Oropharynx Flashcards Preview

A - BNF CHAPTER 12: Ears, Nose and Oropharynx > Oropharynx > Flashcards

Flashcards in Oropharynx Deck (14)
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1
Q

xerostomia

A

Dry Mouth

2
Q

Dry mouth be caused by

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drugs with anti-muscarinic (anticholinergic) side effects (e.g. Antispasmodics, TCAs and some antipsychotics), by diuretics, by irradiation of the head and neck region or by damage to or disease of the salivary glands.

3
Q

Dry mouth treatment

A
  • Dry mouth may be relieved by having frequent sips of cool drinks or sucking pieces of ice. Artificial saliva can provide useful relief of dry mouth.
  • Pilocarpine tablets are licensed for dry mouth following irradiation of head and neck cancer, and for dry eyes + dry mouth (Sjogren’s syndrome). They are effective only in patients who have some residual salivary gland function, and therefore should be withdrawn if there is no response.
4
Q

Oral ulceration and inflammation

A

Secondary bacterial infection may be a cause of mucosal ulceration; which can increase discomfort and delay healing. Chlorhexidine mouthwash may help the healing of the mouth ulcer and Benzydamine hydrochloride + flurbiprofen are NSAIDs which can be useful in reducing discomfort in various ulcerative conditions. Patient can find the full-strength mouthwash can cause stinging, thus its recommended to dilute the solution with the same amount of water.

  • Chlorhexidine mouthwash should not be used for the prevention of endocarditis in patients undergoing dental procedures.
5
Q

Oropharyngeal bacterial infection

A
  • Most throat infections are caused by viruses and many do not require antibacterial therapy. Examples of oropharyngeal infections are Pericoronitis, Givigivitis; and the antibiotic of choice for most of them are Metronidazole or alternatively amoxicillin. Suggested duration of treatment 3 days or until symptoms resolve.
  • In SEVERE infections, initially parental therapy with benzylpenicillin, then oral therapy of Penicillin V (phenoxymethylpenicillin) or amoxicillin.
6
Q

• Sore throat treatment

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Phenoxymethylpenicillin: Suggested duration of treatment 5 to 10 days.If penicillin-allergic, clarithromycin (or erythromycin): Suggested duration of treatment 5 days.

7
Q

Periodontitis treatment

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• Metronidazole, or alternatively in adults and children >12y, doxycycline

8
Q

Abscess (periapical or periodontal) treatment

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• Antibacterial required only in severe disease with cellulitis or if systemic features of infection. Amoxicillin, or alternatively, metronidazole. Treatment = 5 days.

9
Q

Oropharyngeal fungal infection

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 Thrush is usually an acute infection but it may persist for months in patients receiving inhaled corticosteroid, cytotoxics or broad- spectrum antibacterials. If thrush is associated with corticosteroid inhalers, rinsing mouth out with water immediately after use could avoid this
 Treatment with Nystatin or miconazole may be needed. Miconazole is applied locally in the mouth, but it’s absorbed to the extent that potential interactions need to be considered (Warfarin)
 Fluconazole is effective for unresponsive infections or if topical antifungal drug cannot be used or if the patient has a dry mouth. If infection is resistant to fluconazole, then Itraconazole can be used. Topical treatment may not be effective is immunocompromised patient and oral triazole antifungals is preferred.

10
Q

Antiseptic mouthwashes are used to

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prevent oral candidiasis in immunocompromised patient and in the treatment of denture stomatitis.

11
Q

NOTE: if candida infection fails to respond to 1-2 weeks of antifungal treatment, …

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the patient should be sent for investigation to eliminate possible underlying disease. Persistent infections may be caused by reinfection from the GI tract or genitourinary. The patient partner may also need to be treated to prevent reinfection.

12
Q

Oropharyngeal Viral infection

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Viral infections are most commonly caused by a sore throat and they do not benefit from anti-infective treatment

13
Q

Oropharyngeal Viral infection - The management of primary herpetic gingivostomatitis is

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a soft diet, adequate fluid intake, and analgesics as required, including local use of benzydamine hydrochloride. The use of chlorhexidine mouthwash will control plaque accumulation if toothbrushing is painful and will also help to control secondary infection in general.

14
Q

Oropharyngeal Viral infection - In the case of severe herpetic stomatitis

A

A systemic antiviral such as aciclovir is required. Valaciclovir and famciclovir are suitable alternatives for oral lesions associated with herpes zoster. Aciclovir and valaciclovir are also used for the prevention of frequently recurring herpes simplex lesions of the mouth, particularly when implicated in the initiation of erythema multiforme.