Matt Dickie Significantly limited spectrum of antifungal and antiviral drugs when compared to the range of antibiotics Essentially there are three antifungal agents and 2 antiviral agents Introduction ID: 911223
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Slide1
THE ROLE OF ANTIFUNGAL AND ANTIVIRAL AGENTS IN PRIMARY DENTAL CARE
Matt
Dickie
Slide2Significantly limited spectrum of antifungal and antiviral drugs when compared to the range of antibiotics.
Essentially there are three antifungal agents and 2 antiviral agents.
Introduction
Slide3Two main types:Polyenes
1950s
Interacts with fungal cell wall causing loss of cytoplasmic content.Poorly absorbed in the gut- (topical use required)
Lozenge or oral suspension
Poor compliance due to tasteNYSTATIN ORAL SUSPENSION (100,000 units/ml)
Anti Fungals
Slide4Azoles1970s+1980s
Inhibits biosynthesis of
ergosterol (Component of cell wall)Fungistatic
action
Underlying cause needs addressed at the same timeMiconazole is poorly absorbed- topical useMICONAZOLE OROMUCOSAL GEL 20mg/g
Fluconazole is well absorbed- systemic useFLUCONAZOLE CAPSULES 50mg
Anti
Fungals
Slide5Interactions
Slide6Things to look out for
Slide7Pseudomembranous
Acute Erythematous
Chronic Erythematous (Denture Stomatitis)
Chronic Hyperplastic
Angular
Cheilitis
Candidosis
“ The disease of the diseased”
Slide8White plaque like lesion- can be wiped offSoft palate and buccal
mucosa most frequent
Most likely cause in primary care is use of a Corticosteroid inhaler Advise to rinse mouth following use.
If no resolution following local measures then:
Fluconazole 50mg capsule, once daily for 7 days.If Fluconazole contraindicated then:Nystatin
(100,000units/ml) 1ml after food, 4 times daily for 7 days
Pseudomembranous
Slide9Uncomfortable erythematous patches on oral mucosa
Typically dorsum of tongue
Frequently related to broad spectrum antibiotics
Resolution on completion of antibiotic course
Alternatively fluconazole can be prescribed as before.
Fluconazole 50mg capsule, once daily for 7 days.Miconazole can also be prescribed and used topically
Miconazole
oromucosal
gel 20mg/ml, pea sized amount 4 times dailyAgain if azoles contraindicated then Nystatin.Acute Erythematous
Slide10Most frequent form in primary careErythema of mucosa beneath partial or complete denture.
Most
pt’s unaware of signsPredisposing factors include nocturnal wear and/or poorly fitting appliances
Local measures include improving denture hygiene
Immersion in dilute sodium hypochlorite for 15mins twice dailyAlternatively Chlorhexidine 0.2% if any metal components.
Removal of denture as much as possible during the process.
Chronic Erythematous
“Denture Stomatitis”
Slide11Miconazole gel can be applied to the fitting surface of the denture 4 times/day
A new denture maybe require if there has been
hyphal infiltration into the fitting surface of the acrylic.
Why this patient?
Why now?Has then been any changes that might need investigated?Poorly controlled or undiagnosed diabetes for example
Chronic Erythematous
“Denture Stomatitis”
Slide12Most prevalent in middle aged men that are smokers.Generally asymptomatic
If untreated then 5-10% undergo malignant change
Clinically: bilateral white patch at the commissures of the mouth.Histologically: hyphal
invasion of epithelium
Systemic FluconazoleSmoking cessation required. Recurrence common with continued smokingRefer for specialist assessment (Incisional biopsy)
Chronic Hyperplastic
Slide13Corners of the mouth Typically candidal
and bacterial infection
Related to intra-oral infectionElimination of intra-oral
candidal
infectionTopical application of miconazole gel, which has dual action on candida and gram positive bacteriaIf a lack of response then refer
? Haematinic deficiency or diabetes issueAngular
Cheilitis
Slide14Drug therapys are a great adjunct to treatment
However, main focus must be to identify and eliminate the underlying predisposing factors to prevent reoccurrence.
On many occasions primary dental care may be the patients initial presentation.
Opportunistic Infections
Slide153 groups to consider in primary care
Herpes
HSV-1: primary herpetic gingivostomatisRecurrent herpes
labialis
Varicella Zoster: ShinglesHPVOrofacial warts or papiloma
Oropharyngeal SCCCoxsachieHand foot and Mouth
Herpangina
However, antivirals
arent
prescribed for HPV or coxsachieViral Infections
Slide16Aciclovir and penciclovir
are the drugs of choice.
Work by inhibiting the replication of the virus.Therefore needs to be taken as early as possible.
Furthermore, they need to be taken frequently due to the short half life inside the cells.
Anti Virals
Slide17Young childrenNo antivirals routinely prescribed
Importance placed on
maintance of fluid levels, analgesics and a soft diet.Furthermore chlorhexidine can be utilised to help with plaque control.
Typical resolution in 10-14 days.
Primary Herpetic Gingivostomatitis
(PHGS)
Slide1830% of pt's
who have had PHGS will suffer from this.
Most commonly lipsCan affect any part of the face
Typical cycle:
Prodomal tingleBlisterErosionCrusting
Healing within 7-14 days
Secondary Herpes Simplex Infection
"
Cold sore
"
Slide19Topical Aciclovir 5%, 5 times daily on affected area.
Is still effective in the blister stage.
If pt very susceptible then prophylactic systemic Aciclovir 200mg
can be prescribed.
3 time daily for 3 monthsSecondary Herpes Simplex Infection
"
Cold sore"
Slide20Affect Sensory NervesCan affect the Trigeminal Nerve (CN5)
If
mand or max branch then ? Tooth ache like symptoms
May present before mucosal or cutaneous lesions.
Lack of obvious pathology then consider shinglesTreatment:AnalgesicsAciclovir 800mg, 5 times daily, 7 days
Zaricella
Zoster Reactivation
"Shingles"
Slide21Thanks for listening