PHARMACOLOGY DH206 CHAPTER 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 Treatment 1.Infectious lesions 2.Immune reactions 3.Tongue 4.Drug-induced oral side effects 5.Corticosteroids

1. INFECTIOUS LESIONS 1)Necrotizing ulcerative gingivitis (your book calls this ANUG – old term, now use NUG p.135) 2)Herpes 3)Candidiasis 4)Angular Cheilitis

1. INFECTIOUS LESIONS 1)Acute necrotizing ulcerative gingivitis Bacterial, immunological & environmental factors Treatment Good oral hygiene best Mouthwashes: H 2 O 2, 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 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.RAS 2.Lichen Planus

2. IMMUNE REACTIONS 1)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 REACTIONS 1)RAS Tx 1.Corticosteroids: ↓ inflammation 2.Aphthasol Topically applied to decrease duration & increase healing 3.Diphenhydramine (Benadryl) 4.CHX 5.Immunosuppressives Last resort to tx severe cases Imuran, Methotrexate, Cyclosporine, Thalidomide, Interferon BOOK CLARIFICATION TETRACYCLINE NOT RECOMMENDED P.140

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

P.142, Box 12-1 Many drugs can cause side effects in oral cavity Common oral side effects include 1)Xerostomia: cholinergics 2)Sialorrhea 3)Hypersensitivity reactions 4)Drug-induced lichenoid-like reaction: Anticonvulsants, antiarrhythmic 5)Stains: tetracycline, minocycline 6)Gingival Enlargement: Cyclosporin (transplant anti- rejection drug), CCB, Anticonvulsants 7)Osteoradionecrosis: bisphosphonates, cancer tx All NBQ Info!

6. AGENTS USED TO TX ORAL LESIONS

5. CORTICOSTEROIDS AGENTPOTENCY Hydrocortisone cream (1-2.5%)Low Triamcinolone acetonide Fluocinonide(Lidex) Moderate Clobetasol(Temovate)High PrednisoneSystemic ALERT GOTTA KNOW EVERYTHING ON THIS GRAPH! TESTS & BOARDS!!!