Self-Care II: Oral Care

Tooth Hypersensitivity

• Etiologic: _____ and _____

• Pathophysiology: exposed and open dentin though enamel loss or gingival recession; dentin tubules exposed to oral cavity and pulp AND/OR stimuli (heat, cold, pressure, acid) cause fluid in the dentinal tubules to expand + shrink, stimulating pulp nerve fibers, resulting in pain

• Causes: _____ infection, aggressive or improper _____, _____ (attrition, abrasion, erosion), _____ (acidic foods + drink), _____, _____, bruxism (_____)

• Sxs: A _____, fleeting, _____, or _____ pain on exposure to thermal, chemical, or physical stimuli, which stops after stimuli are no longer present

• Assessment: due to attrition, abrasion, or erosion is not serious and is self-treatable; sensitivity due to fracture, faulty restoration, or gingival recession warrants referral to an OHCP

exposed, open dentin tubules, periodontal, brushing, injury, diet, GERD, bulimia, teeth grinding, quick, sharp, stabbing

Toothache (KNOW DIFFERENCE W/Tooth Hypersensitivity)

• Etiologic: _____ extending to the _____

• Pathphysiology: 

  • _____ response to invading bacteria stimulates free nerve endings in the pulp

  • _____ (heat, cold, pressure, acid) cause fluid in the _____ to expand and shrink, stimulating pulp nerve fibers and resulting in _____

• Causes: 

  • _____ present in tooth/teeth under existing restoration, tooth/restoration fracture, or trauma to the dentition

  • Attrition, abrasion, erosion, tooth/restoration fracture, faulty restoration, or gingival recession

• Sxs: 

  • Pain that remians even in the absence of stimulus; _____, _____, and _____ pain on stimulation may indicate reversible damage; _____, _____, and _____ pain without stimulation usually indicates irreversible damage

  • A _____, fleeting, _____, or _____ pain on exposure to thermal, chemical, or physical stimuli, which stops after stimuli are no longer present

• Assessment: Requires _____ for resolution

bacterial invasion, pulp, inflammatory, stimuli, dentinal tubules, pain, cavitation/decay, intermittent, short, sharp, continuous, dull, throbbing, quick, sharp, stabbing, dental care

Plaque Removal Devices: Utilize various instruments such as toothbrushes, dental floss, and oral irrigators

• _____: Effective for removing dental plaque + promoting optimal oral hygiene

• _____: Regular use aids in the removal of interdental plaque, reducing gingival inflammation, and serving as a preventive measure against both periodontal disease + dental caries

• _____: Utilize cleaning devices designed to adapt to irregular tooth surfaces (toothpicks, interdental brushes)

• _____: These devices direct a high-pressure stream of water through a nozzle onto tooth surfaces for effective cleaning

toothbrushes, dental floss, specialized aids, oral irrigators

Fluoride Use

• Increases resistance to enamel _____ by acids

• Facilitates remineralization of early carious lesions of enamel

• Interferes with the _____ cariogenic process and with plaque adherence

• Benefits: fewer _____, _____ or _____ teeth; better tooth retention; lower incidence of _____ (very painful)

• Dental Fluorosis: when children ingest an excess amount of any fluoride product for a sufficient period during the time of tooth formation

• Avoid fluoride use in children < _ d/t increased risk

demineralization, bacterial, decayed, missing, filled, root carries, 6

Exclusions for Tooth Hypersensitivity

• _____

• Mouth soreness associated with _____

• Presence of _____ or _____

• _____ teeth

• _____ gums in the absence of trauma

• Broken or Knocked out teeth

• _____ tooth pain triggered/worsened by _____

• Trauma to the mouth with bleeding, swelling, and soreness

toothache, poor-fitting dentures, fever, swelling, loose, bleeding, severe, stimuli

Exclusion for RAS (Canker sores)

• _____ associated with underlying pathology

• _____ present for ≥ _____

• _____ lesions

• Symptoms of _____

• Failure of _____ (symptoms present for ≥ _____, symptoms _____)

lesions, lesions, 14 days, frequently recurring, systemic illness, self-treatment, 7 days, worsen

Mouth Rinses

• Recommended to regularly use mouth rinse with plaque or calculus control properties as an adjunct to proper tooth brushing with _____ toothpaste

• Effective for the reduction of _____ and _____

• Should be kept out of the reach of children due to accidental ingestion due to possible _____ content contained in rinse (0-27%)

fluoride, plaque, gingivitis, alcohol

Mouth Rinses

• Fluoride Mouth Rinses

  • ACT Anticavity Fluoride Rinse → Sodium fluoride 0.05%

  • Colgate Phos-Flur Ortho Defense → Sodium fluoride 0.04%

  • Listerine Total Care Anticavity Mouthwash → Sodium fluoride 0.02%

• Plaque/Gingivitis Control Mouth Rinses

  • Listerine Antiseptic → Eucalyptol 0.092%; Menthol 0.042%;| Methyl Salicylate 0.06%; Thymol 0.064%

  • Equate Antiseptic Mouthrinse → same as above

• Cosmetic Mouth Rinses (HIGH alcohol content)

  • ClosYS Sensitive Rinses → N/A

  • TheraBreath Fresh Breath Oral Rinse → N/A

KNOW

Other Pharmacological Options (Active Ingredient)

• _____ Chloride

  • Indication/Purpose: Reduce bad breath, plaque, and gingivitis

  • Antimicrobial action

  • May cause brown staining of teeth, tongue, and/or restorations

• Essential oils such as _____, _____, _____, _____

  • Indication/Purpose: Reduce bad breath, plaque, and gingivitis

  • May be a potential allergen or irritant for some patients

• _____ (for dentures)

  • Indication/Purpose: Tooth whitening

  • Reduce extrinsic stains

• _____ & _____

  • Indication/Purpose: Reduce bad breath

  • Chemical prevention of oral malodor

Cetylpyridinium, Eucalyptol, Menthol, Thymol, Methyl Salicylate, Peroxide, Zinc Salt, Chlorine Dioxide

Nonpharmacologic Therapy: Tooth Hypersensitivity

• Treatment plans for tooth hypersensitivity should include identification and elimination of predisposing factors, such as _____ and potentially _____ or _____ toothbrushing technique

• If correct brushing techniques with a fluoride toothpaste do not yield improvement, consider using a _____ toothpaste

acid exposure, improper, aggressive, desensitizing

Pharmacologic Therapy (Selected Nonprescription Desensitizing Toothpastes)

• _____ toothpastes

  • Diffuses along the dentin tubules to decrease the excitability of intradental nerves and alter its membrane potential

  • _____ most common

• _____, _____, Oxalate, Strontium salt-based toothpastes

  • Works by occluding the exposed dentinal tubules, prevents fluid from moving into the tubules, which is the cause of hypersensitivity

Potassium Salt-Based, Potassium Nitrate 5%, Arginine/Calcium, Fluoride

Teething Discomfort

• Nonpharmacologic Therapy: 

  • _____ the gum around the erupting tooth

  • Giving a _____ (not frozen) _____, pacifier, spoon, or washcloth

  • _____ or _____ (if child can tolerate solid food)

• Oral Pain Relievers

  • Pediatric doses of _____ (_____) or _____ (_____)

• Topical Anesthetics [_____]

  • _____ blocks nerve conduction by inhibiting the depolarization of the neuronal membrane, thus blocking the initiation and conduction of nerve impulses

  • Available 5-20% as topical anesthetic

  • Caution: _____ is too potent for _____ → cause _____ (drug _____)

  • FDA and AAP no longer recommend benzocaine for teething due possible interference with _____, causing _____

Massaging, cold, teething ring, dry toast, teething biscuits, NSAIDs, Ibuprofen, APAP, Tylenol, Benzocaine, Benzocaine, Benzocaine 20%, infants, death, OD, gag reflex, choking

Herpes Simplex Labialis

• Nonpharmacologic Therapy:

  • Lesions should be kept clean by gently washing with _____

  • _____ is important in preventing lesion contamination and minimizing autoinoculation of herpes virus

  • The involved skin should be kept _____ to prevent drying and fissuring (cracking), which render lesions susceptible to _____

  • Factors that delay healing (e.g., stress, local trauma, excessive wind or sun exposure, fatigue) should be avoided if known

  • Patients who identify sun exposure as a precipitating event should be advised to routinely use an appropriate sunscreen product on the _____ and _____

mild soap solutions, handwashing, moist, secondary bacterial infection, lips, face

Herpes Simplex Labialis

• Pharmacological Therapy

  • Topical Skin Protectants:

    • Protect the lesions from _____, relieve _____, and keep the involved tissue _____, but they do not reduce the _____

    • Use 3-4 times/day PRN

  • Topical Oral Anesthetics

    • Including benzocaine 5%–20%, dibucaine 0.25%–1%, dyclonine hydrochloride 0.5%–1%, benzyl alcohol 10%–33%, camphor 1%–3%, and menthol 0.1%–1% relieve the discomfort of _____, _____, and _____

  • _____ (Abreva Cream)

    • Only FDA-approved nonprescription product proven to reduce the duration and severity of symptoms

    • Inhibits direct fusion between the herpesvirus and the human cell plasma membrane → preventing viral replication

    • Treatment: reduces the median healing time to healing by approximately _____ (_____ hours); reduces symptom severity by ~20%

    • Apply at the _____ (prodromal stage), _____, until the lesion is healed, but for no more than _____

infection, dryness, soft, duration of symptoms, burning, itching, pain, Docosanol 10%, 1 day, 18, 1st sign of an outbreak, 5x/day, 10 days

Patient Education (Teeth Hypersensitivity)

• Relief may take _____ to _____ (~__), the better the patient is at removing bacterial plaque, the more quickly the sensitivity will resolve

• Use the dentifrice for as long as the dentist recommends and then switch to a _____ (_____) fluoride dentifrice

• Some cases of tooth hypersensitivity require _____ treatment or several _____ treatments

• Do not use _____ or _____ toothpastes in children <_____

• Do not use _____ toothpastes, such as cosmetic pastes that whiten or remove stains

• See a dentist if pain worsens during treatment or if new Sxs develop

several days, several weeks, 4, low-abrasion, non-whitening, long-term, repeated, potassium nitrate, desensitizing, 12 y/o, high-abrasion

Patient Education (Teething Discomfort)

• ADA recommends _____, including a visit within _____ of eruption of the child's _____ and no later than the child’s _____

• If a baby is _____ or has diarrhea, fever, nasal congetion, malaise, pain, or other symptoms not typical of teething discomfort, take the baby to a pediatrician or other primary care provider

• If neither nonpharmacologic measures nor nonprescription medications are relieving the symptoms within _____, the parent should be advised to take the baby to a pediatrician, pediatric dentist, or other primary care provider (Refer AFTER _____)

regular dental checkups, 6 months, first tooth, first birthday, vomiting, 2 days, 2 days

Oral Debriding & Wound-Cleansing Agents

• Cankaid Liquid Oral Antiseptic → Carbamide peroxide 10%

• Gly-Oxide Antiseptic Oral Cleanser → Carbamide peroxide 10%

• Orajel Antideptic Rinse for Mouth Sores → Hydrogen peroxide 1.5%

• Colgate Peroxyl Mouth Sore Rinse → Hydrogen peroxide 1.5%

• Counseling Points

  • Do not use these medications longer than _____ (_____)

  • Chronic use can cause tissue _____, _____ of enamel

  • Do not _____ these medications

7 days, 3-4x/day, irritation, decalcification, swallow

Recurrent Aphthous Stomatitis

• Nonpharmacologic Therapy 

  • General measures aimed at maintaining good oral hygiene, avoiding exacerbating factors, and reducing pain

  • If a deficiency of _____, _____, or _____ is suspected, increase consumption of foods high in the deficient nutrient, or take appropriate nutritional supplements

  • Avoid _____ foods until the lesions heal

  • Avoid _____-textured foods that may cause increased trauma to the lesion

  • If desired, apply ice directly to the lesions in _____ increments but for no longer than _____ in a given hour

  • Do not use _____. If an infection is present, _____ may spread the infection

  • _____ to help cleanse, debride, and soothe area (1-3 tsp salt in 4-8oz water) or baking soda pastes. Can use BEFORE applying medication

iron, folate, vitamin b, spicy or acidic, sharp, 10-minute, 20 mins, heat, heat, salt rinses

Recurrent Aphthous Stomatitis

Pharmacological Therapy (no preference of which one to generally recommend)

• Oral Debriding/Cleansing Agents [Hydrogen Peroxide 1.5%, Carbamide Peroxide 10-15%]

  • Products that release oxygen can be used as debriding and cleansing agents to provide temporary relief of RAS discomfort (direct application)

  • Aid in the removal of debris, phlegm, mucus, or other secretions associated with a sore mouth

  • Cleanse areas of minor gum inflammation and ulcers

  • 1:1 solution of hydrogen peroxide

• Topical Oral Anesthetics

  • Including Benzocaine 5%–20% (2 and up), benzyl alcohol 0.05%–0.1%, Dyclonine 0.05%–0.1%, or hexylresorcinol 0.05%–0.1% generally are recognized as effective for temporary relief of pain associated with RAS

• Topical Oral Protectants

  • Pharmacologically inert substances that coat and can be effective in protecting ulcerations, decreasing friction, and giving temporary symptomatic relief

  • Available as a patch or dissolving disc must be placed against the sore for 10–20 seconds and creates a barrier by using a paste, an adhering film, or a dissolvable patch to cover the lesion

• Systemic Analgesics [NSAIDs/ASA/APAP]

  • Provide additional relief of mouth discomfort

  • Dose per usual recommendations

KNOW

KNOW IMAGE