Re: Denture stomatitis

[Guest guest]

Hi,i think the answer is nystatin. acc. to cawson nystatin or amphotericin can be applied on the mucosa.otherwise apply miconazole gel on the fitting surface of the denture.correct me if i am wrong From: Balsam Majid <balsam_majid@...> " " < > Sent: Sunday, December 18, 2011 7:05 PM

Subject: Denture stomatitis

Dear friendsWould you plz give me your thoughts about this ORE questionWhat is the best treatment for patient with denture stomatitis with resisted angular chelitis 1 miconazole lozenge2 fluconazole 3 nystatinWould you plz tell me ur sources if applicable ThanksBalsamSent from my iPadOn 18 Dec 2011, at 17:18, Irfan Salim <irfansalim85@...> wrote:

hmm .. well I dont exactly know what happened. But if patient opts to have the tooth edxtracted knowing that we have explained the procedure then its patient who has to decide the final procedure based on the pros n cons of the procedure. We can give alternatives and patient can decide. Because we do take consent from patient before extraction so necrosis would be one of the side effects of the procedure mentioned in the consent form. From: Sana Puremel <sanapuremel@...> " " < > Sent: Sunday,

December 18, 2011 9:18 PM Subject: Re: Again bisphosphonates-new guidance..?

The way i handle and communication was fine and i passed that(they grade you on that as well),but the answer abt pulpotomy i guess was wrong...i told everything as it was in MJDF RCS osces..Nothing to do with other osces..because I have fedback from the exam on every osces-passed/failedi feel that i shouldnt refer pt to extract the tooth,i should extract it From: Irfan Salim <irfansalim85@...> To:

" " < > Sent: Sunday, 18 December 2011, 15:12 Subject: Re: Again bisphosphonates-new guidance..?

I dont think that this exact question can be the cause of failure. In OSCE the way you handle the patient is also important. Its about communication skills as well . So I think it might have to do with other osces. With bisphosphonates I would always tell the patient that he pain can be relieved easily by pulpotomy. There is no need to go into problems. Immediate pain relief is via pulpotomy. From: Sana Puremel <sanapuremel@...> " " < > Sent: Sunday, December 18, 2011 8:08 PM Subject: Re: Again bisphosphonates-new guidance..?

Hi guysI offered to my Pt RCT in the exam mfds-I failed this osce,I guess I should say extract the tooth...pt was suffering from a pain,and kept asking me to pull the tooth out...and said you may have the osteonecrosis,,,well i explained everything abt bisphosph.-but i failed the osce.... From: Lyudmyla Huhley <huhley2006@...> " " < > Sent: Sunday, 18 December 2011, 9:52 Subject: Re: Again bisphosphonates-new guidance..?

thank you irfan for confirmation of my thoughts)) SincerelyLyudmyla From: Irfan Salim <irfansalim85@...> " " < > Sent: Sunday, 18 December 2011, 4:13 Subject: Re: Again bisphosphonates-new guidance..?

But I think lyuda you already answered this in your question lol .. From: Lyudmyla Huhley <huhley2006@...> " " < > Sent: Saturday, December 17, 2011 1:29 AM Subject: Again bisphosphonates-new guidance..?

Hi guysI am confused abt bisphosphonates-if Pt has a toothache what shall we do?Extract or RCTIt looks like we can extract tooth but before you need to assess pt if they are at low risk...If any extraction or any oral surgery or procedure which may impact on bone is necessary,assess whether the patient is at low, or higher risk of BONJ as follows:• the patient is at low risk before they have started taking bisphosphonates for any condition,or are taking bisphosphonates for the prevention or management of osteoporosis.• the patient is at higher risk if any of the following factors is present:−−previous

diagnosis of

BONJ;−−taking a bisphosphonate as part of the management of a malignant condition;−−other non-malignant systemic condition affecting bone (e.g. Paget’s disease);−−under the care of a specialist for a rare medical condition (e.g. osteogenesis imperfecta);−−concurrent use of systemic corticosteroids or other immunosuppressants;−−coagulopathy, chemotherapy or radiotherapy.Advise the patient that there may be BONJ risk to enable informed consent, but ensure that theyunderstand that it is an extremely rare condition. It is very important that a patient is not discouragedfrom taking medication or undergoing dental treatment. Record that this advice has been given.Follow the management strategies described in Sections 3.2.1 and 3.2.2.Note: There is no supporting evidence that BONJ risk will be reduced if the patient temporarily, or evenpermanently, stops taking bisphosphonates prior to invasive

dental procedures since the drugs maypersist in the skeletal tissue for years. If a patient has taken bisphosphonates in the past but is nolonger taking them for whatever reason (i.e. completed or discontinued the course, taking a drugholiday), allocate them to a risk group as if they are still taking them. SincerelyLyudmyla

[Guest guest]

can u plz give me an idea tht from where u r getting all these questions?R these from feedbacks? From: Balsam Majid <balsam_majid@...> " " < > Sent: Sunday, December 18, 2011 7:05 PM Subject: Denture stomatitis

Dear friendsWould you plz give me your thoughts about this ORE questionWhat is the best treatment for patient with denture stomatitis with resisted angular chelitis 1 miconazole lozenge2 fluconazole 3 nystatinWould you plz tell me ur sources if applicable ThanksBalsamSent from my iPadOn 18 Dec 2011, at 17:18, Irfan Salim <irfansalim85@...> wrote:

hmm .. well I dont exactly know what happened. But if patient opts to have the tooth edxtracted knowing that we have explained the procedure then its patient who has to decide the final procedure based on the pros n cons of the procedure. We can give alternatives and patient can decide. Because we do take consent from patient before extraction so necrosis would be one of the side effects of the procedure mentioned in the consent form. From: Sana Puremel <sanapuremel@...> " " < > Sent: Sunday,

December 18, 2011 9:18 PM Subject: Re: Again bisphosphonates-new guidance..?

The way i handle and communication was fine and i passed that(they grade you on that as well),but the answer abt pulpotomy i guess was wrong...i told everything as it was in MJDF RCS osces..Nothing to do with other osces..because I have fedback from the exam on every osces-passed/failedi feel that i shouldnt refer pt to extract the tooth,i should extract it From: Irfan Salim <irfansalim85@...> To:

" " < > Sent: Sunday, 18 December 2011, 15:12 Subject: Re: Again bisphosphonates-new guidance..?

I dont think that this exact question can be the cause of failure. In OSCE the way you handle the patient is also important. Its about communication skills as well . So I think it might have to do with other osces. With bisphosphonates I would always tell the patient that he pain can be relieved easily by pulpotomy. There is no need to go into problems. Immediate pain relief is via pulpotomy. From: Sana Puremel <sanapuremel@...> " " < > Sent: Sunday, December 18, 2011 8:08 PM Subject: Re: Again bisphosphonates-new guidance..?

Hi guysI offered to my Pt RCT in the exam mfds-I failed this osce,I guess I should say extract the tooth...pt was suffering from a pain,and kept asking me to pull the tooth out...and said you may have the osteonecrosis,,,well i explained everything abt bisphosph.-but i failed the osce.... From: Lyudmyla Huhley <huhley2006@...> " " < > Sent: Sunday, 18 December 2011, 9:52 Subject: Re: Again bisphosphonates-new guidance..?

thank you irfan for confirmation of my thoughts)) SincerelyLyudmyla From: Irfan Salim <irfansalim85@...> " " < > Sent: Sunday, 18 December 2011, 4:13 Subject: Re: Again bisphosphonates-new guidance..?

But I think lyuda you already answered this in your question lol .. From: Lyudmyla Huhley <huhley2006@...> " " < > Sent: Saturday, December 17, 2011 1:29 AM Subject: Again bisphosphonates-new guidance..?

Hi guysI am confused abt bisphosphonates-if Pt has a toothache what shall we do?Extract or RCTIt looks like we can extract tooth but before you need to assess pt if they are at low risk...If any extraction or any oral surgery or procedure which may impact on bone is necessary,assess whether the patient is at low, or higher risk of BONJ as follows:• the patient is at low risk before they have started taking bisphosphonates for any condition,or are taking bisphosphonates for the prevention or management of osteoporosis.• the patient is at higher risk if any of the following factors is present:−−previous

diagnosis of

BONJ;−−taking a bisphosphonate as part of the management of a malignant condition;−−other non-malignant systemic condition affecting bone (e.g. Paget’s disease);−−under the care of a specialist for a rare medical condition (e.g. osteogenesis imperfecta);−−concurrent use of systemic corticosteroids or other immunosuppressants;−−coagulopathy, chemotherapy or radiotherapy.Advise the patient that there may be BONJ risk to enable informed consent, but ensure that theyunderstand that it is an extremely rare condition. It is very important that a patient is not discouragedfrom taking medication or undergoing dental treatment. Record that this advice has been given.Follow the management strategies described in Sections 3.2.1 and 3.2.2.Note: There is no supporting evidence that BONJ risk will be reduced if the patient temporarily, or evenpermanently, stops taking bisphosphonates prior to invasive

dental procedures since the drugs maypersist in the skeletal tissue for years. If a patient has taken bisphosphonates in the past but is nolonger taking them for whatever reason (i.e. completed or discontinued the course, taking a drugholiday), allocate them to a risk group as if they are still taking them. SincerelyLyudmyla

[Guest guest]

Yes Zahra,,unfortunately they ore feedbacks!!Sent from my iPadOn 18 Dec 2011, at 19:20, Zahra Jamal <zahrajamal21@...> wrote:

can u plz give me an idea tht from where u r getting all these questions?R these from feedbacks? From: Balsam Majid <balsam_majid@...> " " < > Sent: Sunday, December 18, 2011 7:05 PM Subject: Denture stomatitis

Dear friendsWould you plz give me your thoughts about this ORE questionWhat is the best treatment for patient with denture stomatitis with resisted angular chelitis 1 miconazole lozenge2 fluconazole 3 nystatinWould you plz tell me ur sources if applicable ThanksBalsamSent from my iPadOn 18 Dec 2011, at 17:18, Irfan Salim <irfansalim85@...> wrote:

hmm .. well I dont exactly know what happened. But if patient opts to have the tooth edxtracted knowing that we have explained the procedure then its patient who has to decide the final procedure based on the pros n cons of the procedure. We can give alternatives and patient can decide. Because we do take consent from patient before extraction so necrosis would be one of the side effects of the procedure mentioned in the consent form. From: Sana Puremel <sanapuremel@...> " " < > Sent: Sunday,

December 18, 2011 9:18 PM Subject: Re: Again bisphosphonates-new guidance..?

The way i handle and communication was fine and i passed that(they grade you on that as well),but the answer abt pulpotomy i guess was wrong...i told everything as it was in MJDF RCS osces..Nothing to do with other osces..because I have fedback from the exam on every osces-passed/failedi feel that i shouldnt refer pt to extract the tooth,i should extract it From: Irfan Salim <irfansalim85@...> To:

" " < > Sent: Sunday, 18 December 2011, 15:12 Subject: Re: Again bisphosphonates-new guidance..?

I dont think that this exact question can be the cause of failure. In OSCE the way you handle the patient is also important. Its about communication skills as well . So I think it might have to do with other osces. With bisphosphonates I would always tell the patient that he pain can be relieved easily by pulpotomy. There is no need to go into problems. Immediate pain relief is via pulpotomy. From: Sana Puremel <sanapuremel@...> " " < > Sent: Sunday, December 18, 2011 8:08 PM Subject: Re: Again bisphosphonates-new guidance..?

Hi guysI offered to my Pt RCT in the exam mfds-I failed this osce,I guess I should say extract the tooth...pt was suffering from a pain,and kept asking me to pull the tooth out...and said you may have the osteonecrosis,,,well i explained everything abt bisphosph.-but i failed the osce.... From: Lyudmyla Huhley <huhley2006@...> " " < > Sent: Sunday, 18 December 2011, 9:52 Subject: Re: Again bisphosphonates-new guidance..?

thank you irfan for confirmation of my thoughts)) SincerelyLyudmyla From: Irfan Salim <irfansalim85@...> " " < > Sent: Sunday, 18 December 2011, 4:13 Subject: Re: Again bisphosphonates-new guidance..?

But I think lyuda you already answered this in your question lol .. From: Lyudmyla Huhley <huhley2006@...> " " < > Sent: Saturday, December 17, 2011 1:29 AM Subject: Again bisphosphonates-new guidance..?

Hi guysI am confused abt bisphosphonates-if Pt has a toothache what shall we do?Extract or RCTIt looks like we can extract tooth but before you need to assess pt if they are at low risk...If any extraction or any oral surgery or procedure which may impact on bone is necessary,assess whether the patient is at low, or higher risk of BONJ as follows:• the patient is at low risk before they have started taking bisphosphonates for any condition,or are taking bisphosphonates for the prevention or management of osteoporosis.• the patient is at higher risk if any of the following factors is present:−−previous

diagnosis of

BONJ;−−taking a bisphosphonate as part of the management of a malignant condition;−−other non-malignant systemic condition affecting bone (e.g. Paget’s disease);−−under the care of a specialist for a rare medical condition (e.g. osteogenesis imperfecta);−−concurrent use of systemic corticosteroids or other immunosuppressants;−−coagulopathy, chemotherapy or radiotherapy.Advise the patient that there may be BONJ risk to enable informed consent, but ensure that theyunderstand that it is an extremely rare condition. It is very important that a patient is not discouragedfrom taking medication or undergoing dental treatment. Record that this advice has been given.Follow the management strategies described in Sections 3.2.1 and 3.2.2.Note: There is no supporting evidence that BONJ risk will be reduced if the patient temporarily, or evenpermanently, stops taking bisphosphonates prior to invasive

dental procedures since the drugs maypersist in the skeletal tissue for years. If a patient has taken bisphosphonates in the past but is nolonger taking them for whatever reason (i.e. completed or discontinued the course, taking a drugholiday), allocate them to a risk group as if they are still taking them. SincerelyLyudmyla

[Guest guest]

according to drug prescribing pdf released by scottish dental societyfor denture stomatitisFluconazole or miconazole are given and if both are contraindicatedamphotericin losenzes or nystatin is used.For angular chelitismiconazole cream or nystatin ointment is used.since pt is resisted to angular chelitis so fluconazole can be used.correctme if i am wrong. From: Zahra Jamal <zahrajamal21@...> " " < > Sent: Sunday, 18 December 2011 7:18 PM Subject: Re: Denture stomatitis

Hi,i think the answer is nystatin. acc. to cawson nystatin or amphotericin can be applied on the mucosa.otherwise apply miconazole gel on the fitting surface of the denture.correct me if i am wrong From: Balsam Majid <balsam_majid@...> " " < > Sent: Sunday, December 18, 2011 7:05 PM

Subject: Denture stomatitis

Dear friendsWould you plz give me your thoughts about this ORE questionWhat is the best treatment for patient with denture stomatitis with resisted angular chelitis 1 miconazole lozenge2 fluconazole 3 nystatinWould you plz tell me ur sources if applicable ThanksBalsamSent from my iPadOn 18 Dec 2011, at 17:18, Irfan Salim <irfansalim85@...> wrote:

hmm .. well I dont exactly know what happened. But if patient opts to have the tooth edxtracted knowing that we have explained the procedure then its patient who has to decide the final procedure based on the pros n cons of the procedure. We can give alternatives and patient can decide. Because we do take consent from patient before extraction so necrosis would be one of the side effects of the procedure mentioned in the consent form. From: Sana Puremel <sanapuremel@...> " " < > Sent: Sunday,

December 18, 2011 9:18 PM Subject: Re: Again bisphosphonates-new guidance..?

The way i handle and communication was fine and i passed that(they grade you on that as well),but the answer abt pulpotomy i guess was wrong...i told everything as it was in MJDF RCS osces..Nothing to do with other osces..because I have fedback from the exam on every osces-passed/failedi feel that i shouldnt refer pt to extract the tooth,i should extract it From: Irfan Salim <irfansalim85@...> To:

" " < > Sent: Sunday, 18 December 2011, 15:12 Subject: Re: Again bisphosphonates-new guidance..?

I dont think that this exact question can be the cause of failure. In OSCE the way you handle the patient is also important. Its about communication skills as well . So I think it might have to do with other osces. With bisphosphonates I would always tell the patient that he pain can be relieved easily by pulpotomy. There is no need to go into problems. Immediate pain relief is via pulpotomy. From: Sana Puremel <sanapuremel@...> " " < > Sent: Sunday, December 18, 2011 8:08 PM Subject: Re: Again bisphosphonates-new guidance..?

Hi guysI offered to my Pt RCT in the exam mfds-I failed this osce,I guess I should say extract the tooth...pt was suffering from a pain,and kept asking me to pull the tooth out...and said you may have the osteonecrosis,,,well i explained everything abt bisphosph.-but i failed the osce.... From: Lyudmyla Huhley <huhley2006@...> " " < > Sent: Sunday, 18 December 2011, 9:52 Subject: Re: Again bisphosphonates-new guidance..?

thank you irfan for confirmation of my thoughts)) SincerelyLyudmyla From: Irfan Salim <irfansalim85@...> " " < > Sent: Sunday, 18 December 2011, 4:13 Subject: Re: Again bisphosphonates-new guidance..?

But I think lyuda you already answered this in your question lol .. From: Lyudmyla Huhley <huhley2006@...> " " < > Sent: Saturday, December 17, 2011 1:29 AM

Subject: Again bisphosphonates-new guidance..?

Hi guysI am confused abt bisphosphonates-if Pt has a toothache what shall we do?Extract or RCTIt looks like we can extract tooth but before you need to assess pt if they are at low risk...If any extraction or any oral surgery or procedure which may impact on bone is necessary,assess whether the patient is at low, or higher risk of BONJ as follows:• the patient is at low risk before they have started taking bisphosphonates for any condition,or are taking bisphosphonates for the prevention or management of osteoporosis.• the patient is at higher risk if any of the following factors is present:−−previous

diagnosis of

BONJ;−−taking a bisphosphonate as part of the management of a malignant condition;−−other non-malignant systemic condition affecting bone (e.g. Paget’s disease);−−under the care of a specialist for a rare medical condition (e.g. osteogenesis imperfecta);−−concurrent use of systemic corticosteroids or other immunosuppressants;−−coagulopathy, chemotherapy or radiotherapy.Advise the patient that there may be BONJ risk to enable informed consent, but ensure that theyunderstand that it is an extremely rare condition. It is very important that a patient is not discouragedfrom taking medication or undergoing dental treatment. Record that this advice has been given.Follow the management strategies described in Sections 3.2.1 and 3.2.2.Note: There is no supporting evidence that BONJ risk will be reduced if the patient temporarily, or evenpermanently, stops taking bisphosphonates prior to invasive

dental procedures since the drugs maypersist in the skeletal tissue for years. If a patient has taken bisphosphonates in the past but is nolonger taking them for whatever reason (i.e. completed or discontinued the course, taking a drugholiday), allocate them to a risk group as if they are still taking them. SincerelyLyudmyla

[Guest guest]

Thanks ZahraThe tricky thing that's it mentioned resisting angular chelitis !I read that about nystatin in cowson that it gain access only to the palate if patient leaves out the denture although I don't think it's nystatin according to pink book page 324 as its mentioned it's less effective at resolving stomatitis I personally think fluconazole is the treatment for non responsive angular Chelitis but I'm not sureAny thoughts??BalsamSent from my iPadOn 18 Dec 2011, at 19:18, Zahra Jamal <zahrajamal21@...> wrote:

Hi,i think the answer is nystatin. acc. to cawson nystatin or amphotericin can be applied on the mucosa.otherwise apply miconazole gel on the fitting surface of the denture.correct me if i am wrong From: Balsam Majid <balsam_majid@...> " " < > Sent: Sunday, December 18, 2011 7:05 PM

Subject: Denture stomatitis

Dear friendsWould you plz give me your thoughts about this ORE questionWhat is the best treatment for patient with denture stomatitis with resisted angular chelitis 1 miconazole lozenge2 fluconazole 3 nystatinWould you plz tell me ur sources if applicable ThanksBalsamSent from my iPadOn 18 Dec 2011, at 17:18, Irfan Salim <irfansalim85@...> wrote:

hmm .. well I dont exactly know what happened. But if patient opts to have the tooth edxtracted knowing that we have explained the procedure then its patient who has to decide the final procedure based on the pros n cons of the procedure. We can give alternatives and patient can decide. Because we do take consent from patient before extraction so necrosis would be one of the side effects of the procedure mentioned in the consent form. From: Sana Puremel <sanapuremel@...> " " < > Sent: Sunday,

December 18, 2011 9:18 PM Subject: Re: Again bisphosphonates-new guidance..?

The way i handle and communication was fine and i passed that(they grade you on that as well),but the answer abt pulpotomy i guess was wrong...i told everything as it was in MJDF RCS osces..Nothing to do with other osces..because I have fedback from the exam on every osces-passed/failedi feel that i shouldnt refer pt to extract the tooth,i should extract it From: Irfan Salim <irfansalim85@...> To:

" " < > Sent: Sunday, 18 December 2011, 15:12 Subject: Re: Again bisphosphonates-new guidance..?

I dont think that this exact question can be the cause of failure. In OSCE the way you handle the patient is also important. Its about communication skills as well . So I think it might have to do with other osces. With bisphosphonates I would always tell the patient that he pain can be relieved easily by pulpotomy. There is no need to go into problems. Immediate pain relief is via pulpotomy. From: Sana Puremel <sanapuremel@...> " " < > Sent: Sunday, December 18, 2011 8:08 PM Subject: Re: Again bisphosphonates-new guidance..?

Hi guysI offered to my Pt RCT in the exam mfds-I failed this osce,I guess I should say extract the tooth...pt was suffering from a pain,and kept asking me to pull the tooth out...and said you may have the osteonecrosis,,,well i explained everything abt bisphosph.-but i failed the osce.... From: Lyudmyla Huhley <huhley2006@...> " " < > Sent: Sunday, 18 December 2011, 9:52 Subject: Re: Again bisphosphonates-new guidance..?

thank you irfan for confirmation of my thoughts)) SincerelyLyudmyla From: Irfan Salim <irfansalim85@...> " " < > Sent: Sunday, 18 December 2011, 4:13 Subject: Re: Again bisphosphonates-new guidance..?

But I think lyuda you already answered this in your question lol .. From: Lyudmyla Huhley <huhley2006@...> " " < > Sent: Saturday, December 17, 2011 1:29 AM Subject: Again bisphosphonates-new guidance..?

Hi guysI am confused abt bisphosphonates-if Pt has a toothache what shall we do?Extract or RCTIt looks like we can extract tooth but before you need to assess pt if they are at low risk...If any extraction or any oral surgery or procedure which may impact on bone is necessary,assess whether the patient is at low, or higher risk of BONJ as follows:• the patient is at low risk before they have started taking bisphosphonates for any condition,or are taking bisphosphonates for the prevention or management of osteoporosis.• the patient is at higher risk if any of the following factors is present:−−previous

diagnosis of

BONJ;−−taking a bisphosphonate as part of the management of a malignant condition;−−other non-malignant systemic condition affecting bone (e.g. Paget’s disease);−−under the care of a specialist for a rare medical condition (e.g. osteogenesis imperfecta);−−concurrent use of systemic corticosteroids or other immunosuppressants;−−coagulopathy, chemotherapy or radiotherapy.Advise the patient that there may be BONJ risk to enable informed consent, but ensure that theyunderstand that it is an extremely rare condition. It is very important that a patient is not discouragedfrom taking medication or undergoing dental treatment. Record that this advice has been given.Follow the management strategies described in Sections 3.2.1 and 3.2.2.Note: There is no supporting evidence that BONJ risk will be reduced if the patient temporarily, or evenpermanently, stops taking bisphosphonates prior to invasive

dental procedures since the drugs maypersist in the skeletal tissue for years. If a patient has taken bisphosphonates in the past but is nolonger taking them for whatever reason (i.e. completed or discontinued the course, taking a drugholiday), allocate them to a risk group as if they are still taking them. SincerelyLyudmyla

[Guest guest]

its fluconazole:Patients whose angular cheilitis resists treatment require systemic antifungal therapy (e.g., fluconazole) and amphotericin-B lozenges, if available. From: Balsam Majid <balsam_majid@...> To:

" " < > Sent: Sunday, 18 December 2011, 20:04 Subject: Re: Denture stomatitis

Thanks ZahraThe tricky thing that's it mentioned resisting angular chelitis !I read that about nystatin in cowson that it gain access only to the palate if patient leaves out the denture although I don't think it's nystatin according to pink book page 324 as its mentioned it's less effective at resolving stomatitis I personally think fluconazole is the treatment for non responsive angular Chelitis but I'm not sureAny thoughts??BalsamSent from my iPadOn 18 Dec 2011, at 19:18, Zahra Jamal <zahrajamal21@...> wrote:

Hi,i think the answer is nystatin. acc. to cawson nystatin or amphotericin can be applied on the mucosa.otherwise apply miconazole gel on the fitting surface of the denture.correct me if i am wrong From: Balsam Majid <balsam_majid@...> " " < > Sent: Sunday, December 18, 2011 7:05 PM

Subject: Denture stomatitis

Dear friendsWould you plz give me your thoughts about this ORE questionWhat is the best treatment for patient with denture stomatitis with resisted angular chelitis 1 miconazole lozenge2 fluconazole 3 nystatinWould you plz tell me ur sources if applicable ThanksBalsamSent from my iPadOn 18 Dec 2011, at 17:18, Irfan Salim <irfansalim85@...> wrote:

hmm .. well I dont exactly know what happened. But if patient opts to have the tooth edxtracted knowing that we have explained the procedure then its patient who has to decide the final procedure based on the pros n cons of the procedure. We can give alternatives and patient can decide. Because we do take consent from patient before extraction so necrosis would be one of the side effects of the procedure mentioned in the consent form. From: Sana Puremel <sanapuremel@...> " " < > Sent: Sunday,

December 18, 2011 9:18 PM Subject: Re: Again bisphosphonates-new guidance..?

The way i handle and communication was fine and i passed that(they grade you on that as well),but the answer abt pulpotomy i guess was wrong...i told everything as it was in MJDF RCS osces..Nothing to do with other osces..because I have fedback from the exam on every osces-passed/failedi feel that i shouldnt refer pt to extract the tooth,i should extract it From: Irfan Salim <irfansalim85@...> To:

" " < > Sent: Sunday, 18 December 2011, 15:12 Subject: Re: Again bisphosphonates-new guidance..?

I dont think that this exact question can be the cause of failure. In OSCE the way you handle the patient is also important. Its about communication skills as well . So I think it might have to do with other osces. With bisphosphonates I would always tell the patient that he pain can be relieved easily by pulpotomy. There is no need to go into problems. Immediate pain relief is via pulpotomy. From: Sana Puremel <sanapuremel@...> " " < > Sent: Sunday, December 18, 2011 8:08 PM Subject: Re: Again bisphosphonates-new guidance..?

Hi guysI offered to my Pt RCT in the exam mfds-I failed this osce,I guess I should say extract the tooth...pt was suffering from a pain,and kept asking me to pull the tooth out...and said you may have the osteonecrosis,,,well i explained everything abt bisphosph.-but i failed the osce.... From: Lyudmyla Huhley <huhley2006@...> " " < > Sent: Sunday, 18 December 2011, 9:52 Subject: Re: Again bisphosphonates-new guidance..?

thank you irfan for confirmation of my thoughts)) SincerelyLyudmyla From: Irfan Salim <irfansalim85@...> " " < > Sent: Sunday, 18 December 2011, 4:13 Subject: Re: Again bisphosphonates-new guidance..?

But I think lyuda you already answered this in your question lol .. From: Lyudmyla Huhley <huhley2006@...> " " < > Sent: Saturday, December 17, 2011 1:29 AM

Subject: Again bisphosphonates-new guidance..?

Hi guysI am confused abt bisphosphonates-if Pt has a toothache what shall we do?Extract or RCTIt looks like we can extract tooth but before you need to assess pt if they are at low risk...If any extraction or any oral surgery or procedure which may impact on bone is necessary,assess whether the patient is at low, or higher risk of BONJ as follows:• the patient is at low risk before they have started taking bisphosphonates for any condition,or are taking bisphosphonates for the prevention or management of osteoporosis.• the patient is at higher risk if any of the following factors is present:−−previous

diagnosis of

BONJ;−−taking a bisphosphonate as part of the management of a malignant condition;−−other non-malignant systemic condition affecting bone (e.g. Paget’s disease);−−under the care of a specialist for a rare medical condition (e.g. osteogenesis imperfecta);−−concurrent use of systemic corticosteroids or other immunosuppressants;−−coagulopathy, chemotherapy or radiotherapy.Advise the patient that there may be BONJ risk to enable informed consent, but ensure that theyunderstand that it is an extremely rare condition. It is very important that a patient is not discouragedfrom taking medication or undergoing dental treatment. Record that this advice has been given.Follow the management strategies described in Sections 3.2.1 and 3.2.2.Note: There is no supporting evidence that BONJ risk will be reduced if the patient temporarily, or evenpermanently, stops taking bisphosphonates prior to invasive

dental procedures since the drugs maypersist in the skeletal tissue for years. If a patient has taken bisphosphonates in the past but is nolonger taking them for whatever reason (i.e. completed or discontinued the course, taking a drugholiday), allocate them to a risk group as if they are still taking them. SincerelyLyudmyla

[Guest guest]

Thanks Areej bless youBalsam Sent from my iPadOn 19 Dec 2011, at 20:47, Areej Abbas <areej.aldura@...> wrote:

its fluconazole:Patients whose angular cheilitis resists treatment require systemic antifungal therapy (e.g., fluconazole) and amphotericin-B lozenges, if available. From: Balsam Majid <balsam_majid@...> To:

" " < > Sent: Sunday, 18 December 2011, 20:04 Subject: Re: Denture stomatitis

Thanks ZahraThe tricky thing that's it mentioned resisting angular chelitis !I read that about nystatin in cowson that it gain access only to the palate if patient leaves out the denture although I don't think it's nystatin according to pink book page 324 as its mentioned it's less effective at resolving stomatitis I personally think fluconazole is the treatment for non responsive angular Chelitis but I'm not sureAny thoughts??BalsamSent from my iPadOn 18 Dec 2011, at 19:18, Zahra Jamal <zahrajamal21@...> wrote:

Hi,i think the answer is nystatin. acc. to cawson nystatin or amphotericin can be applied on the mucosa.otherwise apply miconazole gel on the fitting surface of the denture.correct me if i am wrong From: Balsam Majid <balsam_majid@...> " " < > Sent: Sunday, December 18, 2011 7:05 PM

Subject: Denture stomatitis

Dear friendsWould you plz give me your thoughts about this ORE questionWhat is the best treatment for patient with denture stomatitis with resisted angular chelitis 1 miconazole lozenge2 fluconazole 3 nystatinWould you plz tell me ur sources if applicable ThanksBalsamSent from my iPadOn 18 Dec 2011, at 17:18, Irfan Salim <irfansalim85@...> wrote:

hmm .. well I dont exactly know what happened. But if patient opts to have the tooth edxtracted knowing that we have explained the procedure then its patient who has to decide the final procedure based on the pros n cons of the procedure. We can give alternatives and patient can decide. Because we do take consent from patient before extraction so necrosis would be one of the side effects of the procedure mentioned in the consent form. From: Sana Puremel <sanapuremel@...> " " < > Sent: Sunday,

December 18, 2011 9:18 PM Subject: Re: Again bisphosphonates-new guidance..?

The way i handle and communication was fine and i passed that(they grade you on that as well),but the answer abt pulpotomy i guess was wrong...i told everything as it was in MJDF RCS osces..Nothing to do with other osces..because I have fedback from the exam on every osces-passed/failedi feel that i shouldnt refer pt to extract the tooth,i should extract it From: Irfan Salim <irfansalim85@...> To:

" " < > Sent: Sunday, 18 December 2011, 15:12 Subject: Re: Again bisphosphonates-new guidance..?

I dont think that this exact question can be the cause of failure. In OSCE the way you handle the patient is also important. Its about communication skills as well . So I think it might have to do with other osces. With bisphosphonates I would always tell the patient that he pain can be relieved easily by pulpotomy. There is no need to go into problems. Immediate pain relief is via pulpotomy. From: Sana Puremel <sanapuremel@...> " " < > Sent: Sunday, December 18, 2011 8:08 PM Subject: Re: Again bisphosphonates-new guidance..?

Hi guysI offered to my Pt RCT in the exam mfds-I failed this osce,I guess I should say extract the tooth...pt was suffering from a pain,and kept asking me to pull the tooth out...and said you may have the osteonecrosis,,,well i explained everything abt bisphosph.-but i failed the osce.... From: Lyudmyla Huhley <huhley2006@...> " " < > Sent: Sunday, 18 December 2011, 9:52 Subject: Re: Again bisphosphonates-new guidance..?

thank you irfan for confirmation of my thoughts)) SincerelyLyudmyla From: Irfan Salim <irfansalim85@...> " " < > Sent: Sunday, 18 December 2011, 4:13 Subject: Re: Again bisphosphonates-new guidance..?

But I think lyuda you already answered this in your question lol .. From: Lyudmyla Huhley <huhley2006@...> " " < > Sent: Saturday, December 17, 2011 1:29 AM

Subject: Again bisphosphonates-new guidance..?

Hi guysI am confused abt bisphosphonates-if Pt has a toothache what shall we do?Extract or RCTIt looks like we can extract tooth but before you need to assess pt if they are at low risk...If any extraction or any oral surgery or procedure which may impact on bone is necessary,assess whether the patient is at low, or higher risk of BONJ as follows:• the patient is at low risk before they have started taking bisphosphonates for any condition,or are taking bisphosphonates for the prevention or management of osteoporosis.• the patient is at higher risk if any of the following factors is present:−−previous

diagnosis of

BONJ;−−taking a bisphosphonate as part of the management of a malignant condition;−−other non-malignant systemic condition affecting bone (e.g. Paget’s disease);−−under the care of a specialist for a rare medical condition (e.g. osteogenesis imperfecta);−−concurrent use of systemic corticosteroids or other immunosuppressants;−−coagulopathy, chemotherapy or radiotherapy.Advise the patient that there may be BONJ risk to enable informed consent, but ensure that theyunderstand that it is an extremely rare condition. It is very important that a patient is not discouragedfrom taking medication or undergoing dental treatment. Record that this advice has been given.Follow the management strategies described in Sections 3.2.1 and 3.2.2.Note: There is no supporting evidence that BONJ risk will be reduced if the patient temporarily, or evenpermanently, stops taking bisphosphonates prior to invasive

dental procedures since the drugs maypersist in the skeletal tissue for years. If a patient has taken bisphosphonates in the past but is nolonger taking them for whatever reason (i.e. completed or discontinued the course, taking a drugholiday), allocate them to a risk group as if they are still taking them. SincerelyLyudmyla

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Thank you so much Chethan but in p324 it is written Denture stomatitis refer to denture sore mouthSent from my iPadOn 19 May 2012, at 19:51, Mausami Chethan <mausamichethan@...> wrote:

hi moka, what they are saying is acute erythematous candidiais is usually a oppurtunistic infection seen in ppl on broad spectrum antibiotic,inhaled steroid users,hiv pts.so bottom line any immunosupressed pts(cd 4 level is reduced),as well as in xerostomia pts and not associated with denture though formerly meaning it was called denture sore mouth..now they do not use tht term.but chronin atrophic candidiasis is seen under upper full dentures as white ares with petechiea. denture sore mouth and denture stomatitis are two different conditions.

From: "Mokaamr@..." <mokaamr@...> " " < > Sent: Saturday, 19 May 2012, 19:36 Subject: Re: Denture stomatitis

Thanks Chethan but in the pink book p 430 they call it Acute erythematous candidosis ???so I am not sure is it chronic or acute ?which condition exactly ?as pink book says denture sore mouth is misleading name for denture stomatitis.then describes erythematous candidosis n between brackets wrote prev denture stomatitis ???On 19 May 2012, at 18:07, Mausami Chethan <mausamichethan@...> wrote:

hi, denture stomatitis is also called chronic atropic candidosis or chronic candidosis. From: "Mokaamr@..." <mokaamr@...> Ore

< > Sent: Saturday, 19 May 2012, 14:54 Subject: Denture stomatitis

Does Denture stomatitis refer to denture sore mouth as in the pink book p 324 or to chronic atrophic candidosis as in pink book p 400.i am really confused,appreciate any explanation .

Thanks

Moka

Sent from my iPad

[Guest guest]

yeah i think because now they no longer address acute erythematous candidiasis as denture sore mouth, they refer denture stomatitis to as denture sore mouth. From: "Mokaamr@..." <mokaamr@...> " " < >

Sent: Saturday, 19 May 2012, 20:33 Subject: Re: Denture stomatitis

Thank you so much Chethan but in p324 it is written Denture stomatitis refer to denture sore mouthSent from my iPadOn 19 May 2012, at 19:51, Mausami Chethan <mausamichethan@...> wrote:

hi moka, what they are saying is acute erythematous candidiais is usually a oppurtunistic infection seen in ppl on broad spectrum antibiotic,inhaled steroid users,hiv pts.so bottom line any immunosupressed pts(cd 4 level is reduced),as well as in xerostomia pts and not associated with denture though formerly meaning it was called denture sore mouth..now they do not use tht term.but chronin atrophic candidiasis is seen under upper full dentures as white ares with petechiea. denture sore mouth and denture stomatitis are two different conditions.

From: "Mokaamr@..." <mokaamr@...> " " < > Sent: Saturday, 19 May 2012, 19:36 Subject: Re:

Denture stomatitis

Thanks Chethan but in the pink book p 430 they call it Acute erythematous candidosis ???so I am not sure is it chronic or acute ?which condition exactly ?as pink book says denture sore mouth is misleading name for denture stomatitis.then describes erythematous candidosis n between brackets wrote prev denture stomatitis ???On 19 May 2012, at 18:07, Mausami Chethan <mausamichethan@...> wrote:

hi, denture stomatitis is also called chronic atropic candidosis or chronic candidosis. From: "Mokaamr@..." <mokaamr@...> Ore

< > Sent: Saturday, 19 May 2012, 14:54 Subject: Denture stomatitis

Does Denture stomatitis refer to denture sore mouth as in the pink book p 324 or to chronic atrophic candidosis as in pink book p 400.i am really confused,appreciate any explanation .

Thanks

Moka

Sent from my iPad

[Guest guest]

http://www.exodontia.info/Oral_Candidiasis.html .just have a look at this,may be will clear ur doubts. From: "Mokaamr@..." <mokaamr@...> " " < > Sent:

Saturday, 19 May 2012, 20:33 Subject: Re: Denture stomatitis

Thank you so much Chethan but in p324 it is written Denture stomatitis refer to denture sore mouthSent from my iPadOn 19 May 2012, at 19:51, Mausami Chethan <mausamichethan@...> wrote:

hi moka, what they are saying is acute erythematous candidiais is usually a oppurtunistic infection seen in ppl on broad spectrum antibiotic,inhaled steroid users,hiv pts.so bottom line any immunosupressed pts(cd 4 level is reduced),as well as in xerostomia pts and not associated with denture though formerly meaning it was called denture sore mouth..now they do not use tht term.but chronin atrophic candidiasis is seen under upper full dentures as white ares with petechiea. denture sore mouth and denture stomatitis are two different conditions.

From: "Mokaamr@..." <mokaamr@...> " " < > Sent: Saturday, 19 May 2012, 19:36 Subject: Re:

Denture stomatitis

Thanks Chethan but in the pink book p 430 they call it Acute erythematous candidosis ???so I am not sure is it chronic or acute ?which condition exactly ?as pink book says denture sore mouth is misleading name for denture stomatitis.then describes erythematous candidosis n between brackets wrote prev denture stomatitis ???On 19 May 2012, at 18:07, Mausami Chethan <mausamichethan@...> wrote:

hi, denture stomatitis is also called chronic atropic candidosis or chronic candidosis. From: "Mokaamr@..." <mokaamr@...> Ore

< > Sent: Saturday, 19 May 2012, 14:54 Subject: Denture stomatitis

Does Denture stomatitis refer to denture sore mouth as in the pink book p 324 or to chronic atrophic candidosis as in pink book p 400.i am really confused,appreciate any explanation .

Thanks

Moka

Sent from my iPad

[Guest guest]

Thank you so much Chethan ,very informative indeed .One last question does chronic hyper plastic candidosis extend to the skin or only in commisure area?because read about difficult eradication coz it extends to superficial layer of skin.Thank youOn 19 May 2012, at 22:47, Mausami Chethan <mausamichethan@...> wrote:

http://www.exodontia.info/Oral_Candidiasis.html .just have a look at this,may be will clear ur doubts. From: "Mokaamr@..." <mokaamr@...> " " < > Sent:

Saturday, 19 May 2012, 20:33 Subject: Re: Denture stomatitis

Thank you so much Chethan but in p324 it is written Denture stomatitis refer to denture sore mouthSent from my iPadOn 19 May 2012, at 19:51, Mausami Chethan <mausamichethan@...> wrote:

hi moka, what they are saying is acute erythematous candidiais is usually a oppurtunistic infection seen in ppl on broad spectrum antibiotic,inhaled steroid users,hiv pts.so bottom line any immunosupressed pts(cd 4 level is reduced),as well as in xerostomia pts and not associated with denture though formerly meaning it was called denture sore mouth..now they do not use tht term.but chronin atrophic candidiasis is seen under upper full dentures as white ares with petechiea. denture sore mouth and denture stomatitis are two different conditions.

From: "Mokaamr@..." <mokaamr@...> " " < > Sent: Saturday, 19 May 2012, 19:36 Subject: Re:

Denture stomatitis

Thanks Chethan but in the pink book p 430 they call it Acute erythematous candidosis ???so I am not sure is it chronic or acute ?which condition exactly ?as pink book says denture sore mouth is misleading name for denture stomatitis.then describes erythematous candidosis n between brackets wrote prev denture stomatitis ???On 19 May 2012, at 18:07, Mausami Chethan <mausamichethan@...> wrote:

hi, denture stomatitis is also called chronic atropic candidosis or chronic candidosis. From: "Mokaamr@..." <mokaamr@...> Ore

< > Sent: Saturday, 19 May 2012, 14:54 Subject: Denture stomatitis

Does Denture stomatitis refer to denture sore mouth as in the pink book p 324 or to chronic atrophic candidosis as in pink book p 400.i am really confused,appreciate any explanation .

Thanks

Moka

Sent from my iPad

[Guest guest]

moka,chr,hyperplastic candidiasis is also called candidal leukoplakia.they occur on the buccal commisures.sinc the main aeitiology for it is heavy smokers,so the leukoplakia patch is invade by candida hyphea for unknown reasons.cellular changes occue from mild dysplasia to malignancy upto 10-40%.hence i guess it isdifficult to irradiate. From:

"Mokaamr@..." <mokaamr@...> " " < > Sent: Saturday, 19 May 2012, 23:23 Subject: Re: Denture stomatitis

Thank you so much Chethan ,very informative indeed .One last question does chronic hyper plastic candidosis extend to the skin or only in commisure area?because read about difficult eradication coz it extends to superficial layer of skin.Thank youOn 19 May 2012, at 22:47, Mausami Chethan <mausamichethan@...> wrote:

http://www.exodontia.info/Oral_Candidiasis.html .just have a look at this,may be will clear ur doubts. From: "Mokaamr@..." <mokaamr@...> " " < > Sent:

Saturday, 19 May 2012, 20:33 Subject: Re: Denture stomatitis

Thank you so much Chethan but in p324 it is written Denture stomatitis refer to denture sore mouthSent from my iPadOn 19 May 2012, at 19:51, Mausami Chethan <mausamichethan@...> wrote:

hi moka, what they are saying is acute erythematous candidiais is usually a oppurtunistic infection seen in ppl on broad spectrum antibiotic,inhaled steroid users,hiv pts.so bottom line any immunosupressed pts(cd 4 level is reduced),as well as in xerostomia pts and not associated with denture though formerly meaning it was called denture sore mouth..now they do not use tht term.but chronin atrophic candidiasis is seen under upper full dentures as white ares with petechiea. denture sore mouth and denture stomatitis are two different conditions.

From: "Mokaamr@..." <mokaamr@...> " " < > Sent: Saturday, 19 May 2012, 19:36 Subject: Re:

Denture stomatitis

Thanks Chethan but in the pink book p 430 they call it Acute erythematous candidosis ???so I am not sure is it chronic or acute ?which condition exactly ?as pink book says denture sore mouth is misleading name for denture stomatitis.then describes erythematous candidosis n between brackets wrote prev denture stomatitis ???On 19 May 2012, at 18:07, Mausami Chethan <mausamichethan@...> wrote:

hi, denture stomatitis is also called chronic atropic candidosis or chronic candidosis. From: "Mokaamr@..." <mokaamr@...> Ore

< > Sent: Saturday, 19 May 2012, 14:54 Subject: Denture stomatitis

Does Denture stomatitis refer to denture sore mouth as in the pink book p 324 or to chronic atrophic candidosis as in pink book p 400.i am really confused,appreciate any explanation .

Thanks

Moka

Sent from my iPad

[Guest guest]

Candidal hyphæ are seen in amongst the epithelial cells. The hyphæ are seen growing (as in Thrush) through the full thickness of the keratin to the prickle cell layer of the skin, where the inflammatory cells tend to be more concentrated.hence they are difficult to irradiate. From: Mausami Chethan <mausamichethan@...> " " < > Sent: Saturday, 19 May 2012,

23:38 Subject: Re: Denture stomatitis

moka,chr,hyperplastic candidiasis is also called candidal leukoplakia.they occur on the buccal commisures.sinc the main aeitiology for it is heavy smokers,so the leukoplakia patch is invade by candida hyphea for unknown reasons.cellular changes occue from mild dysplasia to malignancy upto 10-40%.hence i guess it isdifficult to irradiate. From:

"Mokaamr@..." <mokaamr@...> " " < > Sent: Saturday, 19 May 2012, 23:23 Subject: Re: Denture stomatitis

Thank you so much Chethan ,very informative indeed .One last question does chronic hyper plastic candidosis extend to the skin or only in commisure area?because read about difficult eradication coz it extends to superficial layer of skin.Thank youOn 19 May 2012, at 22:47, Mausami Chethan <mausamichethan@...> wrote:

http://www.exodontia.info/Oral_Candidiasis.html .just have a look at this,may be will clear ur doubts. From: "Mokaamr@..." <mokaamr@...> " " < > Sent:

Saturday, 19 May 2012, 20:33 Subject: Re: Denture stomatitis

Thank you so much Chethan but in p324 it is written Denture stomatitis refer to denture sore mouthSent from my iPadOn 19 May 2012, at 19:51, Mausami Chethan <mausamichethan@...> wrote:

hi moka, what they are saying is acute erythematous candidiais is usually a oppurtunistic infection seen in ppl on broad spectrum antibiotic,inhaled steroid users,hiv pts.so bottom line any immunosupressed pts(cd 4 level is reduced),as well as in xerostomia pts and not associated with denture though formerly meaning it was called denture sore mouth..now they do not use tht term.but chronin atrophic candidiasis is seen under upper full dentures as white ares with petechiea. denture sore mouth and denture stomatitis are two different conditions.

From: "Mokaamr@..." <mokaamr@...> " " < > Sent: Saturday, 19 May 2012, 19:36 Subject: Re:

Denture stomatitis

Thanks Chethan but in the pink book p 430 they call it Acute erythematous candidosis ???so I am not sure is it chronic or acute ?which condition exactly ?as pink book says denture sore mouth is misleading name for denture stomatitis.then describes erythematous candidosis n between brackets wrote prev denture stomatitis ???On 19 May 2012, at 18:07, Mausami Chethan <mausamichethan@...> wrote:

hi, denture stomatitis is also called chronic atropic candidosis or chronic candidosis. From: "Mokaamr@..." <mokaamr@...> Ore

< > Sent: Saturday, 19 May 2012, 14:54 Subject: Denture stomatitis

Does Denture stomatitis refer to denture sore mouth as in the pink book p 324 or to chronic atrophic candidosis as in pink book p 400.i am really confused,appreciate any explanation .

Thanks

Moka

Sent from my iPad