Pharmacological Management of Selected Oral Conditions Flashcards
7 possible factors contributing to the development of angular cheilitis
- Anatomic (skin folds, loss of vertical dimension)
- Chronic fungal infection
- Chronic bacterial infection
- Mixed infection
- Contact reaction - toothpaste
- Nutritional - anemia, vit B12
- Eczema
Treatment for angular cheilitis if chronic fungal infection is suspected
Have pt clean areas with SPECTROGEL h/s
- Rx. Clotrimazole 1%-Betamethasone dipropionate .05% (LOTRIDERM) cream
- Disp. 15g. tube
- Sig: Thin coat BID x 2 weeks
Treatment for angular cheilitis if no response to initial therapy when suspecting fungal infection
ADD:
- Rx Polymyxin B / Bacitracin (POLYSPORIN) ung. 10,000u/500u/g
- Disp 15 g tube
- Sig apply to affected areas after meals and bedtime
Treatment for angular cheilitis if bacterial infection is suspected
- Have patient clean areas with SPECTROGEL h/s
-
Fucidin H cream
- Fusidic acid 2% - hydrocortisone acetate 1%
- Topical antibiotic - corticosteroid
- Disp: 30g tube
- Sig: BID x 2 weeks
- Fusidic acid 2% - hydrocortisone acetate 1%
Treatment for angular cheilitis if no response to initial therapy when bacterial source is suspected
ADD:
- Rx Polymyxin B/ Bacitracin (POLYSPORIN) ung. 10,000u/500u/g
- Disp. 15g tube
- Sig. apply to affected areas after meals and bedtime
Define solar cheilitis
Premalignant epithelial changes of the lower lip related to chronic sun damage
Treatment for solar cheilitis
- OMBRELLE LIP BALM
- Disp. 4.4g stick
- Sig. Apply 30 min before sun exposure and reapply every 1-2 hrs prn
NOTE: Prevention is key. Better to write prescription even if OTC
Treatment for herpes labialis or recurrent intraoral herpes simplex virus infections
- VALTREX 1000mg
- Disp: 4 tabs
- Sig: 2 tabs at earliest symptom and then 2 tabs 12 hr later
- Therapy should be initiated at earliest symptom of cold sore (i.e. tingling, itching, or burning)
Treatment of recurrent herpes labialis for pts who do not want to take a PO med
- Acyclovir cream 5% (ZOVARIX CREAM)
- Apply liberally to the affected area 4 to 6 times daily for up to 10 days
- Therapy should be initiated ASAP following onset
Treatment for recurrent herpes labialis for pts who do not want to take a PO OTC med
- ABREVA (docosanol cream 10%)
- Disp: 2g tube or 2g pump
- Applied topically 5x/day and continue until lesion is healed up to max 10 days
- Begin treatment preferably at prodrome or erythema stage
3 characteristics of primary (acute) herpetic gingivostomatitis
- Pt does not have protective antibodies
- Fever, malaise, vesicular eruption which ulcerates
- Negative hx for herpes labialis
Treatment for acute herpetic gingivostomatitis
- VALTREX 1000 mg
- Disp: 20 tabs
- Sig: 1 tab BID x 10 days
Most effective within 48 hrs of onset
Treatment of herpes zoster
- FAMVIR (500 mg)
- Disp: 21 tabs
- Sig: 1 tab TID x 7 days
Initiate within 72 hrs of onset of rash
Condition to rule out for symptomatic geographic tongue
Vitamin B12 deficiency
3 possible treatments for symptomatic geographic tongue
- Alcohol free pediatric Benadryl elixir
- Disp: 100 mL bottle
- Sig: Rinse hold 5 mL in mouth for 2 min then spit out QID prn
- Flucinonide Gel 0.05% (LYDERM GEL)
- Disp: 15g tube
- Sig: Thin coat BID prn
- NOTE: No more than 1 week
- Dexamethasone (PMS-Dexamethasone) elixir 0.5mg/5mL
- Disp 100 ml bottle
- Sig: Rinse/hold 5mL in mouth for 2 min then spit out BID prn
Condition to rule out in symptomatic lichen planus
Hepatitis C
First line treatments (2) for symptomatic lichen planus
- LYDERM GEL
- Disp: 15g TUBE
- Sig: Thin coat BID x 2 weeks then BID prn
- DEXAMETHASONE ELIXIR 0.5mg/5mL
- Disp: 100mL bottle
- Sig: Rinse hold 5mL in mouth for 2 min then spit out BID x 2 weeks then BID prn
Second line treatment for symptomatic lichen planus
- Clobetasol cream 0.05% (DERMOVATE)
- Disp: 15g tube
- Sig; Thin coat BID prn
Third line treatment for symptomatic lichen planus
- Clobetasol in aq. Solution 0.1% with nystatin 100000U/mL
- Disp: 300 mL
- Sig: Rinse and hold 5mL in mouth for 2 min then spit out, BID x 2 weeks
3 possible treatments for lichen planus with secondary candidiasis
- LOTRIDERM cream
- Disp 15g tube
- Sig: Thin coat BID x 2 weeks, then BID prn
- Nystatin Oral Suspension 100000U/mL
- Disp: 200mL
- Sig: Rinse hold 5mL in mouth for 2 min then spit out QID x 10 days
- Fluconazole 100 mg
- Disp: 7 tabs
- Sig: 1 tab daily x 7 days
General management of recurrent aphthous ulcers
- Aoid any triggers if possible (foods, trauma)
- Trial of Sodium Lauryl Sulfate free toothpaste
- Biotene or Proenamel
2 possible treatments for recurrent aphthous minor when few ulcers in accessible areas
- Alcohol free Chlorexidine 0.12% mouth rinse (GUM-PAROEX)
- Disp: 473mL bottle
- Sig: Rinse with 10 mL BID x 5 days
- Flucinonide Gel 0.05% (LYDERM GEL)
- Disp: 15 g tube
- Sig: Thin coat QID prn x 5 days
Treatment of recurrent aphthous minor when multiple ulcers
- DEXAMETHASONE ELIXIR 0.5mg/5mL
- Disp: 100 mL bottle
- Sig: Rinse hold 5 mL in mouth for 2 min then spit out QID x 5 days
Treatment for traumatic ulcer
- Triamcinolone acetonide (ORACORT) 0.1%
- Disp: 7.5 g tube
- Sig: Apply a thin film after meals and medtime x 7 days
NOTE: Sticky goo containing gelatin, pectin and sodium carbocymethylcellulose in a polytethylene and mineral oil gel base. Only topical steroid formulated for intraoral use
