oral care and maintenance: three tips that will improve ... · international pemphigus and...
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Oral Care and Maintenance: Three Tips
that will Improve Your Oral and Systemic Health
IPPF, Durham 2018Dr. Nancy W. Burkhart
Current Patients of Record
• Records show the following:
• 241 MMP
• 68 PV
Stomatology Center, Texas A&M Univ. College of Dentistry
International Pemphigus and Pemphigoid Foundation
• Average time from lesion onset to diagnosis is 6-10 months.
• Diagnosis may sometimes take up to 10 years
• The earlier the diagnosis and treatment, the better the prognosis
• Dental health professionals have an obligation to recognize unusual oral mucosal diseases and treat or refer.
How Are You Diagnosed?
• Oral Exam
• Complete History
• Biopsy
• Histology-Stain
• Immunofluorescence
Difficulty in DiagnosisDesquamative Gingivitis-General Term
• Mucous Membrane Pemphigoid • Cinnamon Allergy
Desquamative GingivitisWhat is it? Sound Familiar?
• Erythematous gingivitis
• Epithelial desquamation
• Erosion of the gingival epithelium
• Blister formation
• May involve stripping of the tissue
DG• EPIDERMOLYSIS BULLOSA
• EPIDERMOLYSIS BULLOSA ACQUISITA
• ULCERATIVE STOMATITIS
• PLASMA CELL GINGIVITIS
• ERYTHEMA MULTIFORME
• LINEAR IgA DISEASE
• FOREIGN BODY GRANULOMATOSIS
• ORAL FACIAL GRANULOMATOSIS
• FACTITOUS INJURY
• CANDIDA INFECTIONS
Why is accurate diagnosis important?
• Early Treatment
• Less Complications
• Less Scarring (eyes and esophageal)
• Less Anxiety
Treatment of Mucosal Disorders
• Clobetasol (Temovate) 0.05%
• Dexamethasone (Decadron) 0.5mg/ml
• Fluocinonide (Lidex) 0.05% and 0.1%
• Triamcinolone acetonide (Kenalog) 0.1%
• Hydrocortisone 1%
• 0.12% chlorhexidine-GUM Paroex (alcohol free)
• Lips: Desonide (Des Owen) 0.05%
ointment/cream
Dry Mouth: A Related Problem
• In patients over 50, dry mouth is often present and can contribute to severity of mouth lesions, secondary yeast infections, and mouth discomfort. (Candida or Yeast Infection)
• The stress of having a chronic disease can lead to anxiety and depression and treatment of these disorders can also cause dry mouth.
Considerations in Older Patients
• Increase in diabetes in all populations
• Increase in other chronic disease states
• Post menopausal
• Osteopenia and Osteoporosis
• Xerostomia
• Arthritis-limited dexterity
Drugs Associated With Xerostomia
• Anticholinergics
• Antidepressants and antipsychotics
• Diuretics
• Antihypertensives
• Sedatives and Anxiolytics
• Muscle relaxants
• Analgesics
• Antihistamines
• Miscellaneous
- Anticonvulsants
- Antidysrhythmics
- Anti-incontinences
- Antiparkinsonians
- Bronchial dilators
- Ophthalmic formulations
- Smoking cessation agents
Management of Dry Mouth• Avoid smoking, coffee-caffeinated beverages,
alcoholic beverages or mouthrinses containing alcohol.
• Use humidifier at night-XLEAR-STUFFY NOSE
• Use mighteaflow lubricant gels, rinses- Pro Vantage, (MTF), XEROSTOM, Oral Balance
• Use salivary stimulants
• sugarless gum- MTF***, XEROSTOM**
• sugarless mints- MTF lozenge**, XEROSTOM pastille*
Rx Only
FDA Approved Alcohol Free
Chlorhexidine Rinse
GUM® Perio Products
GUM® Paroex® Chlorhexidine Gluconate Oral Rinse USP, 0.12%
• TWO WEEK INTERVALS ARE MORE BENEFICIAL in Periodontal treatment/scaling prodcedures
• MMP affected by oral hygiene treatment Arduino PG Int J Dent Hyg. 2012 May: 10(2):138-41
• Conservative Approach in Patients with PV: Pilot Study. Decrease in bleeding with professional dental hygiene procedures with non-surgical therapy. (specific gingival localization-Desquamative gingivitis) Gambino, et al. International J Dent. 2014.
• Maintained MMP patients appear at no greater risk of increased progression of periodontal disease. Schellinck AE et al. J Periodontol 2009;80:1765-1773.
Protocol for Oral Health• Control inflammation
• Gentle Debridement
• Quadrants-with two weeks in between
• Paroex at 0.12% (Sunstar GUM) 16 oz size and use 2x day to decrease blisters and or desquamation
Toothbrushing
• Brush at least 2 minutes
• High amounts of force are not needed to remove plaque- force can cause trauma
• Change Brush after 9 weeks
Electric Toothbrushes?• Brush Head Replacement-Candida or any
illness such as flu/colds means replacement
• Settings-Speeds are high/low
• Mucosal Disorder Patients and Ultrasonics or Electric Toothbrushes are not a good fit usually
AAP Study FLOSSING
• 35% of people had rather clean their toilet than floss teeth.
• 35% of people had rather do taxes than floss their teeth.
Go-Betweens® Angle Cleaners
Proxabrush® Go-Betweens
®Cleaners 1314
1414
1514
1614
*Data on file**Bristles incorporate an antibacterial agent for continuous bristle protection.
Bacterial growth that may affect the bristles is inhibited. The agent in the bristles
Triangular bristles Remove 25% more
biofilm
Interdental Cleaning “On The Go”
Antibacterial & nylon coating on all sizes!!
Maintaining Oral Health• Practice meticulous oral hygiene at home
• Make frequent dental recall visits (review our maintenance suggestions)
• Use antifungals/antibiotics when prescribed (Note: antifungals may be required on an on-going basis)
• Avoid excessive ingestion of citrus juices or other acid containing foods or drinks (Alcohol-wine, beer)
• Apply topical fluorides daily when suggested
• Use soft (plumper) mouth guards to minimize trauma when suggested.
Images• Permanent record/documentation
• Document progress
• Able to compare images to past visits
• To visually show patient areas of concern or progress on screen
• Use your cell phone more!!
SELF HELP/SUPPORT GROUPS
• PROVIDE INFORMATION
• PROMOTE A SENSE OF COMMUNITY
• SERVE AS A RESOURCE CENTER FOR PATIENTS, FAMILY MEMBERS AND HEALTHCARE PROVIDERS
Dr. Nancy W. Burkhart, Ed.DM.Ed., RDH, AFAAOMDepartment of Periodontics, Adjunct Associate ProfessorCollege of Dentistry, Texas A&M University3302 Gaston Ave.Dallas Texas [email protected]
The International Oral Lichen Planus Support Group https://dentistry.tamhsc.edu/olp/