Oral pain and discomfort Flashcards
TOOTH HYPERSENSITIVITY
Toothaches are not self-treatable*
TOOTH HYPERSENSITIVITY
cause
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
hypersensitivity vs toothache
Exposure of dentin vs bacteria invasion of pulp
pain from sensitivity vs pain remains even in the absence of stumili
Non pharm for tooth hypersensitivity
- 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
exclusion for hypersensitivity
- 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
non pharm for tooth sensitivity
Fluoride dentifrices
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)
tooth hypersensitivity
Pharm Tx: Long-term use (2-4 weeks) may be necessary
- 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 - 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
- Caution using cosmetic pastes that whiten teeth or remove stains
- If no improvement in 14-21 days, see a dentist
TEETHING DISCOMFORT
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
TEETHING DISCOMFORT
Non-Pharm Tx: SHOULD TRY ALL
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.
TEETHING DISCOMFORT
Pharm Tx: LIMITED TO PEDIATRIC DOSES OF SYSTEMIC ANALGESICS
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)
RECURRENT APHTHOUS STOMATITIS (RAS)
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
RECURRENT APHTHOUS STOMATITIS (RAS)
exclusion
- 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
RECURRENT APHTHOUS STOMATITIS (RAS)
non-pharm
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.
RECURRENT APHTHOUS STOMATITIS (RAS)
Pharm Tx
- Oral Debriding and Wound-Cleansing Agents
- Topical Oral Anesthetics
- -Topical Oral Protectants
- -Oral Rinses
- -System Analgesics
-Oral Debriding and Wound-Cleansing Agents
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
RECURRENT APHTHOUS STOMATITIS (RAS)
-Topical Oral Anesthetics
-
● 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
RECURRENT APHTHOUS STOMATITIS (RAS)
–Topical Oral Protectants
-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)
RECURRENT APHTHOUS STOMATITIS (RAS)
–Oral Rinses
● Listerine Antiseptic
● Saline rinse (salt in warm water)
● Paste of baking soda applied to the lesions
RECURRENT APHTHOUS STOMATITIS (RAS)
–System Analgesics
● 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.*
RECURRENT APHTHOUS STOMATITIS (RAS)
special population
and counseling points
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
HERPES SIMPLEX LABIALIS (cold sores or fever blisters)
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
HERPES SIMPLEX LABIALIS (cold sores or fever blisters)
exclusions
- lesions presents 14 days or longer
- increased frequency in outbreak
- compromised immunity
- symptoms of infection
- no previous diagnosed of cold sore
HERPES SIMPLEX LABIALIS (cold sores or fever blisters)
Non-Pharm Tx
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
HERPES SIMPLEX LABIALIS (cold sores or fever blisters)
Pharm Tx
TOPICAL skin protectants
Externally applied analgesics or anesthetics
-Docosanol 10% (Abreva Cream):
DO NOT apply hydrocortisone
