For the patient with a mucosal disorder
Dr. Nancy Burkhart
Texas A&M College of Dentistry
- Patients should have professional cleanings every 2 to 3 months. Periodontal patients may need to be seen every 2 months, depending upon the patient's status and periodontal health.
- Careful scaling of all teeth should be performed with as little disruption of the tissue as possible. When significant periodontal pocketing is present, multiple appointments with gentle scaling and debridement are preferable to conventional deep scaling and root planing.
- All soft tissue areas should be evaluated. Findings should be described and recorded, with any suspicious areas being reevaluated. Careful evaluation for Candida is suggested, especially for patients who are using topical corticosteroids.
- The practitioner should note any areas that are in contact with sharp edges, crowns, or restorative materials.
- Tissue areas that do not respond to treatment may need further evaluation and possibly future biopsy.
- Ultrasonic scalers should not be used for extensive subgingival debridement to minimize irritation to the tissue.
- Polishing paste that is gritty or coarse should not be used because of irritation to the tissue both above and below the gingival margin.
- Mouth rinses containing alcohol should be avoided to prevent patient discomfort and tissue irritation. Some flavoring agents such as mint or cinnamon may act as an irritant to the tissues and should be changed or discontinued if there is any reaction.
- Air polishers are too disruptive to the tissues and should not be used.
- Any polishing of the teeth should be performed using a mild paste such as the toothpaste currently used by the patient and this can be applied with a prophy cup. Simply brushing the teeth with the paste in the dental office will be of some benefit.
- For home care, recommend toothpaste without additives (such as sodium lauryl sulfate), flavor-free products, and the use of a soft bristle brush. Paste without many additives can be tolerated by most patients. It is also highly effective in patients with xerostomia.
- A children’s toothpaste is usually tolerated well with patients since these pastes have limited ingredients.
- Patients should be instructed to discontinue the use of chewing gum, candy, mints, toothpastes, or mouth rinses that contain flavoring agents such as wintergreen, peppermint, spearmint, and cinnamon.
- Periodic oral digital photographs both for initial and for follow-up appointments are suggested. This allows better evaluation of treatment progress or lack of progress. Encourage patients to take photos on their cell phones or with their own digital camera so that the clinician has a good understanding of how the tissue responds between appointments.
- Encourage patients to document any tissue irritations and to keep a log of possible “trigger” mechanisms that may have caused lesions or irritations. The causes may be certain foods, beverages, changes in toothbrush or oral care products, oral injury, etc.
Prepared by Dr. Terry Rees and Dr. Nancy W. Burkhart. Adapted from International Oral Lichen Support Group Web site, https://dentistry.tamhsc.edu/olp/