oral disorders week9 chapter 31

Chapter 31: Drugs Used to Treat Oral Disorders

Overview

  • Text Source: Clayton’s Basic Pharmacology for Nurses, 19th edition by Michelle Willihnganz, MS, RN, CNE
  • Lesson Goals:
    • Explain common oral disorders and their treatments.
    • Identify nursing assessments and interventions associated with treatment of mucositis.

Common Mouth Disorders

Disorders Affecting the Lip

  • Cold Sores: Characterized by recurrent occurrences due to herpes simplex type 1, often painful with potential fever and mouth odor.

Disorders Affecting the Soft Tissues

  • Canker Sores: Also known as aphthous ulcers, present with a gray to whitish appearance with redness, painful, limiting oral functions. Treated with Aphthasol, an anti-inflammatory agent.
  • Candidiasis: Fungal infection caused by Candida albicans, appearing as a white curdlike substance over the oral mucosa, seen commonly in infants, pregnant females, and debilitated patients. Treated with local or systemic antifungal agents.

Disorders Affecting Gums and Teeth

  • Plaque: Whitish-yellow substance responsible for most tooth and gum diseases, forms tartar if not removed within 24 hours, leading to dental caries if untreated.
  • Calculus/Tartar: Hardened, calcified plaque.

Other Disorders

  • Xerostomia: Involves a lack of saliva which can lead to loss of taste, difficulty chewing, and talking, increasing tooth decay risk.
  • Halitosis: Foul breath that may signal underlying conditions, causes include sinusitis, tonsillitis, smoking, and poor oral hygiene.
  • Mucositis: Less common, inflammation of oral mucous membranes, typically associated with chemotherapy and radiation therapy, featuring erythematous ulcerations with white patches.

Oral Anatomy

  • The mouth (oral cavity) is the initial part of the digestive tract.
  • Composed of:
    • Upper and lower lips
    • Jaw bone
    • Tongue
    • Pharynx
    • Teeth
    • Cheeks
    • Hard and soft palate
    • Uvula
    • Tonsils
  • Salivary glands are included in the oral cavity structure.

Cold Sores and Canker Sores

Cold Sores

  • Causes: Virus herpes simplex type 1
  • Characteristics:
    • Recurrent and often predictable.
    • Painful, with possible fever and mouth odor.

Canker Sores

  • Additional Notes:
    • Known as aphthous ulcers, exhibiting a gray to whitish appearance surrounded by redness.
    • Painful and can impair eating, drinking, talking, and oral hygiene.
    • Treatment involves the use of Aphthasol (anti-inflammatory agent).

Audience Engagement

Audience Response Questions

  1. Which oral disorder is contagious?

    • Options:
      • Fever blisters (correct)
      • Xerostomia
      • Mucositis
      • Canker sores

  2. Patient with Chemotherapy and Mucositis: Which technique may provide relief?

    • Options:
      • Frequent oral rinses with commercial mouthwash
      • Use of viscous lidocaine (correct)
      • Regular tooth brushing
      • Sucking on hard candy

  3. When should regular oral care begin for children?

    • Options:
      • At infancy, by rubbing the gums with gauze to cleanse (correct)
      • When teeth first erupt
      • When the child is old enough to hold a toothbrush
      • When the child enters kindergarten

  4. What treatment does a nurse prescribe for a patient experiencing xerostomia?

    • Options:
      • Antibiotics
      • Saliva substitute (correct)
      • Antiviral ointment
      • Surgical removal

  5. How long does breath-freshening action of over-the-counter mouthwashes last?

    • Options:
      • 10 to 30 minutes
      • 30 to 60 minutes
      • 1 to 2 hours
      • 3 hours

Drug Therapy for Various Oral Disorders

Cold Sores

  • Treatment Goals:
    • Control discomfort.
    • Allow healing.
    • Prevent spread to others.
    • Prevent complications.
  • Drugs:
    • Docosanol (Abreva): Only FDA-approved product to clinically shorten healing time.
    • Local Anesthetics: Provide temporary pain relief and prevent drying.
    • Topical Anesthetics: Safe and effective for temporary pain reduction.

Canker Sores

  • Treatment Goals:
    • Control discomfort.
    • Promote healing.
  • Drugs:
    • Topical Anesthetics: Help control discomfort.
    • Oral Analgesics: May provide additional pain relief.
    • Oxygen-Releasing Agents: Used as debriding and cleansing agents, can be used up to four times daily for 7 days.
    • Cautions: Avoid using silver nitrate to cauterize lesions.

Mucositis

  • Basic Oral Hygiene:
    • Essential to reduce complications associated with pain, microorganisms, and healing.
  • Regimen Initiation: Should commence with chemotherapy or radiation therapy.
  • Pain Management: Topical applications must contact tissue for effectiveness.

Plaque

  • Control Methods:
    • Brushing teeth.
    • Flossing between teeth.
    • Using therapeutic mouthwashes.
  • Tools:
    • Dentifrice and floss for plaque and stain removal.
    • Oral irrigators, sponge-tipped applicators, electric toothbrushes.

Halitosis

  • Treatment Approaches:
    • Eliminate causes such as smoking and poor diet.
    • Use mouthwashes and breath mints for temporary masking; effects last less than 1 hour.
    • If causes are unidentified, consult a dentist for further evaluation.

Xerostomia

  • Treatment Options:
    • Adjust medications causing dry mouth or use artificial saliva.
  • Dental Visits: Regular consultations with a dentist are essential.
  • Commercial Saliva Substitutes: Includes products like Mouth Kote, Biotene, Aquaoral, and Caphosol.

Nursing Assessments and Implementation for Oral Health Therapy

Nursing Assessments

  • History:
    • Drug history
    • Dental history
    • Examination of the oral cavity

Nursing Implementation Specifics

  • Approaches for the following conditions:
    • Cold Sores
    • Canker Sores
    • Mucositis
    • Plaque
    • Halitosis
    • Xerostomia

Patient Education

  • Educate on proper oral hygiene cleansing techniques relevant to their conditions.
  • Advise patients undergoing radiation or chemotherapy to follow a scheduled oral hygiene regimen.
  • Foster health maintenance throughout treatment.

Drug Class Information

Dentifrices

  • Action: Abrasive agents used in toothpaste to control tooth decay and gum disease. Recommended for use twice daily.
  • Ingredients:
    • Anticavity Agents: Fluoride
    • Abrasives: Silicate, dicalcium phosphate, calcium pyrophosphate, calcium carbonate
    • Tooth Whiteners: Hydrogen peroxide, carbamide peroxide, perhydrol urea

Mouthwashes

  • Action: Kill bacteria to reduce plaque formation and halitosis.
  • Uses: Remove unpleasant tastes, decrease halitosis, and plaque buildup.
  • Ingredients:
    • Fluoride
    • Chlorhexidine: Antibacterial
    • Zinc Chloride: Helps reduce bleeding and irritation.

Conclusion

  • For effective treatment and management of oral disorders, nursing assessments, patient education, and appropriate drug therapies are essential to ensure optimal oral health.