Chapter 14

Oral Conditions and Their Treatment

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Infectious Lesions: Acute Necrotizing

Ulcerative Gingivitis

Acute necrotizing ulcerative gingivitis (ANUG) is a spreading

ulcer that has both bacteriologic and environmental factors.
It is associated with a distinctive odor and begins at the
interdental papillae.
Good oral hygiene is essential.
Hydrogen peroxide or saline rinses are used for their flushing
action.
Pain or fever can be treated with acetaminophen or other
nonopioid pain relievers.
Vitamin supplements are only for those that are vitamin deficient.
Antibiotics are only necessary if there is systemic infection or the
patient is immunocompromised.

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Infectious Lesions:
Herpes Infection

Cold sores or fever blisters are caused by the herpes

simplex type 1 virus.
They are recurrent and occur in the same area of the mouth.
Treatment ranges from symptomatic to antiviral drugs.
Aspirin, ibuprofen, or acetaminophen can be used to treat
pain.
Many over-the-counter drug products can be used.
Antiviral drugs such as penciclovir and docosanol 10% are
also used.
Acyclovir is used for patients that are immunocompromised.

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Infectious Lesions:
Candidiasis (Moniliasis)

Oral candidiasis, or thrush, is a result of

the fungus candida albicans.
The patient usually presents with white,
milk-curd plaques that can be wiped off.
Pregnant women, infants, and those that
are immunocompromised are at risk.
Treatment includes antifungal drugs.

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Infectious Lesions:
Angular Cheilitis/Cheilosis

Angular cheilitis is characterized by redness,

fissures, erosions, and ulcers at the corners
of the mouth.
Causes can include candida albicans,
bacteria, drugs, and a vitamin B deficiency.
Therapy is dependent upon the cause.
Antifungal therapy is indicated for candida
albicans, antibiotics if the cause is bacterial,
and B vitamin supplements if there is a
deficiency.
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Infectious Lesions:
Alveolar Osteitis

Alveolar osteitis or dry socket is a result of a

loss of necrosis or blood clot after an
extraction that exposes bone.
Predisposing factors include oral
contraceptive use and menstrual cycle phase.
It is characterized by pain, fever,
lymphadenopathy, and malodor.
Treatment includes packing the socket,
analgesics, antibiotics if necessary, supportive
therapy, and debridement.

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Immune Reactions:
Recurrent Aphthous Stomatitis

This oral condition is often referred to as a canker

sore.
It is a common lesion whose cause is unknown.
It is characterized by nonkeratinized areas that are
painful.
Treatment is symptomatic and includes oral pain
relievers, mouth rinses, topical creams with or
without steroids, diphenhydramine, and tetracycline
suspension mixed with nystatin and
diphenhydramine.
Aphthasol is a new topical drug which decreases
the duration of healing and ulcer pain.
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Immune Reactions:
Lichen Planus

Lichen planus is a skin lesion that often

involves lesions on the oral mucous
membranes.
Symptoms range from no pain to extreme
pain.
It is not known what causes it but is
thought to be either autoimmune or a
hypersensitivity reaction to an unknown
agent.

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Miscellaneous Oral Conditions:

Geographic Tongue

The tongue usually has lesions that

appear to be a map of the world.
The lesions are ringed with red and the
center is white.
It may be related to hormonal changes,
stress, infection, psoriasis, or autoimmune
diseases.
Treatment includes reassurance and
avoiding irritating foods and alcohol.

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Miscellaneous Oral Conditions:

Burning Mouth or Tongue Syndrome

The oral cavity appears normal but the

patient describes pain that increases
throughout the day.
Its etiology is unknown.
Treatment is dependent upon suspected
etiology.
Treatment can include antidepressants,
diphenhydramine, or antifungal drugs.

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Inflammation:
Pericoronitis

Pericoronitis is inflammation of the tissue

around the crown of the tooth.
It occurs most commonly in partially
erupted third molars and may be in
response to food or bacteria that becomes
trapped between the operculum and the
tooth.
Treatment includes debridement,
analgesics, and antibiotics.

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Inflammation:
Postirradiation Caries

Changes in saliva and poor oral health

care after radiation therapy can increase
the rate of caries.
Meticulous oral hygiene, frequent visits to
the dental hygienist, artificial saliva, and
self-application of sodium fluoride gel are
recommended.

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Inflammation:
Root Sensitivity

Root sensitivity is characterized by

occlusal trauma and exposed roots.
It is treated with occlusal adjustment,
fluoride, brushing with sodium chloride and
0.4% stannous fluoride, or sodium fluoride
gel.

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Inflammation:
Actinic Lip Changes

Actinic lip changes are caused by constant

exposure to the sun.
Long-term exposure can lead to
irreversible changes known as actinic
cheilitis.
Topical 5-fluorouracil is indicated when
keratotic changes have occurred.
A sun block with an SPF of greater than 15
should be applied before sun exposure.

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Drug-Induced Oral Side

Effects: Xerostomia

Xerostomia or dry mouth is a result of drugs, aging, medical

illness, or radiation therapy.
Treatment includes fluoride trays and gels to counteract the
formation of caries and artificial saliva.
The patient is encouraged to drink plenty of water and to
stay away from caffeine and alcohol-containing beverages
since they make dry mouth worse.
The dose of the drug may have to be lowered if the
xerostomia continues or the patient may require a different
drug.
Pilocarpine is used in patients with functioning parotid
glands to stimulate an increase in saliva flow.

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Drug-Induced Oral Side

Effects: Gingival Enlargement

Gingival enlargement can occur with

several different drugs.
These drugs include phenytoin,
cyclosporine, calcium channel blockers,
carbamazepine, and valproic acid.
Treatment varies dependent upon the
offending drug.

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