PAC3421 Study Guide - Final Guide: Aphthous Stomatitis, Lip Balm, Gingival Enlargement
21 Jun 2018
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Mouth Disorder 1 – Mouth Ulcers (divided into Aphthous Ulcers and Herpes Simplex Ulcers)
A. Apthous Ulcers:
-Unknown cause, but most common on NON-KERATINISED mucosal surfaces
Specific counselling points for aphthous ulcers:
-Avoid eating or drinking hot or cold food immediately after use of local anaesthetics
-Antiseptic contains quaternary ammonium ion (i.e. cationic) which can be inactivated by toothpaste (i.e.
anionic). Therefore, do not use the antiseptic within 30 minutes of cleaning teeth.
-Antiseptic mouthwashes may cause superficial discolouration of teeth with prolonged use
B. Herpes Simplex Ulcers
-Caused by virus -> so only ANTIVIRALS are effective
-Can be divided into minor and severe episode
oTreatments of choice for both minor and severe episode
Minor episode:
Use lignocaine (i.e. anaesthetic) +/- chlorhexidine (i.e. an antiseptic)
Use antiviral CREAM (e.g. acyclovir, penciclovir) at prodromal stage or first sign of infection
Severe episode:
Use antiviral ORAL (e.g. acyclovir, famciclovir, valaciclovir) OR cold sore patch
Referral to doctor for BOTH types of mouth ulcers:
Ulcer that is not healed after 2-3 weeks
Ulcer (i.e. aphthous or herpes) + blister*
Ulcer (i.e. aphthous or herpes) + sore throat*
Petechial haemorrhage on palate or oral mucosa*
*signs of bone marrow suppression
General advices for BOTH types of mouth ulcers:
Brush teeth at least twice daily and floss regularly
Brush teeth very gently, taking care not to slip with the brush
Eat well-balanced diet
Mouth Disorder 2 – Oral candidosis / Oral thrush
-Caused by fungus -> so only ANTIFUNGALS are effective
-Only use TOPICAL antifungal agents to manage this patient:
oMiconazole gel
oNystatin suspension (for sublingual use, then swallow)
oAmphotericin lozenges (suck, then swallow)
When to refer to doctor for oral candidosis?
If a person does not have satisfactory response achieved by local measures because they may require systemic
antifungal agents OR may have leukoplakia (i.e. characterised by persistent white patch)
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Mouth Disorder 3 - Angular Chelitis
-Caused by BOTH fungus AND bacteria -> so only ANTIFUNGALS and ANTIBACTERIAL are effective
-Can be aggravated by dribbling (esp. kids), dry lips* and poor nutrition
-Lip balm (if dry lips)
-Improve diet by taking multivitamins (if poor nutrition)
-In most cases, NO TREATMENT needed (i.e. self-resolving)
*We mention “dry lips” instead of “dry mouth” here is because angular chelitis occurs at corners of the mouth
Mouth Disorder 4 – Drug-induced Mouth Disorders (divided into Dry Mouth, Gingival Hyperplasia and Taste
Disturbance)
A. Dry mouth
-Induced by anticholinergics, isotretinoin, diuretics, levodopa, methyldopa, tricyclic antidepressant
-Recommend patient to chew food thoroughly to stimulate saliva secretion before swallowing to help with dry
mouth
-Ensure adequate hydration and avoid alcohol, coffee or tea
-Artificial saliva (Same treatment used in cytotoxic-induced Mouth Disorder – see later)
B. Gingival hyperplasia
-Induced by Ca2+ ion channel antagonist (nifedipine/amlodipine), cyclosporine, phenytoin
-NO TREATMENT, refer if troublesome
C. Taste disturbance
-Induced by metronidazole, lithium
-NO TREATMENT, refer if troublesome
Mouth Disorder 5 – Cytotoxic or Radiotherapy-induced Mouth Disorders
-Induced by methotrexate, 5-fluorouracil (i.e. through breakdown of rapidly dividing mouth epithelial cells,
leading to ulceration and infection)
-Chlorhexidine mouthwash
-Benzydamine HCl (anti-inflammatory and pain relief)
-Lip balm (same treatment used in angular chelitis)
-Artificial saliva (same treatment used in drug-induced dry mouth)
Mouth Disorder 6 – Malignancies or Mouth Cancer
-Caused by alcohol and tobacco
-Affects pharynx mucosa surface, oral cavity, salivary glands, and tongue
-NO TREATMENT, definitely refer
Mouth Disorder 7 – Halitosis “Bad Breath”
-Caused by oral infection, URTI, smoking, hepatic failure, diabetic ketoacidosis
-Tell patient that halitosis can only be CONTROLLED rather than CURED
-Chlorhexidine mouthwash
-Zn2+-containing lozenges only have limited evidence
find more resources at oneclass.com
find more resources at oneclass.com
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Mouth disorder 1 mouth ulcers (divided into aphthous ulcers and herpes simplex ulcers: apthous ulcers: Unknown cause, but most common on non-keratinised mucosal surfaces. Avoid eating or drinking hot or cold food immediately after use of local anaesthetics. Antiseptic contains quaternary ammonium ion (i. e. cationic) which can be inactivated by toothpaste (i. e. Antiseptic contains quaternary ammonium ion (i. e. cationic) which can be inactivated by toothpaste (i. e. anionic). Therefore, do not use the antiseptic within 30 minutes of cleaning teeth. Antiseptic mouthwashes may cause superficial discolouration of teeth with prolonged use: herpes simplex ulcers. Caused by virus -> so only antivirals are effective. Can be divided into minor and severe episode: treatments of choice for both minor and severe episode. Use lignocaine (i. e. anaesthetic) +/- chlorhexidine (i. e. an antiseptic) Use antiviral cream (e. g. acyclovir, penciclovir) at prodromal stage or first sign of infection. Use antiviral oral (e. g. acyclovir, famciclovir, valaciclovir) or cold sore patch.
