Download Hebert Part 2

7/10/15 CELIAC DISEASE •  TOOTH ERUPTION -­‐ DELAYED IN UP TO 27% -­‐ POSSIBLY DUE TO MALNUTRITION •  ALTERED TOOTH ENAMEL DUE TO ALTERED MINERALIZATION OF THE PERMANENT DENTITION CELIAC DISEASE •  TOOTH ERUPTION -­‐ DELAYED IN UP TO 27% -­‐ POSSIBLY DUE TO MALNUTRITION •  ALTERED TOOTH ENAMEL DUE TO ALTERED MINERALIZATION OF THE PERMANENT DENTITION CELIAC DISEASE •  IMMUNE MEDIATED DISORDER CAUSED BY INGESTION OF GLUTEN AND RELATED PROTEINS IN GENETICALLY PREDISPOSED INDIVIDUALS •  CELIAC SPECIFIC AUTOANTIBODIES •  INFLAMMATORY ENTEROPATHY CELIAC DISEASE CELIAC DISEASE • 
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SHORT STATURE TURNER SYNDROME DOWN SYNDROME WILLIAM SYNDROME IgA DEFICIENCY TYPE I DIABETES MELLITUS CELIAC DISEASE •  HLA DQ2 •  HLA DQ8 16 7/10/15 CELIAC DISEASE DERMATITIS HERPETIFORMIS CELIAC DISEASE THE ASSOCIATION BETWEEN CELIAC DISEASE, DENTAL ENAMEL DEFECTS, AND APHTHOUS ULCERS IN A US COHORT JIANPENG C J CLIN GASTROENTEROLOGY VOL 44 (3): 191-­‐194, 2010 THERAPY OF APHTHAE • 
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OCCLUSIVES ANESTHETICS CLEANSING AGENTS/ANTISEPTICS MILD CAUTERY OR CAUSTICS TO DECREASE PAIN THERAPY OF APHTHAE OCCLUSIVES OR EMOLLIENTS: •  BLOCK IRRITATION OF ULCER AND ASSOCIATED NERVE ENDINGS •  SHIELD SITE FROM MECHANICAL IRRITATION PRODUCTS: •  ZILACTIN, ZILACTIN-­‐B •  ORABASE •  SOOTHE-­‐N-­‐SEAL 17 7/10/15 THERAPY OF APHTHAE PEMPHIGUS ANESTHETIC AGENTS •  BENZOCAINE 5 – 20% MUCOSITIS DIFFERENTIAL DIAGNOSIS: CHEMOTHERAPY, STEVENS JOHNSON VITAMINS / DIET •  VITAMINS, ESP B12 AND C, ZINC, IRON -­‐ MAY PREVENT RECURRENCE IN SOME INDIVIDUALS •  LYSINE -­‐ EQUIVOCAL •  GLUTEN FREE DIET -­‐ HELPFUL ONLY IN CELIACS -­‐ 5 % OF THOSE WITH RAS VITAMINS / DIET •  VITAMINS, ESP B12 AND C, ZINC, IRON -­‐ MAY PREVENT RECURRENCE IN SOME INDIVIDUALS •  LYSINE -­‐ EQUIVOCAL •  GLUTEN FREE DIET -­‐ HELPFUL ONLY IN CELIACS -­‐ 5 % OF THOSE WITH RAS THERAPY OF APHTHAE: CLEANSING AGENTS / ANTISEPTICS: DECREASE THE NUMBER OF BACTERIA ON ULCER SURFACE •  ORAGEL •  AMOSAN •  PEROXYL •  CANKAID •  GLY-­‐OXIDE •  3% HYDROGEN •  SODIUM BICARBONATE PEROXIDE DILUTED ONE TSP IN 4 OZ WATER 1:1 WITH WATER 18 7/10/15 SYMPTOMATIC THERAPY • 
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ANBESOL (lidocaine) KANK-­‐A ORABASE – B ORALIEF SENSO-­‐GUARD TANAC ZILACTIN B LIDOCAINE JELLY •  KIDS < 3 YRS -­‐ APPLY 1.25 ML ON QTIP NO MORE THAN Q 3 HOURS -­‐ MAXIMUM DOSE : 4 X Q 12 HOURS •  KIDS ≥ 3 YEARS – NOT TO EXCEED 4.5 MG/KG/DAY or 300 MG/
DOSE •  SWISH AND SPIT – NO MORE THAN Q 3 HOURS SYMPTOMATIC THERAPY •  HURRICAINE LIQUID (benzocaine 20%) •  QID for > 2 years of age; supervise those < 12 years NOTE: •  Overuse can: -­‐ delay healing -­‐ cause mucosal sloughing •  In young children – rare complica_on = methemoglobinemia SYMPTOMATIC THERAPY • 
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BENZOCAINE – ON Q TIP – 6.4 – 20 % NOT DEMONSTRATED IN CLINICAL TRIALS NOT SHOWN TO IMPROVE HEALING EXCESS USE NEUROTOXICITY APHTHAE SULCRAFATE SUSPENSION
•  IF POORLY TOLERATED: •  DILUTE WITH SALINE 1 : 1 •  OFTEN WELL TOLERATED IF DILUTED FOR TONSILAR APHTHAE EVALUATE FOR: DENTAL EROSIONS, GASTRO ESOPHAGEAL REFLUX, EATING DISORDERS 19 7/10/15 COMBINATION THERAPY • 
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ORABASE + 20 % BENZOCAINE (ORABASE B) ORABASE SOOTH –N –SEAL : CYANOACRYLATE SUPER GLUES: 2-­‐ OCTYL CRYOCYANATE or CYANOACRYLATE (ISO-­‐DENT) MUCOSITIS THERAPY •  ORAL BIOADHERENT CONTAINING POLYVINYLPYRROLIDINE AND SODIUM HYALURONATE GEL •  USED FOR PAIN CONTROL •  GELCLAIR mixed with 15 ml water, s_rred, rinsed around mouth, gargled, expectorated •  WAIT 30 – 60 MINUTES BEFORE EATING RECURRENT APHTHOUS STOMATITIS (RAS) •  IDENTIFY AND CORRECT PREDISPOSING FACTORS -­‐ avoid toothpaste with sodium lauryl sulfate •  BRUSH WITH A SMALL-­‐HEADED SOFT TOOTHBRUSH •  AVOID HARD OR SHARP FOODS -­‐ CHIPS, TOAST LICORICE • 
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GLYCYRRHIZA BIOADHESIVE HYDROGEL PATCH CANKERMELTS GX PATCH ENHANCES ULCER HEALING REDUCES PAIN CONTROVERSIAL THERAPIES •  SILVER NITRATE -­‐ CHANGES ULCER TO A BURN -­‐ BURN HEALS FASTER THAN THE ULCER •  BIOPSY -­‐ CHANGES AN IMMUNE MEDIATED ULCER TO A TRAUMATIC ULCER -­‐ ? LESS PAINFUL, HEAL FASTER THAN APHTHOUS SUMMARY : APHTHAE •  “ORPHAN DISEASE” •  NO ONE SPECIALTY “OWNS” THE PROBLEM •  NEED TO BE ABLE TO: -­‐ CATEGORIZE APHTHAE -­‐ CONSIDER SYSTEMIC ILLNESS -­‐ OFFER THERAPY 20 7/10/15 THERAPY OF APHTHAE FOODS TO AVOID: THERAPY OF APHTHAE: CAUSTIC AGENTS •  ORA5 •  CINNAMON •  BENZOIC ACID -­‐ PRESERVATIVE IN FOODS AND SOFT DRINKS MOUTHWASHES: MAY LESSEN PAIN DO NOT PREVENT RECURRENCES •  LISTERINE •  PERIDEX® •  PERIOGARD® TOOTHPASTES WITHOUT SODIUM LAURYL SULFATE: •  TOM’S OF MAINE •  SENSODYNE PRONAMEL MINT ESSENCE •  CLOSYS SULFATE-­‐FREE FLUORIDE (ROWPAR PHARMACEUTICALS) •  BURT’S BEE’S NATURAL REMBRANDT PREMIUM WHITENING MINT •  AUROMERE SLS FREE HERBAL •  CARDAMON-­‐FENNEL HERBAL TOOTHPASTES WITHOUT SODIUM LAURYL SULFATE: • 
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JASON NATURAL COSMETICS SQUIGLE ENAMEL SAVER – 36% XYLITOL KISS MY FACE KIDS BERRY SMART XYLIWHITE PLATINUM MINT 21 7/10/15 SJOGREN’S SJOGREN’S SJOGREN’S SJOGREN’S XYLITOL SECRETOGOGUE THERAPY •  NATURAL SWEETENER •  NOT EASILY USED AS A FOOD SOURCE BY BACTERIA •  ACTUALLY INTERFERES WITH GROWTH OF BACTERIA KNOWN TO CAUSE TOOTH DECAY •  FDA APPROVED AS A THERAPEUTIC SWEETENER •  SAFE • 
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PILOCARPINE (SALAGEN, MGI PHARMA) CEVIMELINE (EVOXAC, DAIICHI SANKO, INC) BOTH APPROVED FOR SJOGREN’S PILOCARPINE APPROVED FOR POST XRT XEROSTOMIA 22 7/10/15 PILOCARPINE •  PARASYMPATHOMIMETIC ALKALOID •  NON SELECTIVE MUSCARINIC RECEPTOR IN THE PARASYMPATHETIC NERVOUS SYSTEM •  ACTS THERAPEUTICALLY AT THE MUSCARINIC ACETYLCHOLINE RECEPTOR M3 XEROSTOMIA: GUM • 
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THERAGUM (OMNII) TRIDENT GUM WITH XYLITOL (WARNER-­‐LAMBERT) XPONENET XYLTIOL GUM (GLOBAL SWEET POLYOIS) XYLITOL GUM POWER BITE (ROCKY MOUNTAIN HERBALS) CAREFREE KOOLERZ (HERSHEY) XEROSTOMIA: MINTS/LOZENGES/CANDIES • 
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THERAMINTS (XYLICHEW) XYLITOL MINTS (NATURE’S SWEET LIFE) XYLITOL MINTS (XPONENT) XYLITIOL PEPPERMINT MINTS (BIOGENESIS) XEROSTOMIA: GUMS •  BIOTENE DRY MOUTH GUM (GSK) •  ELIMITASTE (ZAPP GUM) •  RICOCHET GUM (EMERALD FORREST) •  THERABREATH ZOX MINTS (THERABREATH) XEROSTOMIA: MINTS/LOZENGES/CANDIES •  MINI MINTS (SOLARAY) •  RICOCHET FRUIT SOURS AND MINTS (EMERALD FOREST) •  SPRY MINTS (XLEAR) •  THAYERS SUGAR FREE CITRUS DRY MOUTH LOZENGES (THAYER) XEROSTOMIA: SALIVA SUBSTITUTES MOISTURIZING SPRAYS/GELS •  BIOTENE ORAL BALANCE MOISTURIZING GEL & DRY MOUTH LIQUID (GSK) •  ENTERTAINER’S SECRET (KLI CORP) •  MOI-­‐STIR (KINGWOOD LABS) •  MOIST PLUS MOUTH MOISTUIRIZER (SAGE PRODUCTS) •  MOUTH KOTE (PARNELL PHARMACEUTICALS) 23 7/10/15 XEROSTOMIA: SALIVA SUBSTITUTES MOISTURIZING SPRAYS/GELS • 
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OASIS MOISTURIZING MOUTH SPRAY (GSK) SALIVA SUBSTITUTE (ROXANE LABS) SALIVART ORAL MOISTURIZER (GEBAUER CO) THERASPRAY (OMNI PHARMACEUTICALS) ALCOHOL FREE MOUTH RINSES •  BIOTENE MOUTHWASH (GSK) •  CREST PRO-­‐HEALTH RINSE (PROCTOR AND GAMBLE) •  ECO-­‐DEN T ULTIMATE NATURAL DAILY RINSE (ECO-­‐DENT) ALCOHOL FREE MOUTH RINSES •  OASIS MOISTURIZING MOUTHWASH (GSK) •  NATURAL ACTICAVITY FLUORIDE MOUTHWASH FOR A DRY MOUTH (TOMS OF MAINE) XEROSTOMIA: SALIVA SUBSTITUTES MOISTURIZING PATCH • 
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ORAMOIST (DENTEK) CONTAINS XYLITOL PLACE PATCH ON HARD PALATE HOLD IN PLACE 10 SECONDS WILL ADHERE FOR 4 HOURS USE UP TO 3 PATCHES PER DAY HOW DO THESE MOUTHWASHES WORK TO RESTORE AND RETAIN MOISTURE? •  CREATE A PHYSICAL FILM THAT PROTECTS AND SOOTHES THE ORAL MUCOSA •  CONTAINS THE SAME TYPE OF ENZYMES AND PROTEINS FOUND NATURALLY IN SALIVA •  NOT MEANT TO BE SWALLOWED XYLITOL •  NATURAL SWEETENER •  NOT EASILY USED AS A FOOD SOURCE BY BACTERIA •  ACTUALLY INTERFERES WITH GROWTH OF BACTERIA KNOWN TO CAUSE TOOTH DECAY •  FDA APPROVED AS A THERAPEUTIC SWEETENER •  SAFE 24 7/10/15 MYCOPLASMA PNEUMONIA-­‐INDUCED RASH AND MUCOSITIS AS A SYNDROME DISTICT FROM STEVENS-­‐
JOHNSON SYNDROME MYCOPLASMA INDUCED MUCOSITIS CACAVAN TN,MATHESEF, FRIEDENI, SHINKAI S JAAD FEB 2015 VOL 72(2)PP239-­‐245 MYCOPLASMA INDUCED MUCOSITIS SEVERE MYCOPLASMA PNEUMONIA TREATED WITH IMMUNOGLOBULINS MYCOPLASMA INDUCED MUCOSITIS ALLERGIC CONTACT DERMATITIS IVIG 0.5 MG/KG/DAY FOR 4 DAYS ACTA PAEDIATR 2011 NOV;100(11):e 238-­‐40 BRESSAN S, MION T, BISOGNO G, DA DALT L 25 7/10/15 WHAT TOOTHPASTE IS LEAST LIKELY TO CAUSE ALLERGIC CONTACT DERMATITIS? WHAT CAUSES THESE SPOTS ON THE INCISORS? FLUOROSIS: POOR CALCIFICATION OF ENAMEL WHEN TEETH ARE FORMED OTHER CAUSES OF WHITE SPOTS ON THE INCISORS •  CELIAC DISEASE – AFFECTS UP TO 4% OF THE POPULATION •  UP TO 89% OF THOSE WITH CELIAC DISEASE HAVE ENAMEL PROBLEMS •  EXCESSIVE USE OF WHITENING STRIPS 26 7/10/15 FLUORIDE FREE TOOTHPASTE PERIFERAL OSSIFYING FIBROMA OCCURS IN TEENAGERS AND YOUNG ADULTS PERIFERAL OSSIFYING FIBROMA OCCURS IN TEENAGERS AND YOUNG ADULTS PERIFERAL OSSIFYING FIBROMA DIFFERENTIAL DIAGNOSIS: •  PYOGENIC GRANULOMA •  PERIFERAL GIANT CELL GRANULOMA PERIFERAL OSSIFYING FIBROMA DENTAL BOOKS ONLINE SHARMA S PERIFERAL OSSIFYING FIBROMA •  ARISES FROM THE GINGIVA ADJACENT TO THE TEETH •  IF ARISES BETWEEN THE TEETH, MAY SEPARATE THE TEETH AND PRODUCE PRESSURE RESORPTION OF INTERDENTAL BONE •  ETIOLOGY = UNKNOWN •  TX = EXCISION; 15% RECURRENCE RATE 27 7/10/15 BRUXISM •  NON FUNCTIONAL CLENCHING OR GRINDING OF THE TEETH •  RUBBING OF TEETH DURING NON FUNCTIONAL MOVEMENTS OF THE MASTICATORY SYTEM •  ETIOLOGY ? •  INVOLUNTARY BRUXISM BRUXISM •  TYPICAL: -­‐ DAYTIME : CLENCH -­‐ NIGHTIME: GNASH AND CLENCH THERAPY: •  OCCLUSION ADJUSTMENT •  INTEROCCLUSAL APPLIANCE •  BEHAVIORAL MODIFICATION BRUXISM J CANADIAN DENTAL ASSOC 72(21):2006:155-­‐60 PRIMARY DENTITION IS MINERALIZED 4% LESS THAN SECONDARY DENTITION BRUXISM PRIMARY DENTITION IS MINERALIZED 4% LESS THAN SECONDARY DENTITION TUBEROUS SCLEROSIS J CANADIAN DENTAL ASSOC 72(21):2006:155-­‐60 28 7/10/15 TUBEROUS SCLEROSIS NEUROFIBROMATOSIS I
THERAPY WITH m TOR INHIBITORS: -­‐ ORAL ULCERATION = COMMOM COMPLICATION ORAL ULCERS NEUROFIBROAMTOSIS I THERAPY WITH m TOR INHIBITORS MUCOSITIS
•  PEMPHIGUS •  STEVENS JOHNSON SYNDROME •  LICHEN PLANUS 29 7/10/15 LICHEN PLANUS PEMPHIGUS CHEILITIS DUE TO ORAL RETINOIDS CHEILITIS DUE TO ORAL RETINOIDS
• AQUAPHOR • CHAP STICK • DCT • CARMEX SMILING HERPES SIMPLEX
•  WOMEN SMILE 62 TIMES PER DAY •  MEN SMILE 8 TIMES PER DAY 30