Orofacial Pain and Discomfort PDF

Orofacial Pain and Discomfort Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 20th Edition Daniel Krinsky Denise A. Mills...

Orofacial Pain and Discomfort Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 20th Edition Daniel Krinsky Denise A. Mills, DDS, MHA, EdD Clinical Professor [email protected]  Caries – dental decay Gingiva – gums Dental Terms Periodontal disease – gum disease Mucosa – soft inner lining of the oral cavity Keratinized mucosa – tissue attached to bone (hard palate and tissue adjacent to the teeth) Orofacial Pain and Discomfort Learning Objectives – Teething Describe Describe nonpharmacologic therapy Explain Explain pharmacologic therapy Provide Provide counseling for teething discomfort Teething Dental Anatomy Teething Starts as early as 3 months Sleep disturbance Irritability Pain  Vomiting Diarrhea Teething Nasal congestion Does NOT Malaise Cause Fever Rashes Benzocaine harmful under the age of 2 Benzocaine Free Teething What to Avoid Choking Hazard Baltic Amber Supposedly releases pain- relieving substance with body heat Choking hazard Teething Eruption Cyst Requires no treatment Teething Nonpharmacologic Therapy Teething Pharmacologic Therapy Pediatric doses of nonprescription analgesics (acetaminophen) American Dental Association Recommendation First dental visit within 6 months of eruption of the child’s first tooth and no later than the child’s first birthday Learning Objectives – Tooth Hypersensitivity Explain Explain the pathophysiology of tooth hypersensitivity Describe Describe clinical presentation Present Present nonpharmacologic therapy Tooth Hypersensitivity Tooth Hypersensitivity Response to a stimuli Stimulus – thermal, chemical, or physical Short duration Sharp pain Stops when stimuli removed Tooth Hypersensitivity Hot Cold Sweet Sour Adult Dental Anatomy  Resultant to periodontal disease Gingival Recession Aggressive/improper brushing Facial piercings  Tooth Hypersensitivity Tooth Hypersensitivity Nonpharmacologic Therapy Brush with a fluoride toothpaste Wait 30-60 minutes to brush after consuming acidic drinks and foods to reduce effects of abrasion Brush with a desensitizing toothpaste Usually resolves in about two weeks  Discover whether the individual is receiving regular dental care Hypersensitivity vs. Toothache? Recommendation – regimen 4 weeks – no resolution see the dentist  American Dental Association Seal of Acceptance No special considerations when choosing these products for pregnant, lactating, or older adults Learning Objectives – Recurrent Aphthous Stomatitis List List precipitating factors Explain Explain the treatment approach Provide Provide patient education Recurrent Aphthous Stomatitis (RAS) Canker sores Aphthous ulcers Affects up 25% of the population 80% of those with RAS have mild condition Affect non-keratinized mucosa Recurrent Aphthous Stomatitis (RAS) Local trauma Systemic Immunologic Genetic Allergic Nutritional factors (iron and B Vit deficiencies)  Smoking Recurrent Chemical irritation Aphthous Biting cheeks or lips Local Trauma Ulcers Trauma from toothbrushing Trauma from braces RAS Treatment Goals Primary - relieve pain so patient can eat, drink, and maintain oral hygiene Secondary – prevent secondary infection and recurrence  If possible inspect the lesion RAS Treatment Identify precipitating factors Approach Is there a hx of RAS? RAS Treatment Approach Begin with topical oxidizing agent and advance to systemic medication as necessary Oral debriding agents 1) Aid in the removal of debris 2) Cleanse minor wounds 3) Cleanse recurrent ulcers RAS Treatment Approach 10-15% carbamide peroxide or 1.5% hydrogen peroxide Apply a few drops to affected area for 1 minute before expectorating Can be done up to 4x per day RAS Treatment Approach 3% hydrogen mix with equal part water Rinse for 10-15 minutes 3-4x per day 1.5 % mouth rinse RAS Treatment Approach Topical Oral Anesthetics Desquamation induced by sodium lauryl sulphate Reduce Incidence of RAS Sodium Lauryl Sulfate-free Toothpaste RAS Topical Oral Protectants RAS Oral Rinses Oral Listerine Antiseptic Saline rinse (1-3 t. in 4-8 oz warm water)  Nutritional deficiency (iron, folate, vitamins) encourage improved diet or supplements Avoid spicy, acidic and sharp textured foods RAS Patient Ice in 10-minute increments (no more than 20 minutes per hour) Education Do not use heat in case of an infection Do not use debriding agents for more than 7 days RAS Treatment Approach Excessive rinsing can lead to: Tooth sensitivity due to enamel decalcification Black hairy tongue RAS Systemic Analgesics Aspirin or NSAID Do not place aspirin on lesion Aspirin Burn RAS When to Seek Medical/Dental Attention Symptoms do not abate after 7 days Lesions do not heal in 14 days Symptoms worsen during self-treatment Manifestation of systemic infection – fever, rash, swelling  Human Papillomavirus (HPV 16 & 14) Risks of Squamous Cell Cancer What Will You Do? Burning/stinging sensation one day ago and now has a “sore” Pamela N. 32 y.o. Healthy diet no ‘sweet tooth’ Multivitamins daily NKDA Learning Objectives – Herpes Simplex Labialis Identify Identify the pathophysiology Describe Describe the clinical presentation Describe Pharmacologic and nonpharmacologic therapy Provide Provide patient education Herpes Simplex Labialis Herpes simplex type 1 (HSV-1)  Preceded by a prodrome 2-48 hours before Herpes Burning, itching, tingling Simplex Labialis Symptoms may include pain, fever, swollen lymph nodes and malaise  Contagious Herpes Transmissible through contact Simplex After primary infection can be latent and Labialis reactive later (cold sore) Reactivated by sun, stress, fatigue, cold, windburn, fever, or dental work Herpes Whitlow  Mainly in children but may occur in adults Lips and gums Covered by pseudomembrane Primary Herpetic Gingivostomatitis Submandibular lymphadenitis Swallowing difficulty Halitosis Primary Herpetic Gingivostomatitis Primary Herpetic Gingivostomatitis Herpes Simplex Labialis Treatment Goals Pain relief Prevent secondary infection Curtail spread of lesions Topical skin protectants (zinc oxide, camphor 3%) Handwashing to prevent autoinoculation Herpetic Stomatitis Abreva Cream at prodromal stage 5 Lesions times a day until lesion is healed but not more than 10 days If secondary infection apply topical triple antibiotic cream 3-4 times daily  When to see Medical Attention Herpetic Lesions Lesion does not heal in 14 days Self-treatment does not relieve discomfort Systemic illness – fever, malaise, rash, swollen lymph glands Symptoms worsen What will you do? 24-year-old Law student Reports NKDA  Differentiation of RAS and HSL Size Duration Incidence Clinical Among Manifestation Sufferers Minor (RAS canker 0.5cm Up to 6 5-10% Gray/yellow ulcers, canker sores) weeks crateriform Herpetiform (HSL