposing factors
- Extrinsic/intrinsic acid exposure, improper brushing
• Brush and floss carefully and completely
• Do not brush within 30-60 min. after consuming acidic foods/drinks
• Avoid whitening or stain removal toothpastes
• Ice may provide temporary relief
• Toothpaste for sensitive teeth
- Containing potassium nitrate 5%
- Use for 2-4 weeks to relieve symptoms
- Long-term treatment needed in ~25% of adults
• Referral to dentist if no relief after 2-3 weeks

18
Q

Tooth Hypersensitivity: Exclusions for Self-Treatment

A
  1. Toothache
  2. Mouth soreness associated with poor-fitting dentures
  3. Presence of fever or swelling
  4. Loose teeth
  5. Bleeding gums w/o trauma
  6. Broken teeth
  7. Severe tooth pain
  8. Trauma to the mouth
19
Q

Eruption Cysts

A

• Bluish, soft and round swellings over emerging incisors and molars during teething process
• Not the result of infection
• No treatment is typically needed (resolve spontaneously)
• Nonpharmacologic
- Massaging gum
- Cold teething ring
- AVOID OTC topical medications (ie benzocaine) risks outweigh benefits

20
Q

Recurrent Aphthous Stomatitis (RAS)

A

• Commonly known as canker sores or aphthous ulcers
• Onset peaks 10-19 years
• Not contagious
• Cannot be cured
• Causes
- Unknown, stress, local trauma, infectious, nutritional deficiency, systemic conditions (HIV)

21
Q

Treatment for RAS: Nonpharmacologic

A

Goal of therapy

  • Relieve pain and irritation so lesions can heal
  • Prevent complications, such as secondary infections

Diet

  • Avoid spicy foods, acidic foods, sharp-textured foods
  • Correct nutritional deficiency

Ice

  • Applied directly to lesions in 10-minute increments
  • Stress removal, relaxation
  • Do not use heat (could spread bacteria if present)
22
Q

Treatment for RAS: Pharmacologic (Refer)

A

• Systemic analgesics (for pain)
• Oral debriding and wound cleansing agents (carbamide peroxide, hydrogen peroxide, sodium perborate monohydrate, sodium bicarbonate)
- Ex: Cankaid, Orajel Antiseptic Rinse
- Apply after meals, to affected area, up to 4x/day

• Topical oral anesthetics (benzocaine, benzyl alcohol, others)

  • Ex: Orajel, Anbesol
  • Apply up to 4x/day

• Oral Protectants

  • Coat and protect ulcerated area by creating a barrier
  • Apply or use as needed

• Oral Rinses

  • Can hasten healing process
  • Ex: Saline rinses

• REFER

  • If no improvement after 7 days of OTC treatment
  • Worsens during self-treatment
23
Q

Herpes Simplex Labialis (HSL) (NonPharm)

A
  • AKA cold sores or fever blister
  • Primary herpes: initial viral infection (childhood, latent)
  • Herpes labialis: recurrent (reactivated by trigger, lips)
  • Generally caused by HSV-1 (contagious, within 1-2wk)
  • Usually resolves in 10-14 days
  • Triggers: menstruation, sun exposure, illness with fever, stress, immunosuppression

• Nonpharmacologic

  • Keep clean
  • Hand washing
  • Keep moist
  • Avoid triggers (stress, sun, fatigue)
24
Q

Treatment for HSL: Pharmacologic (contra, refer)

A

• Duration and severity reduction
- Docosanol 10 (Abreva)
- Dose: Apply to affected area 5x/day as soon as sx onset
• Apply until lesion healed, NTE 10 days

• Relief of discomfort only

  • Systemic analgesics
  • Topical anesthetics
  • e.g. benzocaine 5-20%, benzyl alcohol 10% topical gel (Zilactin)
  • Secondary bacterial infections: triple antibiotic
  • Topical steroids are contraindicated
  • REFER if no improvement after 14 days
25
Q

HSL: Exclusion for Self-Treatment

A
  • Lesions present >14 days
  • Increased frequency of outbreaks
  • Compromised immunity
  • Symptoms of infection (fever, rash, swollen glands)
  • No previous diagnosis of cold sore
26
Q

Halitosis (Treat)

A

• Pathophysiology
- May be related to systemic and oral conditions (~85% oral)
- Volatile sulfur compounds due to breakdown of food debris
- Foods (garlic, onions, alcohol)
- Medical; sinus infection/ulcers
• Dental; gum disease/xerostomia/oral cancers/dentures
• Smoking

• Prevention

  • Good oral hygiene
  • Treat underlying disorders
  • Zinc salts, chlorine dioxide products (Oxyfresh, CloSys)
27
Q

Xerostomia

A
  • Commonly known as dry mouth
  • Salivary flow is limited or completely stopped
  • Etiology: med (antidep/antihis), radiation, nerve damage, nonpharm (alcohol, tobacco, caffeine), mouth breathing, med disorders
  • Can increase dental caries and gingivitis
  • Cause of halitosis
  • Can predispose oral cavity to candidiasis, hypersensitivity
  • Can impair speech, swallowing, ability to taste foods
28
Q

Treatment of Xerostomia

A 
Nonpharmacologic
• Sip water
• Sugar free candies
• Consider change in drug therapy
• Avoid substances that reduce saliva (tobacco, alcohol)
Pharmacologic
• Artificial saliva
• Biotene Rinse
• Salivart Spray
• Entertainer’s Secret Spray
• Xylitol products (e.g. Spry)
• Topical fluoride

• Referral
- If condition worsens or complications develop

Pharmacy Practice II (25 decks)

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