PHARMACOLOGY DH206CHAPTER 12

ORAL CONDITIONS AND THEIR TREATMENT

LISA MAYO, RDH, BSDH

Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.

CHAPTER 13 OUTLINE

Oral Conditions and Their Treatment1. Infectious lesions2. Immune reactions3. Tongue4. Drug-induced oral side effects5. Corticosteroids

1. INFECTIOUS LESIONS

1) Necrotizing ulcerative gingivitis (your book calls this ANUG – old term, now use NUG p.135)

2) Herpes3) Candidiasis4) Angular Cheilitis

1. INFECTIOUS LESIONS1) Acute necrotizing ulcerative gingivitis

• Bacterial, immunological & environmental factors• Treatment

• Good oral hygiene best• Mouthwashes: H2O2, saline, CHX

• Non-opioids for pain relief• Most patients respond dramatically to SCRP alone• CHX: active against gram (-)/(+) & candida• Antibiotics is pt is immunosuppressed or evidence

systemic involvement• Pen VK• Metronidazole

1. INFECTIOUS LESIONS

2) Herpes infections• HSV-1&2 • Primary herpetic gingivostomatitis• Read p.136-138• Tx covered in CH8

1. INFECTIOUS LESIONS

3) Candidiasis: read p.138• Treatment covered in CH8

• Nystatin• Chronic: ketoconazole• Systemic: fluconazole, itraconazole

1. INFECTIOUS LESIONS

4) Angular Cheilitis• Most cases are mixed infections

• Candida + Gram (+) strep or staph• Treatment

• Candida: antifungals (CH8)• Inflammation: topical steroid • Mycolog: antifungal + triamcinolone

agent(steroid) with Trade name Kenalog• Bacteria: systemic penicillinase-resistant

penicillins (Mupirocin) or topical Bactroban• Vit B supplement ONLY if deficiency

2. IMMUNE REACTIONS

1. RAS2. Lichen Planus

2. IMMUNE REACTIONS1) Recurrent aphthous stomatitis

• Unknown etiology: an immune system involvement is suspected (T-lymphocytes)

• May be related to sodium lauryl sulfate, hormones, infection, nutrition, trauma, stress

2) Lichen Planus• Oral & skin lesions• Tx depends on symptoms: steroids, oral retinoids,

immunosuppressant's

2. IMMUNE REACTIONS1) RAS Tx

1. Corticosteroids: ↓ inflammation2. Aphthasol

• Topically applied to decrease duration & increase healing

3. Diphenhydramine (Benadryl)4. CHX5. Immunosuppressives

• Last resort to tx severe cases• Imuran, Methotrexate, Cyclosporine, Thalidomide,

InterferonBOOK

CLARIFICATION TETRACYCLINE

NOT RECOMMENDED

P.140

3. TONGUE

3. TONGUE

• Geographic tongue• Palliative, avoid spicy food & alcohol

• Burning Mouth/Tongue Syndrome: Glossodynia• Atrophy of filiform papillae (NBQ)• Variety of causes• Tx depends on etiology

• Candida• Vitamin deficiencies• Benadryl for palliative tx• Tricyclic antidepressants: amitriptyline

4. DRUG-INDUCED ORAL SIDE EFFECTS

4. DRUG-INDUCED ORAL SIDE EFFECTS• P.142, Box 12-1• Many drugs can cause side effects in oral cavity• Common oral side effects include

1) Xerostomia: cholinergics2) Sialorrhea3) Hypersensitivity reactions 4) Drug-induced lichenoid-like reaction:

Anticonvulsants, antiarrhythmic 5) Stains: tetracycline, minocycline6) Gingival Enlargement: Cyclosporin (transplant anti-

rejection drug), CCB, Anticonvulsants7) Osteoradionecrosis: bisphosphonates, cancer tx

All NBQ Info!

6. AGENTS USED TO TX ORAL LESIONS

5. CORTICOSTEROIDS

AGENT POTENCY

Hydrocortisone cream (1-2.5%) Low

Triamcinolone acetonideFluocinonide(Lidex)

Moderate

Clobetasol(Temovate) High

Prednisone Systemic

ALERTGOTTA KNOW EVERYTHING ON THIS GRAPH!

TESTS & BOARDS!!!