Acute Oral Conditions PDF - C&G Foundations 3

Dental Nursing Foundations Handout 3: Acute oral conditions and abnormalities of the oral cavity Introduction Acute conditions refer to conditions that are severe and are brought on suddenly in a short space of time. Often these conditions are triggered by a vir...

Dental Nursing Foundations Handout 3: Acute oral conditions and abnormalities of the oral cavity Introduction Acute conditions refer to conditions that are severe and are brought on suddenly in a short space of time. Often these conditions are triggered by a virus or an infection, but they can also be caused through trauma after injury or misuse of medication. Oral cancers can manifest from some of the acute conditions listed below where they are considered ‘precancerous’. Oral cancer screening should form part of the routine checks carried out at examinations and patients should be advised what to do if they detect any suspicious lesions or notice changes in their mouth. Erythroplakia and leukoplakia Erythroplakia appears as red patches in the mouth that can bleed easily, whereas leukoplakia appears as white patches that can’t be rubbed away. These patches could be harmless in the mouth, however, they can also be clinical signs of precancerous abnormal cells called dysplasia. If this condition is left untreated it could potentially develop into oral cancer. The biggest risk factor to developing either erythroplakia or leukoplakia is tobacco, which can smoked or chewed. Squamous cell carcinoma Squamous cell carcinomas are the most common type of cancer found in the oral cavity. Squamous cells resemble thin fish scales and line both the mouth and throat. If squamous cell carcinoma develops, these cells mutate and then become abnormal. © 2021 City and Guilds of London Institute. All rights reserved. Page 1 of 5 Dental Nursing This is the most common type of mouth cancer accounting for 9 out of 10 cases. Squamous cells can be found anywhere on the body including inside of the mouth. Mumps This is a viral infection that affects children and young adults. It is quite rare these days as most children are now vaccinated against it with the MMR vaccine. Patients who have mumps will complain of painful swellings in the ear area. It is the parotid gland that is usually affected. If the infection is transmitted to an adult, the effects can be more generalised with the whole glandular system being affected. Along with the swollen parotid gland, patients will also complain of trismus and fever. Mumps may be transmitted by direct contact with droplets from infected saliva and therefore members of the dental team may be at risk if they are not vaccinated. Salivary gland stones A salivary duct can become blocked by a small development of calculus in the duct itself. This blockage or obstruction will prevent saliva from being delivered into the mouth. As a result the patient will report a painful swelling in the area of the duct, especially after eating when the production of saliva is increased by the sight, smell or thought of food. An ultrasound scan can identify stones which may be treated with a laser to break them down or be surgically removed. In severe cases the duct and/or gland itself may also be removed. Glossitis Glossitis causes the tongue to swell and become inflamed. This condition can be caused by trauma, anaemia, vitamin B deficiency or hormone imbalances. Glossitis can reduce the number of papillae on the tongue which can impact on the taste buds, causing food to taste unusual. This condition can cause severe pain and affect the way someone speaks. © 2021 City and Guilds of London Institute. All rights reserved. Page 2 of 5 Dental Nursing Geographic tongue This condition also affects the tongue and causes an unusual appearance as the papillae are often missing. Instead, red smooth areas, referred to as 'islands', appear which often have raised borders. Geographic tongue is a harmless condition but can sometimes increase sensitivity to certain food products, such as spices. Oral thrush Oral thrush or oral candidiasis is a fungal infection which can accumulate in the lining of the mouth. Thrush appears as a white lesions which can affect the tongue and inside of the cheeks. This condition is often linked to babies and elderly individuals who may have reduced immunity. This condition is also common in those who have a suppressed immune system relating to health conditions or medications. Xerostomia This condition is defined as a dry mouth. This can occur if the saliva flow is reduced or absent. Xerostomia can leave the mouth feeling sticky and affect swallowing, tasting and speaking. It can also increase the risk of developing tooth decay. There are a few causes of this condition which include, chemotherapy treatments, adverse effects of prescription medications and autoimmune diseases. © 2021 City and Guilds of London Institute. All rights reserved. Page 3 of 5 Dental Nursing Mouth ulcers Mouth ulcers are often small painful lesions that can develop in your mouth and make eating and drinking uncomfortable. They are not contagious and usually disappear after a week or two. They can be caused by orthodontic appliances, acidic foods or emotional stress factors. Mouth ulcers don’t need treatment but should be closely monitored. If the ulcer doesn’t disappear after a fortnight it should be checked by a dentist. Cancer Mouth cancer is among the 10 most common cancers worldwide. It mostly affects older men but is increasingly seen in younger adults too. Mouth cancer has devastating impacts on sufferers and their families. Early detection can save lives and preserve quality of life of sufferers. There are several factors that increase the risk of developing oral cancer: tobacco use alcohol use betel nut use infection with certain strains of the human papilloma virus poor diet and lack of vitamin A, C and E mouth cancer in the past. Some other diseases also have the potential to become malignant (precancerous) lesions, which may then progress to cancer over time. © 2021 City and Guilds of London Institute. All rights reserved. Page 4 of 5 Dental Nursing Clinical signs and symptoms of cancer Cancer may appear in different ways, such as persistent: red or white patches ulcers (painful or painless) that do not heal lumps unexplained bleeding loose teeth unexplained weight loss numbness and altered sensation persistent hoarseness. Management Early diagnosis is very important to the outcome of oral cancer. Oral cancer most commonly occurs on the lip (can be from sunshine) and on the borders of the tongue. It can also occur on the palate, floor of mouth and throat. Any changes in the oral mucosa identified must be recorded so they can be reviewed regularly. Suspicious areas which do not heal within 3 weeks are referred to the oral medicine dept at a hospital for further examination. Planning of cancer treatment requires a multidisciplinary team (MDT) consisting of a range of specialists: dentist, surgeon, anaesthetist, oncologist, nursing and other dental staff, nutritionist, speech therapist and physiotherapists. Oral cancer is treated largely by surgery and/or radiotherapy. As well as treating the cancer these treatments also focus on preserving important functions of the mouth, such as breathing, swallowing and speaking. After surgery, there may be some cosmetic, sensory and functional problems. After radiotherapy, there may be functional problems such as xerostomia (dry mouth) and difficulty in opening the mouth (trismus). These also increase the risk of caries and infections such as candidiasis and sialadenitis (salivary gland inflammation). © 2021 City and Guilds of London Institute. All rights reserved. Page 5 of 5