Oral Health Flashcards
What are the THREE main ulcer groups?
- Minor Aphthous ulcers
- Major Aphthous ulcers
- Herpertiform ulcers
What are the clinical features of MINOR aphthous ulcers?
roundish grey colour PAINFUL - key presenting factor small- usually less than 1 cm diameter up to 5 in cluster present on gums, inside lips/cheeks, tongue
7-14 days to heal
Recurrence interval of 1-4 months
What are the clinical features of MAJOR aphthous ulcers?
Larger than 1 cm diameter - larger clusters of 10 or more - join to make a large one
present on lips, back of the mouth
Heal slowly & can persist for many weeks
Referral points for ulcers (8)
- Painless - could be leukoplakia or carcinoma
- Irregular shape not caused by trauma
- Longer than 14 days
- Under 10 years old
- crops of more than 5 ulcers
- Weight loss
- Persistent recurrent diarrhoea
8.
What drugs may cause mouth ulcers? (7)
- NSAIDs
- Cytotoxics
- Sulfasalazine
- Nicorandil
- Alendronate
- B-blockers
- Herbal - e.g. feverfew
Usually seen at the start of therapy or when dose increased
What are the clinical features of Herpetiform ulcers?
- Pinpoint/small
- Large clusters of up to 100
- Irregular shapes
- affect the floor of the mouth & gums
What are some examples of OTC medicines for ulcers? Brand name and generic name (6)
- Chlorhexidine/Corsodyl (antibacterial)
- Lidocaine/Anbesol/Iglu (topical anesthetic)
- Benzocaine/Oragel
- Choline salicylate/Bongela (analgesic)
- Topical hydrocortisone
- Benzydamine (Difflam)
Medicines that can be prescribed for ulcers?
Recurrent ulcers?
What supplement can be advised?
- First-line treatment is usually a topical corticosteroid such as hydrocortisone oro-mucosal tablets, beclomethasone spray (delivered via an inhaler device — off-license use), or betamethasone soluble tablets
- Short course of oral prednisolone
- Vitamin b12 (cyanocobalamin)
From what age group is chlorhexidine suitable from?
Suitable for preg/breastfeeding?
Any interactions?
12 years +
OK in preg/breastfeeding
No known interactions
Counselling point/advice for chlorhexidine? (3)
- Can stain teeth/tongue brown - so brush teeth before taking
- 10ml of mouthwash should be rinsed for 1 min BD
- Taste disturbance and burning sensation
Symptoms of Gum disease? (2)
red and swollen gum
bleeding gums after brushing or flossing teeth
If gingivitis is left untreated - it can lead to periodontitis
What are the symptoms? (4)
Bad breath (halitosis)
Unpleasant taste in mouth
Loose teeth
Gum abscesses
When should you refer to dentist? gum disease (8)
Symptoms of acute necrotising ulcerative gingivitis
- Bleeding and painful gums
- Painful ulcers
- Receding gums between teeth
- Metallic taste
- Bad breath
- Excess saliva in mouth
- Difficulty swallowing or talking
- High temp/Fever
Treatment for gum disease?
Pharmacological and non
- Good oral hygiene - brushing x2 daily, fluoride containing toothpaste, flossing teeth, not smoking, regularly visiting dentist
- Chlorhexidine
Symptoms of oral thrush? (4)
- Milky white plaques which can be wiped off to reveal red mucosa (if can’t be wiped off + symptomless = leukoplakia (can eventually turn into cancer) = referral)
- Soreness
- Altered taste
- Burning of tongue
Treatment options for oral thrush? (2)
- Daktarin oral gel (miconazole) 4 months +
2. Nystatin (POM)
How to use Daktarin oral gel?
how about those who use dentures?
QDS after meals. do not swallow - should be kept in mouth for as long as possible. should be used 1 week after resolved.
Remove dentures at night and brush them using the gel
Drug Interactions & contraindications with Daktarin?
Miconazole is systemically absorbed and is known to inhibit CYP2C9 and CYP3A4
Avoid with
- Simvastatin
- Drugs that prolong QT interval
- Oral midazolam
- Warfarin - if need to be used must be carefully monitored
- Phenytoin - monitor levels
- Sulphonylureas - enhanced effect = hypotension - so need to be careful
- Calcium channel blockers - verapamil - monitor
Liver dysfunction
Under 4 months - under developed swallowing
Can daktarin be used in pregnant and breastfeeding?
No - best not to
