What are the treatments for various oral health issues?

Comprehensive Treatments for Oral Health Issues

The most effective treatment approach for oral health issues involves a structured daily oral hygiene routine including brushing teeth four times daily with a soft brush, using alcohol-free mouthwashes, and maintaining proper denture care to prevent tissue injury, infections, and associated complications. 1

General Oral Hygiene Measures

Daily Oral Care Protocol

• Inspect oral mucosa daily for abnormalities
• Brush teeth and gums with a soft toothbrush after meals and before sleep (4 times daily)
• Use mild fluoride-containing, non-foaming toothpaste
• Replace toothbrush monthly to prevent bacterial accumulation
• Rinse with alcohol-free mouthwash upon awakening and at least four times daily
• Maintain adequate hydration to keep the mouth moist 1

Pain Management

• For mild pain: Topical anesthetics such as 2.5% lidocaine ointment
• For moderate pain: Viscous lidocaine 2%
• For severe pain: Follow WHO pain management ladder with systemic analgesics 2

Specific Treatments by Condition

Oral Mucosal Infections

Fungal Infections (Candidiasis)

• First-line treatment: Topical antifungal agents
  • Clotrimazole 1% cream applied 3-4 times daily for 7-14 days
  • Miconazole 2% cream applied 3-4 times daily for 7-14 days 2
• For HIV-infected patients with candidal angular cheilitis:
  • Clotrimazole troches (10 mg) dissolved 5 times daily or
  • Miconazole mucoadhesive tablets 2

Bacterial Infections

• For oral bacterial infections: Amoxicillin (for susceptible strains)
  • Adults: 750-1750 mg/day divided every 8-12 hours
  • Children: 20-45 mg/kg/day divided every 8-12 hours 3
• Use antiseptic oral rinse twice daily:
  • 1.5% hydrogen peroxide mouthwash or
  • 0.2% chlorhexidine digluconate mouthwash 2

Oral Mucositis in Cancer Patients

Preventive Measures

• For patients receiving bolus 5-fluorouracil: 30 minutes of oral cryotherapy 1
• For patients receiving high-dose chemotherapy with stem cell transplant: Recombinant human keratinocyte growth factor-1 (KGF-1/palifermin) at 60 μg/kg/day for 3 days before conditioning and 3 days after transplant 1
• For patients receiving HSCT with high-dose chemotherapy: Low-level laser therapy (wavelength 650 nm, power 40 mW, tissue energy dose 2 J/cm²) 1

Pain Management

• Patient-controlled analgesia with morphine for severe mucositis pain 1
• Avoid painful stimuli:
  • Smoking
  • Alcohol
  • Acidic foods (tomatoes, citrus fruits)
  • Spicy, hot, raw, or crusty foods 1

Denture-Related Issues

Proper Denture Care

• Remove dentures before performing oral care
• Brush dentures with toothpaste and rinse with water
• Clean gums after removing dentures
• Defer wearing dental prostheses until oral tissues heal
• Soak dentures for 10 minutes in antimicrobial solution (e.g., 0.2% chlorhexidine) before insertion 1, 4

Management of Ill-Fitting Dentures

• Regular dental check-ups every 6 months to assess fit 1
• Replace dentures that are more than 5 years old, as they are associated with higher rates of complications 5
• For gingival ulcers due to ill-fitting dentures:
  • Remove denture immediately
  • Apply local corticosteroid (betamethasone)
  • Use oral antiseptic (chlorhexidine digluconate) three times daily 6

Special Considerations

For Patients with X-Linked Hypophosphataemia

• Treat with active vitamin D and phosphate supplementation to improve dentin mineralization
• Schedule dental visits every 6 months
• Seal pits and fissures with flowable resin composite on both temporary and permanent teeth
• Perform thorough clinical investigation for pulp necrosis 1

For Cancer Patients on Targeted Therapy

• Use saline-containing mouthwashes instead of plain water
• For Grade 1 stomatitis: Continue EGFR-TKI with supportive care
• For Grade 3 stomatitis: Discontinue EGFR-TKI, provide supportive care, consider hospitalization
• For Grade 4 stomatitis: Seek specialist dermatology assessment 2

Follow-Up and Monitoring

• Most cases of angular stomatitis should resolve within 7-14 days with appropriate treatment
• If no improvement within 7 days, reassess for other contributing factors
• Follow-up every 3-6 months for persistent symptomatic cases
• Monitor for changes in appearance that could suggest malignant transformation 2

Common Pitfalls to Avoid

1. Using alcohol-based mouth rinses that can cause further irritation
2. Chronic use of petroleum jelly on lips (promotes mucosal dehydration and risk of infection)
3. Starting interdental cleaning during cancer therapy if not previously part of routine
4. Neglecting denture hygiene, which can lead to oral infections and mucosal inflammation
5. Delaying replacement of old dentures (>5 years), which increases risk of complications 1, 5