INTERESSADA: Tricya Freimanis EMENTA: Regulariza a vida escolar da aluna Yasmin Freimanis Pazzine RELATORA : Marta Cordeiro Fernandes Vieira SPU Nº 09062909-4 PARECER Nº 0088/2009 APROVADO EM: 14.04.2009 I – RELATÓRIO Na condição de mãe, Tricya Freimanis, mediante o processo nº 09062909-4, solicita a este Conselho a reclassificação de sua filha Yasmin Freim
Helpful prescriptionsUseful Prescriptions for Common Oral Diseases: 2013
John R. Kalmar, DMD, PhD
The Ohio State University College of Dentistry The following are examples of prescriptions for medications used in treating the common oral disorders. Cost information, as provided by the OSU Wexner Medical Center Walgreen’s pharmacy, is for comparison purposes only. Pricing and availability will vary.
Herpes simplex virus (HSV, HHV-1 and -2)
Must be recognized during the first 2-3 days, otherwise the beneficial effect of the antiviral medication will be minimal. Popsicles helpful for pain, especially in younger patients. Take 2 initially, then 2 at 12 h, and 1 at 24 h Take 4 initially, then 2 at 12 h and 1 at 24 h Recurrent herpes labialis (must start at the earliest prodromal symptom)
Combined use of systemic and topical may be most efficacious.
Take 2 initially, 2 at 12 h, then 1 at 24 hr Take 4 initially, then 2 at 12 h and 1 at 24 h Disp: 5 gm tube (pricey, due to large tube volume) Apply thin film to lesion q4h while awake for 2 days Apply thin film to lesion q4h while awake for 2 days Varicella (VZV, HHV3) Primary lesions (chickenpox) should be a thing of the
past due to the varicella vaccine. This virus is less susceptible to antiviral drugs
compared to HSV; consequently the therapeutic dose is 5 times greater.
Herpes Zoster (Shingles)
Take 5 initially, then 5 q 12 h until gone Note: Zoster affecting the tip of the nose suggests involvement of the
nasociliary nerve, with potential ocular lesions. This is an ophthalmologic
emergency and should be managed by an ophthalmologist.
Coxsackie virus infections (herpangina; hand, foot and mouth disease)
Supportive care is generally adequate, including ibuprofen or acetominophen for pain/fever.
Minor or Major Aphthae
Diprolene (betamethasone dipropionate) gel Apply a thin film to lesion, 4-6 x qd, as early in Apply a thin film to lesion, 4-6 x qd, as early in Apply a thin film to lesion, 4-6 x qd, as early in Patient may consider applying a thin protective film of OTC product (such as Zilactin) over the lesion, after placement of steroid. Herpetiform Aphthae
Decadron (dexamethasone) elixir (0.5 mg/5 ml) 1 tsp. as mouth rinse, then expectorate, bid Prelone (prednisolone) syrup (15 mg/5 ml, adult dose) Use 1 tsp. as mouthrinse, then expectorate, bid Use 1 tsp. as rinse, then expectorate, tid
This is a systemic disease that should be managed by someone with experience using systemic immunosuppressive drugs. Topical
therapy is not indicated in the treatment of pemphigus.
Mucous Membrane (Cicatricial) Pemphigoid
Doxycline (tetracycline is unavailable) and niacinamide regimen
Niacinamide 250 mg (up to750 mg) available OTC Disp: 120 Corticosteroid preparations
Apply a thin film to lesion, 4-6 x qd, as early in Decadron (dexamethasone) elixir (0.5mg/5 ml) 1 tsp. as mouth rinse, then expectorate, bid Apply a thin film to lesion, 4-6 x qd, as early in Apply a thin film to lesion, 4-6 x qd, as early in
Erosive lichen planus
Apply a thin film to lesion, 4-6 x qd, as early in Apply a thin film to lesion, 4-6 x qd, as early in Apply a thin film to lesion, 4-6 x qd, as early in
Take 2 tablets on Day 1, then 1 qd until gone Use 2 tsp as a mouthrinse, holding it in the mouth for as long as possible, then swallow, 5 x qd Angular cheilitis presentations (must exclude or treat concomitant intraoral
candidiasis, if present)
Iodoquinol and hydrocortisone cream (Vytone) Xerostomia
OTC Oral Balance Liquid or Spray (Biotene)
(web address to receive dry mouth kits from Laclede) OTC Oasis Moisturing Mouth Spray (Sensodyne)
OTC MedOral Dry Mouth Spray (MedActive)
OTC Orajel Dry Mouth Moisturing Gel (Church & Dwight)
Take one tid (may be increased to 2 tid if necessary and side effects are tolerated) Xerostomia addendum
The following patient recommendations are provided courtesy of Dr. Susan Zunt,
Indiana University-Purdue University Indianapolis College of Dentistry. Dr. Zunt
has an active clinical practice with a special interest in the management of
patients with dry mouth.
3 principles of treatment in dry mouth management:
1. Establish normal salivary flow if possible. Maximize suboptimal salivary flow.
2. Adequate hydration every day, no exceptions. 72 hour cycle to saliva production.
3. Lubricate, if needed.
1. Establish normal salivary flow rate if possible. Maximize possible salivary flow if unable to
normalize. Do you have functional salivary gland tissue? Effectiveness of pilocarpine (Salagen)
and cevimeline (Evoxac) is dependent on the presence of functional glandular tissue. They are
most effective in the early stages of SS before inflammation causes significant salivary gland
dysfunction and destruction. It may take several months of medication before improvement in
salivary output can be appreciated. (Al-Hashimi 2008). See your dentist or physician for these
prescription medications. Prescription secretagogue medications may improve eye moisture in
RX: Pilocarpine (Salagen) 5 mg, 4x daily
RX: pilocarpine 7.5 mg 4x daily or 10 mg (two 5 mg tabs) 4x daily
RX: cevimeline (Evoxac) 30 mg 3x daily. Some patients can tolerate 60 mg 3x daily.
Off label use: pilocarpine gargle RX: pilocarpine 1% solution by volume, 600 ml, Gargle with 1
teaspoon for 2 minutes, 4x daily. Refill one year. (Bernardi R, et al. 2002)
2. Adequate hydration every day, no exceptions. (72 hr saliva production cycle, Dawes 1996)
Sip 64 oz. water daily or take your body weight divided by 2, and that is a more accurate number
of ounces of water needed per day. Tap water or filtered tap water best. Let ice chips melt in
mouth—do not chew ice chips.
Avoid alcohol and alcohol containing mouthwash unless prescribed by your dentist or physician.
Alcohol is drying and an irritant.
Restrict caffeine intake. Use decaffeinated coffee and tea, and caffeine free beverages.
Avoid acidic (low pH) beverages such as soda or flavored water, etc. If you drink low pH
beverages sip with straw to protect teeth. Do not brush teeth for an hour after drinking low pH
beverages because the enamel has been softened. Baking soda in water can rapidly neutralize
acidic pH. Your dentist may want to prescribe daily topical brush on fluoride, such as neutral
1.1% sodium fluoride gel.
3. Lubricate, if needed.
OTC (use as needed, do not interfere/react with prescription medications, and NO side effects)
Patient can try several until they find the one they prefer.
Oral Balance (Glaxo) mouthwash, gel, liquid and spray.
Orajel (Del Pharmaceuticals) dry mouth moisturizing gel.
Oasis (Gebauer) Moisturizing Mouth Spray
Moi-Stir Mouth Moistening Spray (Kingswood Labs)
Saliva Substitute (Roxane)
Salivart Synthetic Saliva (Gebauer Co.)
Stopper4 Dry Mouth Spray (Woodridge Labs)
Entertainer’s Secret Throat Relief (KLI Corp, Carmel IN)
OTC Saliva Sure (saliva substitute tablets (Scandinavian Pure & Naturals)
Rain mouth spray (Xlear, Inc., xylitol, spearmint, Aloe vera, calcium glycerophosphate)
Salese (Nuvora, soft slow dissolving lozenge) Nuvora, 877-429-2646, Dissolves very slowly-1hr MI Paste [Casein Phosphopeptite (CPP) and Amorphous Calcium Phosphate (ACP)] Amazon.com or ask dentist to order from GC America. OraMoist Dry Mouth Disc (Quantum) gives up to 4 hours relief, adheres to palate (Rite Aid, Duane Reade, Health Food Stores, Walgreens, CVS online)
Thera Tears (Omega 1000 mg flaxseed oil, 450 mg eicosapenaenoic acid (EPA), 300 mg
docosahexaenoic acid (DHA), 163 mg vitamin E as di-alpha tocopherol, 20 mg mixed tocopherol
concentrate, Helps dry eyes, some suggestion that it helps dry mouth.et al. 2010)
Both wheat germ ( 2064 mg daily) and Thera Tears (1935 mg daily) Increased unstimulated and
stimulated salivary flow at 3 months, decreased bleeding on probing and probing depths > 4mm,
and decreased sensation of oral dryness. In this pilot study, supplementation with n-3 was not
found to be significantly better than wheat germ oil in stimulating saliva production in patients with
New information for patients recently diagnosed with primary Sjogren’s syndrome. Rituximab
is a monoclonal antibody that binds to surface antigen B20 and depletes 95% of these circulating
lymphocytes. It has been shown to improve saliva secretion and comfort levels in patients with
primary Sjogren’s syndrome. 20 patients were given1000 mg IV on days 1 and 15, and there
were 10 controls. Most improvement occurred at weeks 12-36 following treatment and lasted 6-9
months. Rituximab was considered to be effective and safe. (Meijer JM et al. Arthritis
Rheumatism 2010) Another study reported that rituximab reverses salivary gland injury. (Pijpe J
et al. Arthritis & Rheumatism 2009) and retreatment is effective. (Meijer JM et al. Ann Rheum
Dis 2009). The glands treated with rituximab exhibited reduced gland inflammation, re-
differentiation of lymphoepithelial duct lesions to regular striated ducts, and normalization
(decrease) of the salivary sodium content. Discuss Tx with your rheumatologist.
Prescription RX: Aquoral (Auriga Pharmaceuticals) artificial saliva spray, 40 ml bottle; 2-3 sprays, 3-4x daily. RX: Numoisyn (Align Pharmaceuticals) lozenges #300, one as needed for dry mouth (if able to make saliva) RX: Numoisyn (Align Pharmaceuticals) liquid, 300 ml, 2 ml. prn (best if little or no saliva) RX: Caphosol (EusaPharma) artificial saliva and remineralizing solution 4 boxes, Mix and use for 1 min, spit, repeat, 4x daily. RX: NeutralSal (Invado Pharmaceticals, supersaturated calcium phosphate rinse) #300, one packet in 1 oz. water, Swish 1 min. spit out. Repeat. 4-10x daily. Lip balms for dry lips (use sparingly), Vaseline 4x daily; OTC Aquaphor 3-4x daily; OTC Lansinoh pure lanolin 3-4x daily, Burt’s Bees Beeswax lip balm. New: Australian Golden Lip Balm (pure lanolin), ChopSaver (Kroger). Use sodium lauryl sulfate-free toothpaste: Biotene toothpaste for dry mouth, Orajel toothpaste for dry mouth. Biotene Sensitive toothpaste is mint free. Most Sensodyne toothpastes are OK except Repair and Protect (contain SLS). Pronamel toothpaste is SLS-free.
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