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.

Tip #1: A Proper Diagnosis

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

Tip #2: MedicationsProper Application

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

Plumper Trays-Brown, RS et al. , 2012

Tip #3: HomecareYour Part in Treatment

Toothpaste/Dental Products

Dry Mouth

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*

Brushing can be painful

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

Chewing Gum/Lozenges

ã Dr. Terri Rees

How do you brush in areas

like this??

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

29

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.

“FLOSS GATE” 2011

• Decrease in visible plaque

• Gingival Bleeding

• Decrease in bacterial species

Even Chimps Floss

• https://youtu.be/AeOFUJSDoro

Tongue Cleaners

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 75246nburkhart@tamhsc.edu

The International Oral Lichen Planus Support Group https://dentistry.tamhsc.edu/olp/