secondary: entails use of systemic corticosteroids; prednisone
Describe the recommendations to relieve pain from oral EM.
Primary: topical anesthetic/antihistamine products; diphenhydramine (kid's benedryl), viscous lidocaine, mixed with a covering agent (kaopectate or maalox)
secondary: Refer to physician
Describe the recommendations to relieve pain from oral CP.
primary: regularly applied tipical high-potency or ultrapotency corticosteroid ointment or gel
secondary: a regimen of dapsone tablets
Identify potential ADEs for each of the therapies for OLP, RAS, oral EM, and oral CP.
OLP: insomnia, mood swings, nervousness, diarrhea, fluid retention, muscle weakness, and hypertension may occur
RAS: problems related to consistent application of agents limit their effectiveness and might lead to oral candidiasis, thinning mucosa or atrophy
oral EM: adequate hydration and nutrition is mandatory
oral CP: head aches, hemolytic anemia, methemoglobineamia, bone marrow suppression, lover toxicity
Describe oral health education topics and application instructions for RAS.
The cause of it is unknown, but the primary goal in the management of it is to identify and eliminate or manage contributory factors which may include:
local factors: trauma, tooth paste allergy
other systemic conditions manifesting ulcerations
Describe oral health education topics and application instructions for OLP
Cause is unknown, but it is believed to be an autoimmune disease with a genetic predisposition
It is the most common dermatologic disease with oral manifestations
trauma, viral and bacterial infections, emotional stress, and drug therapy are all possible predisposing factors
there is a possible association with OLP and oral squamous cell carcinoma
Describe oral health education topics and application instructions for oral EM
The disease can be minor, major, or potentially fatal (stevens-johnson syndrome) and toxic epidermal necrolysis
Most cases are related to infections, especially HSV
but most cases of SJS and TEN are related to pharmacologic agents
It has been reported to develop after immunizations or radiotherapy
If EM is related to a drug, pt should never take that drug, or any other drug with crossreaction potential
the disease often recurs, so pts should be warned, and to seek medical attention right away if it does
Describe oral health education topics and application instructions for oral CP
The mean age of onset of this disease is 62 years, and appears to have a 2:1 predilection for women
Oral mucosal lesions usually heal without scarring, but if they do scar, it is a result of submucosal fibrosis, which is a key feature of disease progression in other sites such as the conjunctiva of the eye, and the larynx
Identify dermatologic conditions with oral lesions. Which is the most common?
Oral Lichen Planus
Differentiate between the clinical appearance of herpes labialis and intraoral recurrent herpetic infection.
herpes labialis: focal vesicular lesions affecting the lip vermilion or other perioral sites such as the skin or ala of the nose, the vesicles rapidly rupture and crust
intraoral recurrent herpetic infection: small clusters of pinpoint ulcers, usually restricted to the keratinized mucosa
Differentiate between treatments for primary versus recurrent herpetic infections.
Primary herpetic infection: strategies are targeted to ensure adequate hydration and nutrition to provide palliation; topical anesthetic agent (diphenhydramine hydrochloride [children's benadryl]) or lidocaine viscous, and if necessary a systemic analgesic
recurrent herpetic lesions: These lesions are self-limiting and often require no treatment; OTC topical agents are available to help, docosanol (Abreva) is the only OTC formulation specifically approved by the FDA for tx of RHL. Penciclovir (Denavir), acyclovir (Zovirax) creams are used
How efficacious are preparations for treating recurrent HSV infection?
They are most effective when initiated during the prodromal phase
these lesions often don't require treatment
the medications will not have a significant effect
Describe oral health instructions related to the presence of RHL and warnings when topical anesthetic agents are recommended for recurrent herpetic lesions.
All pts should avoid touching the lesion and practice good hygiene (wash hands) to reduce the risk of autoinoculation
topical anesthetics are recommended for pts who manifest frequent recurrent episodes, or who otherwise desire antiviral therapy
Also, for pts whom sunlight precipitates an outbreak, SPF 15 or higher lip balm is recommended
List products for the tx of herpetic lesions, and describe instructions for their use.
primary herpetic infection:
diphenhydramine hydrochloride (benadryl) or lidocaine viscous: be careful of self-induced injury or interference with swallowing
aceta minophen, and in rare instances acetaminophen/codeine: avoid aspirin in children
docosanol (Abreva) cream: applied at first prodromal sign, reapplied 5 x's a day until lesion is healed
penciclovir (denavir): apply every 2 hrs until lesion is healed
acyclovir (zovirax): cream applied 5 x's a day until lesion is healed
valacyclovir (valtrex) oral antiviral: 1-day therapy, take 2 tablets taken twice daily (2 tabs bid for 1 day)
List products for candida infection and describe pt instruction for their use
Nystatin: rinse; swished for 5 minutes a day and spit or swallowed, used 5 times a day. pastille is allowed to slowly dissolve in the mouth and is used 4-5 times a day, do not chew or swallow.
Clotrimazole troche: dissolved slowly in the mouth, 5 times a day for 14 days
Ketoconazole cream: applied to affected area once a day for 2-4 weeks
Systemic oral antifungal agents are available for pts who are unresponsive to topical therapy: detoconazole, fluconazole, itraconazole
fluconoazole is drug of choice
itraconazole is reserved for treatment if it resists fluconazole
Describe clinical signs of xerostomia.
noticeable lack of wetness to the mucosal tissues and teeth
saliva that is thick and ropey
absence of saliva pooling in the floor of the mouth
red, dry, and atrophic mucosa
atrophic and fissured tongue
incisal and smooth surfaces caries especially at cervical margins
Describe agents used to manage xerostomia.
tx strategies may be targeted or palliative and supportive, or both
consult w/physician to change, reduce, or discontinue meds that predispose xerostomia
pts advised to: stay hydrated throughout day, use dentifrice w/fluoride 2x day, rinse with a fluoride rinse,remove and clean prostheses at night, avoid food/substances that irritate the mucosa, reduce sugar intake, chew xylitol gum or sugarless gum, don't use alcohol rinse
Salivary substitutes are available: OralBalance, Optimoist, Salivart; buty they are poor imitators, Numoisyn is better
Lip balm w/vitamin E helps chapped lips
sialagogue (tablet): for pts w/residual salivary function
pilocarpine (salagen): tx of it associated w/head and neck radiotherapy and sjogren syndrome, or cevimeline (evoxac)
chlorhexidine gluconate rinse, and supplemental topical fluoride
additional application of fluoride varnish
Identify situations in which sialagogues are recommended. in what disease conditions should these drugs be used with caution?
for pts with residual salivary function: such as head and neck radiotherapy and Sjogren syndrome
Used with caution in pts with: significant cardiovascular disease, asthma, COPD, biliary tract disease, and kidney disease
Describe management of pericoronitis
Step 1: drainage established by a curet or periodontal probe under the operculum
next, irrigation: with saline or antiseptic rinse; may be followed by inserting a wick of iodoform gauze; pt is to rinse w/ warm salt water for 2 mins every waking hour
extract tooth: if opposing tooth is traumatizing operculum, opposing tooth extracted or underto odontoplasty; but make sure the infection is managed
antimicrobial regimen prescribed: if pts manifests systemic signs of infection, and also following debridement to remove exudate (penicillin is initial drug of choice) if pen VK doesn't work, give them metronidazole (it is beta-lactamase resistant)
Write out instructions for an alkaline saline mouth rinse recommended as tx for pts with pericoronitis.
rinsing with warm salt water for 2 minutes every waking hour
Describe management of dry socket.
Chlorhexidine rinse: immediately before extraction, and for 1 week (twice daily) after
atraumatic surgical technique with attetntion to irrigate site w/saline, ensure removal of any bone or tooth fragments, and verify formation of clot
post op instructions icluding: avoid smoking, sucking through a straw, drinking carbonation, and vigorous rinsing
nutritious diet and use of gentle toothbrush
7.5 mg of hydrocodone and 200mg ibu for pain
anything placed in socket will delay healing
Describe oral health information in management of stomatitis
Topical application of medicaments such as aspirin, is ill advised
adverse mucosal effects of tobacco
oral lesions may be associated with accidental exposure to gasoline and other chemicals
can be caused by ill-fitting or poorly maintained removable dental prostheses
meticulous oral hygiene cannot be overemphasized as effective preventive and therapeutic management of stomatitis
Describe management of NUG.
reinforcement of plaque control combined with debridement
ultrasonic instrumentation or hand scaling with cpious irrigation to perform a simple debridement, not a fine scale
pts should gently brush, and rinse w/3% hydrogen peroxide diluted solution or w/chlorhexidine
pts should rest, avoid smoking and drinking alchohol
Describe management of burning mouth syndrome.
bezodiazepine such as chlordiazepoxide (Librium) as an alternative for clozazepam
for pts unresponsive to the previous primary therapies; tricyclic antidepressant such as desipramine may be used
for pts who are refractory to above therapies, anticonvulsant gabapentin may be used