Dental

Question 1

Avoid Tetras with who?

Answer 1

-2nd & 3rd TM (Pregnancy)
-Kids < 8yrs

Question 2

What causes tooth aches?

Answer 2

-Tooth Decay
-Abscess or Infected Gums
-Damaged Fillings
-Repetitive Motions (tooth grinding, chewing gum)

Question 3

Common agents given for tooth aches?

Answer 3

-Ace (incl. T1-T3s)
-NSAIDs (Ibu, Nap, ASA)

Question 3

Common agents given for tooth aches?

Answer 3

-Ace (incl. T1-T3s)
-NSAIDs (Ibu, Nap, ASA)

Question 4

What is the Rx daily limit for Ibu intake? OTC?

Answer 4

Rx: 2400mg (400-600mg Q4-6hrs)

OTC: 1200mg

Question 5

Daily Rx limit for Ace intake?

Answer 5

4000mg (650-1000mg Q6hrs)

Question 6

Topical Benzocaine… Good for pain originating from a tooth?

Answer 6

Nope… Only provides relief of pain if it originates from the Gums.

Question 7

Teething pains are common for infants between 1-2yrs of age… What other conditions might it be?

Answer 7

-Ear Infection
-RSV
-Food Allergies
-Colic

Question 8

What signs indicate an infant is going through teething pains?

Answer 8

-Extra Drooling
-Irritable
-Facial Rash
-Mild Fever

Question 9

What can we give infants for teething pain?

Answer 9

-Teething Rings or other things to gnaw on (toys, cold facecloth, etc.)

-Topical Benzocaine (QID application & avoid feeding for 1hr after use due to throat numbing)

Question 10

Name of rare, acute blood disorder associated with Topical Benzocaine (<2yrs)?

Answer 10

Methemoglobinemia (or “Blue Baby Syndrome”)

Question 11

How does Methemoglobinemia present?

Answer 11

-Within mins to hrs

-1st app or repeat use

-Less O2 carrying capacity in the blood (Pale, Gray or Blue Skin & Lips)

-Can also present in adults during Surgical / Tracheal Applications

Question 12

Best Topical Benzocaine product for teething?

Answer 12

Orajel Medicated Teething Relief

Question 13

Why is Baby Orajel shit?

Answer 13

Lacks Benzocaine (is unmedicated… jump straight to teething rings).

Question 14

1 Pharmacist prescribing scenario?

Answer 14

Cold Sores

Question 15

What virus primarily causes cold sores?

Answer 15

HSV-1

Question 16

What is recurrence rate for cold sores?

Answer 16

20-40% people (2-6 episodes / yr)

Question 17

What re-activates dormant HSV-1 virus in cold sore patients?

Answer 17

Stress, Sunlight, Trauma

Question 18

How do cold sores present?

Answer 18

Painful, fluid-filled sores that linger around for 7-10d

Question 19

Can cold sores start in the mouth?

Answer 19

Yes (but canker sores can as well)

Question 20

In what phase of cold sore infection are meds beneficial?

Answer 20

During the “Prodrome Syndrome” phase (ie. Day 1-2)… Must catch infection early.

Question 21

Progression of cold sores?

Answer 21

Day 0.5: Tingling, Itching, Burning

Days 1-2: Blister Formation

Day 4: Blister Bursting

Days 5-8: Scab Formation

Question 21

Progression of cold sores?

Answer 21

Day 0.5: Tingling, Itching, Burning

Days 1-2: Blister Formation

Day 4: Blister Bursting

Days 5-8: Scab Formation

Question 22

Differential conditions that may present similarly to cold sores?

Answer 22

-Angular Cheilitis (cracking around corners of lip creases)

-Impetigo (brown, crusty lesions & painless)

Question 23

What differentials can be used to distinguish cold sores from impetigo?

Answer 23

-Less painful -Vesicles present within lesions themselves (occasionally w cold sores but more Impetigo) -Age (Impetigo more common in kids)

Question 24

Non-Pharmacological measures for cold sore management?

Answer 24

-Reduce stress -Protect from sun -No popping / squeezing -Lip Balm

Question 25

Is Heparin / ZnSO4 good for cold sores?

Answer 25

Nope... Sulfate present dries lesions out & could lead to cracking.

Question 26

Propolis or Lysine good to use for cold sores?

Answer 26

Not therapeutically helpful

Question 27

One OTC product that may actually help treat cold sores?

Answer 27

Docosanol

Question 28

Preventative lip gel that can be used to prevent cold sores (doesn't actually treat).

Answer 28

Lipivir

Question 29

How does Docosanol actually help treat cold sores?

Answer 29

-Reduces viral entry into host cells

Question 30

Application instructions for Docosanol?

Answer 30

-Apply at 1st sign (ie. During Prodromal Phase). -Apply 5x / day until healed.

Question 31

Given Docosanol is 2nd best topical product for cold sores, what are some other options?

Answer 31

Valacyclovir 2g BID (8tabs) or Acyclovir 5% / HC 1% crm (5x daily for 5d)

Question 32

Referral cases that might present cold sore-ish would be what?

Answer 32

Basal / Squamous Cell infiltration with the Elderly (pre-cancerous?)

Question 33

What will you say to someone who has already blistered over cold sores?

Answer 33

-AV's of no use (didn't catch early enough). -Lip Balms & Benzocaine for numbing!

Question 34

A younger patient (4yrs) comes in with his mom & presents painful sores in the mouth. She tells you he had a fever, malaise & sore throat 1.5d ago. He also presents with a light skin rash. What might be his condition?

Answer 34

HFM Disease

Question 35

Johnny comes in with complaints of painful, white ulcers within the inside of his mouth. He is otherwise asymptomatic & healthy. What might he have?

Answer 35

Canker Sores (Aphthous Ulcers)

Question 36

Kimmy recently went in for chemo treatments & comes to your Pharmacy complaining of internal mouth ulcers. What might she have developed from the chemo?

Answer 36

Stomatitis

Question 37

Are Sodium Perborate or Hydrogen Peroxide rinses more effective anti-septic treatments for Canker Sores than Regular Saline?

Answer 37

Nope

Question 38

Is Orabase Paste better than Zilactin Gel for intra-oral applications in Canker Sore treatments?

Answer 38

Yes, paste better (slightly better adherence to mucosal tissues but tamper pt. expectations).

Question 39

Rx Therapy option for Canker Sores?

Answer 39

Oracort (Triamcinolone Paste)... Apply to sore HS & prn after meals. -No healing within 7d = Referral to Dentist or MD.

Question 40

What does Oral Thrush (C. albicans) sometimes present as in young babies?

Answer 40

Milk Residue (wipes off much easier though... C. albicans much grabbier).

Question 41

How does Thrush present?

Answer 41

-Creamy white lesions along tongue or cheek -Painful or burning sensation -Slight bleeding when scraped -Potential accompanying diaper rash (infants)

Question 42

Predispositions for Oral Thrush infections?

Answer 42

-Disease States (DM / HIV / Anemia / Leukemia / Xerostomia) -Meds (ICS / BS AB's / Chemo) -Poor Oral Hygiene, Dentures, Babies...

Question 43

If I wanted a Holistic fix for Oral Thrush for my baby, what product might I try?

Answer 43

Gentian Violet 1% Sol'n (very messy) ***NO LONGER ON MARKET!!!***

Question 44

Rx Therapy for Oral Thrush?

Answer 44

Nystatin Oral Suspension... Typically relief in 1-2d but carry out therapy for 4-7d to prevent relapse. <1yr: 100-200 000 U applied QID >1yr: 500 000 U applied QID

Question 45

Secondary Rx Therapies for Oral Thrush?

Answer 45

Miconazole & Fluconazole (MD Prescription)

Question 46

Xerostomia is commonly seen with what pt. demographic?

Answer 46

Elderly

Question 47

Other causes of dry mouth?

Answer 47

-Radiation / Chemo -Mouth Breathing -Chronic Disease -Meds (ie. TCA's / 1st gen AH's / Opioids) -Anxiety / Dehydration / Viral Infections

Question 48

Pharmacological agents to treat Xerostomia?

Answer 48

Saliva Subs (Moi-Stir, Oralbalance, Biotene)

Question 49

What medications can potentially induce Gingivitis?

Answer 49

-Phenytoin -Cyclosporine -Ca2+ Channel Blockers

Question 50

Name of condition associated with clicking or popping sounds & pain or discomfort around the jaw joint?

Answer 50

TMJ