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OTC 812 Exam 2 > Oral pain and discomfort > Flashcards

Oral pain and discomfort Flashcards

1
Q

TOOTH HYPERSENSITIVITY

A

Toothaches are not self-treatable*

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2
Q

TOOTH HYPERSENSITIVITY

cause

A

Exposure of dentin to both the oral cavity and the pulp by infection, injury (aggressive or improper brushing), or the presence of extrinsic (acidic medications, foods, drinks) and intrinsic (gastric contents) acids.

symptoms
pain from hot, cold, sweet, or sour solutions, as well as when hot or cold air touches the teeth; pain varies in intensity, ranging from mild discomfort to sharp, excruciating pain

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3
Q

hypersensitivity vs toothache

A

Exposure of dentin vs bacteria invasion of pulp

pain from sensitivity vs pain remains even in the absence of stumili

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4
Q

Non pharm for tooth hypersensitivity

A
  • Identify and eliminate extrinsic and intrinsic acid exposure
  • Less vigorous brushing using a standard fluoride dentifrice and a soft-bristle toothbrush
  • Avoid brushing teeth within 30-60 min of consuming acidic foods or drinks
  • If no improvement with correct technique and fluoride paste, a desensitizing dentifrice should be used
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5
Q

exclusion for hypersensitivity

A
  • toothache
  • mouth soreness w/poor fitting dentures
  • presence of fever or swelling
  • loose teeth
  • bleeding gums in absence of trauma
  • broken or knocked-out teeth
  • severe tooth pain
  • trauma of the mouth with bleeding, swelling, and soreness
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6
Q

non pharm for tooth sensitivity

Fluoride dentifrices

A

safe and effective for preventing and treating carious lesions

  • Sodium fluoride, sodium monofluorophosphate re-mineralize and strengthen weakened enamel in addition to reducing gingivitis and sensitivity
  • Stannous fluoride also creates a protective mineral layer over the teeth to prevent plaque in addition to above mentioned actions (may cause tooth discoloration, not permanent, >12 yr)
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7
Q

tooth hypersensitivity

Pharm Tx: Long-term use (2-4 weeks) may be necessary

A
  1. Potassium salt, most widely used and in combo with sodium fluoride (Colgate, Crest, Sensodyne, Tom’s Sensitive)
    Potassium nitrate 5% - not for children <12 yr
    Safe for pregnant or lactating women and geriatric patients
  2. 8% arginine (amino acid in saliva) combined with calcium carbonate works by preventing fluid from moving into the tubules; excess calcium can affect the bioavailability of fluoride
  3. Caution using cosmetic pastes that whiten teeth or remove stains
  4. If no improvement in 14-21 days, see a dentist
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8
Q

TEETHING DISCOMFORT

A

Causes: eruption of deciduous (primary or baby) teeth through the gingival tissues
Symptoms: mild pain, irritation, reddening, excessive drooling, mouth biting, gum rubbing, low-grade fever, or slight swelling of the gums while teething may precede or accompany sleep disturbance or irritability etc.

Teeth eruption can begin as early as 6 months and each tooth has a period of over 8 days erupting

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9
Q

TEETHING DISCOMFORT

Non-Pharm Tx: SHOULD TRY ALL

A 
Massaging the gum around the erupting tooth, cold teething ring
Frozen pacifier (teething ring) or cold wet cloth. If @ age to tolerate food, give food to chew.
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10
Q

TEETHING DISCOMFORT

Pharm Tx: LIMITED TO PEDIATRIC DOSES OF SYSTEMIC ANALGESICS

A

Avoid topical anesthetics and homeopathic teething tablets and gels in babies.

Topical analgesics that are approved for use in infants and pediatric doses of systemic analgesics

  • Topical oral analgesics
    Benzocaine 5%-20% (unsafe and no studies in pregnant women, too potent for infants and can cause overdose) not for use in children <2yr; Lidocaine 2% solution. Brand Names: Anbesol, Hurricane, Orajel, Baby Orajel, Orabase, various store brands)

-Systemic Analgesics (ibuprofen and acetaminophen)

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11
Q

RECURRENT APHTHOUS STOMATITIS (RAS)

A

incurable, only symptomatic relief
Symptoms: internal as the tongue, the floor of the mouth, soft palate, inside lining of lips and cheeks
– round or oval,
- flat or crater-like,
-gray to grayish-yellow with an erythematous - halo of inflamed tissue surrounding ulcer

severe- crater form, gray or yellow like. minor cases- flat ulcer, pink or red

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12
Q

RECURRENT APHTHOUS STOMATITIS (RAS)

exclusion

A
  • lesions associated with underlying pathology
  • presents greater or equal to 14 days
  • frequently recurring lesions
  • symptoms of systemic illness
  • failure of prior appropriate self-treatment
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13
Q

RECURRENT APHTHOUS STOMATITIS (RAS)

non-pharm

A

Non-Pharm Tx:

  • If nutritional deficiency, increase deficient nutrients or take supplements
  • If food allergy, eliminate agent and improve diet
  • Relaxation and stress removal may be useful
  • Ice applied in 10-minutes increments directly to the lesion. DO NOT USE HEAT.
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14
Q

RECURRENT APHTHOUS STOMATITIS (RAS)

Pharm Tx

A
  • Oral Debriding and Wound-Cleansing Agents
  • Topical Oral Anesthetics
  • -Topical Oral Protectants
  • -Oral Rinses
  • -System Analgesics
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15
Q

-Oral Debriding and Wound-Cleansing Agents

A

aid removing secretions and cleansing minor wounds
● Carbamide peroxide 10% - 15% in anhydrous glycerin
● Hydrogen peroxide 3%
● Sodium bicarbonate
● 4x day
Do not continue self-care for more than 7 days; can cause black hairy tongue if chronic use

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16
Q

RECURRENT APHTHOUS STOMATITIS (RAS)
-Topical Oral Anesthetics
-

A

● Benzocaine commonly used. DO NOT USE in pt with history of hypersensitivity to other common local anesthetics products. (Oral Gel)
● Menthol, phenol, campher
● 4x day
Avoid use of dentifrices containing lauryl sulfate

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17
Q

RECURRENT APHTHOUS STOMATITIS (RAS)

–Topical Oral Protectants

A

-protect ulcerations, decrease friction; create a barrier using a paste, an adhering film, or a dissolvable patch to cover the lesion
- after meals (3-4x a day) and avoid eating or drinking for at least 30 min after
- Products available as a patch or dissolving disc must be placed against the sore for 10-20 seconds. the barrier will remain for 8-12 hrs
Canker Cover (menthol 2.5 mg) and Cankermelts (glycyrrhiza extract 30 mg)

18
Q

RECURRENT APHTHOUS STOMATITIS (RAS)

–Oral Rinses

A

● Listerine Antiseptic
● Saline rinse (salt in warm water)
● Paste of baking soda applied to the lesions

19
Q

RECURRENT APHTHOUS STOMATITIS (RAS)

–System Analgesics

A

● Aspirin, NSAID, acetaminophen.
● Use as needed
A topical anesthetic will provide short-term relief of pain and the oral debriding agents will help to keep the ulcer clean.*

20
Q

RECURRENT APHTHOUS STOMATITIS (RAS)
special population
and counseling points

A

Special Populations: The safety of these agents with use during pregnancy is unknown; no special considerations needed for older adults; unknown how these products affect lactating women; not approved for pediatric patients.

Counseling Points: Seek provider if symptoms persist after 7 days of tx, lesions do not heal in 14 days

21
Q

HERPES SIMPLEX LABIALIS (cold sores or fever blisters)

A

Also known as cold sores or fever blisters (externally)

Occurs around the lip

Red, fluid-filled vesicles. Crusted when mature

Crackling of the lesion is more susceptible to secondary bacterial infection

herpetic gingivostomatitis – mainly in children and immunocompromised adults, differs from RAS by infected gums, this is referral to MD

22
Q

HERPES SIMPLEX LABIALIS (cold sores or fever blisters)

exclusions

A
  • lesions presents 14 days or longer
  • increased frequency in outbreak
  • compromised immunity
  • symptoms of infection
  • no previous diagnosed of cold sore
23
Q

HERPES SIMPLEX LABIALIS (cold sores or fever blisters)

Non-Pharm Tx

A

Non-Pharm Tx:

  • Keep lesions by washing with mild soap solutions; handwashing is important to prevent further contamination;
  • kept moist to prevent drying and cracking (can cause secondary infections and delay healing);
  • Lip and face sunscreen for sun irritation
  • avoid stress, local trauma, wind excessive sun exposure, fatigue
24
Q

HERPES SIMPLEX LABIALIS (cold sores or fever blisters)

Pharm Tx

A

TOPICAL skin protectants

Externally applied analgesics or anesthetics

-Docosanol 10% (Abreva Cream):

DO NOT apply hydrocortisone

25
Q

HERPES SIMPLEX LABIALIS (cold sores or fever blisters)

Complementary Therapies:

A

Essential oil Melaleuca alternifolia or tree oil

26
Q

HERPES SIMPLEX LABIALIS (cold sores or fever blisters)

TOPICAL skin protectants

A

protect lesions, relieve dryness, and keep the tissue soft but do not reduce the duration of symptoms

Topical skin protectants like allantoin, petrolatum, and cocoa butter to keep lesions moist and prevent cracking

27
Q

HERPES SIMPLEX LABIALIS (cold sores or fever blisters)

Externally applied analgesics or anesthetics

A

relieve burning, itching, and pain, but do not reduce duration of symptoms (menthol in concentrations >1% can produce a counterirritant effect)

DO NOT apply hydrocortisone
●	Benzocaine (do not use if history of hypersensitivity to other benzocaine containing products)
●	Dibucaine
●	Dyclonine hcl
●	Benzyl alcohol
●	Camphor <3%
●	Menthol <1%
28
Q

HERPES SIMPLEX LABIALIS (cold sores or fever blisters)

-Docosanol 10% (Abreva Cream):

A

ONLY FDA APPROVED NONPRESCRIPTION PRODUCT proven to reduce the duration and severity of symptoms;

Docosanol 10% (Abreva) to prevent viral replication and limit burning , tingling, and itching. For speed healing. 5x day, no more than 10 days

if secondary bacterial infection is seen, rec. a thin layer of triple-abx ointment 3-4x daily
Use of topical steroids is contraindicated; avoid highly astringent products; avoid zinc sulfate (toxicity)
-Oral debriding and wound-cleansing agents and oral mucosal protectants are NOT used to treat HSL

29
Q

HERPES SIMPLEX LABIALIS (cold sores or fever blisters)

counseling points

A

Counseling Points:

  • Highly contagious, include appropriate measures to prevent transmission
  • Disorder is self-limiting and healing is within 10-14 days
30
Q

MINOR ORAL MUCOSAL INJURY OR IRRITATION

A

causes: minor wounds or inflammation resulting from dental procedures, accidental injury (biting tongue, cheek, or abrasion from sharp, crisp foods)

31
Q

MINOR ORAL MUCOSAL INJURY OR IRRITATION

non-pharm

A
  • application of ice in 10 min increments but no longer than 20 min in an hour, sodium
  • bicarbonate solutions (1/2-1 tsp baking soda in 4oz water) can be a wound cleanser,
  • saline rinses (1-3 tsp of salt in 4-8oz water) can cleanse and smooth area
32
Q

MINOR ORAL MUCOSAL INJURY OR IRRITATION

exclussions

A
  • toothache or severe mouth pain
  • soreness associated with poor fitting dentures
  • fevere
  • loose teeth
  • bleeding of gums in absence of trauma
  • broken or knockout teet
  • severe tooth pain triggered or worse with cold, hot or chewing
  • trauma to the mouth with bleeding, swelling, soreness
33
Q

MINOR ORAL MUCOSAL INJURY OR IRRITATION

Pharm

A

Topical analgesic/anesthetics - benzocaine

Systemic analgesics

Oral protectants

Oral debriding/ wound cleansing agents

Oral rinses

Astringents may be used

34
Q

MINOR ORAL MUCOSAL INJURY OR IRRITATION

counseling points

A

Counseling Points: Minor injury or irritation should resolve within 7 days of tx and within 10 days of the initial injury

35
Q

XEROSTOMIA

A

cause: limited salivary flow - can be an autoimmune condition, diabetes mellitus etc.

Difficulty talking and swallowing, stomatitis (inflammation of mouth/lip), burning tongue, and halitosis (bad breath)

36
Q

XEROSTOMIA (dry mouth)

non-pharm

A
  • avoid tobacco, caffeine, hot spicy foods, and alcohol (including mouth rinses)
  • modify medication schedules to align with natural stimulation (1hr before a meal)
  • limit sugary, starchy, and acidic foods to prevent tooth decay
  • chewing gum sweetened with sugar alcohols may be beneficial (increase salivary flow and xylitol is cariogenic)
  • increase water intake, especially if fluoridated
  • use a humidifier at home, use soft-bristle toothbrushes
37
Q

XEROSTOMIA

pharm

A

Artificial saliva products are the primary agents for relieving the discomfort of dry mouth.

If on a low sodium diet, avoid artificial saliva that contain sodium

Brush and floss your teeth at least twice daily using a regular toothbrush with fluoride, and see your dentist regularly

38
Q

XEROSTOMIA

product selection

A

Product Selection: majority are sprays and gels but gums and toothpastes are also available (ACT Total Care Dry Mouth Lozenges, Biotene Oral Balance Gel/Liquid, Biotene Moisturizing Mouth Spray, Entertainer’s Secret Spray, Biotene Dry Mouth Gum, Biotene Dry Mouth Toothpaste)
Proper use of a gel involves placing ~1/2 inch length of extruded product onto the tongue and spreading it thoroughly in the mouth

39
Q

XEROSTOMIA
special population
and counseling points

A

Special Populations: no special considerations for children, pregnant, or lactating women, or older adults
Counseling Points: encourage good oral hygiene measures and see dentist regularly
-Return for evaluation after 5-7 days of self-treatment

40
Q

XEROSTOMIA

Exclusions

A
  • tooth erosion, decalcification, and decay
  • candidiasis, gingivitis and periodontitis
  • reduced dentures-wearing time
  • mouth soreness associated with poor fitted dentures
  • fever or swelling
    -loose teeth
  • broken or knocked out teeth
  • severe tooth pain triggered ro worsened with hot, cold, or chewing
  • trauma to the mouth
    sjogern syndrome- autoimmune disease, it attacks the glands that make tears and saliva

OTC 812 Exam 2 (7 decks)

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