Drugs in Dentistry

1. ROLE OF MEDICATIONS IN
DENTISTRY
By
Dr. Divvi Anusha
1st
year post graduate
Department of public health
dentistry

2. • Introduction
• Drugs used in emergencies
• Antibiotic prophylaxis
• Drugs used in out-patient basis
– Dentoalveolar abscess
– Odontogenic and space infections
CONTENTS

3. – ANUG
– Pseudomembranous candidiasis
– Denture stomatitis
– Angular chelitis
– Herpetic gingivostomatitis
– Varicella zoster infections

4. – Odontogenic pain
– Trigeminal neuralgia
– MPDS
– Apthous ulcers
– Xerostomia
– Oral Submucous fibrosis

5. – Oral Lichen planus
– Oral Leukoplakia
• Drugs to be avoided during pregnancy
• Conclusion
• References

6. INTRODUCTION
• Dentists prescribe several categories of
medications
• Prescription of medications is more complicated
now than in the past – microbial resistance – drug
interactions
• Infections of the teeth and oral cavity - life
threatening situations

7. • Infection management  dental or surgical
procedures + antimicrobials
• Antimicrobial activity maximized - specific
microbe identification - antimicrobial active
against that microbe - appropriate dose

8. • Dentist should realize - medical emergencies can,
do and will happen - course of practice
• A medical emergency - life-threatening - without
proper treatment
• So, a dentist should always be prepared

9. MEDICAL EMERGENCIES IN DENTAL
SETUP
Types of emergencies
• UNCONSCIOUSNESS / SYNCOPE
– Vasodepressor Syncope
– Postural/Orthostatic Hypotension
– Acute Adrenal Insufficiency
– Hypoglycemia

10. • SEIZURES
• RESPIRATORY EMERGENCIES
– Asthma
• CARDIOVASCULAR EMERGENCIES
– Angina Pectoris
– Myocardial Infarction

11. • DRUG RELATED EMERGENCIES
– Allergies

12. EMERGENCY DRUGS IN DENTISTRY
• SYNCOPE
• 100% oxygen – flow rate: 10 liters/minute until
consciousness is regained.
• Ammonia tablets crushed and sniffed to the
patients

13. • HYPOGLYCEMIA
• If the patient remains conscious and cooperative
• administer oral glucose (10–20 g), repeated, if
necessary, after 10–15 mins
• If the patient is unconscious administer glucagon,
1 mg/ml, intramuscular injection

14. For children:
• Glucagon, intra muscular injection
• 2–18 year body-weight <25 kg ……..0.5 mg/ml
• 2–18 years body-weight >25 kg……..1 mg/ml
• administer oral glucose (10–20 g) when the patient
regains consciousness

15. • SEIZURES
• Administer 100% Oxygen– flow rate 10
liters/minute.
• If repeated or prolonged (5 minutes or longer),
continue administering oxygen and:
• Administer Diazepam 10 mg/2ml intramuscularly

16. • ASTHMA
• Salbutamol 4 puffs (if patients own puff available)
• Salbutamol 5 mg + Ipratropium bromide 500 µmg
nebulised
• Oxygen 10 L/min
• Hydrocortisone 100 mg/2ml iv

17. • Angina pectoris
• Drug of choice – nitroglycerine 0.3mg
• When taken sublingually, it acts in 1-2 min
• Availability 0.1, 0.3, 0.6 mg

18. • Myocardial infarction
• Administer 100% oxygen – flow rate:10 lit/min
• Administer nitroglycerine 1 tab sublingually
• Administer Aspirin 300-mg dispersible tablet,
orally.
• Morphine 5 mg/ml intramuscularly

19. • Anaphylaxis
• Adrenaline, 0.5 ml (1:1000) IM injection repeated
after 5 minutes if needed
• 100% oxygen – flow rate:10 liters/minutes
• Chlorpheneramine 10mg/ml IV

20. • Antibiotic prophylaxis
• Also called chemoprophylaxis
• Use of antimicrobial agents to prevent infection
• May not be required in routine dental treatment if
patient’s immune function is normal

21. CARDIAC CONDITIONS FOR
PROPHYLAXIS
High risk
• Prosthetic cardiac valves
• Previous bacterial
endocarditis
• Congenital heart disease
• Surgically constructed
systemic pulmonary
shunts
Moderate risk
• Acquired valvular
dysfunction
• Hypertrophic
cardiomyopathy
• Mitral regurgitation
and/or thickened valve

22. PROPHYLAXIS
Standard prophylaxis
• Amoxicillin
• Adults - 2.0 grams;
• Children – 50mg/kg
• orally one hour before
procedure
Cannot take oral medication
• Ampicillin
• Adults - 2.0 g
• Children - 50 mg/kg
• IM or IV within 30
minutes before
procedure

23. IF ALLERGIC TO PENICILLIN

24. If allergic to penicillin and cannot take oral
medication

25. DRUGS USED ON OUT-PATIENT BASIS
1. Dentoalveolar abscess
Amoxicillin capsules 500mg TDS for 5 days
Metronidazole Tablets, 400 mg tds X 5 days
For children:
Metronidazole Tablets - 200 mg or
Oral Suspension - 200 mg/5 ml

26. • Advise patient to avoid alcohol
(metronidazole has a disulfiram - like
reaction with alcohol)

27. • Erythromycin is an alternative to the penicillins
• Erythromycin tablets 500mg BD for 5 days
• Also clindamycin(clincin) 300 mg tid
• For children:
• Erythromycin Tablets, 250 mg, or
• Oral Suspension, 125 mg/5 ml daily

28. 2. Odontogenic and space infections
Indications of antibiotics
• Acute onset infection
• Diffuse swelling
• Compromised host defences
• Involvement of facial spaces
• Severe pericoronitis

29. Selection of antibiotic therapy
• Antibiotics are typically prescribed for 7 days or
until 3 days after symptoms have resolved.
• Amoxicillin
• Adults: 500 mg every 8 hours
• Children: 25–50 mg/kg/day divided into 4 doses

30. • Cephalexin
• Adults: 500 mg every 6 hours
• Children: 25–50 mg/kg/day divided into 4 doses
• Metronidazole
• Adults:400 mg twice daily
• Children: 15–30 mg/kg/day divided into 3 doses

31. • Clindamycin
• Adults: 300–450 mg every 6 hours
• Children: 10–30 mg/kg/day divided into 3 or 4
doses
• Erythromycin
• Adults: 500 mg enteric coated every 8 hours
• Children: 30–50 mg/kg/day divided into 2–4 doses

32. • Acute necrotizing ulcerative gingivitis (ANUG)
• Amoxicillin 500 mg TID for
10d plus Metronidazole 200 mg TID for 10dor
• Clindamycin 150-300 mg TID for 10d or
• Doxycycline 100 mg BID for 10d

33. • Patients with ANUG should be given a topical
anesthetic and NSAIDs, because pain control is
very important in allowing the patient to perform
good oral hygiene
• Ibuprofen 400-600mg TID for 3 days

34. • Pseudomembranous Candidiasis
• Fluconazole Capsules, 50mg (fluzone) for 7 days
• lf Fluconazole and Miconazole are contraindicated
• Amphotericin B 10mg (fungisome). 1 lozenge
dissolved slowly in the mouth QID for 10 days
• Advise patient to continue use for 48 hours after
lesions have healed.

35. • Nystatin Oral Suspension,100,000 units/ml.
• 1 ml after food four times daily for 7 days

36. • Angular chelitis
• Miconazole Cream, 2%
• Advise patient to continue use for 10 days after
lesions have healed.
• Nystatin Ointment(mycostatin) 1lakh units/ gram
• Apply to angles of mouth four times daily

37. • Sodium Fusidate Ointment, 2% qid X 10 days
• An appropriate regimen for unresponsive cases is
a choice of:
Hydrocortisone (1%) and
Miconazole (2%) Cream bid X 7 days

38. • Herpetic gingivostomatitis
• Acyclovir Tablets, 400 mg X 5 times /day X 5days
• For children:
• Acyclovir Tablets, 200 mg, or
• Oral Suspension 200 mg/5 ml

39. • Acyclovir Cream, 5%
• Apply to lesion every 4 hours for 5 days
• Acyclovir cream can be applied for up to 10 days,
if required.

40. • Varicella-zoster infection
• In patients with herpes zoster (shingles),
systemic antiviral agents reduce pain, and
reduce the incidence of post-herpetic neuralgia
and viral shedding

41. • Acyclovir is the drug of choice
• Acyclovir Tab 800 mg 5 times/day X 7 days

42. • Odontogenic pain
• For mild to moderate odontogenic or post-
operative pain, an appropriate 5-day regimen is:
• Paracetamol Tablets, 500 mg X4/day daily
• For children:
• Oral Suspension 120 mg/5 ml or 250 mg/5 ml

43. • For mild to moderate inflammatory pain, an
appropriate 5-day regimen is:
• Ibuprofen Tablets, 400 mg x4 /day
• For children:
• Ibuprofen Oral Suspension,100 mg/5 ml

44. • For moderate to severe inflammatory or post-
operative pain, an appropriate 5-day regimen is:
• Aceclofenac tablets, 100mg bid
• Diclofenac Tablets, 75 mg tid
• Tramadol 50 mg tid

45. • Trigeminal neuralgia
• Carbamazepine Tablets, 200 mg bd x10 days can
be increased to 600 mg bd
• Baclofen 5 mg tid for 3 days and increased up to
10 mg
• Phenytoin 300 -600 mg bd

46. MPDS
• Ibuprofen 400mgtd+diazepam 10 mg bd
• Naproxen 500 mg bd or celecoxib 100 mg bd
• Amytryptyline 10 mg od
• Chlorzoxazone 500 mg tid

47. • Chymoral forte qid

48. Xerostomia
• Pilocarpine 5-10mg three times per day.
• The initial recommended dose is 5mg three times
per day, which can be increased up to 30 mg/day
depending upon the response.
• The onset of action is 30 minutes and the duration
of action is approximately 2 to 3 hours.

49. Oral leukoplakia
• Isotrenitoin/ 13-cis-retinoic acid
• Beta carotene- 30mg TID
• Topical bleomycin - 0.5-1% solution/2 weeks

50. Oral submucous fibrosis
• Mild cases – Intralesional inj of Dexamathasone
4mg to reduce symptoms
• Recent study – intralesional inj of gamma
interferon 3 times a week, improves mouth
opening significantly

51. Oral lichen planus
• Corticosteroids is the treatment of choice
• Fluocinoide or clobetasol gel for 2 weeks, with 3
months follow up

52. Apthous ulcers
• Topical corticosteroids such as
hydrocortisonehemisuccinate 2.5 mg pellets, or
• 0.1% triamcinolone acetonide in Orabase used
four times daily or
• 0.3% tricaine gel
• In adults, tetracycline rinses 4 -5 /day

53. DRUGS TO BE AVOIDED DURING
PREGNANCY
• Majority of pregnant women (40 – 90%) are
exposed to medications during pregnancy
• Maternal and embryo fetal effects of most of the
therapeutic agents are unknown for about one-
half of medications.
• unless absolutely necessary - not be used during
pregnancy - can harm fetus .

54. Drugs that are to be avoided during pregnancy
includes:
Thalidomide Phocomelia
Methotrexate Foetal death
Tetracycline Discoloured and deformed teeth,
retarded bone growth
Phenytoin Hypoplastic changes, cleft
lip/palate, microcephaly
Carbamazepine Neural tube defects
Valproate sodium Spina bifida
Indomethacin/aspirin Premature closure of ductus
arteriosus
Isotretinoin Craniofacial, heart and CNS
defects

55. CONCLUSION
• Please Remember !!!
- Principle 1- No drug ever exerts a single action
- Principle 2- No clinically useful drug is entirely
devoid of toxicity.
- Principle 3- The potential toxicity of a drug rests
in the hands of the user.

56. REFERENCES
• Essentials of medical pharmacology ,K.D.Tripati 6th
edition
• Essentials of Pharmacology for dental students and
allied health sciences 2nd
edition, Padmaja Udaykumar
• Emergencies in dental office, Malamed
• Textbook of Oral medicine, 10th
edition, Burket

57. THANKYOU