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Pharmacist Provided Care I > Oral Pain and Discomfort > Flashcards

Oral Pain and Discomfort Flashcards

1
Q

What is tooth hypersensitivity?

A

Short, sharp pain that comes from the dentin due to external stimuli

(quick, fleeting, sharp, or stabbing pain on stimulation which stops after stimuli are no longer present)

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2
Q

What causes tooth hypersensitivity?

A

Tooth or gum erosion which can be caused by:

  • GERD
  • bulimia
  • vigorous brushing with a hard bristled toothbrush
  • frequent consumption of acidic medications, foods, and drinks
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3
Q

How do you assess tooth hypersensitivity?

A
  • self treatable
  • sensitivity is due to attrition, abrasion, or erosion and is not serious
  • due to fracture, faulty restoration or gingival recession is referred to dentist
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4
Q

What are the symptoms of toothache?

A
  • continuous, dull, throbbing pain without stimulation is irreversible damage and requires dental or medical care for resolution
  • intermittent, short, sharp pain on stimulation is reversible damage
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5
Q

What pharmacological toothache help is available?

A
  • topical anesthetics (benzocaine)
  • systemic analgesics (acetaminophen and ibuprofen)
  • Eugenol (red cross toothache): active component from clove–has antibacterial and pain relieving properties–FDA category 3, not enough data to support efficacy
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6
Q

What are the goals of tooth hypersensitivity treatment?

A
  • alter damaged tooth surface by using appropriate toothpaste
  • stop abrasive tooth brushing practices
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7
Q

What is the general approach for tooth hypersensitivity treatment?

A
  • determine patient’s dental history–how often do they care for their own teeth and how often they see a dentist
  • determine if it is a toothache or hypersensitivity
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8
Q

What non-pharmacological treatment options are there for tooth hypersensitivity treatment?

A
  • avoid acidic foods and beverages

* use soft bristled toothbrush

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9
Q

What pharmacologic treatments are there for tooth hypersensitivity treatment?

A
  • desensitizing denitrifies with potassium salts (potassium nitrate 5%)
  • combination products with fluoride are preferred (stannous fluoride 0.454% or sodium monofluorophosphate 0.76%)
  • other ingredients (strontium, chloride, acetate, calcium sodium phosphosilicate, oxalates, arginine and calcium carbonate, nanoparticles with various functionalizing agents)
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10
Q

How should you use desensitizing dentifrice?

A
  • Apply a 1 inch strip to a soft bristled toothbrush twice daily
  • brush for at least 1 minute
  • do not rinse mouth with water after brushing
  • may take 2 to 4 weeks to relieve symptoms
  • refer to dentist if no relief is seen
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11
Q

Who should not use desensitizing dentifrice?

A

children under 12, unless recommended by a dentist

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12
Q

What counseling points should should you tell patients about tooth sensitivity?

A
  • avoid using whitening products in patients with tooth hypersensitivity
  • use desensitizing products for a max of 4 weeks unless dentist recommends longer
  • if new pain develops or begins to persist or worsen, refer to dentist
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13
Q

What is teething discomfort? What symptoms can be seen and felt?

A

Teeth pushing through gingival tissue in babies

  • mild pain, irritation, reddening, or swelling of gums
  • excessive drooling, sleep disturbances, irritability
  • eruption cysts may be present
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14
Q

What is the treatment goal for teething discomfort?

A

relieve pain and irritation

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15
Q

What should be your general approach for treatment of teething discomfort?

A
  • start with non-pharmacologic methods

* if unsuccessful, then try pharmacologic treatments

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16
Q

What non-pharmacologic treatments are there for teething discomfort?

A
  • massage the gums
  • frozen pacifier
  • cold, wet cloth
  • food
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17
Q

What pharmacologic treatments are there for teething discomfort?

A
  • oral analgesics (benzocaine and phenol)

* systemic analgesics (acetaminophen and ibuprofen)

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18
Q

What kind of benzocaine should you recommend and not recommend?

A

Benzocaine is available in 5 to 20% strengths.

  • dont use products with 20% in children/babies
  • Baby Anbesol Gel (7.5%) and Baby Orajel Teething Nighttime Formula (10%) are the best choices
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19
Q

What is the dose for acetaminophen in children?

A

10 to 15 mg/kg (6 months and older)

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20
Q

What is the dose for ibuprofen in children?

A

5 to 10 mg/kg (6 months and older)

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21
Q

What is the preferred treatment for teething?

A
  • gels are preferred over solutions and suspensions

* avoid products with alcohol

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22
Q

What counseling points should you tell patients about teething discomfort treatments?

A
  • do not apply more than 4 times daily
  • watch for hypersensitivity relations to benzocaine
  • CAUTION: METHEMOGLOBINEMIA WITH BENZOCAINE
  • follow up should be done 3 to 5 days after self care treatments started (if pain not relieved, refer to pediatrician)
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23
Q

What is methemoglobinemia?

A

Baby turns blue because the oxygen is not moving right–happens with overuse of benzocaine (never use more than 10%)

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24
Q

What are the other names for RAS?

A
  • recurrent aphthous stomatitis
  • canker sore
  • aphthous ulcer
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25
Q

What percentage of US has RAS?

A

1 to 66%

(most common in people in their 20s and 30s, females, children of higher socioeconomic status, stressed individuals–first appears in childhood and decreases at age of 40)

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26
Q

What causes RAS?

A
  • stress or trauma
  • genetic component likely
  • food allergies
  • hormonal changes
  • systemic conditions
  • medications
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27
Q

Describe the symptoms of RAS?

A
  • ulceration of mucosal surfaces of parts of the mouth (tongue, floor of mouth, soft palate, inside lining of lips and cheeks)
  • rarely can occur on gingiva or external lips
  • typically round or oval, flat or crater like, and gray to grayish yellow
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28
Q

What are the 3 different types of RAS?

A
  • minor
  • major
  • herpetiform

(different from cold sores)

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29
Q

How do minor, major, and herpetiform RAS manifest themselves?

A
  • MINOR: OVAL, FLAT ULCER, ERYTHEMATOUS TISSUE AROUND ULCER
  • major: oval, ragged, gray/yellow ulcers, crater form
  • herpetiform: small ulcers in crops, similar to minor RAS
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30
Q

What location do minor, major, and herpetiform RAS show up in?

A
  • MINOR: ALL AREAS EXCEPT GINGIVA, HARD PALATE, VERMILLION
  • major: same as minor
  • herpetiform: any intra-oral area
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31
Q

How many lesions do minor, major, and herpetiform RAS have?

A
  • minor 1 to 5
  • major 1 to 10
  • herpetiform 10 to 100
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32
Q

Which type of RAS has common scarring?

A

major

33
Q

What is a cause of all types of RAS?

A

immunologic defect

34
Q

What are the treatment goals for RAS?

A
  • control pain
  • promote healing
  • prevent recurrence
  • prevent complications
35
Q

What is the treatment approach for RAS?

A
  • determine if it is RAS
  • determine what has been tried in the past
  • treatments should protect users from further irritation
36
Q

What excludes a patient from self treatment of RAS?

A
  • lesions associate with underlying pathology
  • lesions present for 14 days or more
  • failure of prior self treatment attempt
  • frequently recurring lesions
  • symptoms of systemic illness
37
Q

What non-pharmacologic treatments of RAS are there?

A
  • supplement with nutrients (if caused by nutrient deficiency)
  • avoid food causing the allergy (if caused by food allergy)
  • avoid spicy and acidic foods
  • avoid foods that can cause local injury
  • ICE APPLIED IN 10 MINUTE INTERVALS MAY HELP WITH PAIN
  • do NOT use heat
  • relaxation techniques may prevent recurrence
38
Q

What pharmacologic treatments for RAS are there?

A

Oral rinses like listerine, saline rinses, or baking soda.

Systemic analgesics like NSAIDS, ASA, and APAP (DO NOT PLACE ASA DIRECTLY AGAINST ULCER BECAUSE THE ACID CAN WORSEN THE SITUATION)

HONEY (applied 4 times daily, shown to be more effective than triamcinolone 0.1%)

Topical oral protectants like canker cover (menthol 2.5mg)

Topical oral anesthetics like:

  • BENZOCAINE 5 -20%
  • DYCLONINE 0.05 - 0.1%
  • MENTHOL 0.04 - 2%
  • PHENOL 0.5 - 1.5%
  • hexylresorcinol
  • phenolate sodium
  • benzyl alcohol
  • salicylic acid

Oral debriding and wound cleansing agents like:

  • CARBAMIDE PEROXIDE 10 - 15% (GLYOXIDE 10%)
  • HYDROGEN PEROXIDE 1.5 - 3% (COLLAGE PEROXYL DENTAL RINSE 1.5%)
  • sodium bicarbonate
39
Q

What are the counseling points for pharmacological treatments of RAS?

A
  • extended use can cause soft tissue irritation, tooth sensitivity, overgrowth of undesirable organisms
  • DO NOT USE FOR MORE THAN 7 DAYS–IF YOU DO, YOU CAN HAVE A BLACK HAIRY TONGUE
40
Q

How do you apply oral debriding and wound cleansing agents?

A

Place few drops on sore and let sit for 1 minute or place drops on tongue, mix with saliva, and swish for 1 minute

41
Q

What are the important points of pharmacological treatment of RAS?

A
  • benzocaine is used most commonly
  • use caution with benzocaine in patients predisposed to hypersensitivity reactions
  • dry sore with cotton swab and apply product 3 to 4 times a day
  • do not eat or drink for 30 minutes after application
42
Q

How do topical oral protectants help with RAS? What are the counseling points?

A
  • protect ulcer from external stimuli and irritants
  • products create a barrier via a paste, film, or patch

Counsel:

  • apply patch by holding in place for 10 to 20 seconds
  • disc will dissolve overtime
  • can apply 3 to 4 times daily
43
Q

How do oral rinses help with RAS?

A
  • listerine heal lesions more rapidly
  • saline rinses sooth ulcers (1 to 3 teaspoons of salt in 4 to 8 ounces of warm water)
  • baking soda soothes ulcers (create a paste and apply to ulcer)
44
Q

What are the general counseling points of RAS?

A
  • do not use anesthetics in patients allergic to local anesthetics
  • do not use salicylic acid in patients allergic to aspirin
  • do not use menthol, phenol, and camphor in concentration higher than recommended
  • lesions should resolve within 14 days
45
Q

What are some causes of minor oral mucosal injury or irritation?

A
  • biting cheek
  • abrasive foods
  • minor dental procedures
46
Q

What are the exclusions for self care of minor oral mucosal injury or irritation?

A
  • toothache
  • loose teeth, broken, or knocked out teeth
  • bleeding gums in absence of trauma
  • severe tooth pain triggered by hot, cold, or chewing
  • trauma to the mouth with bleeding, swelling, soreness)
47
Q

What non-pharmacologic therapy is there for minor oral mucosal injury or irritation?

A
  • ice applied in 10 minute increments
  • combine 1/2 to 1 teaspoon of sodium bicarbonate with 4 ounces of water and rinse for 1 minute, then spit
  • saline rinse of 1 to 3 teaspoons of salt with 4 to 8 ounces of warm water also can be used
48
Q

What pharmacologic therapy is there for minor oral mucosal injury or irritation?

A
  • topical analgesics/anesthetics, oral protectants, oral debriding/wound cleansing agents
  • astringents and combination products may be used
49
Q

When should you refer a patient with minor oral mucosal injury or irritation?

A

*symptoms should resolve within 7 days with treatment or within 10 days of the initial injury

(braces are a common cause of mucosal injury and irritation)

50
Q

What are the common names of HSL?

A
  • cold sore
  • fever blister
  • herpes simplex labialis
51
Q

What is HSL caused by?

A

Herpes simplex virus 1

52
Q

What is HSL?

A

It is a contagious virus that is spread via direct contact with an infected source. The virus remains dormant until triggered.

  • typically occurs on the lips or area bordering the lip, may also occur intra-orally
  • lesions are recurrent and can be painful
  • PRODROME SYNDROME OCCURS: burning, itching, tingling, numbness in the area where the sore will develop
53
Q

What are the possible triggers for HSL?

A
  • stress
  • UV radiation
  • fatigue
  • cold
  • menstruation
  • food allergy
  • fever
  • injury
  • dental work
  • infectious disease
  • decreased immune function
54
Q

Describe the lesions of HSL.

A
  • small, red papule with fluid containing vesicles
  • 1 to 3 mm in diameter
  • lesions often form together to create a larger area
  • eventually a crust will form over the lesions
  • frequency of episodes varies
55
Q

What are the treatment goals for cold sores?

A
  • relieve discomfort from the lesions
  • prevent secondary bacterial infection
  • prevent spread to others
56
Q

What are the exclusions to self care for cold sore treatment?

A
  • lesions present for more than 14 days
  • increased frequency of outbreaks
  • compromised immunity
  • symptoms of infection (pus, fever, rash, enlarged glands)
57
Q

What non-pharmacologic treatment is there for cold sores?

A
  • wash lesions with mild soap
  • wash hands to prevent spreading of virus
  • keep lesions moist
  • if sun causes cold sore, always use lip and face sunscreen (SPF 15)
  • cool, wet compresses or ice for 15 to 20 minutes 2 to 3 times a day to decrease swelling and redness
  • avoid sharing items like towels, razors, and silverware when blisters are present
58
Q

What pharmacologic treatment is there for cold sores?

A

Topical skin protectants like petrolatum and cocoa butter.

  • do not reduce duration of symptoms
  • help protect from infection
  • keep moist

External analgesics/anesthetics

  • relieve burning, itching, pain
  • do not reduce duration of symptoms
  • ingredients can be benzocaine, dibucaine, dyclonine, benzyl alcohol, camphor, menthol.

Abreva (Docosanol)

  • if bacterial infection is suspected, a triple antibiotic ointment can be used 3 to 4 times daily
  • oral analgesics can be used to help with pain
  • use of topical steroids is contraindicated
  • avoid use of strong astringents
59
Q

What is abreva?

A
  • ACTIVE INGREDIENT IS DOCOSANOL 10%
  • ONLY FDA APPROVED OTC PRODUCT THAT WILL REDUCE THE DURATION AND SEVERITY OF SYMPTOMS
  • mechanism of action is it inhibits fusion between the herpes virus and the human cell plasma membrane, results in inhibition of viral replication
  • APPLICATION: APPLY DURING PRODROMAL STAGE; USE 5 TIMES DAILY UNTIL LESION IS HEALED
  • DECREASES DURATION BY 1 DAY COMPARED TO PLACEBO
60
Q

What complementary and alternative medicines are there for cold sores?

A
  • tea tree oil
  • LYSINE (oral administration and topical administration–1000mg daily–Super Lysine Plus is used every 2 hours)
  • LEMON BALM (also called melissa) reduces symptoms, shortens healing time, prevents infection spread–used topically
  • rhubarb sage topical cream
  • Releev (benzalkonium chord, echinacea)
  • Herpecin L (dimethicone, sunscreen, lysine)
  • Lip Clear Lysine Plus (L-lysine, propolis extract, zinc oxide, tea tree oil)
61
Q

What should we tell patients during cold sore counseling?

A
  • INFORM PATIENT THAT LESIONS ARE CONTAGIOUS
  • explain the uses of the different products and the outcomes of use
  • if condition continues for 14 days, refer to medical doctor
62
Q

What is xerostomia?

A

dry mouth

63
Q

What are some causes of dry mouth?

A
  • disease states (sjogren syndrome, diabetes, depression, chrohn’s disease)
  • age
  • radiation therapy of head and neck
  • medications like antihistamines, decongestants, antihypertensives, diuretics, antidepressants, antipsychotics, sedatives
  • alcohol, tobacco, caffeine
  • salivary gland stones
  • breathing through the mouth
64
Q

What are some symptoms of dry mouth?

A
  • difficulty talking and swallowing, stomatitis, burning tongue, halitosis
  • loss of appetite
  • sensitive teeth
  • tooth decay
65
Q

What are the treatment goals for dry mouth?

A
  • relieve discomfort
  • prevent and treat oral infections
  • reduce risk of dental caries
66
Q

What are the exclusions to self care for dry mouth?

A
  • candidiasis
  • reduced denture wearing time or mouth soreness caused by poor fitting dentures
  • fever or swelling
  • loose, broken, or knocked out teeth, trauma to mouth
  • severe tooth pain
67
Q

What non-pharmacologic therapy is there for dry mouth?

A
  • avoid tobacco and alcohol
  • modify medications if possible
  • to prevent dental decay you can limit sugary and acidic foods, chewing gum with sugar alcohols (xylitol) may be helpful, increase water intake, and use very soft toothbrushes
68
Q

What pharmacologic treatment is there for dry mouth?

A

Artificial saliva products (biotin, entertainer’s secret spray, salivart)

  • work as a replacement product, not a cure
  • created to have viscosity, mineral content, and palatability
  • dosage form is typically a spray or gel
  • apply 1/2 inch of gel on tongue and spread throughout the mouth

Mucoadhesive patch (OraMoist)

  • applied to side of palate or cheek in denture wearers
  • dissolves over 2 to 4 hours
  • stimulates saliva release
  • contains xylitol, hydroxypropylcellulose base
69
Q

What patient counseling points are there for dry mouth?

A
  • review good oral hygiene practices
  • review non-pharmacologic and pharmacologic measures that will keep mouth moist
  • combination of products may be most effective like a gel and toothpaste
  • determine if other symptoms such as dry eye are present to decide if possible case of sjogren’s syndrome
  • saliva substitutes may need to be used indefinitely, re-evaluate after 5 to 7 days
70
Q

Can toothache be self treated?

A

No, refer to a dentist

71
Q

What is the active ingredient in most products for tooth hypersensitivity?

A

potassium nitrate

72
Q

What is the APAP dosing for children?

A

10 to 15 mg/kg

73
Q

What is the ibuprofen dosing for children?

A

5 to 10 mg/kg

74
Q

What is the most important thing about oral debriding agents?

A

Not to overuse them because they can cause black hairy tongue

75
Q

What should you advise patient’s about using ice?

A

Do not exceed 10 minutes when using ice to treat oral injuries

76
Q

What is the only FDA approved product to shorten the duration of a cold sore?

A

Abreva

77
Q

How often should Areva be applied and when?

A
  • 5 times daily

* during the prodromal stage to have max benefit

78
Q

What can dry mouth be treated with?

A

Saliva substitutes like Biotin and Entertainer’s Secret Spray

Pharmacist Provided Care I (8 decks)

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