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Pharmacology of drugs
used in Endodontic and
Restorative treatment
Iyad Abou Rabii
DDS. OMFS.MRes.PhD
What Drugs can be applied
restorative and endodontic
treatment ?
• Pulp Capping
• Pulp necrosis generating
• Endodontic retorative materials contains
  aiding drugs
• Haemostatic agent
• Antiseptics
• Topical local aneasthesic agents
Pulp Capping

• Pulp dent: Premixed Calcium Hydroxide
  Paste For Vital Pulp Therapy and Root
  Canal Therapy Bactericidal –
  Bacteriostatic (High pH destroyes baterial
  cell wall) - Radiopaque Calcium Hydroxide
Pulp Capping

• stimulates consistent dentin bridge
  formation.
• The new dentin bridge re-encloses the
  pulp in its own natural protective chamber
  and is visible clinically after approximately
  2-3 months.
Endodontic retorative materials
contains aiding drugs
• Endodontic retorative materials contains
  aiding drugs
   • Active Points Chlorhexidine ® from
     Roeko) that contains Chlohexidine in
     order to desinfect route canal.
Endodontic retorative materials
contains aiding drugs
• Tempacanal ®
   • Antimicrobial intracanal dressing
     between visits in order to desinfect
     canal .
   • Used for
      • large periapical lesions and cysts
      • Transverse root fracture
      • Avulsed teeth
Different Calcium Hydroxide
Preperations
Pulp necrosis
  • (Caustinerf Arsenical ® from
    Septodont) that contains Arscenica
    Hydrochloride in addition to Lidocaine
    and Ephedrine Hydrochloride used to
    generate pulb necrosis.
Haemostatic agents
  • Haemostatic agent used to stop
    hemorrage from the inflammated pulp,
    and injured gengiva they are four types:
     • Hemostaic dressings
     • Absorbable Gelatin
     • Astringents and styptics
     • Vasoconstrictors
Haemostatic dressings
  • The simpliste way of bleeding control is
    to apply sterile gauze with moderate
    pressure.
  • Collagen dressing may be applied
  • In more severe casses (bony bleeding)
    Absorbable Gelatin Sponge may be
    used
Absorbable Gelatin Sponge
  • Applied on the operated tissues,
    controls oozing and seal up the
    bleeding tissues immediately. This
    prevents blood loss from the deeper
    wounds
  Example : Surgispon ®
  • absorbed biologically within 4-6 weeks
  • Not used in Restorative and
    Endodontics practice
Thrombin

  • Can be apply locally, especially with
    patent having oral anti-coagulant drugs
  • thrombin can regulate the growth, cell
    cycle progression, and functional
    reorganization of the pulp tissue during
    pulp healing and inflammatory
    processes (Mei-Chi Chang,1999)
Astringents and styptics
  • An astringent (also spelled
    adstringent) substance is a chemical
    compound that tends to shrink or
    constrict body tissues
  • Styptics (also spelled stiptics) are a
    specific type of antihemorrhagic agent
    that work by contracting tissue to seal
    injured blood vessels
  • Zinc, iron, and aluminum salts are the
    best Astringents and styptics
    substances used in dentistry
Vasoconstrictors
  • Applied locally and for a very short
    time.
  • Can be injected, but it is better to avoid
    to do this
  • adrenalin dipped gauze are available in
    the market
Examples
• Astrigedent X ® from Ultradent
• Dental TD Zett ® from J.Morita
• Quick Stat FS ® from Vista
Astrigedent X ® from Ultradent
  • Astrigedent X is an aqueous 12.7% iron
    solution containing equivalent ferric
    sulfate and ferric subsulfate for difficult-
    to-stop, problem bleeding
  • Less acidic than competitive iron
    subsulfate solutions
Dental TD Zett ® from J.Morita
• It is a fast-acting intraoral topical
  hemostatic agent.
• It combines aluminum chloride, which has
  an astringent action, with Cetylpyridinium
  chloride and also lidocaine.
• Indications - For hemostasis in the
  following cases:
  1) Subgingival abutment tooth or cavity
  preparation
  2) Gingival retraction during Gingivoplasty
Quick Stat FS from Vista
• 15.5% Ferric Sulfate Haemostatic Gel
• Provides effective tissue management
  when completing impressions,
  restorations, crown & amp; bridge, and
  Pedodontic pulp treatment
• Doesn`t flow onto surrounding tissue
Oral Rinses
  Rinses are generally classified by the
    U.S. Food and Drug Administration
    (FDA) as either :
  • cosmetic
  • therapeutic
  • a combination of the two.
Cosmetic rinses
• Cosmetic rinses are commercial over-the-
  counter (OTC) products that help remove
  oral debris before or after brushing,
  temporarily suppress bad breath, diminish
  bacteria in the mouth and refresh the
  mouth with a pleasant taste.
Therapeutic rinses
•    Antiplaque/antigingivitis rinses containing
    an active bacteria- fighting ingredient such
    as quaternary ammonium compounds,
    boric and benzoic acid phenolic
    compounds.
•   Anticavity fluoride rinses.
•   Topical antibiotic rinses
•   Enzyme rinses
•   Artificial saliva rinses
•   Rinses that control calculus formation
Natural/Herbal Oral Rinses
• Natural oral rinses do not contain alcohol,
  harsh chemicals, dyes or preservatives.
  They often contain herbs with beneficial
  properties and alternative ingredients
• For instance, Xylitol, a natural sweetener
  derived from the fibrous parts of plants,
  helps reduce the risk of tooth decay and
  promotes oral health. Recently several
  chewing gums have entered the
  marketplace that contain Xylitol and are
  promoted as reducing decay.
Examples :
• Phenol products: Listerine ®
• Chlorhexidine products: Peridex ®
• Herbal Sanguinaria products: Viadent ®
• Therapeutic Anticavity Fluoride Rinses :
  Oral-B ® Anticavity Rinse
• Cosmetic Breath Freshening Mouth
  Rinses: Signal ®
Side effects
•   ulcers
•   sodium retention
•   stains
•   soreness
•   numbness
•   changes in taste
•   painful mucosal erosions.
Symptoms of an oral rinse
overdose include:
When swallowing especially by children
1. Breathing problems, such as deep
   breathing, rapid shallow breathing,
   slowed breathing or breathing stoppage
2. Gastrointestinal problems, such as
   abdominal pain, diarrhea, nausea and
   vomiting
3. Nervous system problems, such as coma,
   dizziness or drowsiness
Symptoms of an oral rinse
overdose include:
4. Bluish skin, particularly lips and
    fingernails
5. Collapse
6. Convulsions
7. Decreased blood pressure (hypotension)
8. Less-frequent urination
9. Excessive sweating and thirstiness
10. Trouble walking normally
11. Slurred speech
topical anesthetic for oral
mucosal application.
Examples
•   Comfort caine ® (Harry Basworth)
•   Cainetips ® (J. Morita)
•   Pharmaethyl ® (Septodent)
•   Anaestho Gel ® (Voco)
Comfort Caine ®
• Comfort Caine is a topical anesthetic for oral
  mucosal application.
• Comfort Caine contains the active ingredient ethyl
  4-amino benzoate 20% Benzocaine, in a flavored
  polyethylene glycol base sweetened with
  saccharin.
• Comfort Caine combines fast onset (15-20
  seconds) and short duration (12-15 minutes) with
  virtually no systemic absorption.
Cainetips
• Individually wrapped, disposable swabs
  pre-filled with a 20% Benzocaine solution,
  CaineTips oral pain relievers are designed
  for intraoral applications
Cainetips ®
• The single dose packaging allows for
  direct and precise application with no
  mess or drips and delivers quick pain relief
  onset.
• Recommended for pre-injection,
  periodontal curettage, deep scaling, and
  post-care treatment, they also help prevent
  cross-contamination. Available in a cherry
  flavored solution
Pharmaethyl ®
• Topical freezing agent with natural mint
  flavor.
• Pharmaethyl is used for local applications
  on the mucous membrane of the oral
  cavity and its adnexa: lancing of
  abscesses, extractions of deciduous teeth,
  extraction of pyorrheal teeth, vitality tests.
• Do not spray close to an open flame or
  any incandescent sources.
Anaestho Gel ®
• Contains the active ingredient of
  Lidocaine.
• Useful in case of aphtous ulcerations
• Gag reflex inhibition
Iyad Abou Rabii
DDS.OMFS.MRes.PhD

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Redph

  • 1. Pharmacology of drugs used in Endodontic and Restorative treatment Iyad Abou Rabii DDS. OMFS.MRes.PhD
  • 2. What Drugs can be applied restorative and endodontic treatment ? • Pulp Capping • Pulp necrosis generating • Endodontic retorative materials contains aiding drugs • Haemostatic agent • Antiseptics • Topical local aneasthesic agents
  • 3. Pulp Capping • Pulp dent: Premixed Calcium Hydroxide Paste For Vital Pulp Therapy and Root Canal Therapy Bactericidal – Bacteriostatic (High pH destroyes baterial cell wall) - Radiopaque Calcium Hydroxide
  • 4. Pulp Capping • stimulates consistent dentin bridge formation. • The new dentin bridge re-encloses the pulp in its own natural protective chamber and is visible clinically after approximately 2-3 months.
  • 5. Endodontic retorative materials contains aiding drugs • Endodontic retorative materials contains aiding drugs • Active Points Chlorhexidine ® from Roeko) that contains Chlohexidine in order to desinfect route canal.
  • 6. Endodontic retorative materials contains aiding drugs • Tempacanal ® • Antimicrobial intracanal dressing between visits in order to desinfect canal . • Used for • large periapical lesions and cysts • Transverse root fracture • Avulsed teeth
  • 8. Pulp necrosis • (Caustinerf Arsenical ® from Septodont) that contains Arscenica Hydrochloride in addition to Lidocaine and Ephedrine Hydrochloride used to generate pulb necrosis.
  • 9. Haemostatic agents • Haemostatic agent used to stop hemorrage from the inflammated pulp, and injured gengiva they are four types: • Hemostaic dressings • Absorbable Gelatin • Astringents and styptics • Vasoconstrictors
  • 10. Haemostatic dressings • The simpliste way of bleeding control is to apply sterile gauze with moderate pressure. • Collagen dressing may be applied • In more severe casses (bony bleeding) Absorbable Gelatin Sponge may be used
  • 11. Absorbable Gelatin Sponge • Applied on the operated tissues, controls oozing and seal up the bleeding tissues immediately. This prevents blood loss from the deeper wounds Example : Surgispon ® • absorbed biologically within 4-6 weeks • Not used in Restorative and Endodontics practice
  • 12. Thrombin • Can be apply locally, especially with patent having oral anti-coagulant drugs • thrombin can regulate the growth, cell cycle progression, and functional reorganization of the pulp tissue during pulp healing and inflammatory processes (Mei-Chi Chang,1999)
  • 13. Astringents and styptics • An astringent (also spelled adstringent) substance is a chemical compound that tends to shrink or constrict body tissues • Styptics (also spelled stiptics) are a specific type of antihemorrhagic agent that work by contracting tissue to seal injured blood vessels • Zinc, iron, and aluminum salts are the best Astringents and styptics substances used in dentistry
  • 14. Vasoconstrictors • Applied locally and for a very short time. • Can be injected, but it is better to avoid to do this • adrenalin dipped gauze are available in the market
  • 15. Examples • Astrigedent X ® from Ultradent • Dental TD Zett ® from J.Morita • Quick Stat FS ® from Vista
  • 16. Astrigedent X ® from Ultradent • Astrigedent X is an aqueous 12.7% iron solution containing equivalent ferric sulfate and ferric subsulfate for difficult- to-stop, problem bleeding • Less acidic than competitive iron subsulfate solutions
  • 17. Dental TD Zett ® from J.Morita • It is a fast-acting intraoral topical hemostatic agent. • It combines aluminum chloride, which has an astringent action, with Cetylpyridinium chloride and also lidocaine. • Indications - For hemostasis in the following cases: 1) Subgingival abutment tooth or cavity preparation 2) Gingival retraction during Gingivoplasty
  • 18. Quick Stat FS from Vista • 15.5% Ferric Sulfate Haemostatic Gel • Provides effective tissue management when completing impressions, restorations, crown & amp; bridge, and Pedodontic pulp treatment • Doesn`t flow onto surrounding tissue
  • 19. Oral Rinses Rinses are generally classified by the U.S. Food and Drug Administration (FDA) as either : • cosmetic • therapeutic • a combination of the two.
  • 20. Cosmetic rinses • Cosmetic rinses are commercial over-the- counter (OTC) products that help remove oral debris before or after brushing, temporarily suppress bad breath, diminish bacteria in the mouth and refresh the mouth with a pleasant taste.
  • 21. Therapeutic rinses • Antiplaque/antigingivitis rinses containing an active bacteria- fighting ingredient such as quaternary ammonium compounds, boric and benzoic acid phenolic compounds. • Anticavity fluoride rinses. • Topical antibiotic rinses • Enzyme rinses • Artificial saliva rinses • Rinses that control calculus formation
  • 22. Natural/Herbal Oral Rinses • Natural oral rinses do not contain alcohol, harsh chemicals, dyes or preservatives. They often contain herbs with beneficial properties and alternative ingredients • For instance, Xylitol, a natural sweetener derived from the fibrous parts of plants, helps reduce the risk of tooth decay and promotes oral health. Recently several chewing gums have entered the marketplace that contain Xylitol and are promoted as reducing decay.
  • 23. Examples : • Phenol products: Listerine ® • Chlorhexidine products: Peridex ® • Herbal Sanguinaria products: Viadent ® • Therapeutic Anticavity Fluoride Rinses : Oral-B ® Anticavity Rinse • Cosmetic Breath Freshening Mouth Rinses: Signal ®
  • 24. Side effects • ulcers • sodium retention • stains • soreness • numbness • changes in taste • painful mucosal erosions.
  • 25. Symptoms of an oral rinse overdose include: When swallowing especially by children 1. Breathing problems, such as deep breathing, rapid shallow breathing, slowed breathing or breathing stoppage 2. Gastrointestinal problems, such as abdominal pain, diarrhea, nausea and vomiting 3. Nervous system problems, such as coma, dizziness or drowsiness
  • 26. Symptoms of an oral rinse overdose include: 4. Bluish skin, particularly lips and fingernails 5. Collapse 6. Convulsions 7. Decreased blood pressure (hypotension) 8. Less-frequent urination 9. Excessive sweating and thirstiness 10. Trouble walking normally 11. Slurred speech
  • 27. topical anesthetic for oral mucosal application.
  • 28. Examples • Comfort caine ® (Harry Basworth) • Cainetips ® (J. Morita) • Pharmaethyl ® (Septodent) • Anaestho Gel ® (Voco)
  • 29. Comfort Caine ® • Comfort Caine is a topical anesthetic for oral mucosal application. • Comfort Caine contains the active ingredient ethyl 4-amino benzoate 20% Benzocaine, in a flavored polyethylene glycol base sweetened with saccharin. • Comfort Caine combines fast onset (15-20 seconds) and short duration (12-15 minutes) with virtually no systemic absorption.
  • 30. Cainetips • Individually wrapped, disposable swabs pre-filled with a 20% Benzocaine solution, CaineTips oral pain relievers are designed for intraoral applications
  • 31. Cainetips ® • The single dose packaging allows for direct and precise application with no mess or drips and delivers quick pain relief onset. • Recommended for pre-injection, periodontal curettage, deep scaling, and post-care treatment, they also help prevent cross-contamination. Available in a cherry flavored solution
  • 32. Pharmaethyl ® • Topical freezing agent with natural mint flavor. • Pharmaethyl is used for local applications on the mucous membrane of the oral cavity and its adnexa: lancing of abscesses, extractions of deciduous teeth, extraction of pyorrheal teeth, vitality tests. • Do not spray close to an open flame or any incandescent sources.
  • 33. Anaestho Gel ® • Contains the active ingredient of Lidocaine. • Useful in case of aphtous ulcerations • Gag reflex inhibition