Week 11: Xerostoia, Apthous uclers, cold sores

Question 1

What is xerstomia?

Answer 1

dry mouth where the salivary glands do not produce enough saliva

Question 2

What is saliva made up of?
What is the function?

Answer 2

Made up of water, mucins, electrolytes, gustin, bicarbonate, phosphate, calcium, salivary enzymes

Functions:
- Antifungal, antibacterial, antiviral
- lubrication
- food digestion, teeth mineralization
- Buffer

Question 3

What are some causes of xerostomia?

Answer 3

Lifestyle
- smoking, alcohol, caffeine

Taking new meds
- antihistamines, decongestants, anticholinergics, opioids

medical conditions
- Autoimmune disease (sjogren’s, Crohns’) diabetes, HIV

Question 4

What are direct and indirect symptoms of xerostomia

Answer 4

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

Question 5

What are the 4 questions to identify xerostomia when one is positive?

Answer 5

1. Does the amount of saliva in your mouth seem too little?
2. Does your mouth feel dry when eating a meal?
3. Do you sip liquids to aid in swallowing dry food
4. Do you have difficulty swallowing?

Question 6

What are some xerostomia management strategies

Answer 6

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

Question 7

If they are using short term medications and experience dryness is it a red flag

Answer 7

no

Question 8

What type of mouthwash and toothpaste should you use if you have xerostomia

Answer 8

• Fluoride mouthwashes
• Toothpaste without sodium lauryl sulfate

Question 9

What are some non-pharm, pharmacologic nonrx, and pharmacologic rx medications to take if you have xerostomia

Answer 9

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

Question 10

If you can see something on the inside what is it considered?

Answer 10

Aphthous ulcer (canker sore)
- are recurrent, have a halo
- occur on nonkeratinized oral mucosal surface

Question 11

What are risk factors of oral apthous ulcers
When does it first occur?

Answer 11

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

Question 12

What are the 3 types of Aphthous Ulcers

Answer 12

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

Question 13

What are red flags of aphthous ulcers

Answer 13

• Any major or herpetiform canker sore
• happening 6+ times a year
• Lasts more than 14 days
• fever or radiation therapy recently

Question 14

What is the differential diagnosis

Answer 14

• Thrush (fungal infections on tongue)

Question 15

What are nonpharmacologic treatments for canker sores

Answer 15

• 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

Question 16

What are nonprescription + prescription products for canker sores?

Answer 16

• benzocaine to numb pain
• mucosal protectants
• acetaminophen
• AVOID NSAIDs
• antiseptics and hexetidine do not work

Prescription: oracort
- antibiotics, antivirals do not work

Question 17

What are the 2 types of HSV. How are they transmitted

Answer 17

HSV-1: causes oral infections
- through saliva, oral sex
HSV-2: usually causes genital infection
- through pregnancy

Question 18

Explain Primary HSV infections. Asymptomatic vs. Symptomatic

Answer 18

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

Question 19

Explain Secondary HSV infections. Asymptomatic vs. Symptomatic

Answer 19

Asymptomatic: viral shedding
Symptomatic: herpes/cold sores

Symptoms:
- prodrome: a tingling or itching 2-24 hours before the manifestation

Question 20

Is reactivation more severe in primary or secondary infections

Answer 20

more severe in primary infections

Question 21

What are red flags of herpes

Answer 21

• Fever
• Multiple lesions
• 14+ days
• inflammation of surrounding skin
• more than 6+ times a year

Question 22

What should you provide if patient

presents with herpes
patient presents with prodromal symptoms
Patient is asymptomatic but has history of herpes

Answer 22

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

Question 23

What are some symptomatic therapies for cold sores

Answer 23

menthol, benzocaine, lidocaine
- abreva (only OTC disease modifying therapy)
- topical analgesic
- systemic analgesics (tylenol, NSAIDs)
- max 3 days

Question 24

What antivirals can you give for cold sores

Answer 24

valacyclovir, acyclovir
(oral is better than topical hydrocortisone)

Question 25

What are bartholin’s glands

Answer 25

Produce secretions in response to sexual stimulation

Question 26

What is the pH of a vagina

Answer 26

3.5-4.5

Question 27

What is leukorrhea?

Answer 27

• Vaginal discharge
• 4mL in 24 hours
• Newborns can have vaginal discharge