Special Operations Forces Medical Handbook

5-17

Subjective: Symptoms
Burning, itching, or stinging.

Objective: Signs
Macule progressing to small ulcer surrounded by reddish halo (bull’s eye) on loose tissues of the mouth (i.e.,
cheek, inner lip, tongue, soft palate, and floor of the mouth).

Assessment:

Differential Diagnosis - herpetic lesions, Traumatic ulcer. May be seen in more serious systemic
and local diseases including Sutton’s disease, Beçhet’ s disease, Reiter’s syndrome, leukopenias, Crohn’s
disease and ulcerative colitis (see index).

Plan:
Apply topical steroids (Kenalog in Orabase gel, Lidex gel, Decadron rinses) to reduce pain and duration
of lesions. Address underlying disorders and/or avoid triggers. Maintain healthy diet, ample fluids, and
adequate rest.

6. PERICORONITIS
   This is the acute inflammation of tissue flaps over partially erupted teeth, caused by trauma from opposing
   teeth, food and debris, and bacteria. Commonly seen with erupting wisdom teeth.

Subjective: Symptoms
Marked pain radiating to the ear, throat and the floor of the mouth; fever; general malaise; muscle spasm
in jaw.

Objective: Signs
Red, swollen, tender, suppurative gums localized over tooth; fever; cervical lymphadenopathy; trismus of the
masticator muscles.

Assessment:
Differential Diagnosis - periapical abscess, trauma from opposing tooth.

Plan:

1. Wrap the tip of a blunt instrument with a wisp of cotton. Dip the cotton in 3% peroxide and carefully clean
   the debris from beneath the tissue flap; pus may be released.


2. Flush the area using warm saline solution.


3. Instruct the patient to use a hot saline mouth rinse hourly.


4. Prescribe an adequate soft diet.


5. Repeat this treatment at daily intervals until the inflammation subsides.


6. Stress that oral hygiene must be maintained.


7. Extract the offending tooth if necessary. Extract the opposing molar if the inflammation does not subside.


8. Initiate antibiotic therapy if there is involvement of the cervical nodes, fever, and/or trismus of the
   masticator muscle.

CANDIDIASIS (THRUSH) See Infectious Disease chapter.

7. LOCALIZED OSTEITIS (DRY SOCKET)
   Caused by breakdown and/or loss of blood clot at the site of an extracted tooth. Increases in frequency with
   patient age (>25 years old) and tobacco use.

Subjective: Symptoms
Constant moderate to severe pain, may involve entire side of mandible; occurs 3 to 5 days after extraction