14 oral conditions their treatment

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Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 14

Oral Conditions and Their Treatment


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Infectious Lesions: Acute NecrotizingUlcerative Gingivitis

Acute necrotizing ulcerative gingivitis (ANUG) is aspreading ulcer that has both bacteriologic andenvironmental factors.It is associated with a distinctive odor and begins at

the interdental papillae.Good oral hygiene is essential.Hydrogen peroxide or saline rinses are used for their flushing action.Pain or fever can be treated with acetaminophen or other nonopioid pain relievers.Vitamin supplements are only for those that arevitamin deficient.

Antibiotics are only necessary if there is systemicinfection or the patient is immunocompromised.

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Infectious Lesions:Herpes Infection

Cold sores or fever blisters are caused by the herpessimplex type 1 virus.They are recurrent and occur in the same area of themouth.

Treatment ranges from symptomatic to antiviral drugs. Aspirin, ibuprofen, or acetaminophen can be used to treatpain.Many over-the-counter drug products can be used.

Antiviral drugs such as penciclovir and docosanol 10% arealso used.

Acyclovir is used for patients that are immunocompromised.

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Infectious Lesions:Candidiasis (Moniliasis)

Oral candidiasis, or thrush, is a result of the fungus candida albicans.The patient usually presents with white,milk-curd plaques that can be wiped off. Pregnant women, infants, and those thatare immunocompromised are at risk.

Treatment includes antifungal drugs.

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Infectious Lesions: Angular Cheilitis/Cheilosis

Angular cheilitis is characterized by redness,fissures, erosions, and ulcers at the cornersof the mouth.

Causes can include candida albicans,bacteria, drugs, and a vitamin B deficiency.Therapy is dependent upon the cause.

Antifungal therapy is indicated for candidaalbicans, antibiotics if the cause is bacterial,and B vitamin supplements if there is adeficiency.

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Infectious Lesions: Alveolar Osteitis

Alveolar osteitis or dry socket is a result of aloss of necrosis or blood clot after anextraction that exposes bone.

Predisposing factors include oralcontraceptive use and menstrual cycle phase.It is characterized by pain, fever,lymphadenopathy, and malodor.

Treatment includes packing the socket,analgesics, antibiotics if necessary, supportivetherapy, and debridement.

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7/16Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Immune Reactions:Recurrent Aphthous Stomatitis

This oral condition is often referred to as a canker sore. It is a common lesion whose cause is unknown.It is characterized by nonkeratinized areas that arepainful.Treatment is symptomatic and includes oral painrelievers, mouth rinses, topical creams with or without steroids, diphenhydramine, and tetracyclinesuspension mixed with nystatin anddiphenhydramine.

Aphthasol is a new topical drug which decreases theduration of healing and ulcer pain.

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Immune Reactions:Lichen Planus

Lichen planus is a skin lesion that ofteninvolves lesions on the oral mucousmembranes.

Symptoms range from no pain to extremepain.It is not known what causes it but isthought to be either autoimmune or a

hypersensitivity reaction to an unknownagent.

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Miscellaneous Oral Conditions:Geographic Tongue

The tongue usually has lesions thatappear to be a map of the world.The lesions are ringed with red and the

center is white.It may be related to hormonal changes,stress, infection, psoriasis, or autoimmunediseases.

Treatment includes reassurance andavoiding irritating foods and alcohol.

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Miscellaneous Oral Conditions:Burning Mouth or Tongue Syndrome

The oral cavity appears normal but thepatient describes pain that increasesthroughout the day.Its etiology is unknown.Treatment is dependent upon suspectedetiology.

Treatment can include antidepressants,diphenhydramine, or antifungal drugs.

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Inflammation:Pericoronitis

Pericoronitis is inflammation of the tissuearound the crown of the tooth.It occurs most commonly in partially

erupted third molars and may be inresponse to food or bacteria that becomestrapped between the operculum and thetooth.

Treatment includes debridement,analgesics, and antibiotics.

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Inflammation:Postirradiation Caries

Changes in saliva and poor oral healthcare after radiation therapy can increasethe rate of caries.Meticulous oral hygiene, frequent visits tothe dental hygienist, artificial saliva, andself-application of sodium fluoride gel arerecommended.

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Inflammation:Root Sensitivity

Root sensitivity is characterized byocclusal trauma and exposed roots.It is treated with occlusal adjustment,fluoride, brushing with sodium chloride and0.4% stannous fluoride, or sodium fluoridegel.

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Inflammation: Actinic Lip Changes

Actinic lip changes are caused by constantexposure to the sun.Long-term exposure can lead to

irreversible changes known as actiniccheilitis.Topical 5-fluorouracil is indicated whenkeratotic changes have occurred.

A sun block with an SPF of greater than 15should be applied before sun exposure.

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Drug-Induced Oral SideEffects: Xerostomia

Xerostomia or dry mouth is a result of drugs, aging,medical illness, or radiation therapy.Treatment includes fluoride trays and gels tocounteract the formation of caries and artificial saliva.The patient is encouraged to drink plenty of water andto stay away from caffeine and alcohol-containingbeverages since they make dry mouth worse.The dose of the drug may have to be lowered if the

xerostomia continues or the patient may require adifferent drug.Pilocarpine is used in patients with functioning parotidglands to stimulate an increase in saliva flow.

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Drug-Induced Oral SideEffects: Gingival Enlargement

Gingival enlargement can occur withseveral different drugs.These drugs include phenytoin,cyclosporine, calcium channel blockers,carbamazepine, and valproic acid.Treatment varies dependent upon the

offending drug.

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14 oral conditions their treatment

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