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DRUGS USED TO TREAT

ORAL DISORDERS
DRUG CLASSIFICATIONS
DENTIFRICES
ACTIONS: Contain one or more abrasive agents, a foaming agent,
and flavoring materials. Available in powder, paste, or gel and
are best used with a soft nylon toothbrush.
Fluoride is added to detifrices as a therapeutic agent for its
anticaries activity.
USES: Everyone should brush at least twice daily with a fluoride
toothpaste.
Therapeutic outcomes: Reduction in plaque formation and
cavities.
DENTIFRICES

Gel

Powder
Paste
DRUG CLASSIFICATIONS
MOUTHWASHES

ACTIONS: Mouthwashes are solutions of flavoring, coloring,


water, surfactants, and sometimes therapeutic ingredients.
Flavoring agents are used to give pleasant taste and freshen the
breath.
USES: Can be subdivided into Cosmetic mouthwashes and
Medicinal Mouthwashes.
Cosmetic mouthwashes only freshen the breath. Medicinal
mouthwashes can reduce plaque accumulation and gingivitis.
Coloring suggests a certain type of mouthwash:

Green or blue Red


(Minty) (Spicy)
MOUTHWASHES

White Brown
(Whitening) (Medicinal)
MOUTHWASHES
• A 0.9 % normal saline solution is an effective
gargle. It can provide temporary, soothing
relief of pharyngeal irritation from nasogastric
tubes, endotracheal tubes, sore throat, or
oral surgery.
Oral Disorders
• Cold sores
• Canker sores
• Mucositis
• Plaque
• Halitosis
• Xerostomia
COLD SORES
• Caused by the herpes
simplex type 1 virus
(herpes simplex labialis).

• Found at the junction of the


mucous membrane and the skin
of the lips or nostrils. It can also
occur inside mouth (gums, hard
and soft palate).
Drug Therapy for COLD SORES
Docosanol (Abreva)

Action: Shorten healing time and duration of symptoms such as


tingling, pain, burning, and itching.
Indication: Used to treat cold sores/fever blisters on lips or
mouth.
Frequency: Apply five times daily starting the first sign of
outbreak.
Form: Cream Side effects: Local stinging
Classification: Dentifrices
CANKER SORES
• “Recurrent aphthous
stomatitis (RAS)”
• Singaw in layman term

• Caused by toothbrush
abrasion, irritation from
braces, biting the inside of the cheeks or lips.

• Lesions can be painful and inhibit the normal eating,


drinking, talking and swallowing as well as oral hygiene.
Drug Therapy for CANKER SORES
Topical amlexanox paste 5%
(Aphthasol)
Action: an anti inflammatory agent that hastens healing of
canker sores.
Indication: Apply directly into the affected site.
Frequency: apply four times daily following oral hygiene after
breakfast, lunch, dinner and at bedtime.
Form: paste
Classification: Dentifrices
Side effects: transient stinging, pain or burning at the site of
application.
MUCOSITIS
• Once called stomatitis

• Painful inflammation of the


mucous membranes of the
mouth. The sores are
erythematous ulcerations
intermixed with white,
patchy mucous membranes.

• It is commonly associated with


chemotherapy and radiation therapy.
Drug Therapy for MUCOSITIS
Chlorhexidine (Peridex)

Indication: Treats mucositis.


Frequency: Use twice daily for 30
seconds morning and evening after
tooth brushing.
Form: Liquid
Classification: Mouthwash
Side effects: staining in teeth, increased tartar on teeth, tongue
coating, toothache, skin irritation and hypersensitivity reaction.
Adverse effects: Sign of allergic reaction
(nasal congestion, shortness of breath, skin rash or itching and
swelling).
PLAQUE
• The whitish yellow
substance that
builds up on teeth
and gum lines
around the teeth,
is thought to
originate from saliva.
• If not removed with in 24 hours,
it begins to calcify, forming calculus
or tartar and which can cause gingivitis (inflammation).
Treatment for PLAQUE
Plaque is controlled by :
• brushing of teeth
• flossing between teeth
• using mouthwashes
If plaque is removed regularly, tartar will not form.
HALITOSIS
• Very foul mouth odor.
• Temporary foul odor is normal
in healthy individuals, such as
“morning breath” or after eating
garlic or onions.
• Halitosis can signify an underlying pathologic condition.
Halitosis comes from nonoral causes which includes:
• Sinusitis, tonsillitis, and rhinitis.
• Smoking can cause halitosis called the “Smoker’s Breath”.
Treatment for HALITOSIS
• Treated easily by eliminating the causes, such as smoking and
certain foods.
• Regular brushing of teeth and using dental floss
• Mouthwashes and breath mints can mask halitosis but
usually last less than 1 hour.

Dental Flossing
NOTE
If halitosis is persistent and has no readily
identifiable cause such as smoking or diet, a dentist
should be consulted for a thorough examination to
ensure that no other pathologic condition is
underlying the cause. .
XEROSTOMIA
• Is a condition in which the flow
of saliva is either partially or
completely stopped.
• Xerostomia causes loss of taste,
difficulty talking, and it increases
tooth decay.
• Can cause burning sensation and MUCOSITIS.
• Common causes of xerostomia are some of these medicines
like anticholinergic agents, diuretics etc.
Drug therapy for XEROSTOMIA
• Xerostomia is treated by changing the medicines that cause
dry mouth or with artificial saliva.
• Artificial saliva products do not stimulate natural saliva
production, but mimic the viscosity, mineral content and
taste.
• Patients with xerostomia should be seen by a dentist
regularly to help avoid additional dental caries.
Commercially available saliva
substitutes:
Caphosol
Indication: For dry mouth or
throat (hyposalivation or
xerostomia).
How to use:
Mix 1 blue (Caphosol A) and 1 clear
ampule (Caphosol B).
Swish the mouth thoroughly for 1
min with half of the solution and
spit out.
• Use immediately after mixing ampules.
Frequency: Repeat 2-10 times a day or as needed.

There is no adverse effects expected if swallowed. Avoid eating


or drinking for 15 mins after use.
SUMMARY:
Drug Classification
DENTIFRICES
Cold sores – Docosanol (Abreva) Cream
Canker sores – Topical amlexanox paste 5% (Aphthasol) Paste

MOUTHWASHES
Mucositis – Chlorhexidine (Peridex)
Plaque – Brushing teeth, dental flossing, using mouthwashes
Halitosis – Avoid smoking, brushing teeth, use dental floss and
mouthwashes
Xerostomia – Caphosol
Oral Disorder Drug Classification Treatment
COLD SORES Dentifrices Docosanol (Abreva)

CANKER SORES Dentifrices Topical amlexanox


5% (Aphthasol)
MUCOSITIS Mouthwash Chlorhexidine
(Peridex)
PLAQUE Mouthwash Listerine
HALITOSIS Mouthwash Listerine

XEROSTOMIA Caphosol
NURSING RESPONSIBILITIES
Assessment
1. Obtain history of recent drug therapy.
2. Obtain a dental history that includes frequency of
visits to dentist and brief summary of procedures
that have been performed.
3. Ask about tobacco and alcohol use.
4. Ask about difficulty of chewing, swallowing or
speaking.
5. Ask any changes in the taste of foods such as
burning or tingling.
6. Put on gloves and inspect the oral cavity with
flashlight and tongue blade. Inspect the mucous
membranes for inflamed or receding gums.
7. Note the presence or absence of halitosis.
8. Biopsy of the soft tissues of the oral cavity to
confirm diagnosis of oral lesion.
Implementation
COLD SORES
1. Teach the patients with cold sores that lesions are common
and may occur at any time from childhood to adulthood. Cold
sores are contagious when an active lesion is present.
2. Cold sores must be kept clean by washing with mild soap
solutions. Instruct the patient that it should be kept moist to
prevent cracking and bacterial infection.
3. Instruct to apply docosanol (abreva) as prescribed.
4. When secondary infection are present, apply topical
antibiotic ointment (Neosporin) to cold sore.
NURSING RESPONSIBILITIES
CANKER SORES
1. Apply topical anesthetics before the patient eats or perform
oral hygiene.
2. Apply Aphtasol after meals and oral hygiene, 4 times daily.
3. Saline rinses using 1 to 3 tsp of tablesalt dissolved in 4 to 8 oz
of warm tap water.
4. Changes in diet can also reduce irritation to the sores.
NURSING RESPONSIBILITIES
MUCOSITIS
1. Oral hygiene regimens should be started at the time of
chemotherapy or radiation therapy.
2. Oral hygiene should include a soft-bristled brush.
3. Do not use containing alcohol mouthwashes because they
dry and irritate the mouth.
4. Instruct patient not to take food or drink approximately 15
mins after the medication has been given.
5. Mouth dryness can be relieved by chewing gum and sucking
on ice chips or ice pops. Dry lips can be coated with
petroleum jelly or lip balm and cocoa butter.
NURSING RESPONSIBILITIES
PLAQUE
1. Perform tooth brushing and dental flossing and use
mouthwashes on a scheduled basis daily to prevalent plaque.

HALITOSIS
1. Brushing dentures and teeth regularly and using dental floss
can remove particles of decaying food. Mouthwashes and
breath mints can mask halitosis, but usually last less than 1
hour.
NURSING RESPONSIBILITIES
XEROSTOMIA
1. Monitor the medication routine, report xerostomia to the
healthcare provider, and use artificial saliva if prescribed.
PATIENT EDUCATION
• Teach the patient proper cleansing techniques for
oral hygiene.
• Teach patient with the proper use of analgesics and
comfort measures.
• Discuss dietary practices that may relieve symptoms,
such as bland foods.
• Instruct the patient to report to the healthcare
provider conditions that are not relieved by the
prescribed therapies.
Thank you!