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phm 516: self-care > oral self-care > Flashcards

oral self-care Flashcards

1
Q

oral lesions - recurrent aphthous stomatitis

A
  • canker sores or aphthous ulcer
  • cause = unknown
  • precipitating factors = local trauma (most common), systemic, immunologic, nutritional
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2
Q

recurrent aphthous stomatitis (RAS) clinical presentation

A

-location: non-keratinized mucosal surfaces of moveable mouth parts, such as the tongue, floor of the mouth, soft palate, or inside lining of the lips & cheeks

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3
Q

RAS description

A
  • individual ulcers are usually
  • (1) round or oval
  • (2) flat or crateriform
  • (3) gray to grayish yellow, with an erythematous halo of inflamed tissue surrounding the ulcer
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4
Q

RAS symptoms

A
  • prodrome = a pricking or burning sensation approx. 2-48 hours before the lesion actually appears
  • painful, with the pain increasing with eating and drinking, and normal functions including eating, drinking, swallowing, talking and routine oral hygiene may be severely limited
  • fever or lymphadenopathy not usually present
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5
Q

RAS exclusions for self-care

A
  • lesions associated with underlying pathology
  • lesions present for/more than 14 days
  • frequently recurring lesions
  • symptoms of systemic illness
  • failure of prior appropriate self-treatment
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6
Q

RAS treatment goals

A
  • relieve pain and irritation
  • prevent complications like a secondary infection
  • deter recurrence
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7
Q

RAS non-pharmacologic treatment

A
  • remove contributing or precipitating factors
  • avoid spicy or acidic foods
  • avoid sharp-textured foods
  • apply ice directly to the lesions in 10-min increments (max duration: 20 min per hour)
  • do not use heat -> may spread infection if present
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8
Q

RAS pharmacologic treatment

A
  • provides pain relief but does NOT prevent recurrence
  • therapeutic options: oral debriding and wound-cleansing agents, topical oral anesthetics, topical oral protectants, oral rinses, certain systemic analgesics (NOT approved and should NOT be used in pediatrics)
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9
Q

RAS treatment safety/special populations

A
  • mostly unknown safety in pregnancy and lactating women, except acetaminophen which appears to be mostly safe
  • should refer these patients to PCP or DDS
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10
Q

oral debriding and wound-cleansing agents: primary ingredient is CARBAMIDE PEROXIDE 10%

A
  • Cankaid Liquid Oral Antiseptic

- Gly-Oxide Antiseptic Oral Cleanser

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11
Q

oral debriding & wound-cleansing agents: primary ingredient is HYDROGEN PEROXIDE 1.5%

A
  • Orajel Antiseptic Rinse for Mouth Sores

- Colgate Peroxyl Mouth Sore Rinse

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12
Q

Oral debriding & wound-cleansing agents administration: DROPS

A

-apply a few drops to the affected area and keep in place for 1 minute before expectorating

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13
Q

oral debriding & wound-cleansing agents: RINSE

A

-place drops on the tongue, mix with saliva, and swish in the mouth for 1 minute

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14
Q

oral debriding & wound-cleansing agents: AQUEOUS SOLUTION

A
  • mix solution with an equal amount of water before rinsing the mouth
  • swish in mouth as long as tolerated (up to 15 min)
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15
Q

oral debriding & wound-cleansing agents: general administration

A
  • do not swallow (drops/rinse/aqueous solution)
  • used after meals (3-4 times a day)
  • avoid eating or drinking for at least 30 min after application
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16
Q

oral debriding & wound-cleansing agents side effects

A

-prolonged rinsing with oxidizing products can lead to soft tissue irritation, transient tooth sensitivity from decalcification of enamel, cellular changes, and overgrowth of undesirable organisms that could possibly result in development of a black hairy tongue

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17
Q

oral debriding & wound-cleansing agents: limitations of self-care

A
  • should not be continued longer than 7-days -> contact oral health care provider (OHCP) if symptoms persist or worsen
  • if a rash develops at any time -> discontinue drug and contact OHCP
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18
Q

RAS topical oral anesthetics

A
  • benefit: effective for temporary relief of pain
  • mechanism: reversibly block nerve conduction near their site of administration
  • administration: apply up to 3-4x daily for most products
  • side effects: mild stinging, burning, itching, skin tenderness, dry white flakes where applied
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19
Q

RAS topical oral anesthetics: limitations of self-care

A
  • avoid concurrent use of potentially inflammatory products containing substantial amounts of menthol, phenol, or camphor (may cause tissue irritation and damage or systemic toxicity)
  • avoid the use of dentifrices containing sodium lauryl sulfate to reduce the incidence of RAS
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20
Q

RAS topical oral protectants

A
  • benefit: can be effective in protecting ulcerations, decreasing friction, and giving temporary symptomatic relief
  • mechanism: coats & protects the ulcerated area by creating barrier by using a paste, an adhering film, or a dissolvable patch to cover the lesion
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21
Q

RAS topical oral protectants administration

A
  • apply as needed
  • products available as a patch or dissolving disc must be placed against the sore for 10-20 seconds -> once the disc adheres to the lesion, the barrier is formed, and the disc will stay in place until dissolved -> dissolves in approx. 8-12 hours
22
Q

topical oral protectants side effects

A

-mild itching/discomfort

23
Q

topical oral protectants limitations of self care

A
  • should not be continued longer than 7 days -> contact OHCP if symptoms persist of worsen
  • if a rash develops at any time -> discontinue drug and contact OHCP
24
Q

RAS oral rinses benefit/mechanism

A

-hastens the healing of the lesions

25
Q

RAS oral rinses administration

A
  • rinse the mouth and spit after swishing
  • saline rinses: mix 1-3 teaspoons of salt in 4-8 ounces of warm tap water and use up to 4 times a day
  • paste of baking soda: apply to the lesions for a few minutes
26
Q

RAS oral rinses: side effects

A

-stinging, local irritation

27
Q

RAS oral rinses: limitations of self care

A

-none

28
Q

RAS systemic analgesics

A
  • aspirin, non-steroidal anti-inflammatory drugs, acetaminophen
  • counseling: ASA tablets should not be retained in the mouth before swallowing, nor placed in the area of the oral lesions
29
Q

RAS: aspirin special considerations

A
  • GI risk (ulcers, bleeding)

- pregnancy: aspirin should be avoided during pregnancy, esp. during the last trimester

30
Q

RAS: NSAIDs (ibuprofen, naproxen)

A
  • caution for use in those with kidney impairment, liver impairment, or drink alcohol heavily
  • GI risk (ulcers, bleeding)
  • cardiovascular risk
  • increased bleeding with concurrent anticoagulants
  • pregnancy: contraindicated during the third trimester of pregnancy
31
Q

RAS: acetaminophen

A
  • caution for use in those with liver impairment or those who drink alcohol heavily (especially doses >3 g/day)
  • pregnancy: crosses the placenta but is considered safe for use during pregnancy
32
Q

RAS: follow-up

A
  • minor RAS lesions typically are self-limiting -> should resolve within 14 days
  • symptoms should resolve within 7 days of use with oral debriding and wound-cleansing agents
33
Q

RAS limitations to self-care

A
  • symptoms do not resolve after 7 days of treatment with oral debriding or wound-cleansing agents
  • lesions do not heal in 14 days
  • symptoms worsen during self-treatment
  • manifestations of systemic infection develop fever, rash, or swelling
34
Q

xerostomia: definition

A

dry mouth, a syndrome in which salivary flow is limited or completely arrested

35
Q

xerostomia clinical presentation

A

-difficulty talking and swallowing, stomatitis, burning tongue, halitosis

36
Q

xerostomia clinical impact

A
  • loss of appetite which can progress to decline in nutritional status
  • tooth hypersensitivity
  • cervical carries and gingivitis
  • candidiasis
37
Q

xerostomia treatment goals

A
  • to relieved discomfort of dry mouth
  • to reduce risk of dental decay/periodontal disease
  • to prevent and treat infections
38
Q

xerostomia: exclusions for self-care

A
  • tooth erosion, decalcification & decay
  • candidiasis, gingivitis, periodontitis
  • reduced denture-wearing time
  • mouth soreness associated with poor-fitting dentures
  • presence of fever or swelling
  • loose teeth
  • bleeding gums in the absence of trauma
  • broken or knocked out teeth
  • severe tooth pain triggered or worsened by hot, cold, or chewing
  • Sjogren Syndrome
  • Salivary gland stones
39
Q

xerostomia non-pharmacologic treatment

A
  • remove precipitating factors
  • prevention of tooth decay/carries
  • maintain good dental hygiene
  • limit sugary, starchy, acidic intake
  • use a soft-bristle toothbrush
  • stimulation of salivary flow (sugarless sweets, chewing gum, sucking on ice chips, increase water intake, cool mist humidifier)
40
Q

xerostomia pharmacologic treatment

A

-artificial saliva (mimics natural saliva both chemically & physically, typically consists of carboxymethyl or hydroxyethylcellulose solutions with or without fluoride, aids in relieving comfort, does NOT contain the many naturally occurring protective components that are not present in innate saliva)

41
Q

xerostomia: pharmacologic treatment administration

A

-can be used any time; suggested after all meals and at bedtime

42
Q

xerostomia side effects

A
  • artificial saliva
  • many products contain preservatives (often methyl- or propylparaben) -> beware of hypersensitivities
  • some products contain sodium -> should be avoided in patients with low sodium diets
43
Q

xerostomia limitations to self-care

A
  • if symptoms do not decrease or severity worsens after 5-7 days of treatment
  • self-care is accompanies by a dental professional
44
Q

pediatric teething definition

A
  • teething = eruption of the deciduous (baby/primary) teeth though the gingival tissues
  • natural process
  • begins as early as the age of 3 months
  • teething process lasts up to 8 days after each tooth erupts
  • not always eventful, but can cause pain, sleep disturbances or sleep irritability
45
Q

pediatric teething clinical presentation

A

-mild pain, irritation, reddening, excessive drooling, mouth biting, gum rubbing, low-grade fever, or slight swelling of the gums while teething -> sleep disturbances or irritability

46
Q

pediatric teething: eruption cysts

A
  • bluish soft, round swellings over emerging incisors and molars
  • NOT an infection, will subside without treatment
47
Q

pediatric teething: mamelons

A
  • three bumps on the biting surfaces (incisal edges) of emerging incisors
  • should subside naturally without treatment
48
Q

pediatric teething: non-pharmacologic treatments

A
  • first line; before pharmacologic treatments
  • teething jewelry recommended AGAINST by FDA
  • massaging the gum around the erupting tooth
  • cold teething RING (do NOT expose to temperature extremes)
  • damp wash cloth that has been twisted and frozen
  • give food to bite on (dry toast, teething biscuits, avoid food high in sucrose)
  • regular dental check-ups (within 6 months of first tooth eruption but no later than first birthday)
49
Q

pediatric teething treatment goal

A

to relieve gum, pain, irritation

50
Q

pediatric teething: pharmacologic treatment

A
  • LIMITED to systemic analgesics at pediatric recommended doses
  • parents of children younger than 8 years should consult a pediatrician before giving their children non-rx medications
  • acetaminophen and ibuprofen ONLY when advised appropriately
  • AVOID aspirin and aspirin-containing products in children and teens due to risk of Reye sydrome
  • topical oral anesthetics carry strict warnings from the FDA AGAINST their use
  • homeopathic agents recommended AGAINST by FDA
51
Q

pediatric teething: limitations to self-care

A
  • if non-pharmacologic + systemic analgesia is not relieving pain after 2 days of treatment
  • if symptoms uncharacteristic of teething discomfort have developed

phm 516: self-care (5 decks)

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