Preoperative testing (eg, CBC, serum chemistry panel, urinalysis) and a thorough oral examination under anesthesia should be pursued. Elevated total protein and neutrophilia are typical findings in CUPS patients. While the patient is under general anesthesia with intubation, a tooth-by-tooth examination should be conducted, including periodontal probing and intraoral radiographs. The teeth should be thoroughly cleaned above and below the gum line and then polished.
Oral examination findings should be discussed with the clients to consider the best way to tailor patient-specific therapy, which often initially or eventually involves multiple extractions and future plaque-control options.
In these patients, even a small amount of plaque can initiate a painful ulcerative inflammatory reaction. Teeth affected by grades 3 and 4 periodontal disease should be extracted.
Either a dental sealant applied at the time of anesthesia that lasts 6 months or a waxy polymer applied weekly is recommended to help decrease plaque accumulation in teeth that have not been extracted. Antibiotics approved for dental infections are not indicated as sole therapy. Contact mucositis, even with ulceration, is considered a primarily inflammatory disease and not infectious.
Other medications that have been used in the past with limited success include pentoxifylline to decrease inflammation.5 Niacinamide may also be helpful. Pain relief is likewise indicated. 5 Pulsed antibiotic therapy (dental-approved antimicrobial administered the first 5 days of each month) is not recommended.2,5 The use of anti-inflammatory medications in control of CUPS may be helpful but is controversial because the cause of the syndrome (plaque and tartar rubbing against the mucosa) is not addressed.2,4
Related Article: Pain Management & Periodontal Disease
Home care, including teeth brushing twice a day to prevent plaque accumulation and extralabel daily application of a plaque gel barrier, may be helpful in controlling mucositis and ulceration.
In advanced cases in which the client cannot provide twice-daily plaque control or if such care is not successful, removal of the teeth adjacent to the ulcerated areas or, in some cases, all teeth can result in rapid elimination of inflammation and pain (Figure 8).
The use of the CO2 laser to photovaporize contact mucositis and mucositis with ulceration lesions has met with favorable results when combined with strict plaque control. The laser should be set between 3 to 6 watts in continuous mode. CO2 laser treatment of the exposed ulcer surfaces may be beneficial to lessen patient discomfort and aid healing (Figures 9 and 10).6