Medical Emergencies · patient case question
Which is the most appropriate recommendation?
Patient case: Asthmatic man with white plaques on the tongue and buccal mucosa
Patient: Male, 41 years old
Chief complaint: “I'm here for a check up and I want a cleaning done today.”
Background: Asthma. Medication: beclomethasone dipropionate (Qvar®) inhaler.
Current findings: White plaques on the buccal mucosa and dorsal surface of the tongue. The plaques wipe away, leaving erythematous mucosa underneath.
Show answer and explanation
Correct answer: D. Rinse with water after each use of the inhaler
- A. Changing an asthma prescription is the physician's decision, and is unnecessary for a preventable local side effect.
- B. Never advise a patient to stop a controller asthma medication. That is dangerous and outside your scope.
- C. Antifungal therapy may be warranted for an active symptomatic infection, but the BEST recommendation targets the cause. Note also that you would prescribe it yourself, not send him to his physician for it.
- D. CORRECT. This addresses the CAUSE and prevents recurrence. Residual corticosteroid deposited on the mucosa is what permits candidal overgrowth; rinsing and spitting after each use, and using a spacer, removes it. This is squarely within the dentist's scope and is the best answer.
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