Week 11: Xerostoia, Apthous uclers, cold sores Flashcards
What is xerstomia?
dry mouth where the salivary glands do not produce enough saliva
What is saliva made up of?
What is the function?
Made up of water, mucins, electrolytes, gustin, bicarbonate, phosphate, calcium, salivary enzymes
Functions:
- Antifungal, antibacterial, antiviral
- lubrication
- food digestion, teeth mineralization
- Buffer
What are some causes of xerostomia?
Lifestyle
- smoking, alcohol, caffeine
Taking new meds
- antihistamines, decongestants, anticholinergics, opioids
medical conditions
- Autoimmune disease (sjogren’s, Crohns’) diabetes, HIV
What are direct and indirect symptoms of xerostomia
Direct
- decreased saliva
- dry and sore tongue
- loss of taste
- difficulty swallowing
- sensitivity to acidic and spicy food
- tooth decay
- dry lips
- bad breath
Indirect
- dry nose, eyes, and skin
- decreased sweating
- fatigue, weight loss
- vaginal infections
What are the 4 questions to identify xerostomia when one is positive?
- Does the amount of saliva in your mouth seem too little?
- Does your mouth feel dry when eating a meal?
- Do you sip liquids to aid in swallowing dry food
- Do you have difficulty swallowing?
What are some xerostomia management strategies
prevention of dryness
- by avoiding substances that reduce salivation, cause irritation, or erode tooth enamel
prevention of tooth decay
- by practicing good oral hygiene
- alleviate symptoms
- by using artificial saliva products
If they are using short term medications and experience dryness is it a red flag
no
What type of mouthwash and toothpaste should you use if you have xerostomia
- Fluoride mouthwashes
- Toothpaste without sodium lauryl sulfate
What are some non-pharm, pharmacologic nonrx, and pharmacologic rx medications to take if you have xerostomia
Nonpharm
- avoid calorigenic foods
- chew gum
- suck ice chips
- increase water intake
Pharmacologic non rx
- biotene oral balance gel/spray/rinse
- The focus is on things that contain XYLITOL, STIMULATES SECRETION
Pharmacologic rx
- pilocarpine
- anethole
If you can see something on the inside what is it considered?
Aphthous ulcer (canker sore)
- are recurrent, have a halo
- occur on nonkeratinized oral mucosal surface
What are risk factors of oral apthous ulcers
When does it first occur?
First occurence 10-20 years
Risk factors
- Stress
- iron, B6 B12, B1 B2, zinc folic acid deficiencies (MODIFIABLE)
- NSAID = #1 drug risk factor
- Any, beta blockers, NSAIDs, opioid analgesics, anti-arrhythmic medications
What are the 3 types of Aphthous Ulcers
Minor (can treat in our scope)
- 2-10 mm
- in the same area (singly)
- 7-10 days
- no scarring
Major (red flag)
- 10mm+ , deeper
- clusters 2+
- persist for weeks
Herpetiform (red flag)
- 2-3mm
- Occur in clusters 10-100
- 7-30 days
What are red flags of aphthous ulcers
- Any major or herpetiform canker sore
- happening 6+ times a year
- Lasts more than 14 days
- fever or radiation therapy recently
What is the differential diagnosis
- Thrush (fungal infections on tongue)
What are nonpharmacologic treatments for canker sores
- avoid foods that cause it, maintain oral hygiene
- make sure toothpaste does not have SLS
LESS
L: local trauma (sharp, spicy food)
E: avoid smoking relapse
S: supplementation
S: start ice apply in 10-min increments
What are nonprescription + prescription products for canker sores?
- benzocaine to numb pain
- mucosal protectants
- acetaminophen
- AVOID NSAIDs
- antiseptics and hexetidine do not work
Prescription: oracort
- antibiotics, antivirals do not work
What are the 2 types of HSV. How are they transmitted
HSV-1: causes oral infections
- through saliva, oral sex
HSV-2: usually causes genital infection
- through pregnancy
Explain Primary HSV infections. Asymptomatic vs. Symptomatic
Asymptomatic: virus enters the body and remains latent
Symptomatic:
- gingivostomatitis (younger age) sores around mouth
- pharyngitites (older children teens) very sore throat, lesions on tongue
Explain Secondary HSV infections. Asymptomatic vs. Symptomatic
Asymptomatic: viral shedding
Symptomatic: herpes/cold sores
Symptoms:
- prodrome: a tingling or itching 2-24 hours before the manifestation
Is reactivation more severe in primary or secondary infections
more severe in primary infections
What are red flags of herpes
- Fever
- Multiple lesions
- 14+ days
- inflammation of surrounding skin
- more than 6+ times a year
What should you provide if patient
presents with herpes
patient presents with prodromal symptoms
Patient is asymptomatic but has history of herpes
presents with herpes
- non-pharm
- symptomatic therapies
- Antivirals for future episode
patient presents with prodromal symptoms
- non-pharm
- symptomatic therapies
- antivirals for this episode
- antivirals for future episode
Patient is asymptomatic but has history of herpes
- non-pharm
- antivirals for future episode
What are some symptomatic therapies for cold sores
menthol, benzocaine, lidocaine
- abreva (only OTC disease modifying therapy)
- topical analgesic
- systemic analgesics (tylenol, NSAIDs)
- max 3 days
What antivirals can you give for cold sores
valacyclovir, acyclovir
(oral is better than topical hydrocortisone)
What are bartholin’s glands
Produce secretions in response to sexual stimulation
What is the pH of a vagina
3.5-4.5
What is leukorrhea?
- Vaginal discharge
- 4mL in 24 hours
- Newborns can have vaginal discharge
