This document contains summaries of common medical conditions and their management provided by Dr. Firas Kassab. It discusses appropriate treatment regimens for conditions such as allergic reactions, asthma, angina, cardiac arrest, seizures, fainting, hypoglycemia, anxiety, infections, dental infections, sinusitis, and oral thrush. For each condition, it provides signs and symptoms, management steps, and recommended medications and their dosages.

1. Dr. Firas Kassab

2. • 32 .6% antibiotics
• 23.2% NSAIDS
• 3.6 % vitamins
• Others-antiseptics like chx,listerine
Dr. Firas Kassab

3. • Drugs used in emergencies
• Drugs used in outpatient basis
Dr. Firas Kassab

4. • Adrenaline , 1-ml ampoules of 1:1000 solution for
intramuscular (i.m.) injection
• Glucagon, for i.m. injection of 1 mg
• Glyceryl trinitrate (GTN)
• Oral glucose /dextrose
Dr. Firas Kassab

5. • Oxygen
• Salbutamol inhaler, 100 µg per actuation
• Chlorphenamine
• Parenteral midazolam /diazepam
• Aspirin, 300-mg dispersible tablets
• Morphine
• Ammonia tabs
Dr. Firas Kassab

6. Signs and symptoms include:
• Generalised itching (urticaria),
particularly of hands and feet
• Rhinitis, conjunctivitis
• Abdominal pain, vomiting,
diarrhoea, and a sense of
impending doom
• Flushing, but pallor might also
occur
• Marked upper airway
(laryngeal) oedema and
bronchospasm, causing stridor
and wheezing
Dr. Firas Kassab

7. Call for an ambulance.
Secure the patient’s airway and help to restore their blood
pressure by laying the patient flat and raising their feet.
Administer adrenaline, 0.5 ml (1:1000), i.m. injection repeated
after 5 minutes if needed
Administer 100% oxygen – flow rate:10 litres/minute.
Dr. Firas Kassab

8. For milder forms of allergy:
Administer 1 chlorphenamine tablet,4 mg.(cadistin)
For children:
Chlorphenamine Tablet, 4 mg or Oral Solution, 2 mg/5 ml
Chlorphenamine can cause drowsiness. Advise patients not to drive.
Dr. Firas Kassab

9. acute severe asthma
• Inability to complete sentences
in one breath
• Respiratory rate >25 per
minute
• Tachycardia (heart rate >110
per minute)
Life threatening asthma
• Cyanosis or respiratory rate
<8 per minute
• Bradycardia (heart rate <50
per minute)
• Exhaustion, confusion,
decreased conscious level
Dr. Firas Kassab

10. • Salbutamol 4 puffs (if patients own puff available)
• Salbutamol 5 mg +ipratropium bromide 5OOumg nebulised
• Oxygen 10 l/min
• Hydrocortisone 100 mg iv
• Ventilation if needed
Dr. Firas Kassab

11. Signs and symptoms include:
• Chest pain
• Shortness of breath
• Fast and slow heart rates
• Increased respiratory rate
• Low blood pressure
• Poor peripheral perfusion
management
• Administer glyceryl trinitrate
(GTN) dispersible tab
• Administer 100% oxygen –
flow rate 10 litres/minute.
• If the patient suffers more-
severe attacks of chest pain
or if there are sudden
alterations in the patient’s
heart rate, call for an
ambulance.
Dr. Firas Kassab

12. Signs and symptoms include:
• Loss of consciousness
• Loss of pulse and blood
pressure
• Absence of breathing
management
• Call for an ambulance.
• Adrenaline 1 mg and repeated
after 3 – 5 mins
• 2 nd dose of adr +atropine 1 mg
iv
+
• Initiate CPR, using 100% oxygen
for ventilation – flow rate: 10
litres/minute.
Dr. Firas Kassab

13. Signs and symptoms include:
• Progressive onset of severe, crushing
pain in the centre and across the
front of chest; the pain might
radiate to the shoulders and down
the arms (more commonly the left),
into the neck and jaw or through to
the back
• Skin becomes pale and clammy
• Nausea and vomiting are common
• Pulse might be weak and blood
pressure might fall
• Shortness of breath
• Call for an ambulance and allow the
patient to rest in a comfortable
position.
• Administer 100% oxygen – flow
rate:10 litres/minute.
• Administer GTN 1 tab sublingually
• Administer aspirin, 300-mg
dispersible tablet, orally.
• Morphine 5 mg im
For children:
• Do not use in children because,
rarely, it can cause Reye’s syndrome
Dr. Firas Kassab

14. Signs and symptoms include:
• Brief warning or ‘aura’
• Sudden loss of consciousness, the patient
becomes rigid, falls, might give a cry
and becomes cyanosed (tonic phase)
• After a few seconds, there are jerking
movements of the limbs; the tongue
might be bitten (clonic phase)
• There might be frothing from the mouth
and urinary incontinence
• The seizure typically lasts a few minutes;
the patient might then become floppy
but remain unconscious
• After a variable time the patient regains
consciousness but might remain confused
Management
• Do not try to restrain convulsive
movements.
• Ensure the patient is not at risk
from injury.
• Administer 100% O2– flow
rate10 litres/minute.
• If the epileptic fit is repeated or
prolonged (5 minutes or longer),
continue administering oxygen
and:
• Administ er diazepam 10 mg im
Dr. Firas Kassab

15. Signs and symptoms include:
• Patient feels faint, dizzy,
light-headed
• Slow pulse rate
• Low blood pressure
• Pallor and sweating
• Nausea and vomiting
• Loss of consciousness
Management
• Lay the patient flat and, if
the patient is not breathless,
raise the patient’s feet.
Loosen any tight clothing
around the neck.
• Administer 100% oxygen –
flow rate:10 litres/minute
until consciousness is
regained.
• Ammonia tabs crushed and
sniffed to the patients
Dr. Firas Kassab

16. •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, i.m. injection
For children:
•Glucagon, i.m. injection
•2–18 year body-weight <25 kg ……..0.5 mg
•2–18 years body-weight >25 kg……..1 mg
•administer oral glucose (10–20 g) when the patient regains consciousness
•If the patient does not respond or any difficulty is experienced, call for an
ambulance.
Dr. Firas Kassab

17. appropriate regimen to produce mild sedation
to aid anxiety management is:
• Diazepam Tablets, 5 mg, 1 tablet on night before
procedure and 1 tablet 2 hours before procedure
• Advise all patients that they should not to drive.
Dr. Firas Kassab

18. • Localized Infection, Non-allergy Patients:
penicillin and amoxicillin continue to be the first drugs of
choice due to their safety and effectiveness against oral
infections. ions. The usual dosage is 500mg tid. .
• for the localized, non-allergy patient, the drug of
choice is amoxicillin 500 mg tid If the patient does not
improve after 3 days then consider "piggy-backing" the
remainder of the amoxicillin with metronidazole400mg,
bid. The metronidazole is effective against resistant
anaerobic bacteria and works well when taken with
amoxicillin.
Dr. Firas Kassab

19. • Spreading Infection, Non-allergy Patients: the first drug of
choice is
Augmentin/clavum
Ampicillin +cloxacillin(megapain)
• Spreading Infection, Allergy to Penicillin Patients: the drugs of
choice are (clarithromycin) and(azithromycin) which are second
generation erythromycin drugs and are effective against oral
pathogens and are also broad spectrum like Augmentin. The best
choice in this category is azithromycin
• Clindamycin can also be used
Dr. Firas Kassab

20. High risk category
• Dental extractions
• Periodontal procedures including surgery,
scaling, rootplaning and probing
• Dental implant placement, reimplantation of
teeth
• Endodontic instrumentation or surgery
beyond the tooth apex
• Subgingival placement of antibiotic fibers
or strips
• Initial placement of orthodontic bands but
not brackets
• Intraligamentary local anesthetic injections
• Prophylactic cleaning of teeth or
implants with andanticipated bleeding
PROCEDURES NOT RECOMMENDED FOR PROPHYLAXIS
• Restorative dental procedures with or
withoutretraction cord
• Local anesthetic injections (except for
intraligamentary)
• Intracanal endodontic procedures,
• post placement andbuildup
• Placement of rubber dams
• Postoperative suture removal
• Placement of removable orthodontic or
prosthodonticappliances
• Taking oral impressions
• Fluoride treatments
• Taking oral radiographs
• Orthodontic appliance adjustment
• Shedding of primary teeth
Dr. Firas Kassab

21. High risk
• Prosthetic cardiac valves
• Previous
bacterialendocarditis
• Complex,cyanoticcongenitalh
eart disease
• Surgicallyconstructed
systemicpulmonary shunts
Moderate risk
• Most other congenital cardiac
malformations not otherwise
indicated
• Acquired valvulardysfunction
• Hypertrophiccardiomyopathy
• Mitralvalveprolapsewithregurgit
ation and/or thickened valve
leaflets
Dr. Firas Kassab

22. Standard
Prophylaxis
Amoxicillin
Adults, 2.0 grams;
Children
50
milligrams/kilogra
m
orally one hour
before
procedure
Cannot Use
Oral
Medications
Ampicillin
Adults, 2.0 g
IMor IV
children, 50
mg/kgIMor
IV within 30
minutes
before
procedure
Clindamycin
Adults, 600 mg;
children,
20 mg/kg orally one
hour
before procedure
Cephalexin
Adults, 2.0 g;
children,
50 mg/kg orally one
hour
before procedure
Azi/clarithromycin
Adults, 500 mg;
children,
15 mg/kg orally one
hour
before procedure
Allergic to Penicillin
Clindamycin
Adults, 600 mg;
children,
15 mg/kg IV one
hour
before
procedure
Cefazolin
Adults, 1.0 g;
children,
25 mg/kg IM or
IV within
30 minutes
before
procedure
Allergic to
Penicillin and
Unable
to Take Oral
Medications
Dr. Firas Kassab

23. Management
Local Measures – to be used in
the first instance
• If pus is present in dental
abscesses, drain by
extraction of the tooth or
through the root canals.
• If pus is present in any soft
tissue, attempt to drain by
incision.
Antiboitics used
If drug treatment is required, an
appropriate 5-day regimen is a
choice of:
Amoxicillin Capsules, 500 mg tds
X 5 days
Amoxiclav
Megapain
Dr. Firas Kassab

24. • Metronidazole Tablets,
400 mg tds X 5 days
For children:
• Metronidazole Tablets,
200 mg, orOral
Suspension, 200 mg/5
ml
• advise patient to avoid
alcohol (metronidazole
has a disulfiram-like
reaction with alcohol).
• The anticoagulant effect
of warfarin might be
enhanced by
metronidazole.
Dr. Firas Kassab

25. • Erythromycin is an
alternative to the
penicillins:Erythromycin
(erythrocin) Tablets, 500mg
bd X5 days
• Also clindamycin(clincin)
300 mg tid
For children:
• Erythromycin Tablets, 250
mg, or
• Oral Suspension, 125 mg/5
mldaily
• Clindamycin is not
recommended for the routine
treatment of oral infections
because it is no more effective
against anaerobes than the
penicillins and can cause the
serious adverse effect of
antibiotic-associated colitis
more frequently than other
antibiotics.
• The empirical use of
antibiotics, such as
clindamycin, cephalosporins,
co-amoxiclav or other broad-
spectrum antibiotics, over
amoxicillin, metronidazole and
erythromycin for most dental
patients can also be done
Dr. Firas Kassab

26. The primary treatment of odontogenic infections has been surgical
Antibiotics are a necessary adjunctive therapy
in many infections to hasten complete
the antibiotic must be effective against
Streptococcus and anaerobes
Dr. Firas Kassab

27. • A. Very effective
• 1. Peniccilin
• Tab clavum /augmentin
• megapain
• 2. Clindamycin
• 3. Metronidazole (alone or in
combination with penicillin)
• B. Effective
• 1.Erythromycin/azithromyn
• 2. cefexime
• Parenreral
• Clavum iv od
• Cefazolin iv bd
• Ceftriaxone iv bd +
• Metronidazole iv tid
Dr. Firas Kassab

28. • In the penicillin-allergic
patient, clindamycin is
the second drug of
choice. In the penicillin-
allergic patient,
clindamycin is the second
drug of choice.
• The first-generation cephalosporins
have the same effect on the microbial
population causing odontogenic
infections that penicillindoes.
• The second-generation drug cefoxitin is
more active against the anaerobic
bacteria but loses some of the anti-
streptococcal activity of the first-
generation drugs.
• The third-generationcephalosporins
are generally effective against
anaerobes but also have increased
effectivenessagainst streptococci
• Thus the second- and third-generation
drugs are not highly desirable
Dr. Firas Kassab

29. management
local Measures – to be used in
the first instance
in anug undidemeer LA-do
debridement
3 % h2o2 mouthwash 2 hourly
for 5 -7 days then switch to
Chx mouthwash 0.2% bd for
15 days
Medications
• If drug treatment is required, an
appropriate 3-day regimen is:
• Metronidazole Tablets, 400mg tid
• For children:
• MetronidazoleTab 400mg, or
Oral Suspension, 200 mg/5 ml
Or
• Amoxicillin Capsules, 500mg, or
Oral Suspension 125 mg/5 ml
• Have a day gap re schedule for the
treatment outcome
Dr. Firas Kassab

30. Sinusitis
• Local Measures – to be
used in the first instance
• Advise the patient to
use steam inhalation.
Do not recommend the
use of boiling water for
steam inhalation in
children.
• If drug treatment is required, an
appropriate regimen is:
• Ephedrine Nasal Drops, 0.5 % 1 drop into
each nostril up to three times daily when
required
Advise patient to use for a maximum of 7
days. In adults and children, the dose of
ephedrine nasal drops can be increased to
2 drops 3 or 4 times daily, if required.
If an antibiotic is required, an appropriate 7-
day regimen is a choice of:
Amoxicillin Capsules, 500mg tds
Doxycycline Capsules, 100 mg. 2 capsules on
the first day, followed by 1 capsule daily
Dr. Firas Kassab

31. Local Measures – to be used in the
first instance
• Advise patients who use a
corticosteroid inhaler to rinse their
mouth with water or brush their teeth
immediately after using the inhaler.
• If drug treatment is required, an
appropriate 7-day regimen is a choice
of:
• Fluconazole Capsules, 50mg(fluzone)
• lf fluconazole and miconazole are
contraindicated, an appropriate
regimen is a choice of:
• Amphotericin b 10mg (fungisome). 1
lozenge dissolved slowly in the mouth
after food four times daily for 10
days
Advise patient to continue use for 48
hours after lesions have healed.
• Nystatin Oral Suspension,100,000
units/ml. 1 ml after food four times
daily for 7 days
Dr. Firas Kassab

32. Denture Stomatitis
Advise the patient to:
• clean their dentures thoroughly (by
soaking in chlorhexidine mouthwash or
sodium hypochlorite for 15 minutes twice
daily; note that hypochlorite should only
be used for acrylic dentures) and brush
their palate daily to treat the condition;
• leave their dentures out as often as possible
during the treatment period;
• not wear their dentures at night
If dentures themselves are identified as
contributing to the problem, ensure the
dentures are adjusted or new dentures
are made to avoid the problem recurring.
• If drug treatment is
required, an appropriate
7-day regimen is a choice
of:
• Fluconazole Capsules,
150 mg per weekly
• Miconazole Oromucosal
Gel24 mg/ml (daktarin)
If fluconazole andmiconazole
are contraindicated, an
appropriate regimen is a
choice :Amphotericin
Lozenges, 10 mg
• Nystatin Oral Suspension,
100,000 units/ml
Dr. Firas Kassab

33. • Miconazole Cream, 2%
Advise patient to continue
use for 10 days after lesions
have healed.
Nystatin Ointment(mycostatin)
(100,000 units per g) Apply to
angles of mouth four times
daily
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
Dr. Firas Kassab

34. Aciclovir Tablets, 400 mg X 5 times
/day X
For children:
Aciclovir Tablets, 200 mg, or
Oral Suspension 200 mg/5 ml
.
Aciclovir Cream, 5% Apply to
lesion every 4 hours for 5 days
Aciclovir cream can be applied
for up to 10 days, if required
Penciclovir Cream, 1%
Apply to lesions every 2 hours
during waking for 4 days
Dr. Firas Kassab

35. Dr. Firas Kassab
• In patients with herpes zoster
(shingles), systemic antiviral
agents reduce pain, and
reduce the incidence of post-
herpetic neuralgia and viral
shedding
• Aciclovir is the drug of choice.
However, valaciclovir and
famciclovir are suitable
alternatives
• Aciclovir Tab 800 mg X5/day
X7 days.

36. • 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
• For mild to moderate odontogenic,
post-operative or inflammatory
pain, an appropriate 5-day
regimen is:
Ibuprofen Tablets, 400 mg x4 /day
• For children:
• Ibuprofen Oral Suspension,100
mg/5 ml
Dr. Firas Kassab

37. • For mild to moderate
odontogenic or
inflammatory pain,
an appropriate 5-
day regimen
is:ipobrufin
+pcm(flexon)
• Or ketorolac 10 mg
tid
• For moderate to severe
inflammatory or post-
operative pain, an
appropriate 5-day
regimen is:
• Codep(codine +pcm) tid
• Diclofenac Tablets, 75 mg
three times daily
• Tramadol 50 mg tid
Dr. Firas Kassab

38. • If a patient with
trigeminal neuralgia
presents in primary
care, control quickly by
treatment with
carbamazepine(tegret
al)
• Carbamazepine
Tablets, 200 mg bd
x10 days(tegretal) can
be increased to 600
mg bd
• Baclofen 5 mg tid for 3
days and increased up to
10 mg tid for 3 days
• Phenytoin 300 -600 mg
bd
• Gabapentin and
oxycarbamazepine can
also be prescribed
• LA injections at pain sites
Dr. Firas Kassab

39. Pharmacotherapy
•Ibuprofen400mgtd+diazepam
10 mg bd
•Naproxen 500 mg bd or
celecoxib 100 mg bd
•Amytryptaline 10 mg od(triad)
•Chlorzoxazone 500 mg
tid(lorzone)
• tizanidine 2 mg tds
•Chymoral forte qid
•Pepsa 10 mg tid x 5 days
50 % of patients get relieved by this
treatment
Psychological counselling
Trigger point injections
0.5 -1 ml of LA injection
covering the conical area
around the trigger zone(0.5 ml
of procaine or 1 ml of
lignocaine)
Botulism toxin patch or injection(botox)
Capsaicin patch
0.025%-0.075% used
It it’s a substance p depleter so
there is decreased nerve
sensitisation
Used 4 times a day for atleast 2
weeks
Dr. Firas Kassab

40. Causes of mouth ulcers.
● Local causes:
– trauma
– burns
● Drugs
● Recurrent aphthous stomatitis
● Malignant ulcers
● Systemic disease:
–blood disorders
– gastrointestinal disorders
–mucocutaneous disease
– connective tissue disease
– vasculitides
–infective diseases
● Others
• Lichen planus
• Kenakort topical
• Tacrolimus 0.003% topical
• Careage –multivitamin
• lycostar-antioxidant
• If large lichen ulcer …prescribe 20
mg tds x 5 days later tapered to 20
mg bd and then 10 mg bd and 5 mg
bd and 5 mg od x 5 days
prednisolone
Dr. Firas Kassab

41. • Local Measures – to be used in
the first instance
• Antimicrobial Mouthwashes
Chlorhexidine Mouthwash, 0.2%
1 minute with10 ml twice daily
• Hydrogen Peroxide Mouthwash,
6% Rinse mouth for 2 minutes
with 15 ml diluted in half a glass
of warm water three times daily
• Tetracycline mouthwash (now
using doxycycline) is effective in
some patients with recurrent
aphthous stomatitis.
Local Analgesics
• Lidocaine 5% ointment can be
applied to the ulcer
Benzydamine Mouthwash, 0.15% 2
hourly as required
Advise patient that benzydamine
mouthwash can be diluted with an
equal volume of water if stinging
occurs.
• Advise patient to spit out mouthwash
after rinsing.
• The mouthwash is usually given for not
more than 7 days.
Dr. Firas Kassab

42. • Betamethasone Soluble Tab,500
umg 1 tablet dissolved in 20 ml
water as a
Triamcinolone ointment_ Apply a
thin layer to dried mucosa four
times daily
Systemic corticosteroids in cases of
immune mediated
mucocutaneous ulcerations
Dr. Firas Kassab

43. Management of traumatic ulcers
•Remove aetiological factors and prescribe
a chlorhexidine 0.2% mouthwash.
•Maintenance of good oral hygiene and
the use of benzydamine
(absorb)(tantum)or hot saline mouthbaths
may help
•Most ulcers of local cause heal
spontaneously in about 1 week if the
cause is removed and suchsupportive care
given.
Dr. Firas Kassab

44. Information to be given to the patients
• These are common
• The cause is not known
• Children may inherit ulcers from
parents
• Aphthous ulcers are not thought to be
infectious
• Some deficiencies or diseases may
predispose toulcers
• No long-term consequences are known
• Blood tests and biopsy may be
required
• Ulcers can be controlled but rarely
cured
Management of aphthae
• Any underlying predisposing factors
should betreated where possible, and
the aphthaecontrolled with:
• chlorhexidine 0.2% aqueous
mouthwash, or
• topical corticosteroids such as
hydrocortisonehemisuccinate 2.5 mg
pellets, or
• 0.1% triamcinolone acetonide in
Orabase usedfour times daily or
• 0.3% tricaine gel oe kenacort
• in adults, tetracycline rinses 4 -5 /day
Dr. Firas Kassab

45. Treat systemic or local
disease if present
Local Measures – to be used
in the first instance
• Advise the patient to take
frequent sips of water
• Prilocarpine (salagen) 5
mg tid
• Saliva-stimulating Tablets
(SSTs)Eg .prescription of sst
like neutrasal and caphosol
Dr. Firas Kassab

46. • Removal of habits is the most important factor
• Treatment is usually done with
• Hyaluronidase mixed with hydrocortisone and lignocaine and injected
intralesionally
• Vit A and B and E tabs(careage)
• Lycostar-antioxidant(vit A ,C ,E, zinc ,selinium ,lycopene)
Dr. Firas Kassab

47. • Aminoglycosides
• Tetracyclines
• floroquinolones
Dr. Firas Kassab

48. • Textbook of pharmacolgy:K D .Tripathi
• Emergencies in dental office:Malamed
• Textbook of oral medicine:Burkit
• CIMS-drugs and dosage
• Journal of drugs used in dentistry:scottish
Dr. Firas Kassab