Therapeutic Drugs in Oral Medicine

Question 1

What are examples of non-steroid topical treatments of oral mucosal lesions?

Answer 1

• Chlorhexidine mouthwash
• Benzdamine mouthwash or spray
• OTC remedies eg Igloo, Listerine, Bonjela

Question 2

What are examples of steroid based topical treatments of oral mucosal lesions?

Answer 2

• hydrocortisone mucoadhesive pellet
• betamethasone mouthwash
• beclomethasone metered dose inhaler

Question 3

How do hydrocortisone mucoadhesive tablets work to treat oral mucosal lesions?

Answer 3

stick tablet to lesion and allow it to dissolve over the ulcer

Question 4

Is betamethasone mouthwash licensed or unlicensed for oral mucosal treatment use?

Answer 4

UNLICENSED
- must supply patient with a tailored information leaflet

Question 5

Describe how 0.5mg Betnesol tablets are used:

Answer 5

• 2x 1mg tablets with 2 teaspoons water (10mls)
• 2 mins rinsing
• Twice daily
• DO NOT SWALLOW
• Refrain from eating/drinking for 30 mins after use
• Do not rinse after use

Question 6

What side effects can occur as a result of using Betamethasone mouthwash to treat oral mucosal lesions?

Answer 6

Small oral candida risk

Question 7

How is Beclomethasone MDI used in the treatment of oral mucosal lesions?

Answer 7

• Exit vent directly over ulcer
• 2 puffs
• 2-4 times daily
• Do not inhale
• Don’t rinse after use

Question 8

What “version” of Beclomethasone MDI must be prescribed to be used to treat oral mucosal lesions?

Answer 8

Pressurised device NOT a breath activated device

Question 9

Aside from treatment of oral mucosal lesions, why can Beclomethasone MDI be prescribed?

Answer 9

Asthma and COPD

Question 10

What systemic steroid may be used to treat troublesome ulcers? What is the dosage?

Answer 10

Prednisolone
- 30mg for 5 days

Question 11

What risks are associated with systemic steroid prescription?

Answer 11

• Adrenal suppression (steroid dependency)
• Cushingoid features
• Osteoporosis risk
• Peptic ulcer risk (proton pump inhibitor prophylaxis)
• Mood/sleep alteration and mania/depression risk

Question 12

What are examples of immune suppressant medication?

Answer 12

• Hydroxychloroquine
• Azathioprine
• Mycophenolate

Question 13

What are examples of immune modulating medications?

Answer 13

• Adalimumab
• Enterecept

Question 14

What risks are associated with immune systemic treatment e.g Hydroxychloroquine?

Answer 14

• infection risks
• cancer risks
• adverse drug reactions

Question 15

What tests must be run before allowing a patient to start taking Immunomedulatory Treatments?

Answer 15

• blood borne virus screen
• FBC
• liver function tests
• chest X-ray
• cervical smear up to date
• ## pregnancy test

Question 16

What long term risk is associated with immunomodulatory treatment?

Answer 16

Cancer risk increased
- Azathioprine and skin cancer **