Care of patients with oral cavity disorders

Peridontsal disease

Gingivitis

Swollen, red, painful gums, Receding gum lines, Pus when gums are pressed, Loose teeth, Bleeding when brushing teeth

Peridontal disease-gingivitis

Asessment of teeth, gums, Assess diet, Stress importance of brushing, flossing, fluoride use, regular dental check ups, Teach signs and symptoms of dental disease, Refer to a periodontist

Stomatitis primary (broad term)

Apthous ulcers-non infectious, Herpes simplex stomatitis, Traumatic ulcers

Secondary stomatitis

Usually caused by Candida albicans, Found in pts who are immunosuppressed, Can be prompted by long term antibiotic therapy

History of recent infection, Nurtritional changes, oral hygiene habits, Oral trauma, Stress, Drug history OTC, herbal supplements, Recent out breaks interfering with swallowing or eating

Dry painful mouth, Open ulcerations, Odynphagia (painful swallowing) Dysphagia (difficulty swallowing), Impaired airway, Oral candidasis: plaque like lesions on tongue, palate pharynx, buccal mucosa, Candidasis: underlying surface plaques are red/sore, Candidasis: Lypmh node swelling

Remove dentures if a patient has severe stomatitis or pain, Oral hygiene after each meal, Soft bristled tooth brush, Disposable foam swabs, Toothpaste that is free of sodium lauryl sulfate `, Rinse mouth q2-3 hrs with sodium bicarb solution or warm saline, Avoid most commercial mouth washes, Help patient select bland, non acidic foods, Apply topical anesthetic or analgesics as ordered, Monitor affect of treatments

Tetracycline syrup- rinse for 2 minutes then swallow, Minocycline- oral suspension rinse and swallow, Chlorhexidine mouthwashes

Acyclovir (topical)- Herpes simplex stomatitis, IV acyclovir (Zovirax)- Immunocomprimesed Herpes simplex stomatitis

Mycostatin oral suspension swish and swallow/ lozenges, Topic triamcinolone in benzocaine (Kenalog orabase) and oral dexmethasone elixir (swish and spit) for recurrent apthous stomatitis

Topical amlexanox (Apthasol), Topical granulucyte macrophage colony simulating factor (GM-CSF), Thalidomide

Compromised tissue integrity due to oral and/or esophageal lesions., Pt will exhibit healthy oral cavity AEB absence of lesions, pink mois intact skin.

Encourage cool or cold liquids, Avoid foods that are hard,spiced salty or acidic, Include foods that are high in protein and Vitamin C

OTC benzocain anesthetic (orabase, anbesol), Magic mouthwash, Viscous lidocaine (gargle or mouthwash), Campor phenol

At higher risk for oral candidasis, Use of meds that lead to oral dryness, Soft denture liners can lead to colonization of Candida albicans, Possible poor oral hygiene

Fibroms, lipomas, neurfibroma, hemangiomas

Occupy space and cause pressure, Surgical removal

Thick, white firmly attached white patches, Slighlty raised, slightly rounded, Pre cancerous, but most are benign, Results from long term irritation

Leukoplakia

Hairy leukoplakia

Red velvety lesions on surface of oral mucosa, More malignant changes than leukoplakia, Should be biopsied

Usually not painful, Lesion that does not heal in 2 weeks, Lump or thickening of cheak, Oral lesions red raised eroded areas

Squamous cell carcinoma

Founds on lips, tongue, buccal, mucosa, oropharynx, Slow growing, Leading type of oral cancer (primary cause is chemical irritation, i.e. alcohol, tobacco), Increased occurance: with peridontal disease with madibular bone loss, sun exposure, poor nutrition, poor oral hygiene

Occurs primarily on lips, Asymptomatic, Raised scab evolves into an uncler with raised pearly boarder

Bleeding from the mouth, Poor appetite, Difficulty chewing, Dysphagia (difficulty swallowing), Poor nutrition status/weight loss, Thick or absent saliva, Painless oral lesion that is red, raised or eroded, Thickening or lump in cheek

During a routine dentist exam

Biopsy, MRI- spread, CT- spread to liver or lungs

Surgical, Chemo, Radiation

No

Remove secretions, Respiratory assessment, Coughing/deep breathing, Cool mist face tent-oxygen, Semi-Fowlers, High Fowlers position, Encourage fluids

Local excision of small tumors, Glossectomy (removal of tongue, last resort), Mandibulectomy (removal of mandible), Hemiglossectomy (removal of part of tongue)

Radical neck dissection (removable of all tissue under skin from jaw to clavicle and anterior border of trapezius to midline, cervical lymph nodes, sternocleidomastoid muscle, spinal accessory nerve, jugular vein), Modified radical neck dissection (removal of soft tissue& lymph nodes only), COMMANDO procedure, part of mandible removed w/lesion usually combined with radical neck (COMbined MAndibuletomy and Neck Disection Operation), Will usual have a Trach and feeding tube post op

Pre-op teaching regarding post-op management of trach, communication, Maintain patent airway, Respiratory assessments, Protect suture lines from trauma (no toothbrush, frequent rinsing of oral cavity), Pain management, Nutrition

Acute Sialadentits

Make sure pt is well hydrated, Frequent oral hygiene, Warm compresses, Saliva substitute, Stimulate secretions (sugarless gum or hardy candy)

Form when glands inactive metabolic condition favors precipitation of salts, Local inflammation, swelling, pain, when gland stimulated to secrete as during chewing, Local excision required