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Australian Pharmacist January 2014 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
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Rosemary to visit her doctor to ensure
her diabetes is under control, as you are
concerned that her current symptoms may
be associated with her diabetes.
Bleeding gums and mouth ulcers can be
caused by a variety of factors, from oral
trauma to underlying health conditions.
It is essential that pharmacists obtain
a detailed patient history in order to
determine the need for referral for
further investigations in cases of oral
Additionally, pharmacists should be
adept at patient counselling regarding
common OTC oral health products and
basic oral hygiene measures.
You explain to Rosemary that there are a
number of potential causes of her current
symptoms. You highlight that she is at
an increased risk of periodontal disease,
oral health infections and delayed wound
healing, as she has type 2 diabetes.
You provide Rosemary with advice
regarding oral hygiene, and recommend
some chlorhexidine mouth wash, rinsed
for at least one minute, every 8–12 hours.
This may assist with the treatment of
her bleeding gums and may also reduce
the risk of her mouth ulcer becoming
infected. You also offer Rosemary Orabase
Protective Paste, applied at frequent
intervals, at least two-to-three times a
day, which will provide a protective barrier
against mouth ulcer irritants. A topical
analgesic gel, such as benzydamine gel
(Difflam oral gel) may also be useful to
assist with any associated pain.
You refer Rosemary to her dentist and
doctor. Her dentist will thoroughly assess
her oral health, and most likely perform a
professional scale and clean. The dentist
will also be able to provide Rosemary with
comprehensive education and advice
regarding her oral health. You advise
1. Periodontal disease can be caused
by which ONE of the following
b) Coeliac disease.
d) Malignant disease.
2. Patients with diabetes are at a higher
risk of oral health conditions as a
a) High glucose concentrations in saliva
leading to enhanced pathogenic
b) Altered response to infections due to
impaired erythrocyte function.
c) Enhanced response to infections due to
reduced secretion of pro-inflammatory
cytokines, such as tumour necrosis
d) An increased chance of developing
periodontal pockets due to insulin
3. Which of the following over-the-
counter treatments for mouth ulcers
is not recommended for patients
a) Difflam oral gel.
b) Chlorhexidine mouth wash.
c) Orabase protective paste.
d) Kenalog in orabase.
4. Prevention of periodontal disease
a) Avoiding spicy, acidic or salty foods.
b) Correction of nutritional deficiencies
(such as B vitamin deficiencies).
c) Professional dental cleans three-to-four
times a year.
d) Avoidance of potential trigger factors,
such as chocolate.
5. Choline salicylate is contraindicated
a) Patients under the age of four months
due to the risk of Reye’s syndrome.
b) Patients with diabetes due to the risk
of impaired defensive responses in oral
tissue increasing the risk of infections.
c) Patients with herpes simplex or an
underlying immune disorder.
d) Patients with discoloured teeth, as
long term use can further worsen this
COUNSELLING IN PRACTICE
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