SDCEP Flashcards
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dental infection
1st instance
local measures
drain infection e.g. XLA, incise and drain, extirpate
1st line antibiotics
Phenoxymethylpenicillin tablets 250mg,
send 40tablets,
2tablets 4xdaily for 5 days
Amoxicillin 500mg
Send: 15 tablets
Label: Take 1 tablet three times daily for five days
1st line antibiotics if allergic to penicillin
Metronidazole 400mg
Send: 15 tablets
Label: Take 1 capsule three times daily for five days.
avoid alcohol, and not if on warfarin
2nd line antibiotics
clindamycin capsules 150mg,
send 20capsules,
1capsule 4xdaily for 5days
Co-amoxicalv
ANUG and pericoronitis assoc with which type bateria
anaerobic
local measures for ANUG
remove supra gingival and sub ging depositis and OHI
may be limited in acute phase due to pain
pericoronitis local measures
irrigation and debridement
drug tx for pericoronitis and ANUG if required
metronidazole tablets 200mg
send - 9 tablets
1 tablet 3xdaily for 3 days
not alcohol and not if on warfarin (amox)
sinusitis
generally self limiting (av duration 2.5weeks)
steam inhalayion
ephdrine nasal drops 0.5%, 1 drop inot each nostril up to 3xdaiy when required (10ml total)
predispositon to pseudomembranous or erythematous candidosis
inhaled corticosteroids,
cytotoxics,
broad spectrum antibacterials,
diabetic pts,
nutrional deficiencies,
reduced immunity (leukaemia, HIV)
local measures for candidosis
rinse with water after use of corticosteroid inhaler
denture hygiene
drug tx for candidosis
7 days
* miconazole oromucosal gel 20mg/g (80g tube), apply pea sized amount after food 4xdaily, use for 7days after leasions heal
* fluconazole capsules, 50mg, 1 capsile daily for 7 days
NOT IF ON WARFARIN OR STATINS
nystatin oral suspension, 100,000units/ml, 1ml after food 4xdaily for 7days - retain near lesion for 5mins before swallowing, cont to use for 48hours after lesion healed
angular cheilitis most likely caused by ….
in denture wearing
candida spp.
angular cheilitis most likely causde by….
in non denture wearing pts
streptococcus spp,
staphylococcus spp.
angular cheilitis tx
miconazole cream 2% (20g tube), apply to angles of mouth 2xdaily and use for 10 days after lesions healed (NOT IF ON WARFARIN OR STATINS)
sodium fusidate ointment 2% (15g tube), apply to angles of mouth 4xdaily
if unresponsive - use in miconazole 2% with hydrocortisone 1% and use for max 7days
1st management primary herpetic gingivostomatitis
due to herpes simplex virus
symptomatic relief - nutrious diet, fluids, analagesia, rest, antimicrobial mouthwash
management of sevre primary herpetic gingivostomatitis or if pt immnocompromised
aciclovir tablets 200mg, 1 tablet 5xdaily for 5days
CHX 0.2%
if on lips aciclovir cream 5%
100mg <1yo
managemetn of herpes zoster (shingles)
aciclovir tablets 800mg (shingles treatment pack - 35 tablets), 1 tablet 5xdaily for 7days
reduce pain, incidence of post-herpetic neuralgia and viral shedding
MRONJ dedinition
exposed bone, or bone that can be probed through an IO or EO fistula in the maxillofacial region that has persisted for more than 8weeks in pt with a history of tx with anti-resorptive or anti-angiogenic drugs, and where there has been no history of radiaiton therapy to the jaw or no obvious metastatic disease to jaw
symptoms MRONJ
- delayed healing following dental XLA or other OS
- pain
- soft tissue infection and swelling
- numbness/paraesthesia or exposed bone
- pain or altered sensation in the absence of exposed bone
- can be asymp
what should aim be re MRONJ
get pt as dentally fit as feasible prior to commencing any anti-resorptive or anti-angiogenic drigs, priorting prevantative care
e.g. bisphosphonates, RANKL inhibitors,
examples of drigs which cause MRONJ
alendronic acid
risedronate sodium
zoledronic acid
ibandronic acid
paidronate disodium
sodium clodronate
densomuab
bevacizumab
suntinib
afilbercept
what to advise pt at risk of MRONK
risk of developing MRONJ but small risk and should continue drug regime whilst dental tx happening, record in notes
higher risk of MRONJ when
pt being tx with anti-resorptive or anti-angiogenic drugs for management of cancer
taking bisphosphonates for more than 5 years
concurrently taking a systemic glucocorticoid e.g. predinisolone