self care conditions Flashcards
- look at notion notes in week 8 for images and extra notes on gum disease, headaches, oral conditions
Gum diseases are (…) conditions
inflammatory
examples of gum diseases:
gingivitis
-> then leads to chronic periodontitis
characteristics of gingivitis
Mostly caused by bacteria build up in dental plaque
Dental plaque
Calculus
Does not affect support for teeth
Usually mild
Can be reversible
Characteristics of chronic periodontitis
Involves supporting tissues around teeth
Largely irreversible tissue damage
Slowly progressive
Tissue and bone damage, tooth loosens
gingivitis progression?
- Normally we build up of plaque each day
(and normal brushing should remove each day)
But if you don’t brush…
- Bacteria produces calculus if built up over a few days
- Sticks to teeth holding bacteria close
- Enzymes and toxins released cause inflammation in gingiva (gum)
- Over years mild damage results in a pocket forming between tooth and gum
- Then tooth root erodes and tooth comes loose-periodontitis
signs and symptoms - gingivitis
Inflammation of gum
Swollen, red and sore
Bleeds easily on mild trauma – bleedings with brushing, flossing, or eating hard food.
Plaque visibility
No fever, or malaise.
when do we Suspect periodontitis rather than just gingivitis
if
Halitosis, foul taste in mouth, difficulty eating, pain
Gum recession or root sensitivity.
Loosening or drifting of teeth
Sign of infection – abscess/puss
Halitosis is what?
bad breath
epidomology behind gingivitis
Different studies show varying percentages
Some degree of gingivitis in 50-90% of adults
Increased risk:
Poor nutrition
Ineffective oral hygiene
Pregnancy
Diabetes
Smoking
Immunocompromised
Age
Drugs causing dry mouth
Stress
Local factors
questioning 2 deal with gingivitis
- Confirm symptoms – consistent with gingivitis?
- Bleeding – with or without trauma
- No trauma = likely periodontitis so refer
- Toothbrushing technique
- Too vigorous = gums bleed
- Other medicines E.g. warfarin, heparins, NSAIDs / phenytoin s/e = gum hypertrophy
differential diagnosis options rather than gingivitis:
- oral malignancy
- hepatic gingivostomatitis (viral)
- allergic reactions
- platelet disorder
- denture associated trauma
epidemiology of headaches:
- affects everyone occasionally
- higher in women than men
- most common a&e reason
- most self-manage
aetiology headaches (causes)
most people have headaches occasionally which
resolve relatively quickly
Usually a physiological response to circumstances
DIFFERENT CAUSES FOR DIFF TYPES (see below, mainly medication overuse)
symptoms of headaches
pain:
- acute or chronic (>3 months/beyond expected)
- subjective, emotional symptom: defined as unpleasant sensory or emotional
experience associated with actual or potential tissue damage
4 types: Nociceptive (stimulation of specific pain receptors), Somatic (musculoskeletal pain), Visceral (internal organs), Neuropathic (peripheral or central nervous system)
Questions to ask – other symptoms: headaches
- N+V = migraine, space-occupying lesion, meningitis
- Fever = sinusitis, temporal arteritis, viral infection
- Nasal congestion = sinusitis, cluster headache
- Insomnia = severe headache
- Visual disturbances = migraine, glaucoma, temporal arteritis, stroke, intraocular pathology
- Neck stiffness = injury, meningitis
- Rash =meningitis (non-blanching), viral
- Weight loss = cranial arteritis, malignancy (unusual)
- CNSsymptoms
- –General – loss of coordination, drowsiness, irritability, personality
changes, convulsions
- –Localised lesions – slurred speech, limb muscle
weakness, disturbances in smell or hearing
- space-occupying lesions e.g. tumours, haemorrhage - Tendertemples
- –Inflamed temporal arteries – may see red, congested vessel in temple
area
- –Pressure applied to area is painful, possible jaw ache
- –Usually in older people
primary headaches symptoms
not associated with underlying condition
most common type
patients present OTC
migraine, tension type, cluster etc
secondary headaches symptoms
precipitated by another condition or disorder
origins include:
trauma, injury, drug induced, psychiatric
require referral
Questions to ask when examining headaches
- Location and spread of pain?
- Speed of onset?
- Duration? If headache does not improve or
resolve over 1-2 weeks, refer (unless
tension headache) - Intermittent or constant
- Frequency? P resent on awakening may be serious but need further history
- Severity? (pain scale) - If progressively getting
worse or non-responsive, refer. - Other Symptoms
- Aggravating or relieving factors → Establishing pattern to onset of headaches
can show cause and recognise trigger
factors. - Food, exercise, light, menstruation, fatigue,
drugs e.g. oral contraceptives in migraine. - Guide to severity: Impact on daily living: Social, emotional and psychological impact?
Medication?
HOW DOES the location of pain affect the headache? e.g. frontal, occipital, hemicranial, orbital, or temporal?
FRONAL - idiopathic headache, sinusitis, nasal congestion
HOW DOES the location of pain affect the headache? occipital
tension, anxiety (especially if pain radiates over the top and sides of head)
HOW DOES the location of pain affect the headache? hemicranial
migraine, sinusitis, shingles, trigeminal neuralgia etc
HOW DOES the location of pain affect the headache? orbital
sinusitis, migraine, shingles, pain from within the eye
HOW DOES the location of pain affect the headache? temporal
temporal arteritis (over 50 years, and sensitivity to touch on temples)
sinus headache = pain where
behind brow bone / cheekbones
cluster headache = pain where
pain in and around one eye
tension headache = pain where
like a band squeezing the head
-> often a constant / nagging pain
migraine headache = pain where
pain/nausea and visual changes are typical of classic form
details of a migraine
- characterised by unilateral, moderate - severe, throbbing pain
- builds up over minutes - hours
- usually occurs every few weeks
- sensitivity to light and sound
- limits daily activity/disabling
- with or without aura
theory: related to dilation of blood vessels within or around skull
what does ‘aura’ mean - headaches
visual symptoms, sometimes sensory and speech disturbances
- usually disappears within an hour: followed by severe headache lasting 4-72 hrs
characteristics of a tension headache
- episodic or chronic
- bilateral pain, generalised ache, tight band around head spreading to the top of the head
theory: muscle spasm in neck & scalp/tension in muscles resulting in constricted capillaries, reducing blood flow = lack O2
migraine vs tension headache:
migraine:
- mod-severe pain
- usually unilateral
- pulsating
- aggravated by normal activities
- often accompanied by symptoms: sensitivity to light N+/-V
tension:
- mild-moderate pain
- bilateral
- non-pulsating
- not aggravated by normal activities
- usually no symptoms. like the migraine ones
cluster headache traits:
- severe, unilateral pain within and above eye/temporal region
- 15mins-3hours
- occurrence: once every other day - 8 times a day (with circadian rhythm)
- can occur same time of the day / clusters at same time each year
- associated with autonomic symptoms e.g. lacrimation, rhinitis, facial sweating, sense of restlessness etc
what are some other types of headaches
- chronic
- med overuse ones
- secondary
- new daily persistent ones
what makes a headache ‘chronic’
- 15=/+ days headache per month for 3 months
- most result from the transformation of an episodic headache disorder
should refer
what’s a medication overuse headache
2ndary headache
- exaggerated response of receptors that are more frequent or potent analgesics do not stop
- vicious cycle
- usually due to analgesic overuse causing an inc in number of pain receptors switched on.
refer to notion notes on: what a secondary headache is, and what to do when acting as a pharmacist for headaches
what’s a new daily persistent headache
- acute sudden onset ‘out of the blue’
- occurs everyday after it starts: unremitting
- may newly present in children and adults
- often mimics clinical features of tension or migraine headache
- often mild/moderate and doesn’t impact daily activities
options for management of pain
- rule out referral
- remove causative factors
- non drug therapy e.g. massages. acupuncture
- stop analgesia
med overuse headaches NICE guidance - 2012
1/50 = due to med overuse
- stop cold turkey all headache meds for a month
symptoms = worse before improving
some combos are bad and cause the headaches e.g. paracetamol, aspirin, or nsaid either alone or in combination for at least 15 days per month for over 3 months
types of headache treatments - for details on all, check notion
- opioid and non-opioid analgesics
- antimigraine drugs
- balance caffeine excess or withdrawal can cause headache
- herbal supplements
Describe the diagnostic signs of cold sores and mouth ulcers:
- located around the mouth (nose less common)
- Prodromal symptoms– Skin itches, burning, pain, tingling
– 6-48 hours before - Skin eruption (10-14 day process)
– Blister or vesicle
– Fluid filled & appear anywhere on face
– burst, Crust over into a scab, dry up, itchy, sore, red (24 hours)
– Skin heals (7-10 days)
cold sore differential diagnosis conditions - notion = more detail
- impetigo
- angular cheilitis
contraction of cold sores:
virus particles pass to uninfected person via direct contact, and it then infects epidermal and dermal cells
→ after initial infection, sensory ganglia, then moves to dorsal root ganglia of the trigeminal nerve where it lies dormant in a latent state
- activated or triggered by factors personal to the patient
→ once activated, moves from sensory ganglia to the outer layer of skin & the cold sore lesion apears again.
cold sores epidemiology:
- a viral infection (herpes simplex virus)
- mainly HSV1<90% (HSV2 is genital herpes)
- highly contagious, some have the virus but don’t manifest infection tho
cold sores triggers for re-presentation:
- viral infection e.g. common cold
- menstruation
- dental/surgical procedures
- immunosuppression
cold sores general advice:
- look at triggers
- hygiene is vital
- no sharing/contact avoidance
cold sores – referral criteria
- when it lasts longer than 14 days
- if symptoms worsen (e.g. lesion spreads, new ones develop, or persistent fever or difficulty taking fluids)
- if no significant improvement is seen after 5-7 days
- located anywhere else than the lips, e.g. mouth
- widespread or very large
- immunocompromised patients
- frequently recurs
treatment for cold sores usually=
gels / creams - on notion
how many MAIN types of mouth ulcers are there
3
the 3 main types of mouth ulcers are?
- minor (Aphthous ulcers)
- major (Aphthous ulcers)
- herpetiform
- minor (Aphthous ulcers)
Very common – representing 75-85% of aphthous ulcers
Round or ovoid , grey-white in colour, lesions inside the mouth
Affect Non-Keratinized Mucosa (more delicate areas), e.g. Cheeks, tongue, inside lips
Small (diameter 2-4mm), shallow with clearly defined rim Very Painful – may impact eating and drinking
Can occur in groups of up to six ulcers at a time.
Usually heal within 7-10 days with little or no scarring.
Mouth Ulcers: Aphthous ulcers – major
- Less common – representing 10-15% of aphthous ulcers.
- Diameter of 1-3cm
- Longer duration – 10days – 6weeks or longer.
- Significant Pain and dysphagia.
- Can occur in groups of up to 6 ulcers
- Can occur on any oral site including the palate and dorsum
of the tongue. - More common in immunosuppressed, e.g. Patients with HIV.
- Refer
Mouth Ulcers: Herpetiform ulcers
- Uncommon
- Present as multiple “pinhead-sized” ulcers which come together to form a larger area of ulceration.
- Very painful
- Can involve any oral site including palate and dorsum
of tongue. - > 10 days to heal.
- Frequently recurrence may make ulceration seem constant.
- More common in females, and later age onset
- Refer
Outline the main causes and triggers for these ulcers
- cannot be passed from person 2 person: mainly unknown/often recurrent
- some examples = genetics, stress, trauma, nutritional deficiencies, stopping smoking, etc… not all known
- can occur with all ages, but freq and severity reduce with increasing age
Compare the main drug treatments and essential non drug advice that should be given for mouth ulcers
main treatments:
- gels, pastes, mouthwashes, liquids, pastilles
- protective bases
- antibacterials e.g. benzalkonium
- local analgesic e.g. choline salicylate, or bonjela gel to the ulcer
patient advice:
- wash hands before and after treatment
- frequent application
- avoid certain foods e.g. acidic, salty, spicy (worsens pain)
- use soft toothbrushes, and certain tooth pastes
mouth ulcers referral criteria
- 14 days - 3 weeks + (must refer)
- left a scar or elsewhere on the body
- irregular shaped ulcers
- multiple in mouth / one big
- ulcer caused by major trauma
- located towards back of mouth
mouth ulcers differential diagnoses conditions - details on notion
- oral malignancy
- aphthous-like ulcers
- primary oral herpes simplex
- adverse drug reactions
- chicken pox or hand foot and mouth
