Dental Conditions Flashcards
What are different dental conditions?
Teething Oral Pain Oral Candidiasis Cold Sores Aphthous Ulcer Dry Mouth Periodontal Disease Mouth Rinses Halitosis
What are the symptoms of teething pain?
Gum redness, swelling or tenderness
Drooling, rubbing the gum, flushed cheeks because of mild increase in body temperature
Irritability restlessness, crying, insomnia, decreased appetite, increased thirst
What are NOT symptoms of teething pain?
Fever (although there may be slight elevation of temperature)
Diarrhea (although there may be loose stools)
Vomiting
Common cold symptoms
When do teething symptoms begin?
Symptoms can begin up to 4 days prior to the eruption of the tooth
What are some non pharmacological treatments for teething?
Rub the baby’s gums by using a clean finger or a damp washcloth to massage the gums
Cool the affected area by letting the chew on a frozen facecloth or a cold pacifier/teether (avoid contact with extreme cold; don’t freeze pacifiers)
Wipe the baby’s face often with a cloth to remove the drool and prevent rashes from developing
What are some pharmacological options for teething pain?
Acetaminophen 10-15 mg/kg/dose q4-6h prn (max 65 mg/kg/day)
Ibuprofen 5-10 mg/kg/dose q6-8h hours prn (max 40 mg/kg/day)
Refer if no relief with treatment after 3 to 5 days
What are some topical anesthetic products that can be used for teething pain?
Benzocaine gel (Baby Orajel 7.5%, Baby Orajel Night time 10%, Baby Anbesol 7.5%)
Should topical anesthetics be used for teething pain?
They only provide relief for a maximum of 45 minutes
They are controversial due to potential harm. They inactivate the gag reflex, which increases the risk of choking. They are a sensitizers. In some cases, they can cause Methemoglobineia; the benzocaine can prevent oxygen from binding to the blood cells (requires a genetic polymorphism). This can cause shortness of breath, blue lips and even death
What causes symptoms of a toothache?
Symptoms that may be due to a variety of causes.
Cracked tooth has abrupt pain with biting and resolves with removal of pressure (requires a referral to the dentist for assessment and treatment)
Post-dental procedure discomfort
What are pharmacological treatment options for a toothache?
NSAIDs
Acetaminophen
Benzocaine (OraJel regular (10%), Maximum strength (20%), PM (20%), Anebsol Liquid/gel (20%)
What is tooth hypersensitivity?
Short, quick sharp dental pain due to exposure to a stimulus (thermal, chemical, osmotic, physical) on exposed dentin
A dental referral is necessary to determine (and potentially treat) the underlying cause
What does tooth hypersensitivity result from?
May result from: “tooth decay, fractured teeth, worn fillings, gum disease, worn tooth enamel or an exposed tooth root due to gum recession”
What are some non-pharmacological suggestions for tooth hypersensitivity?
Soft-bristled toothbrush
Reduce acidic foods and drinks
What are pharmacological options for tooth hypersensitivity?
Desensitizing toothpaste work by blocking the repolarization of the nerve fibre membranes, thereby decreasing the pain
Key ingredient: potassium nitrate
Product examples: Sensodyne F, Crest-Pro Health, Colgate Sensitivity
What is oral candidiasis?
Also known as thrush
Most commonly caused by C. albicans
What are the two major forms of oropharyngeal candidiasis?
The pseudomonas form is the most common and appears as white plaques on oral mucosa
The atrophic form (denture stomatitis) appears as erythema without plaque. Common in elderly with dentures
What are risk factors for oral candidiasis?
Diseases that affect the immune system (e.g., diabetes, HIV infection) and medications that suppress the immune system (e.g., chemotherapy) Xerostomia (dry mouth) Use of systemic corticosteroids or corticosteroid inhalers Recent use of broad spectrum antibiotics Infants and children Local mucosal trauma Poor dental or denture hygiene Pregnant women Smoking
What are signs and symptoms of oral candidiasis?
“Cottage cheese” soft plaques that are white or creamy-yellowish on the buccal mucosa, tongue, gums and throat
Plaques are easily removed by vigorous rubbing but can leave red (erythema) or bleeding sites when removed
Red, flat lesions on the mucosa under the denture
May cause cracked, red, moist areas on skin at the corners of the mouth
Symptoms are varied and may range from none to sore, painful mouth, burning tongue, metallic taste and dysphagia
What are red flags for oral candidiasis?
Patients with signs and symptoms not typical of mild oral thrush
Patient is on chemotherapy or is immunocompromised due to drug therapy
Patient has systemic symptoms such as unexplained weight loss or thirst which could indicate diabetes
Other organ involvement such as conjunctivitis, uveitis or accompanying genital ulcers
Any lesion present for 3 weeks or longer should be referred to physician as it may require biopsy and/or systemic antifungal treatment
Possible symptoms of an adverse drug reaction. If a prescription medication is suspected, refer to physician for evaluation and possible change in medication
Suspect another type of infection (e.g., viral herpes infection)
Unable to confirm diagnosis of oral thrush. Refer for further evaluation and/or physician-supervised therapy
Treatment unsuccessful after 14 days
Can oral candidiasis be treated by a pharmacist?
Only in Manitoba
Patients with mild signs and symptoms can be treated by a pharmacists (only when you feel very comfortable)
Patients with atypical symptoms should be referred
What are the goals of treatment of oral candidiasis?
Eradicate infection
Prevent complications
Prevent recurrence
What are non-pharmacological suggestions for oral candidiasis for infants?
Sterilize toys, soothers, and feeding bottles/nipples
If breastfed, the mother may have candidal infection on the nipples and require treatment
What are non-pharmacological suggestions for oral candidiasis for those with dentures?
Remove dentures overnight
Wear dentures only for 6 hours
Soak and clean dentures when not using
Clean oral cavity with soft toothbrush and investigate if dentures fit properly
What are prescription options for oral candidias?
Pharmacist options: Nystatin (for mild disease)
Physician/dentist options: Oral azole antifungals (fluconazole tablets or suspension, itraconazole, ketoconazole, posaconazole, voriconazole)
Why is gentian violet (OTC) not used anymore?
In the past, Gentian Violet (OTC) was applied to affected area. Difficult to determine therapeutic progress and decreased compliance as it can cause mucosal irritation, ulceration and staining. Safety is questionable (linked to carcinogenicity)
Required longer treatment, stains skin and clothing, should not be swallowed, NAPRA schedule II (may have to dilute appropriate concentration)
What is nystatin oral suspension?
Fungi-static and cidal
Effective for candidal infections, considered first line for mild disease
How is the liquid nystatin used?
Shake well before using, need to swish and swallow. Recommend instilling half of the dose in each side of the mouth to ensure contact with lesions for as long as possible before swallowing
Infants: do not feed for 5-10 minutes after dose is given
What are the side effects of nystatin?
Considered well tolerated. In high doses: nausea, vomiting and diarrhea.
Rarely: rash, irritation, urticaria and Stevens-Johnson syndrome
What is the dosing for nystatin oral suspension?
Adults and children: 4 to 6 ml of 100 000 unit/ml suspension QID 7 to 14 days
Infants: 1 to 2 ml of 100 000 unit/ml suspension QID for 7 to 14 days
Note: treatment should continue for at least 48 hours after symptoms have resolved
What are the monitoring parameters for oral candidias?
After prescribing nystatin, follow up with the patient should occur in 7 days
If symptoms resolved for 48 hours, can discontinue medication
If improvement but not resolution of symptoms ensure the patient continue nystatin for another 7 days
If no improvement, refer to physician or dentist for assessment
