• Systemic therapy: penicillin or tetracycline in large doses for
3–6 mo • Wide excision of infected tissue
Acute Herpetic Gingivostomatitis • Systemic therapy
• Valacyclovir 500 mg #20; 1 tablet twice daily × 10 d • Acyclovir 400 mg #50; 1 tablet 5 times daily × 10 d
• Fluids • Analgesia
3–6 mo • Wide excision of infected tissue
Acute Herpetic Gingivostomatitis • Systemic therapy
• Valacyclovir 500 mg #20; 1 tablet twice daily × 10 d • Acyclovir 400 mg #50; 1 tablet 5 times daily × 10 d
• Fluids • Analgesia
Acute Necrotizing Ulcerative Gingivitis • Débridement of necrotic tissue • Aggressive oral hygiene and plaque control • Metronidazole 250 mg #40; 1 4 times daily × 10 d
Angioedema • Systemic therapy
• Antihistamine: diphenhydramine 50 mg capsules #12; 1 every 6 h × 2–3 d
• Doxepin 25 mg tablets #12; 1 every 6 h × 2–3 d • Prednisone 10 mg tablets #12; 4 tablets daily × 3 d
Aphthous Stomatitis • See “Recurrent Aphthous Stomatitis.”
Behçet’s Disease • Treat as for aphthosis (see “Recurrent Aphthous Stomatitis”). • Refer to a dermatologist, a rheumatologist, or an ophthalmolo-
gist, depending on organ involvement, for ongoing care, which may include systemic immunosuppressive and/or anti-inflammatory drugs.
Candidiasis • Identify and correct provocative factors. • Topical therapy
• Nystatin oral suspension (100,000 units/mL); rinse 5 mL and swallow 4 times/d
• Clotrimazole (Lotrimin) solution 1%; rinse 5 mL and swallow 4 times/d
• Clotrimazole troches (Mycelex) 10 mg; dissolve 1 troche in mouth 5 times/d
/2 of 500 mg tablet dissolved in mouth bid
• Clotrimazole vaginal tablets
1
• Systemic therapy • Fluconazole (Diflucan) 100 mg #15; 2 tablets on the first day,
1 tablet days 2–7, 1 tablet every other day for days 8–21 • Ketoconazole (Nizoral) 200 mg #21; 1 tablet every day with
breakfast × 21 d • Itraconazole (Sporanox) 200 mg #21; 1 tablet every day
with breakfast × 21 d • May use shorter duration for less severe infections
Cheilitis Glandularis • Challenging to treat • Trials of therapy
• Intralesional corticosteroids as triamcinolone acetonide 5–10 mg/mL; inject 1–3 mL per session with sessions at 3–4 wk intervals
• Systemic antibiotic: tetracycline 500 mg tid • Systemic corticosteroid: prednisone 5 mg tablets #40
– Take each morning for 8 with breakfast, 8-8-6-6-4-42-2 mg, stop
– Will shorten the course of an individual episode but not change the natural history of the disease
Cheilitis Granulomatosa • Challenging to treat • Trials of therapy
• Intralesional corticosteroids such as triamcinolone acetonide 5–10 mg/mL; inject 1–3 mL per session with sessions at 3–4 wk intervals
• Systemic antibiotic: tetracycline 500 mg tid • Systemic corticosteroids: prednisone 5 mg tablets #40
– Take each morning for 8 d with breakfast, 8-8-6-6-4-42-2 mg-stop
– Will shorten the course of an individual episode but not change the natural history of the disease
• Dapsone 25 mg tablets – Check baseline complete blood count (CBC), liver function
tests, urinalysis, and glucose-6-phosphate red blood cell enzyme level before treatment.
/2 of 500 mg tablet dissolved in mouth bid
• Clotrimazole vaginal tablets
1
• Systemic therapy • Fluconazole (Diflucan) 100 mg #15; 2 tablets on the first day,
1 tablet days 2–7, 1 tablet every other day for days 8–21 • Ketoconazole (Nizoral) 200 mg #21; 1 tablet every day with
breakfast × 21 d • Itraconazole (Sporanox) 200 mg #21; 1 tablet every day
with breakfast × 21 d • May use shorter duration for less severe infections
Cheilitis Glandularis • Challenging to treat • Trials of therapy
• Intralesional corticosteroids as triamcinolone acetonide 5–10 mg/mL; inject 1–3 mL per session with sessions at 3–4 wk intervals
• Systemic antibiotic: tetracycline 500 mg tid • Systemic corticosteroid: prednisone 5 mg tablets #40
– Take each morning for 8 with breakfast, 8-8-6-6-4-42-2 mg, stop
– Will shorten the course of an individual episode but not change the natural history of the disease
Cheilitis Granulomatosa • Challenging to treat • Trials of therapy
• Intralesional corticosteroids such as triamcinolone acetonide 5–10 mg/mL; inject 1–3 mL per session with sessions at 3–4 wk intervals
• Systemic antibiotic: tetracycline 500 mg tid • Systemic corticosteroids: prednisone 5 mg tablets #40
– Take each morning for 8 d with breakfast, 8-8-6-6-4-42-2 mg-stop
– Will shorten the course of an individual episode but not change the natural history of the disease
• Dapsone 25 mg tablets – Check baseline complete blood count (CBC), liver function
tests, urinalysis, and glucose-6-phosphate red blood cell enzyme level before treatment.
– Take each morning with breakfast, 1 × 3 d, 2 × 3 d, 3 × 3 d, 4 × 7 d, and 5 daily thereafter
– Check CBC and liver function every month for 3 mo, then every 3 mo thereafter.
– Use for long-term control of disease
– Check CBC and liver function every month for 3 mo, then every 3 mo thereafter.
– Use for long-term control of disease