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Compounding for the Dental Patient: A Focus on Ulcers of the Mouth

Author(s):  Bassani August S, Keim David

Issue:  Nov/Dec 2004 - Endotoxin
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Abstract:  Many unique therapeutic challenges in dentistry call beyond the realm of commercially available solutions. As a partner-in-care, the compounding pharmacist has the potential to make significant contributions to the care of dental patients. One area in which this is particularly true is the common oral ulcers, especially recurrent aphthous stomatitis (canker sores), herpes simplex ulcers (cold sores), and lichen planus. The most common symptom of these conditions is pain. Treatment strategies include decreasing exposure to predisposing factors or infectious agents (by educating patients) and managing symptoms. Topical therapies are usually adequate in all but the most severe or widespread ulcers. Mucosal adhesion of topical therapies is a problem that can be overcome in some patients by use of a “mucosal bandage,” which is applied as a dry powder and turns to an occlusive gel on hydration. The gel protects the ulcer while it heals and may include anti-infective, anti-inflammatory, wound healing, and analgesic components. Other dosage forms, such as traditional gels or rinses, containing similar components may be more appropriate for some patients. In the initial, acute stage of herpes simplex infection, analgesics may be needed to treat fever and pain. Recurrent herpes ulcers of the lip (herpes labialis), however, usually can be treated with customized lip balm or ointment containing sunscreen as well as anti-infective, anti-inflammatory, and analgesic agents. Although lichen planus may cause no symptoms, the ulcerative form often causes severe pain. Systemic steroids are required in some patients to reduce pain and inflammation, but topical preparations have a tole in symptom relief (eg, anti-inflammatory agents) and modulation of the immune system (eg, mast-cell stabilizers, inhibitors of tumor necrosis factor alpha).

Related Keywords: Gus Bassani, PharmD, mouth ulcers, aphthous ulcers, aphthous stomatitis, herpes simplex, herpes labialis, lichen planus, formulation, misoprostol mucoadhesive anesthetic powder


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