ANATOMY OF DIGESTIVE SYSTEM

Parotid Gland - the largest salivary glands in the body,

located in front of the ears. They produce saliva to help
with chewing, swallowing, and digestion.
Stensen Duct – a salivary duct that carries saliva from
the parotid gland to the mouth.
Wharton duct - connects the submandibular gland to the
floor of the mouth.
DENTAL PLAQUE - A soft, sticky film of bacteria
that forms on the teeth. It can lead to dental caries if not
removed through proper oral hygiene.

DENTAL CARIES - or tooth decay, is an erosive

process initiated by bacteria acting on fermentable
carbohydrates, producing acids that dissolve tooth
enamel.

History
The prevalence of dental caries remains high across
various age groups, notably affecting adolescents
(56.8%) and older adults (96.2%).

Risk factors
• Presence of dental plaque (a gluey, gelatinlike
substance that adheres to the teeth)
• Length of time acids are in contact with the teeth
• Strength of acids and the ability of the saliva to
neutralize them
• Susceptibility of the teeth to decay.
• Inability to afford dental care is associated with a
decrease in the quality of life of adults ages 45 years and
older

Signs and Symptoms

DENTAL PLAQUE
1. Visible Plaque: A whitish or yellowish film on the
teeth, especially along the gum line.
2. Bad Breath
3. Gum Inflammation: or bleeding gums (gingivitis)
when brushing or flossing.
4. Tooth Sensitivity: To hot, cold, or sweet foods and
drinks

DENTAL CARIES
1. Toothache: Persistent pain in or around a tooth, which
may be sharp, throbbing, or constant.
2. Sensitivity: To hot, cold, or sweet foods and drinks
3. Visible Cavities
4.Discoloration: white spots (early decay), brown spots,
or black areas.
5. Foul Taste
6. Swelling: Swelling in the gums or face if an infection
develops

DIAGNOSTICS
1. X-ray studies - provides valuable information that
cannot be obtained through a visual examination alone.

Management Of Dental Plaque and Caries

1. Surgical Management
 - Selective removal of carious tissue to preserve Needle aspiration or examination confirms purulent
healthy tooth structure. material.
- Utilizes minimally invasive techniques like selective
caries excavation. MANAGEMENT
- Restorative options include fillings or crowns to Needle aspiration or incision to drain abscess and relieve
restore function and aesthetics. pressure.
Antibiotics
2. Medical Management Analgesics
- Focuses on non-invasive treatments for early-stage
caries. DEFINITIVE MANAGEMENT:
- Includes fluoride applications and silver diamine Root canal therapy or tooth extraction.
fluoride (SDF) to halt progression. Possible apicoectomy to remove the infected root apex.
- Pit and fissure sealants are materials applied to the
occlusal pits and fissures of teeth to prevent or arrest NURSING MANAGEMENT
dental caries. Post-procedure care to manage bleeding and swelling.
- Regular monitoring and risk assessments guide Education on oral hygiene and adherence to medication
individualized treatment plans. regimen.
- Managing related systemic diseases
TEMPOROMANDIBULAR JOINT DISORDER
3. Patient Education Problems that affect the jaw joint (temporomandibular
- Promotes oral hygiene practices such as brushing joint or TMJ) and the muscles that help move your jaw.
with soft bristle toothbrush and flossing daily. They can cause pain, difficulty moving your jaw, and
- Dietary changes to reduce sugar and starch intake. other symptoms.
- Refraining from smoking and excessive alcohol use.
- Emphasizes the importance of regular dental check- Types of TMD
ups. Myofascial Pain - Pain in the muscles that control the
- Encourages the use of fluoride toothpaste and jaw, neck, and shoulders.
understanding sealants' roles in prevention. Internal Joint Problems - Issues like a dislocated jaw, a
shifted disc inside the joint, or an injured joint bone.
4. Nursing Management Degenerative Joint Diseases - Conditions like arthritis
- Wipe the teeth with a gauze pad and then have the that cause wear and tear in the jaw joint.
patient swish an antiseptic mouthwash several times
before expectorating into an emesis basin Common history of a patient
-Jaw pain ranging from dull ache to severe throbbing
PERIAPICAL ABSCESS pain.
Localized infection at the apex of a tooth caused by -Pain radiating to ears, teeth, and facial muscles.
untreated dental caries, trauma, or infection extending -Restricted jaw motion and jaw locking.
into the pulp. It may manifest acutely with intense pain, -Clicking, popping, or grating sounds during movement.
swelling, and systemic symptoms or chronically as a -Associated symptoms: headaches, dizziness, earaches,
granuloma detected during imaging. and hearing issues

HISTORY Imaging Studies:

Untreated dental caries. MRI:
Occasional dental visits with no recent treatments. X-rays or CT scans
High-sugar diet, poor oral hygiene, and irregular
brushing/flossing habits. Management
- Maxillomandibular Fixation (MMF): Wires or elastic
DIAGNOSTIC bands are used to immobilize the jaw for simple
Clinical findings: Swelling, tenderness, and redness of fractures without displacement.
the gum opposite the affected tooth. - Open Reduction Internal Fixation (ORIF): Preferred for
Radiologic evidence complex or displaced fractures. This involves using
metal plates, screws, or arch bars to stabilize the bone.
- Bone Grafting: For extensive bone loss, grafts are
sourced from the patient's iliac crest, ribs, or cranial sites Lifestyle Changes:
to reconstruct the jaw. Quit smoking as it delays healing.
Ensure good nutrition with calcium and vitamin D to
Caring for Patients with TMD strengthen bones.
After Surgery
For Patients with MMF (Wired Jaws): CANCER OF THE ORAL CAVITY
- They’ll need a liquid diet for 7–10 days. Oral cancer includes cancers of the mouth and the back
- Rinse the mouth regularly to maintain hygiene. of the throat. Oral cancers develop on the tongue, on the
- Apply cold compresses to the affected area during the tissue lining the mouth and gums, under the tongue, at
first 48 hours to reduce swelling. the base of the tongue, and the area of the throat at the
back of the mouth.
For Patients with ORIF (Plates or Screws):
- A soft diet is recommended for 4–6 weeks to allow the HISTORY
jaw to heal. Oral cancer most often occurs in people over the age of
- Maintain oral hygiene 40 and affects more than twice as many men as women.
- Apply cold compresses to the affected area during the Most cancers in the mouth are related to tobacco use,
first 48 hours to reduce swelling. drinking alcohol, or both.

Preventing Problems During Recovery PHYSICAL EXAMINATION

- Keep an eye out for infections, wound issues, or A physical exam for oral cancer is a systematic
hardware problems. inspection and palpation of the mouth and neck to check
- Advise the patient to avoid smoking and alcohol, as for signs of cancer. The exam may also include assessing
they can slow healing. speech, swallowing, breathing, and hearing.

Medical Management Extraoral exam

Pain Medication The doctor will examine the lips, salivary glands, and
NSAIDs for inflammation and mild pain. lymph nodes in the neck. They will look for swelling,
Opioids for severe, acute pain after surgical tenderness, or discoloration.
interventions.
Muscle Relaxants: For alleviating jaw tension or spasms. Intraoral exam
Antibiotics: Prevents infection in open fractures or post- The doctor will feel for lumps or swelling in the mouth,
surgery. including the cheeks, lips, tongue, and roof of the mouth.
They will also check for white patches, sores, or areas of
Patient Education irritation.
Physical Therapy:
Encourage jaw exercises to improve mobility and Tongue exam
strength as advised by the provider. The doctor will ask the patient to open their mouth wide
Gradually reintroduce chewing and jaw movements with and stick their tongue out as far as they can. They will
guidance. then grasp the tongue with gauze and rotate it side to
side to inspect the tissue.
Avoiding Risky Behaviors:
Avoid clenching or grinding teeth (bruxism) by using What to look for
stress management techniques or a mouthguard if -Swelling, lumps, or rashes on the face
necessary. -White or red patches in the mouth
Stop habits like chewing ice, hard candy, or pen caps. -Sores that bleed easily or don't heal
-Difficulty swallowing or chewing
Follow-Up Appointments: -A mass or lump in the neck
Stress the importance of attending follow-ups for X-rays If you notice any of these signs, you should make an
and check-ups to assess healing progress. appointment with your doctor as soon as possible.
Adjustments to plates, screws, or appliances (if ORIF
was performed) may be necessary. LABORATORY TEST
1.) Biopsy a.) Teach the importance of regular oral care using soft-
2.) Histopathological Examination bristled toothbrushes, saline rinses, and avoiding irritants
3.) Molecular and Genetic Tests like alcohol or tobacco.
b.) Encourage a soft, high-protein, high-calorie diet if
IMAGING STUDIES eating is difficult. Suggest liquid supplements if needed.
1.) X-rays c.) Educate about swallowing techniques and using
2.) Ultrasound feeding aids if dysphagia is present.
3.) Computed Tomography (CT) Scan e.) Address concerns about body image, especially after
4.) Magnetic Resonance Imaging (MRI) reconstructive surgery.
5.) Positron Emission Tomography (PET-CT) f.) Provide resources for counseling or support groups
for emotional well-being.
NURSING MANAGEMENT g.) Educate about the importance of quitting smoking
1. Surgical Nursing Management and alcohol consumption to reduce recurrence risk.
Preoperative Care: h.) Encourage regular follow-ups and adherence to
a.) Provide emotional support and address patient fears prescribed treatment.
regarding surgery, appearance, and outcomes. i.) Educate about managing pain and recognizing signs
b.) Collaborate with a dietitian to ensure the patient is of complications, such as infection or recurrence.
nutritionally prepared for surgery, especially if oral
intake is compromised. ACHALASIA
c.) Educate the patient about surgical procedures, Achalasia is absent or ineffective peristalsis of the distal
possible outcomes. esophagus accompanied by failure of the esophageal
d.) Promote oral care to reduce the risk of infection. sphincter to relax in response to swallowing. Narrowing
of the esophagus just above the stomach results in a
Postoperative Care: gradually increasing dilation of the esophagus in the
a.) Monitor for airway obstruction due to swelling or upper chest.
secretions. Administer humidified oxygen and suction as
needed. History
b.) Administer prescribed analgesics and assess pain Rare; may progress slowly and occurs often in ages 20
regularly. - 40 and 60 - 70 years.
c.) Monitor surgical sites for infection, bleeding, or
dehiscence. Clinical Manifestations
e.) Manage feeding tubes, parenteral nutrition, or dietary Dysphagia
modifications if the patient has difficulty swallowing. - The primary symptom, characterized by difficulty
swallowing solid food.
2. Medical Nursing Management - Patients often describe a sensation of food sticking in
Radiation Therapy: the lower esophagus.
a.) Monitor for side effects such as mucositis, Regurgitation
xerostomia (dry mouth), taste changes, and skin - Occurs as the condition progresses.
reactions. - Food is either spontaneously or intentionally
b.) Encourage hydration and pain management to regurgitated to relieve discomfort caused by prolonged
maintain oral intake. esophageal distention.
Noncardiac chest or epigastric pain
Chemotherapy: - Pain may or may not be associated with eating.
a.) Monitor for systemic side effects such as nausea, Pyrosis (heartburn)
vomiting, fatigue, neutropenia, and oral mucositis. - May or may not be related to food intake.
Diagnostic confusion with GERD
Targeted Therapy/Immunotherapy: - Symptoms overlap with GERD, leading to frequent
a.) Monitor for specific side effects (e.g., skin rashes, misdiagnosis and treatment for GERD
infusion reactions).
Assessment and Diagnostic Study
3. Patient Education X-ray studies
 - Reveal esophageal dilation above the narrowing at the
lower gastroesophageal sphincter, termed a "bird's beak Examples of ingested foreign bodies are the following:
deformity."  Dentures
 Fish bones
Diagnostic imaging  Pins
- Barium swallow: Highlights esophageal  Small batteries
 Items containing mercury or lead
abnormalities.
 Short-blunt objects
- CT scan of the chest: Provides additional diagnostic
 Long objects
detail.  Sharp-pointed objects
- Endoscopy: Used to assess structural issues in the  Disc
esophagus.  Batteries
 Magnets
High-resolution manometry  Coins
- Confirms the diagnosis by measuring:
- Peristalsis Clinical manifestations
- Contraction amplitudes * Pain
- Esophageal pressure * Dysphagia
- Performed by a radiologist or gastroenterologist * Dyspnea
* Cyanosis
Management * Swelling or tenderness, in suspected area
Dietary modifications * Wheezing may occur
- Eat slowly and drink fluids with meals.
Botulinum toxin injection Priority the airway!
- Inhibits smooth muscle contraction in the esophagus. The nurse performs an initial and ongoing respiratory
- Used for patients unable to undergo definitive (airway-focused) assessment of a patient with a foreign
treatments. body in the esophagus. Intubation may be required to
- Benefits are temporary and may cause submucosal protect the airway.
fibrosis.
Pneumatic dilation Imaging Studies
- Stretches the narrowed area of the esophagus. -X-ray
- High success rate, but usually requires two sessions. -Endoscopy
- May cause pain and requires moderate sedation.
- Low risk of perforation. Management
Emergency surgical procedure:
Surgical treatment -Endoscopic procedure and retrieval devices
- Heller myotomy: Cutting esophageal muscle fibers, -Endoscopic extraction and dilatation
often performed laparoscopically.
- May include fundoplication to reduce the risk of Medication
GERD. - Gluacagon (1 mg thru IV)
- Per-oral endoscopic myotomy (POEM): A newer,
minimally invasive alternative adopted by specialized Education
centers. 1. Instruct the client to strictly follow diet restriction
starting with clear liquids and progress to soft foods
FOREIGN BODIES as tolerated, as prescribed by the doctor.
Foreign bodies are objects that become lodged in or on 2. Encourage clients to have adequate fluid intake to
the body unintentionally. They may be ingested, or promote healing and prevent constipation.
introduced through trauma. Many swallowed foreign 3. Encourage client’s rest as needed and avoid
bodies pass through the GI tract without the need for strenuous activities.
medical intervention depending on size, material, and 4. Instruct client to avoid bending or lying flat
location that can be possible inert, toxic, or infectious immediately after eating
that may cause obstructions or harm into esophagus that 5. Instruct client to avoid chewing gum or candies if it
must be removed. is a high risk of choking
6. Instruct clients to ensure proper food preparation and
avoid eating fish with small bones or other foods
that may pose risks.
7. If Using dentures or dental appliances, ensure that
they fit well to reduce swallowing risks.

GASTROESOPHAGEAL REFLUX DISEASE

- GERD is a common disorder marked by backflow of
gastric or duodenal contents into the esophagus that
causes troublesome symptoms/or mucosal injury to the
esophagus.

HISTORY
- Tobacco use, coffee drinking, alcohol consumption,
spicy and fatty foods, lying down after eating, large
meals, and gastric infection with Helicobacter Pylori.

SIGNS AND SYMPTOMS

Heartburn (burning sensation in the chest, often after
eating or at night)
Regurgitation (sour or bitter-tasting fluid coming back
up into the throat or mouth)
Dysphagia (difficulty swallowing)
Chest pain (may mimic heart-related pain but is due to
acid reflux)

DIAGNOSTIC
1. Ambulatory pH monitoring which involves trans nasal
catheter placement or endoscopic wireless capsule
placement for approximately 24 hours.
2. Endoscopy or barium swallow is used to evaluate
damage to the esophageal mucosa and rule out strictures
and hernias.

SURGICAL MANAGEMENT
1. Open or laparoscopic Nissen fundoplication which
involves wrapping a portion of the gastric fundus around
the sphincter area of the esophagus.

MEDICAL MGT
1. Antacids/Acid neutralizing agents
2. Histamine-2 receptor antagonist
3. Prokinetic Agents
4. Proton pump inhibitors
5. Reflux Inhibitors
6. Surface agents/Alginate-based barriers
7. Inhibitors of transient lower esophageal sphincter

PATIENT EDUCATION
1. Tobacco cessation, limiting alcohol, weight loss,
elevating the head of the bed, avoiding eating before
bed, and altering diet.