Disorders of the Mouth Jan 24 PDF

Wednesday 31st January 2024 Disorders of the Mouth Sinéad McGonagle School of Pharmacy & Biomolecular Sciences LEARNING OUTCOMES Recognise the signs and symptoms of conditions affecting the oral cavity Describe the prevalence, aetiology and pathology associated with these conditi...

Wednesday 31st January 2024 Disorders of the Mouth Sinéad McGonagle School of Pharmacy & Biomolecular Sciences LEARNING OUTCOMES Recognise the signs and symptoms of conditions affecting the oral cavity Describe the prevalence, aetiology and pathology associated with these conditions Recognise appropriate, safe, and effective treatment for these conditions Describe how the medicines used work THE ORAL CAVITY Comprises of the cheeks, hard and soft palates and tongue The oral cavity  CONDITIONS AFFECTING THE ORAL CAVITY Mouth ulcers Oral Thrush Gingivitis Xerostomia (Dry mouth) Angular Chelitis  MOUTH ULCERS (APHTHOUS ULCERS) Common, superficial painful oral lesions ABOUT MOUTH ULCERS Minor aphthous ulcers are the most common (80%). Small (12 years) Hexetidine (e.g. Oraldene) TOPICAL ANAESTHETICS & ANALGESICS Anaesthetics (Lidocaine) – Used, mixed evidence – Retention on the affected area can be problematic Analgesics – Choline salicylate = Derivative of salicyclic acid with some analgesic properties – Benzydamine – Non steroidal anti inflammatory drug (NSAID) PROCTECTANTS Polyvinylpyrrolidone (Aloclair- also contains Aloe and Hyaluronic acid)- Spray, mouthwash, gel formulations Carbenoxolone sodium 2% TOPICAL CORTICOSTEROIDS Hydrocorticone Formulated as a muco-adhesive tablet – local drug delivery Beclomethasone – Inhaler formulation – Soluble tablet used as a mouth wash FUNGAL INFECTIONS OF THE MOUTH OROPHARYNGEAL CANDIDIASIS Opportunistic mucosal infection Need to identify risk factors Candida albicans generally harmless yeast Most common in very young/old Risk factors include: – Diabetes, dry mouth, immunocompromised, antibiotic use, inhaled corticosteroids, ill-fitting dentures OROPHARYNGEAL FUNGAL INFECTIONS Thrush - Pseudomembranous candidiasis is usually an acute infection but it may persist in chronic forms. Acute erythematous candidiasis – usually associated with a burning sensation in the mouth or tongue. Chronic atrophic candidiasis (denture stomatitis) – candida infection in patients wearing dentures Chronic hyperplastic candidiasis – plaque- like candidiasis – requires specialist referral increased risk of malignancy FEATURES Cream/white soft elevated patches Can be wiped off Reveal red mucosa There may be pain/burning/soreness Lesions can affect the tongue, palate, lips and cheeks TREATMENT OPTIONS Miconazole (Daktarin Oral Gel) Antifungal topical gel Requires retention in the mouth Absorbed from GI tract – potential for interactions Nystatin Oral Suspension Antifungal suspension No GI absorption – local drug delivery Fluconazole capsules Systemic treatment Extensive infection or other therapies unsuitable/ineffective GINGIVITIS GINGIVITIS Inflammation of the gums Caused by build-up of plaque usually Preventable and treatable Very common SIGNS AND SYMPTOMS Often mild and painless Routine dental check ups can identify it Bleeding gums characteristic sign Swelling and reddening of the gums that bleed easily with slight trauma +/- visible plaque/halitosis (bad breath) OTHER CAUSES Medicine-induced gum bleeding: Warfarin/heparin/NSAIDs/anti-platelets Warfarin patients should have INR monitored Phenytoin and ciclosporin cause gum hypertrophy (gingival hyperplasia) TREATMENTS Most effective is chlorhexidine at 0.1 or 0.2% Others – Hexetidine – Hydrogen peroxide GENERAL ADVICE Brush teeth regularly (twice daily) Use fluoride toothpaste Brush after eating Flossing/interdental brushes Rinse mouthwash for 30 seconds to one minute Regular dental visits XEROSTOMIA (DRY MOUTH) XEROSTOMIA (DRY MOUTH) Dry mouth associated with decreased saliva production may be caused by a variety of drugs Various causes, increases with advancing age Patients with xerostomia are at greater risk of dental infections & oral infections (particularly candidiasis) TREATMENT Care with diet Strict dental care practices Chew sugarless gum Stop smoking/decrease caffeine Ice chips/pineapple/sip water Breathe through your nose Use a humidifier Artificial saliva products e.g. Biotene, BioXtra, Glandosane available OTC in Ireland ANGULAR CHEILITIS ANGULAR CHEILITIS Characterised by soreness, erythema and fissuring at the angles of the mouth, commonly associated with denture stomatitis but may represent a nutritional deficiency or immunosuppression. Both yeasts (Candida spp.) and bacteria (Staphylococcus aureus and beta-haemolytic streptococci) are commonly involved as interacting, infective factors. It is normally self - limiting TREATMENT Identifying underlying cause – mix of fungal & bacterial infection Miconazole cream – Antifungal Fusidic acid cream – Antibacterial Hydrocortisone cream – Can be added if other treatments ineffective SUMMARY Range of disorders – Mouth ulcers – Oral Thrush – Gingivitis – Xerostomia (Dry mouth) – Angular Chelitis Treatment options – OTC & prescription medicines – Anaesthetics, analgesics, corticosteroids, protectants, antifungals, antibacterials – Formulations available LEARNING OUTCOMES Recognise the signs and symptoms of conditions that affect the oral cavity Describe the prevalence, aetiology and pathology associated with these conditions Select an appropriate, safe, and effective (non) pharmacological treatment for the patient based on individual patient factors Describe how the medicines used work