Throat & Oral Cavity

Question 1

What are common causes of xerostomia?

Answer 1

Xerostomia = dry mouth

1) Drug side effect
2) Obligate Mouth Breathers
3) Sjogrens Syndrome

Question 2

What can you recommend to treat xerostomia?

Answer 2

1. Sugar alcohols (xylitol)
2. Limit caffeine intake
3. Avoid alcohol and product with alcohol
4. Avoid oral nicotine
5. Regularly sip H2O
6. Use saliva substitutes/oral moisturizers
7. Breathe through nose when possible
8. Humidify the sleeping space

Question 3

A patient is suffering from dry mouth. Treat or Refer?

Answer 3

May treat but MUST REFER TO THE DENTIST yo!

May also refer to PCP

Question 4

When do you refer a patient to a PCP for dry mouth?

Answer 4

1. Nutrition status declines
2. Unintentional weight loss
3. Snores
4. Needs a medication changed due to side effects.

Question 5

What is stomatitis?

Answer 5

general term describing an inflamed or sore mouth that interferes with a patients ability to eat, talk and/or sleep

Question 6

When do you refer a patient with stomatitis to a PCP?

Answer 6

1) Failure of OTC products to provide relief
2) Symptoms last longer than 7 days
3) Interference with sleep or nutrition
4) Body temp of > 103

Question 7

What products can be used to treat symptoms of stomatitis?

Answer 7

1) Topical or oral analgesics: benzocaine, lidocaine, NSAIDs, APAP
2) Ice

Question 8

What is mucositis?
Who is likely to develop this condition?
What are the signs/symptoms?

Answer 8

Inflammation and/or ulceration of the mucous membranes lining the digestive tract

Patients undergoing cancer chemotherapy or radiation therapy

S/S: Oral soreness, ulcers present, patient has difficulty swallowing food

Question 9

What counseling point should you make sure to information patients about who use magic mouthwash?

Answer 9

Be aware that you may not feel hot/cold foods as easily due to the numbing and you may be at risk for burns and chocking
- Try to avoid eating or drinking around the time of administration

Question 10

When should you refer patients who have mucositis?

Answer 10

Right away and only to the PCP. Call the PCP for a heads up especially if there is an ulcer

Question 11

What do you use Abreva, an OTC product, to treat? When is it most effective?

Answer 11

Used to treat Herpes Simplex infection aka cold sores

- Best to use when “Prodrome” symptoms begin

Question 12

What is docosanol?

Answer 12

OTC product ingredient in Abreva

- Inhibits the fusion of the HSV envelope to the host cell’s plasma membrane to prevent entry and replication

Question 13

What Rx therapies are prescribed for cold sores?

Answer 13

1. Antivirals: Acyclovir, famiciclovir or valacyclovir

Dr. Ally recommends 3 g @ onset of prodrome then 3 g Q12H later

She does not recommend topical acyclovir = ineffective

Question 14

When do you refer a patient who comes into the pharmacy with a cold sore?

Answer 14

1. If it is their 1st cold sore
2. If it is larger than a dime and extensively red
3. If it interferes with sleep or nutrition
4. Patient has a temp of > 103

Question 15

Which triggers should you counsel patients to avoid to reduce cold sore development?

Answer 15

Sun, wind, extreme stress, sleep deprivation

Treat a fever quickly (always have a thermometer)

Question 16

Another name for canker sores is ___________________.

Answer 16

Aphthous ulcer

Question 17

What can you recommend for patients who complain of canker sore pain and presence?

Answer 17

1. Avoid citrus/acidic foods
2. Use analgesics like benzocaine or NSAIDs or APAP
3. May use a debriding agent like H2O2

Question 18

When should you refer a patient with a aphthous ulcer?

Answer 18

1. Unintentional weight loss
2. Last longer than 7 days
3. If it interferes with sleep or nutrition
4. Patient has a temp of > 103
5. Associated with an oral appliance

Question 19

What can you recommend for teething pain?

Answer 19

Systemic anagesics dosed appropriately
Cold, Chewing Massage

Under 2 = NO benzocaine (baby orajel)

Question 20

What can you recommend for a tooth ache?

Answer 20

NOTHING besides going to the Dentist ASAP and some topical/systemic analgesics

Question 21

Poor oral health progresses from ___________ to _____________.

Answer 21

Gingivitis to Periodontitis

Question 22

Why do we want to prevent gingivitis?

Answer 22

Prevent pockets of bacteria in the gums

Question 23

Why do we want to prevent periodontitis?

Answer 23

Prevent tooth loss

Question 24

Which drugs increase a patients chance of developing gum disease?

Answer 24

Antidepressants: Tricyclics
Phenytoin due to increased gum growth
CCBs: Dihydropyridines
High Progestin contraceptives
Methamphentamine

Anticholinergic drugs that cause dry mouth

Question 25

What is important about gum disease and smokers?

Answer 25

Their gums don’t bleed but they are at risk for gum disease as well

Question 26

Why are the following ingredients included in tooth and oral health products:

1. Fluoride
2. Potassium Nitrate
3. Zinc
4. Soluble pyrophosphates

Answer 26

1. Fluoride = Reduction of the solubility of enamel
2. Potassium Nitrate = Decreases tooth sensitivity by decreasing intradental nerve sensation
3. Zinc = tartar control
4. Soluble pyrophosphates = tartar control
   - May cause contact dermatitis