Oral health and Smoking

Question 1

What are mouth ulcers?

Answer 1

painful sores that appear inside the mouth, usually appearing as round or oval lesions with a red/white/yellow centre

resolve in 1-2 weeks

Question 2

What is treatment for mouth ulcers?

Answer 2

anti-bacterial agents
- chlorhexidine (>12 yrs)

choline salicylate
- Bonjela cool, Bonjela adult, >12 yrs

local anaesthetics
- lidocaine, benzocaine

Question 3

What is gum disease?

Answer 3

inflammation of the gums caused by
excess build up pf plaque on the teeth
- red and swollen gums
- bleeding gums after brushing or
flossing your teeth

Question 4

What is treatment for gum disease?

Answer 4

good oral hygiene
- brush twice a day
- floss regularly
- use toothpaste with fluoride
- no smoking

Corsodyl 2% mouthwash
- >12 years
Corsodyl 1% gel
- >12 years old

Question 5

What is oral thrush?

Answer 5

Creamy white soft, elevated patches
often on the tongue or inner cheeks
and can be wiped off to reveal a red
area that may bleed

loss of taste
cracks at corners of mouth

Question 6

What is treatment for oral thrush?

Answer 6

Miconazole (Daktarin oral gel)
- > 4 months old
- 1.25ml (4m-2yrs), 2.5ml (>2yrs) QDS

continue treatment for up to one week after the symptoms have disappeared

Question 7

What are herpes/cold sores?

Answer 7

viral infection

tingling, itching or burning sensation (prodromal)
painful blisters on inflamed skin - may burst, white matter

headache, sore throat, painful gums

Question 8

What is the treatment for herpes/cold sores?

Answer 8

antiviral cream
- aciclovir: 5 times a day for 5 days

hydrocolloid patches

analgesics: paracetamol, ibuprofen

Question 9

What is ‘stop on one go’ vs ‘harm reduction approach’?

Answer 9

‘stop in one go’
- individual makes a commitment to stop smoking on or before a particular date (the quit date)

‘harm reduction appraoch’
- cutting down before stopping smoking, reducing smoking (without intending to stop), or temporarily not smoking

Question 10

What are the types of treatment for smoking cessation

Answer 10

nicotine replacement therapy (NRT)

varenicline

bupropion hydrochloride

1st line - varenicline OR combination of long acting NRT and short acting NRT

Question 11

What are the types of NRT?

Answer 11

long acting
- transdermal patches: 16 hrs if sleep disturbances OR 24hrs if craving upon waking

short acting
- sublingual tablet, oral spray, nasal spray, lozenge, inhalator, gum

Question 11

What are the side effects of NRT?

Answer 11

inhalation - cough, irritation of mouth and throat, altered taste

oral - increased saliva, dry mouth, throat irritation

nasal spray - nasal irritation, runny nose, epistaxis, sneezing, watery eyes

transdermal - urticaria, itching, redness at site, sleep disturbances

Question 12

What to avoid when having NRT orally?

Answer 12

acidic beverages may decrease the absorption of nicotine through the buccal mucosa and should be avoided for 15 minutes before use
- coffee or fruit juice

Question 13

What are the requirements for bupropion use?

Answer 13

period of treatment 7–9 weeks

start treatment 1–2 weeks before target stop date
discontinue if abstinence not achieved at 7 weeks

Question 14

What is the maximum dosage for patient at risk for seizures and elderly?

Answer 14

150mg daily

Question 15

What is the MHRA waring for bupropion?

Answer 15

risk of serotonin syndrome with use with other serotonergic drugs

Question 16

What should be monitored for bupropion?
What are the counselling points?

Answer 16

blood pressure
- before and during

report
- any clinical worsening of depression, suicidal behaviour or thoughts and unusual changes in behaviour

driving and performance of skilled tasks
- increased risk of dizziness and light-headedness.