chapter 13: oral conditions and their treatment copyright © 2011, 2007 mosby, inc., an affiliate of...

Chapter 13:Chapter 13:

Oral Conditions and Their TreatmentOral Conditions and Their Treatment

Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.

22Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.

Chapter 13 OutlineChapter 13 Outline

Oral Conditions and Their TreatmentOral Conditions and Their Treatment Infectious lesionsInfectious lesions Immune reactionsImmune reactions Miscellaneous oral conditionsMiscellaneous oral conditions InflammationInflammation Drug-induced oral side effectsDrug-induced oral side effects Common agents used to treat oral lesionsCommon agents used to treat oral lesions


Oral Conditions and Their Oral Conditions and Their TreatmentTreatment

Haveles (p. 165)Haveles (p. 165) The dental health care worker is the first The dental health care worker is the first

professional that patients visit when they professional that patients visit when they notice a lesion in the oral cavitynotice a lesion in the oral cavity The first step is diagnosisThe first step is diagnosis Depending on the diagnosis, the lesion may Depending on the diagnosis, the lesion may

require only reassurance, palliative treatment, require only reassurance, palliative treatment, specific treatment, or even surgical interventionspecific treatment, or even surgical intervention


Infectious LesionsInfectious Lesions Haveles (pp. 165-168) (Table 7-1)Haveles (pp. 165-168) (Table 7-1)

Acute necrotizing ulcerative gingivitisAcute necrotizing ulcerative gingivitis Has both bacteriologic and environmental factorsHas both bacteriologic and environmental factors

• A spreading ulcer associated with a distinctive odorA spreading ulcer associated with a distinctive odor

Good oral hygiene is the cornerstone of treatment, Good oral hygiene is the cornerstone of treatment, but other modalities have been recommendedbut other modalities have been recommended• Mouthwashes assist by their flushing actionMouthwashes assist by their flushing action

Aspirin or acetaminophen can be recommended if Aspirin or acetaminophen can be recommended if pain or an elevated temperature accompany the pain or an elevated temperature accompany the conditioncondition

Antibiotics should be considered only if the patient is Antibiotics should be considered only if the patient is immunosuppressed or if evidence of systemic immunosuppressed or if evidence of systemic involvement existsinvolvement exists

cont’d…cont’d…


Infectious LesionsInfectious Lesions Haveles (pp. 165-166)Haveles (pp. 165-166)

Herpes infectionsHerpes infections OverviewOverview

Primary herpetic gingivostomatitis, or primary herpes, Primary herpetic gingivostomatitis, or primary herpes, is the manifestation of the initial herpes infectionis the manifestation of the initial herpes infection• Occurs principally in infants and children, caused by herpes Occurs principally in infants and children, caused by herpes

simplex virus (HSV)simplex virus (HSV)

• Also known as a fever blister or cold soreAlso known as a fever blister or cold sore

Beginning as an erythematous area; numerous ulcers Beginning as an erythematous area; numerous ulcers with a circumscribed area of erythema appearwith a circumscribed area of erythema appear• Vesicles form that become scabbedVesicles form that become scabbed


Herpes InfectionsHerpes Infections

Haveles (pp. 165-166)Haveles (pp. 165-166) OverviewOverview

Self-limiting without treatment in the patient with Self-limiting without treatment in the patient with normal immunitynormal immunity• Approximately 80% to 90% of the adult population has Approximately 80% to 90% of the adult population has

been exposed to HSVbeen exposed to HSV HSV-1 is involved in most oral lesionsHSV-1 is involved in most oral lesions HSV-2 is usually responsible for genital herpes and is HSV-2 is usually responsible for genital herpes and is

transmitted sexuallytransmitted sexually

• Both types can spread to other parts of the bodyBoth types can spread to other parts of the body




Haveles (p. 166)Haveles (p. 166) OverviewOverview

The patient may experience recurrent outbreaks The patient may experience recurrent outbreaks after the primary episode that occur at irregular after the primary episode that occur at irregular and variable intervalsand variable intervals• Effectiveness of antiviral drugs varies, depending on Effectiveness of antiviral drugs varies, depending on

whether the outbreak is a primary episode or recurrence whether the outbreak is a primary episode or recurrence and whether the patient is immunocompromised or and whether the patient is immunocompromised or nonimmunocompromisednonimmunocompromised




Haveles (pp. 165-166) (Table 13-1) Haveles (pp. 165-166) (Table 13-1) TreatmentTreatment

May include an antiviral agent, depending on the May include an antiviral agent, depending on the patient and the episodepatient and the episode• Acyclovir: available as tablets, capsules, oral Acyclovir: available as tablets, capsules, oral

suspension, ointment, cream, and parenteral formssuspension, ointment, cream, and parenteral forms Approved indications include treatment of primary and Approved indications include treatment of primary and

recurrent HSV in the immunocompromised patientrecurrent HSV in the immunocompromised patient In the nonimmunocompromised patient, oral acyclovir is In the nonimmunocompromised patient, oral acyclovir is

indicated for both treatment of the primary outbreak and indicated for both treatment of the primary outbreak and prophylaxisprophylaxis




Haveles (p. 167)Haveles (p. 167) PenciclovirPenciclovir

Only available topicallyOnly available topically Reduces lesion duration and viral shedding by 0.7 daysReduces lesion duration and viral shedding by 0.7 days

Famciclovir and valacyclovirFamciclovir and valacyclovir Prodrugs that are converted to active antiviral agentsProdrugs that are converted to active antiviral agents Indicated in the treatment of acute localized varicella-Indicated in the treatment of acute localized varicella-

zoster infections and recurrent genital herpes in zoster infections and recurrent genital herpes in immunocompetent adultsimmunocompetent adults




Haveles (p. 167)Haveles (p. 167) Treatment of symptomsTreatment of symptoms

Palliative treatment involves treating the patient’s Palliative treatment involves treating the patient’s symptomssymptoms• In a primary episode, fever may be managed by the In a primary episode, fever may be managed by the

administration of acetaminophen or by sponging the administration of acetaminophen or by sponging the affected area with tepid wateraffected area with tepid water

• Discomfort may be relieved by swishing diphenhydramineDiscomfort may be relieved by swishing diphenhydramine

• Sodium carboxymethylcellulose paste may reduce Sodium carboxymethylcellulose paste may reduce discomfortdiscomfort


CandidiasisCandidiasis

Haveles (p. 167)Haveles (p. 167) Candidiasis, a fungal infection caused by Candidiasis, a fungal infection caused by

Candida albicans,Candida albicans, often affects the oral and often affects the oral and vaginal mucosavaginal mucosa Because Because CandidaCandida is part of the normal oral flora, it is part of the normal oral flora, it

is always present in small numbersis always present in small numbers CandidaCandida can predominate when other flora are can predominate when other flora are

suppressedsuppressed Searching exhaustively for potential predisposing Searching exhaustively for potential predisposing

factors is important factors is important cont’d…cont’d…


CandidiasisCandidiasis

Although candidiasis can appear in several Although candidiasis can appear in several different forms, the lesions are typical and different forms, the lesions are typical and can usually be diagnosed by clinical can usually be diagnosed by clinical appearanceappearance They may be confirmed by cultureThey may be confirmed by culture Ketoconazole tablets taken orally once daily can Ketoconazole tablets taken orally once daily can

be used with chronic candidiasisbe used with chronic candidiasis


Angular Cheilitis/CheilosisAngular Cheilitis/Cheilosis

Haveles (p. 167)Haveles (p. 167) Appears as simple redness, fissures, erosion, Appears as simple redness, fissures, erosion,

ulcers, and crusting located at the angles of the ulcers, and crusting located at the angles of the mouthmouth May or may not be painfulMay or may not be painful

Depending on the presentation of the patient’s Depending on the presentation of the patient’s lesion, therapy is addressed toward treating the lesion, therapy is addressed toward treating the secondary infectionsecondary infection If bacterial overgrowth is suspected, the organisms If bacterial overgrowth is suspected, the organisms

responsible are usually similar to staphylococci and responsible are usually similar to staphylococci and streptococcistreptococci



Angular Cheilitis/CheilosisAngular Cheilitis/Cheilosis

Cheilosis can result from deficiency of vitamin Cheilosis can result from deficiency of vitamin BB66 or vitamin B or vitamin B22

Vitamin B supplements would be useful but only if Vitamin B supplements would be useful but only if a vitamin deficiency existsa vitamin deficiency exists


Alveolar OsteitisAlveolar Osteitis

Haveles (p. 168)Haveles (p. 168) Alveolar osteitis occurs in 2% to 3% of all tooth Alveolar osteitis occurs in 2% to 3% of all tooth

extractions, most commonly in the lower molar extractions, most commonly in the lower molar regionregion Thought to be caused by loss or necrosis of the blood Thought to be caused by loss or necrosis of the blood

clot that has formed in the extraction site, exposing clot that has formed in the extraction site, exposing the underlying bonethe underlying bone

Predisposing factors include oral contraceptive use Predisposing factors include oral contraceptive use and menstrual cycle phaseand menstrual cycle phase

Smoking can increase the likelihood of a dry socketSmoking can increase the likelihood of a dry socketcont’d…cont’d…


Alveolar OsteitisAlveolar Osteitis

Treatment consists of rinsing with saline Treatment consists of rinsing with saline water and debridement, placement of a pack, water and debridement, placement of a pack, analgesics, and supportive therapyanalgesics, and supportive therapy Most literature does not recommend the use of Most literature does not recommend the use of

prophylactic antibioticsprophylactic antibiotics Antibiotics are indicated if infection is presentAntibiotics are indicated if infection is present


Immune ReactionsImmune Reactions

Haveles (p. 168)Haveles (p. 168) Recurrent aphthous stomatitisRecurrent aphthous stomatitis

Sometimes called a canker soreSometimes called a canker sore• Seen in about 20% of the populationSeen in about 20% of the population

Unknown etiology; an immune system involvement is Unknown etiology; an immune system involvement is suspectedsuspected

Presents clinically as a few small to many large ulcersPresents clinically as a few small to many large ulcers• Three distinct types have been clinically identified: minor, Three distinct types have been clinically identified: minor,

major, and herpetiformemajor, and herpetiforme


Recurrent Aphthous StomatitisRecurrent Aphthous Stomatitis(RAS)(RAS)

Haveles (p. 168)Haveles (p. 168) CorticosteroidsCorticosteroids

Steroids have been the mainstay of therapy for Steroids have been the mainstay of therapy for RAS for many yearsRAS for many years• Topical steroids are used to reduce the inflammation Topical steroids are used to reduce the inflammation

associated with these lesionsassociated with these lesions



Recurrent Aphthous StomatitisRecurrent Aphthous Stomatitis (RAS) (RAS)

Haveles (pp. 168-169)Haveles (pp. 168-169) AphthasolAphthasol

A new drug used topically, applied four times dailyA new drug used topically, applied four times daily Diphenhydramine (DPH)Diphenhydramine (DPH)

DPH alone is now preferred because of its local DPH alone is now preferred because of its local anesthetic actionanesthetic action

ImmunosuppressivesImmunosuppressives Used as a last resort to treat severe aphthous Used as a last resort to treat severe aphthous

ulcersulcers


Lichen PlanusLichen Planus

Haveles (p. 169)Haveles (p. 169) A skin condition that often involves lesions on A skin condition that often involves lesions on

the oral mucous membranesthe oral mucous membranes Oral lesions are present without skin lesions in 65% Oral lesions are present without skin lesions in 65%

of the casesof the cases Lichen planus can present in three forms: Lichen planus can present in three forms:

striated, plaque-like, and erosivestriated, plaque-like, and erosive The most characteristic type is hypertrophic; this The most characteristic type is hypertrophic; this

lesion has a white lace-like pattern that intersects to lesion has a white lace-like pattern that intersects to form a reticular patternform a reticular pattern



Lichen PlanusLichen Planus

Symptoms vary between no pain and extreme Symptoms vary between no pain and extreme pain, depending on the presence of ulcerationpain, depending on the presence of ulceration Etiology is unknown, current hypotheses include a Etiology is unknown, current hypotheses include a

viral infection, an autoimmune disease, and a viral infection, an autoimmune disease, and a hypersensitivity reaction to an unknown agenthypersensitivity reaction to an unknown agent

Treatment depends on symptomsTreatment depends on symptoms Includes oral and topical steroids, oral retinoids, Includes oral and topical steroids, oral retinoids,

and immunosuppressantsand immunosuppressants


Miscellaneous Oral ConditionsMiscellaneous Oral Conditions

Haveles (p. 169)Haveles (p. 169) Geographic tongueGeographic tongue

The tongue may have lesions that typically appear The tongue may have lesions that typically appear to be a map of the world, with the lesions to be a map of the world, with the lesions appearing to be the continentsappearing to be the continents• The lesions are usually ringed with erythema, and their The lesions are usually ringed with erythema, and their

centers are whitecenters are white

• Changes in patterns occur over time, and they may even Changes in patterns occur over time, and they may even disappeardisappear


Geographic TongueGeographic Tongue

The etiology is unknown; may be related to The etiology is unknown; may be related to hormonal changes, stress, infection, psoriasis, or hormonal changes, stress, infection, psoriasis, or autoimmune diseasesautoimmune diseases

Treatment includes reassurance and avoidance of Treatment includes reassurance and avoidance of irritating food and alcoholirritating food and alcohol


Burning Mouth or Tongue Burning Mouth or Tongue SyndromeSyndrome

Haveles (p. 169)Haveles (p. 169) The oral cavity appears normal, but the patient The oral cavity appears normal, but the patient

gives a history of experiencing a discomfort gives a history of experiencing a discomfort described as pain or a burning sensation that described as pain or a burning sensation that increases in severity through the dayincreases in severity through the day Glossodynia is a painful tongue and is divided into two Glossodynia is a painful tongue and is divided into two

types: with and without observable alterations on the types: with and without observable alterations on the tonguetongue• It can be caused by many conditions, both local and systemicIt can be caused by many conditions, both local and systemic




Haveles (p. 169)Haveles (p. 169) The nature of the psychologic component of the The nature of the psychologic component of the

disease is uncleardisease is unclear Research shows that the presence of chronic disease Research shows that the presence of chronic disease

can lead to depression and anxietycan lead to depression and anxiety The etiology has not been elucidatedThe etiology has not been elucidated

Numerous hypotheses have been proposed, including Numerous hypotheses have been proposed, including xerostomia, candidiasis, acid reflux, nutritional xerostomia, candidiasis, acid reflux, nutritional deficiency, immunologic reaction, hormonal changes, deficiency, immunologic reaction, hormonal changes, allergic reaction, inflammatory process, psychogenic allergic reaction, inflammatory process, psychogenic reaction, or an idiopathic reactionreaction, or an idiopathic reaction




Treatment depends on the particular etiology Treatment depends on the particular etiology in which the practitioner believesin which the practitioner believes Some treat the patient as they would for candidiasisSome treat the patient as they would for candidiasis Others test for vitamin deficienciesOthers test for vitamin deficiencies

Palliative therapy involves topical DPH to Palliative therapy involves topical DPH to relieve symptomsrelieve symptoms

Tricyclic antidepressants can be used on a Tricyclic antidepressants can be used on a trial basistrial basis


InflammationInflammation

Haveles (p. 169)Haveles (p. 169) PericoronitisPericoronitis

Inflammation of the tissue around the crown of the toothInflammation of the tissue around the crown of the tooth Most commonly applied to partially erupted third molarsMost commonly applied to partially erupted third molars Refers to an inflammatory response that is produced Refers to an inflammatory response that is produced

when food and bacteria become trapped between the when food and bacteria become trapped between the operculum and the toothoperculum and the tooth• Debridement with saline irrigation and the use of warm saline Debridement with saline irrigation and the use of warm saline

rinses will rectify the situation if the condition is observed early rinses will rectify the situation if the condition is observed early in its coursein its course


PericoronitisPericoronitis

Repeated episodes may occur with erupting Repeated episodes may occur with erupting third molarsthird molars Analgesics can be used for discomfortAnalgesics can be used for discomfort Infection, usually managed by local treatment, Infection, usually managed by local treatment,

may rapidly spread in debilitated patients and may rapidly spread in debilitated patients and should be aggressively treated with antibioticsshould be aggressively treated with antibiotics


Postirradiation CariesPostirradiation Caries

Haveles (p. 169)Haveles (p. 169) Changes in saliva after irradiation therapy Changes in saliva after irradiation therapy

and lack of proper plaque control can rapidly and lack of proper plaque control can rapidly accelerate the rate of dental cariesaccelerate the rate of dental caries Generalized cervical decay within the first year Generalized cervical decay within the first year

after radiation therapy can resultafter radiation therapy can result Meticulous oral hygiene, reinforced by the Meticulous oral hygiene, reinforced by the

hygienist, short duration between subsequent hygienist, short duration between subsequent recall appointments, artificial saliva, and self-recall appointments, artificial saliva, and self-application of sodium fluoride gel four times application of sodium fluoride gel four times daily in a bite guard are recommendeddaily in a bite guard are recommended


Root SensitivityRoot Sensitivity Haveles (p. 170)Haveles (p. 170)

Sensitivity of exposed root surfaces may be Sensitivity of exposed root surfaces may be precipitated by heat, cold, and sweet or sour precipitated by heat, cold, and sweet or sour foodsfoods Occlusal trauma may produce irritation to the exposed Occlusal trauma may produce irritation to the exposed

dentinal tubulesdentinal tubules Roots exposed by periodontal surgery, extensive Roots exposed by periodontal surgery, extensive

root planing, or accumulation of plaque and its root planing, or accumulation of plaque and its byproducts are more difficult to managebyproducts are more difficult to manage



Root SensitivityRoot Sensitivity

The patient may use home brushing with The patient may use home brushing with concentrated sodium chloride and 0.4% concentrated sodium chloride and 0.4% stannous fluoridestannous fluoride Sodium fluoride gel may be self-applied in a bite Sodium fluoride gel may be self-applied in a bite

guardguard Desensitizing toothpastes have helped some patientsDesensitizing toothpastes have helped some patients Current research indicates that root sensitivity Current research indicates that root sensitivity

caused by recession, bleaching, or abrasion may be caused by recession, bleaching, or abrasion may be successfully treated with amorphous calcium successfully treated with amorphous calcium phosphatephosphate


Actinic Lip ChangesActinic Lip Changes

Haveles (p. 170)Haveles (p. 170) Long-term exposure of the lip to the sun can Long-term exposure of the lip to the sun can

cause irreversible tissue changes known as cause irreversible tissue changes known as actinic cheilitisactinic cheilitis These sun-related changes occur near the These sun-related changes occur near the

vermilion border of the lips and can progress to vermilion border of the lips and can progress to malignancymalignancy

Sunscreen preparations with higher sun protective Sunscreen preparations with higher sun protective factors should be applied before sun exposurefactors should be applied before sun exposure

If keratotic changes have occurred, treatment is If keratotic changes have occurred, treatment is topical 5-fluorouracil (5-FU), an antineoplastic topical 5-fluorouracil (5-FU), an antineoplastic agent that promotes sloughing of the skinagent that promotes sloughing of the skin


StomatitisStomatitis

Haveles (p. 170)Haveles (p. 170) An inflammation of the mucus lining the An inflammation of the mucus lining the

cheeks, gums, tongue, lips, throat, and roof cheeks, gums, tongue, lips, throat, and roof or floor of the mouthor floor of the mouth Caused by poor oral hygiene, poorly fitting Caused by poor oral hygiene, poorly fitting

dentures, mouth burns from hot food or drinks, or dentures, mouth burns from hot food or drinks, or by conditions that affect the entire body, such as by conditions that affect the entire body, such as medications, allergic reactions, radiation therapy, medications, allergic reactions, radiation therapy, or infectionsor infections

Treatment is based on its cause and usually Treatment is based on its cause and usually includes good oral hygiene includes good oral hygiene


Drug-Induced Oral Side EffectsDrug-Induced Oral Side Effects

Haveles (pp. 170-172) (Box 13-1) (appendix E)Haveles (pp. 170-172) (Box 13-1) (appendix E) Can be produced by a wide variety of drugsCan be produced by a wide variety of drugs

Different kinds of lesions can be produced with the Different kinds of lesions can be produced with the same drugsame drug

The same kind of lesion can be produced by The same kind of lesion can be produced by different agentsdifferent agents

Common oral side effects include xerostomia, Common oral side effects include xerostomia, drug-induced lichenoid-like reaction, and drug-induced lichenoid-like reaction, and hypersensitivity reactionshypersensitivity reactions


XerostomiaXerostomia

Haveles (p. 170)Haveles (p. 170) Xerostomia may result from a drug, a Xerostomia may result from a drug, a

disease, age, or radiationdisease, age, or radiation Radiation therapy to the head and neck affects the Radiation therapy to the head and neck affects the

salivary glands so that the consistency of saliva is salivary glands so that the consistency of saliva is altered and its volume is reduced substantiallyaltered and its volume is reduced substantially



XerostomiaXerostomia

Haveles (p. 170)Haveles (p. 170) TreatmentTreatment

Caries preventionCaries prevention Artificial salivaArtificial saliva Home careHome care Change in medication or reduction in doseChange in medication or reduction in dose PilocarpinePilocarpine Cevimeline hydrochlorideCevimeline hydrochloride


SialorrheaSialorrhea

Haveles (p. 170)Haveles (p. 170) Certain drugs may produce an increase in Certain drugs may produce an increase in

saliva termed sialosis, sialism, or sialorrheasaliva termed sialosis, sialism, or sialorrhea One example is the cholinergic agent pilocarpineOne example is the cholinergic agent pilocarpine


Hypersensitivity-Type ReactionsHypersensitivity-Type Reactions

Haveles (p. 170)Haveles (p. 170) May be hyperimmune responses triggered by May be hyperimmune responses triggered by

an antigenic component of the drug or its an antigenic component of the drug or its metabolitemetabolite Contact stomatitis is more localized when gum and Contact stomatitis is more localized when gum and

candy are responsible and is more diffuse with candy are responsible and is more diffuse with toothpaste usetoothpaste use

The potential for a hypersensitivity reaction is The potential for a hypersensitivity reaction is determined by the particular drug, the frequency of determined by the particular drug, the frequency of administration, the route of administration, and the administration, the route of administration, and the patient’s immune systempatient’s immune system


Oral Lesions that Resemble Oral Lesions that Resemble Autoimmune-Type ReactionsAutoimmune-Type Reactions

Haveles (pp. 171-172) (Box 13-2)Haveles (pp. 171-172) (Box 13-2) Lichenoid-like eruptionsLichenoid-like eruptions

Many drugs are associated with eruptions that Many drugs are associated with eruptions that resemble lichen planusresemble lichen planus

The most common drug is hydrochlorothiazide (HCTZ)The most common drug is hydrochlorothiazide (HCTZ) Lupus-like reactionsLupus-like reactions

Oral manifestations can occur with lupusOral manifestations can occur with lupus These lesions may also be produced by a variety of These lesions may also be produced by a variety of

drugsdrugs Erythema multiforme-like lesionsErythema multiforme-like lesions

Some drugs can produce lesions that resemble Some drugs can produce lesions that resemble erythema multiformeerythema multiforme


StainsStains

Haveles (p. 172)Haveles (p. 172) Staining may occur either as the teeth are Staining may occur either as the teeth are

formed or in a few cases in adult teethformed or in a few cases in adult teeth Tetracyclines are incorporated into forming teeth Tetracyclines are incorporated into forming teeth

and thereby stain the teethand thereby stain the teeth Minocycline is thought to produce a blue-gray Minocycline is thought to produce a blue-gray

coloration to the bone in adult teethcoloration to the bone in adult teeth Chlorhexidine rinse and liquid iron preparations Chlorhexidine rinse and liquid iron preparations

can also cause extrinsic stainingcan also cause extrinsic staining


Gingival EnlargementGingival Enlargement

Haveles (p. 172)Haveles (p. 172) Gingival enlargement can occur in relation to Gingival enlargement can occur in relation to

several drug groupsseveral drug groups phenytoin (Dilantin)phenytoin (Dilantin) CyclosporineCyclosporine Calcium channel blockersCalcium channel blockers Other including anticonvulsants such as Other including anticonvulsants such as

carbamazepine (Tegretol) and valproic acid carbamazepine (Tegretol) and valproic acid (Depakene)(Depakene)


Common Agents Used to Treat Common Agents Used to Treat Oral LesionsOral Lesions

Haveles (pp. 172-173)Haveles (pp. 172-173) CorticosteroidsCorticosteroids

Used for many oral lesions, especially those with a Used for many oral lesions, especially those with a component of inflammation or immune responsecomponent of inflammation or immune response• Depending on the severity of the lesions, the topical Depending on the severity of the lesions, the topical

corticosteroids would be selected based on their potencycorticosteroids would be selected based on their potency

• If topical corticosteroid therapy is ineffective, or if the If topical corticosteroid therapy is ineffective, or if the condition is severe, then systemic corticosteroids may be condition is severe, then systemic corticosteroids may be indicatedindicated



Common Agents Used to Treat Common Agents Used to Treat Oral LesionsOral Lesions

Haveles (p. 173)Haveles (p. 173) Palliative treatmentPalliative treatment

Treatment designed to make the patient more Treatment designed to make the patient more comfortablecomfortable• Agents that reduce the pain of the oral cavity can be Agents that reduce the pain of the oral cavity can be

topical and systemictopical and systemic Topical agents are applied by swishing the liquid around in Topical agents are applied by swishing the liquid around in

the mouththe mouth Systemic analgesics can often provide relief from a painful Systemic analgesics can often provide relief from a painful

oral lesionoral lesion

• Topical and systemic agents may be used together for Topical and systemic agents may be used together for an additive effectan additive effect

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