Dr. Jack Sahlaney, DMD
South Hills Village
Suite 205
Pittsburgh, PA 15241
Sahlaney Orthodontics

American Association of Orthodontists

Invisalign Certified

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Helpful Hints for Minor Dental and Oral Problems

By Dr. Jack Sahlaney, D.M.D., M.D.S.

As we are in the winter months and the cold weather is a problem in Western Pennsylvania, you and/or your child may experience some minor dental and oral problems.  These problems can include chapped lips which do not heal mouth ulcers, and inflammation around the lips.  I will review each problem and try to provide some solutions to alleviate the discomfort.  More severe cases may require a visit to your dentist. 

One of the most common problems we see in our office in the winter months is chapped lips which do not heal or red crusty sores at the corners of the lips.  These lip problems are more common in children than adults, although these lip problems can be seen in adults.  The lips may splint and often do not heal regardless of what is used to keep the lips moist.  This is because the lips have a minor fungal infection.  This problem can easily be treated by consulting your dentist to obtain a prescription for Mycolog II ointment (Nystatin an antifungal and Triamcinolone a topical steroid).  The ointment should be applied to the infected area(s) after meals and at bedtime.  This problem should be cleared within one week.  If the lips do not heal, you should consult your dentist again and possibly a dermatologist. 

The most frequent problem I encounter in my orthodontic practice is mouth ulcers.  The causes of mouth ulcers can include braces, poking wires on the braces, or trauma causing a break on the inner lining of the lips.  The ulcers caused by the braces or wires are treated by placing wax on the brace causing the ulcer or having your orthodontist cut the long wire. A warm salt water rinse should then be used after meals and at bedtime to help promote healing.  If your child does not like salt water, they can use an over-the-counter product called Peroxyl (by Colgate).  Peroxyl is flavored hydrogen peroxide which is an alternative for salt water.  Peroxyl can also be used as a mouth rinse in fighting bad breath.  Some children and adults can develop localized or generalized mouth ulcers without braces or trauma.   There is no known cause why individuals acquire these ulcers, although some say it may be due to a virus, daily diet (acidic foods; i.e. sauces, salad dressings, or excessive juice intake), or stress.  The ulcers can be found on the inside of the lips and on the gums.  These ulcers can be treated with salt water, Peroxyl, Benadryl and Maalox rinse, Kenalog in Orbase (prescription product), and a tetracycline rinse (prescription product). An alternative to salt water and Peroxyl is Benadryl (diphenhydramine) and Maalox.  The Benadryl and Maalox mixture seems to be effective in treating multiple mouth ulcers caused by the diet.  The Benadryl has many uses and in this case has a topical anesthetic (pain decreasing) property.  The Maalox decreases the acidic nature of the saliva.  This mixture can be made by combining equal amounts of Benadryl and Maalox.  One tablespoonful should be swished for 1 to 2 minutes and spit out without rinsing.  This should be done after meals and at bedtime.  If this fails to improve the discomfort, there are two prescription products your dentist will usually prescribe, Kenalog in Orbase or a tetracycline rinse.  The Kenalog in Orbase is a corticosteroid (triamcinolone acetonide) ointment you apply to the ulcers after meals and at bedtime.  The nice thing about this ointment is that it adheres to the ulcer upon application and forms a thin, protective film, acting like a band-aid in the mouth. The tetracycline rinse can be used as a rinse or can be applied to the ulcers individually a cotton swab.  Some individuals can not handle the taste of tetracycline as they swish the rinse.  If the tetracycline is applied to individual ulcers, a capsule should be opened and mixed with one teaspoonful of water.  This mixture should then be applied to the ulcers with a swab after meals and at bedtime.  The most important thing to remember about treating ulcers is regarding their healing time.  If they do not heal after 2 weeks, you should consult your dentist for an evaluation.

Last week I noticed a patient in my office had swollen lips and a rash around her lips after we had changed her wire.  She had no history of latex allergy, but I advised her mother to observe her lips and skin over the next several hours.   We administered some liquid Benadryl (diphenhydramine) to the patient help control the rash before leaving the office.  The diphenhydramine or Benadryl decreases histamine release in allergic reactions.  The mother called me the next day and said she did take her daughter to the emergency room and discovered that she is now allergic to latex.  The most important lesson to take away from this experience is the possibility of an individual developing an allergy with no prior symptoms or history.  The signs and symptoms of a true allergy are urticaria (hives), swelling, skin rash, chest tightness, and shortness of breath.  Hives, swelling, and skin rashes, if mild, should be treated with oral diphenhydramine.  If the allergic reaction is more severe in nature and includes shortness of breath and/or chest tightness, the individual should be taken to the emergency room immediately for treatment. 

Take home message

One thing all house holds should have is Benadryl in the liquid or capsule form.  Benadryl can be used in treating dermatologic or skin allergies, as a topical anesthetic in treating mouth ulcers, and in treating seasonal allergies.

 If an individual has chapped and cracked lips which do not heal, please call your dentist to have him or her write a prescription for Mycolog II ointment (antifungal) and (topical steroid).  This ointment helps with the healing of chapped, cracked lips and irritated corners of the lips due to a fungal infection.  As stated earlier, you should contact your dentist and/or dermatologist if the lips do not heal.

 Ulcers in the mouth can be caused by trauma (braces, long wires, or simple trauma to the gum tissue or lips from a toothbrush), diet, or stress.  There are over-the-counter solutions (salt water or Peroxyl) and prescription products (Kenalog in Orbase, Benadryl with Maalox, and a tetracycline rinse).  As stated earlier, please call and schedule an evaluation by your dentist if the ulcers do not heal afterss two weeks of treatment.    

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