DISORDERS OF THE LIPS, MOUTH, AND GUMS

Condition Abnormalities of the Lips Actinic cheilitis Signs and Symptoms Irritation of lips associated with scaling, crusty, ssure; white overgrowth of horny layer of epidermis (hyperkeratosis) Considered a premalignant squamous cell skin cancer Possible Causes Exposure to sun; more common in fair-skinned people and in those whose occupations involve sun exposure, such as farmers May lead to squamous cell cancer Nursing Considerations Teach patient importance of protecting lips from the sun by using protective ointment such as sun block Instruct patient to have a periocheckup by physician

Herpes simplex 1 (cold sore or fever blister)

Symptoms may be delayed up to 20 days after exposure; singular or clustered painful vesicles that may rupture

An opportunistic infection; frequently seen in immunosuppressed patients; very contagious May recur with menstruation,fever,or sun exposure

Use Acyclovir (Zovirax) ointment or systemic medications as prescribed Administer analgesics as prescribed Instruct patient to avoid irritating foods

Chancre

Reddened circumscribed lesion that ulcerates and becomes crusted

Primary lesion of syphilis; very contagious

Comfort measures: cold soaks to lip,mouth care Administer antibiotics as prescribed Instruct patient regarding contagion

Contact dermatitis

Red area or rash; itching

Allergic reaction to lipstick, cosmetic ointments, or toothpaste

Instruct patient to avoid possible causes Administer corticosteroids as prescribed

Abnormalities of the Mouth Leukoplakia White patches; may be hyperkeratotic; usually in buccal mucosa;usually painless Fewer than 2% are malignant, but may progress to cancer Common among tobacco users Instruct patient to see a physician if leukoplakia persists longer than 2 weeks Eliminate risk factors, such as tobacco

Hairy leukoplakia

White patches with rough hair-like projections; typically found on lateral border of the tongue

Possibly viral; smoking and use of tobacco Often seen in people who are HIV positive

Instruct patient to see a physician if condition persists longer than 2 weeks

Lichen planus

White papules at the intersection of a network of interlacing lesions; usually ulcerated and painful

Recurrences are common May lead to a malignant process Unknown cause

Apply topical corticosteroids such as uocinolone acetonide oral base gel Avoid foods that irritate Administer corticosteroids systemically or intralesionally as prescribed Instruct the patient of need for follow-up if condition is chronic

Candidiasis (moniliasis/thrush)

Cheesy white plaque that looks like milk curds; when rubbed off, it leaves an erythematous and often bleeding base

Candida albicans fungus; predisposing factors include diabetes, antibiotic therapy, and immunosuppression

Antifungal medications such as nystatin (Mycostatin), amphotericin B, clotrimazole, or ketoconazole may be prescribed; these may be taken in pill form or as a suspension; when used as a suspension, instruct the patient to swish vigorously for at least 1 minute and then swallow

Aphthous stomatitis (canker sore)Singaw

Shallow ulcer with a white or yellow center and red border; seen on the inner side of the lip and cheek or on the tongue; it begins with a burning or tingling sensation and slight swelling; painful; usually lasts 710 days and heals without a scar

Associated with emotional or mental stress, fatigue, hormonal factors, minor trauma (such as biting), allergies, acidic foods and juices, and dietary deciencies Associated with HIV infection May recur

Instruct the patient in comfort measures, such as saline rinses, and a soft or bland diet Antibiotics or corticosteroids may be prescribed

Nicotine stomatitis (smokers patch)

Two stagesbegins as a red stomatitis; over time the tongue and mouth become covered with a creamy, thick, white mucous membrane, which may slough, leaving a beefy red base

Chronic irritation by tobacco

Cessation of tobacco use; if condition exists for longer than 2 weeks a physician should be consulted and a biopsy may be needed

Kaposis sarcoma

Appears rst on the oral mucosa as a red, purple, or blue lesion; may be singular or multiple; may be at or raised

HIV infection

Instruct patient regarding side effects of planned treatment

Stomatitis

Mild redness (erythema) and edema; if severe, painful ulcerations, bleeding, and secondary infection

Chemotherapy; radiation therapy; severe drug allergy; myelosuppression(bone marrow depression)

Prophylactic mouth care, including brushing, ossing, and rinsing, for any patient receiving chemotherapy or radiation therapy Teach patient proper oral hygiene, Including the use of a softbristled Toothbrush and nonabrasive toothpaste; for painful ulcers, oral Swabs with sponge-like applicators can be used in place of a toothbrush;avoid alcoholbased Mouth rinses and hot or spicy foods. Apply topical anti inammatoryantibiotic,and anesthetic agents as prescribed

Abnormalities of the Gums Gingivitis Painful, inamed, swollen gums; usually the gums bleed in response to light contact Poor oral hygiene: food debris, bacterial plaque, and calculus (tartar) accumulate; the gums may also swell in response to normal processes such as puberty and pregnancy Teach patient proper oral hygiene; toothbrushing, ossing, rinsing, dental appointments at least every 6 months

Necrotizing gingivitis (trench mouth)

Gray-white pseudomembranous ulcerations affecting the edges of the gums, mucosa of the mouth, tonsils, and pharynx; foul breath; painful, bleeding gums; swallowing and talking are painful

Poor oral hygiene; bacterial infection, inadequate rest, overwork, emotional stress, smoking, and poor nutrition may contribute to development

Teach patient proper oral hygiene; see Chart 35-2 Irrigate with 2% to 3% hydrogen peroxide or normal saline solution Avoid irritants such as smoking and spicy foods

Herpetic Gingivostomatitis

Burning sensation with the appearance of small vesicles 2448 hours later; vesicles may rupture, forming sore, shallow ulcers covered with a gray membrane

Herpes simplex virus; occurs most frequently in people who are immunosuppressed; may occur in other infectious processes such as streptococcal pneumonia, meningococcal meningitis, and malaria May result from untreated gingivitis Poor or inadequate dental hygiene and inadequate diet contribute to development

Apply topical anesthetics as prescribed; may need opioids if pain is severe Saline or 2% to 3% hydrogen peroxide irrigations Antiviral agents such as acyclovir may be prescribed

Periodontitis

Little discomfort at onset; may have bleeding, infection, gum recession, and loosening of teeth; later in the disease tooth loss may occur

Instruct patient in proper oral hygiene Instruct patient to consult a dentist

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