Oral Conditions and Their Treatment Chapter 14 Oral Conditions and Their Treatment

Infectious Lesions: Acute Necrotizing Ulcerative Gingivitis Acute necrotizing ulcerative gingivitis (ANUG) is a spreading ulcer that has both bacteriologic and environmental 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 are vitamin deficient. Antibiotics are only necessary if there is systemic infection or the patient is immunocompromised. 2

Infectious Lesions: Herpes Infection Cold sores or fever blisters are caused by the herpes simplex type 1 virus. They are recurrent and occur in the same area of the mouth. Treatment ranges from symptomatic to antiviral drugs. Aspirin, ibuprofen, or acetaminophen can be used to treat pain. Many over-the-counter drug products can be used. Antiviral drugs such as penciclovir and docosanol 10% are also used. Acyclovir is used for patients that are immunocompromised. 3

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 that are immunocompromised are at risk. Treatment includes antifungal drugs. 4

Infectious Lesions: Angular Cheilitis/Cheilosis Angular cheilitis is characterized by redness, fissures, erosions, and ulcers at the corners of 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 candida albicans, antibiotics if the cause is bacterial, and B vitamin supplements if there is a deficiency. 5

Infectious Lesions: Alveolar Osteitis Alveolar osteitis or dry socket is a result of a loss of necrosis or blood clot after an extraction that exposes bone. Predisposing factors include oral contraceptive use and menstrual cycle phase. It is characterized by pain, fever, lymphadenopathy, and malodor. Treatment includes packing the socket, analgesics, antibiotics if necessary, supportive therapy, and debridement. 6

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 are painful. Treatment is symptomatic and includes oral pain relievers, mouth rinses, topical creams with or without steroids, diphenhydramine, and tetracycline suspension mixed with nystatin and diphenhydramine. Aphthasol is a new topical drug which decreases the duration of healing and ulcer pain. 7

Immune Reactions: Lichen Planus Lichen planus is a skin lesion that often involves lesions on the oral mucous membranes. Symptoms range from no pain to extreme pain. It is not known what causes it but is thought to be either autoimmune or a hypersensitivity reaction to an unknown agent. 8

Miscellaneous Oral Conditions: Geographic Tongue The tongue usually has lesions that appear 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 autoimmune diseases. Treatment includes reassurance and avoiding irritating foods and alcohol. 9

Miscellaneous Oral Conditions: Burning Mouth or Tongue Syndrome The oral cavity appears normal but the patient describes pain that increases throughout the day. Its etiology is unknown. Treatment is dependent upon suspected etiology. Treatment can include antidepressants, diphenhydramine, or antifungal drugs. 10

Inflammation: Pericoronitis Pericoronitis is inflammation of the tissue around the crown of the tooth. It occurs most commonly in partially erupted third molars and may be in response to food or bacteria that becomes trapped between the operculum and the tooth. Treatment includes debridement, analgesics, and antibiotics. 11

Inflammation: Postirradiation Caries Changes in saliva and poor oral health care after radiation therapy can increase the rate of caries. Meticulous oral hygiene, frequent visits to the dental hygienist, artificial saliva, and self-application of sodium fluoride gel are recommended. 12

Inflammation: Root Sensitivity Root sensitivity is characterized by occlusal trauma and exposed roots. It is treated with occlusal adjustment, fluoride, brushing with sodium chloride and 0.4% stannous fluoride, or sodium fluoride gel. 13

Inflammation: Actinic Lip Changes Actinic lip changes are caused by constant exposure to the sun. Long-term exposure can lead to irreversible changes known as actinic cheilitis. Topical 5-fluorouracil is indicated when keratotic changes have occurred. A sun block with an SPF of greater than 15 should be applied before sun exposure. 14

Drug-Induced Oral Side Effects: Xerostomia Xerostomia or dry mouth is a result of drugs, aging, medical illness, or radiation therapy. Treatment includes fluoride trays and gels to counteract the formation of caries and artificial saliva. The patient is encouraged to drink plenty of water and to stay away from caffeine and alcohol-containing beverages 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 a different drug. Pilocarpine is used in patients with functioning parotid glands to stimulate an increase in saliva flow. 15

Drug-Induced Oral Side Effects: Gingival Enlargement Gingival enlargement can occur with several different drugs. These drugs include phenytoin, cyclosporine, calcium channel blockers, carbamazepine, and valproic acid. Treatment varies dependent upon the offending drug. 16