THE PHARMACIST’S PERSPECTIVE
Common oral health disorders seen by the community pharmacist
EACH YEAR, October is observed as Oral Health Month in Jamaica. Yes, October has ended, however, as we celebrate Pharmacy week during November 20 to 26, 2022 and we wish to extend the discussions on good oral health. This article aims to sensitise the public to common oral disorders seen in our routine pharmacy practice. We will focus on canker sore (recurrent aphthous ulcers or stomatitis) and cold sores (fever blisters or herpes simplex labialis).
Recurrent aphthous ulcers (RAS) or canker sores
Canker sores are ulcerations on the movable mouth parts (tongue, floor of the mouth, soft palate, or inside lining of the lips and cheeks). It is not contagious but cannot be cured.
Approximately 80 per cent of patients with mouth ulcers present to the community pharmacy experiencing minor aphthous ulcers (MAU). MAU is more common in patients ages 10 to 40 years with young adults mostly affected (66 per cent).
MAU is linked to family history (40 per cent of cases). Triggers include stress, local trauma (eg, smoking, chemical irritation, biting the inside of the cheek or lips or injury caused by tooth brushing or braces), food sensitivities, nutritional deficiencies (iron, zinc, and vitamin B12), and infection.
How can you tell if you are experiencing MAU? The ulcers rarely occur on the gingival (gum) mucosa; instead, they appear on the inside of the cheeks, tongue and inside lips. Ulcers located towards the back of the mouth are more associated with major aphthous ulcers. They are painful, usually small (less than 1 cm in diameter), appear singularly or in crops, roundish or oval shaped, flat and shallow with a raised rim or a craterlike appearance, and gray or white in colour. At the start of an outbreak patients might experience pricking or burning at the site up two to 48 hours before the lesions appear.
Medicines, such as some cancer drugs, beta-blockers (used to manage high blood pressure), and painkillers classified as NSAIDs (nonsteroidal anti-inflammatory drugs) have been linked to the occurrence of mouth ulcers.
RAS will heal spontaneously if left untreated in 10 to 14 days or sometimes subsides after three to four days. Some lesions associated with major aphthous ulcers can take up to three to four weeks to heal.
Over-the-counter medication can support oral care during episodes of outbreak of RAS. Products might include those containing anaesthetics (lidocaine, benzocaine), antibacterial agents (chlorhexidine, benzydamine), antiseptic agents and protectants (pastes containing gelatin, pectin and carmellose sodium). Consult your pharmacist to see the age specification for available products.
COLD SORES (FEVER BLISTERS OR HERPES SIMPLEX LABIALIS)
Cold sores are infections caused by the herpes simplex virus (HSV) subtype 1 and can spread between infected and uninfected individuals. The virus sheds into saliva which increases the spread of the virus through activities, such as kissing or direct mucous membrane contact or exposure to abraded skin.
It is estimated that approximately 50 per cent of adults in the west are infected with HSV 1 although some might not manifest with symptoms. A total of five to 10 per cent of affected people might have six recurrences per year and 20 to 50 per cent will experience cold sores at some point in their life.
Symptoms manifest commonly at the junction of the oral mucosa and the skin of the lip, but can occur around and inside the nose. Symptoms include itching, burning, pain or tingling followed by an eruption of fluid-filled sacs or blisters. The lesions spontaneously resolve in seven to 10 days. Triggers linked to cold sore outbreak include exposure to sunlight (UV light) - 20 per cent of sufferers, stress, ill health, viral infection (eg, common cold), and menstruation.
Management of cold sores include prescription antiviral medicines (oral or topical, eg, acyclovir) and are more effective when started within the first 48 hours of the outbreak. Non-prescription topical creams and gels containing ingredients, such as urea, zinc, lidocaine, phenol, menthol, and docosanol can also be used.
Self-care best practices:
· Fever blisters (cold sore)
- Wash hands after touching a cold sore (fever blisters). - Replace your toothbrush. - Do not rub your eyes after touching your cold sore; Do not kiss someone who has a cold sore or use that person’s utensils, towels, or razors.
- Apply sunscreen to the face and lips before prolonged exposure to the sun.
- Replace your lipstick or lip balm.
· Canker sores
- Avoid extensive or prolonged use of oral debriding or wound-cleaning agents, such as products containing hydrogen peroxide and carbamide peroxide. These products should not be used for more than seven days and must be diluted prior to use.
RED FLAG
Report to your doctor if you are experiencing the following:
1. Painless mouth ulcers – possible link to serious conditions such as cancer.
2. Creamy white, soft-elevated patches on the tongue - a sign of oral thrush (fungus).
3. Fever accompanying mouth ulcers or lesions – a sign of a secondary bacterial infection.
4. Lesions not self-resolving and lasting more than 14 days, or lesions that spread away from the mouth or lips onto the face.
5. Patients experiencing lesions with weakened immune systems due to conditions such as HIV/AIDS, cancer or from taking immunosuppressive drugs.