ch.31 Treat Oral Disorders

Chapter 31: Drugs Used to Treat Oral Disorders

Source: Clayton’s Basic Pharmacology for Nurses, 19th edition by Michelle Willihnganz, MS, RN, CNE

Lesson 31.1: Introduction to Oral Disorders

  • Objective: Explain common oral disorders and their treatments. Identify nursing assessments and interventions associated with the treatment of mucositis.

Common Mouth Disorders

  • Cold Sores:

    • Infectious lesions caused by herpes simplex virus type 1.

    • Characterized by recurrent outbreaks that are often predictable.

    • Symptoms include pain and possible fever, with notable mouth odor.

  • Canker Sores:

    • Also known as aphthous ulcers.

    • Typically present as gray to whitish lesions surrounded by redness.

    • They are painful, leading to limitations in eating, drinking, talking, and maintaining oral hygiene.

    • Treatment involves Aphthasol, an anti-inflammatory agent.

  • Candidiasis:

    • A fungal infection caused by Candida albicans.

    • Noted for a white, curd-like appearance covering the oral mucosa.

    • Commonly observed in infants, pregnant women, and immunocompromised individuals.

    • Treatment is effective with local or systemic antifungal agents.

  • Mucositis:

    • Defined as painful inflammation of the oral mucous membranes.

    • Frequently arises in patients undergoing chemotherapy and radiation therapy.

    • Symptoms include erythematous ulcerations intermixed with white, patchy mucous membranes.

  • Plaque:

    • Recognized as the primary cause of most dental, gum, and periodontal diseases.

    • Formed as a whitish-yellow substance that accumulates on teeth and around gum lines.

    • If not removed within 24 hours, it hardens into tartar and can lead to dental caries if untreated.

  • Xerostomia:

    • Refers to a condition characterized by a lack of saliva.

    • It can lead to difficulties in taste, chewing, and speaking, while increasing the risk of tooth decay.

  • Halitosis:

    • Describes foul breath, which can stem from a variety of causes including sinusitis, tonsillitis, dental issues, smoking, and poor oral hygiene.

    • It may signify underlying pathologies that require attention.

Oral Anatomy

  • The mouth, or oral cavity, serves as the entry point to the digestive tract.

  • Components include the following:

    • Upper and lower lips

    • Jaw bone

    • Tongue

    • Pharynx

    • Teeth

    • Cheeks

    • Hard and soft palates

    • Uvula

    • Tonsils

  • The salivary glands are also integral to the oral cavity, aiding in digestion and maintaining oral health.

Treatment of Cold Sores and Canker Sores

  • Cold Sores Treatment:

    • Goals include controlling discomfort, allowing healing, preventing spread to others, and preventing complications.

    • Docosanol (Abreva) is the only FDA-approved product shown to shorten healing time.

    • Local anesthetics may offer temporary pain relief and prevent drying.

    • Topical anesthetics can be safely utilized to mitigate pain.

  • Canker Sores Treatment:

    • Aims to control discomfort and promote healing.

    • Options include topical anesthetics and oral analgesics for pain relief.

    • Oxygen-releasing agents can serve as debriding and cleansing agents, used up to four times daily for a week.

    • Silver nitrate should not be used for cauterizing lesions.

Assessment and Interventions for Mucositis

  • Painful mucositis often requires special attention due to its prevalence in chemotherapy and radiation therapy.

  • Key nursing assessments to perform include gathering drug history, dental history, and evaluating the oral cavity.

  • Implementation strategies include maintaining oral hygiene to alleviate pain and limit complications linked to microorganisms and slow healing.

Understanding Plaque and Oral Hygiene

  • Plaque Control Measures:

    • Essential practices include regular brushing, flossing, and using mouthwashes to eliminate dental plaque and stains.

    • Using dentifrice is significant for effective cleaning.

    • Additional tools such as oral irrigators, sponge-tipped applicators, and electric toothbrushes enhance plaque removal.

Treatment Strategies for Halitosis and Xerostomia

  • Halitosis Treatment:

    • The simplest approach involves eliminating underlying causes such as smoking and poor dietary choices.

    • Mouthwashes and breath mints provide temporary relief, generally lasting less than an hour.

    • If no clear cause of halitosis is identified, consult a dentist for thorough examination to rule out potential pathologies.

  • Xerostomia Treatment:

    • Management can include discontinuing medications that exacerbate dry mouth or using artificial saliva replacements.

    • Patients should have regular dental check-ups to monitor oral health.

    • Commercial saliva substitutes available include brands like Mouth Kote, Biotene, Aquaoral, and Caphosol.

Patient Education and Nursing Role

  • Educating patients on proper oral hygiene is crucial, tailored to individual conditions.

  • Patients undergoing radiation or chemotherapy should be instructed to diligently maintain their oral hygiene regimen, starting ahead of treatment to ensure health maintenance.

Drug Classes for Oral Treatment

  • Dentifrices:

    • Action: Serve as abrasive agents in toothpastes to control tooth decay and gum disease.

    • Recommended use: Twice daily.

    • Key Ingredients:

    • Anticavity agent: Fluoride

    • Abrasive agents: Silicate, dicalcium phosphate, calcium pyrophosphate, calcium carbonate

    • Tooth whiteners: Hydrogen peroxide, carbamide peroxide, perhydrol urea

  • Mouthwashes:

    • Action: Kill bacteria to reduce plaque formation and address halitosis.

    • Uses include removing undesirable tastes, reducing halitosis, and controlling plaque buildup.

    • Key Ingredients:

    • Fluoride

    • Chlorhexidine: Antibacterial agent

    • Zinc chloride: Aids in reducing bleeding and irritation.

Conclusion

  • Knowledge of oral disorders, their treatments, and nursing interventions enables effective management of oral health issues. Regular assessments and patient education are critical for improving patient outcomes related to oral health.