Drugs used in Paediatric Dentistry

1. COMMONLY USED DRUGS IN
PAEDIATRIC DENTISTRY
Dr. PRAGYNA PRIYADARSHINI
MDS (Paediatric & Preventive Dentistry)
Saveetha University & Hospitals
Chennai, India.

2. INTRODUCTION
“The adult may be treated as a child:the conversecan lead to disaster.”
-Sir Lancelot Barrington
A drug can be definedas any substance or product that is usedor is intendedtobe usedtomodify or explore physiological systemsor pathological states for
the benefit of the recipient.(WHO,1966)

3. CLASSIFICATION OF DRUGS IN PAEDIATRIC
DENTISTRY
•Drugs for infectioncontrol:Antibiotics.
•Drugs for pain control:
•Non steroidal anti-inflammatory drugs
•Opioid analgesics.
•Local anaesthetics.
•Drugs for Conscious sedation
•Drugs for General anaesthesia.
•Miscellaneous drugs.
•Drugs for medical emergencies.
•Drugs as nutritionalsupplements.

4. DOSE CALCULATION IN PAEDIATRIC DENTISTRY
AGE
•Young’s rule
•Dilling’s rule
•Brunton’s rule
•Fried‘s rule
•Cowling’s rule
•Starkenstein’s rule
•Starkenstein’s Rule
BODY WEIGHT
•Clarke’srule
BODY SURFACEAREA
•Clark’sSA rule
In the calculationof dosages, weight has a more direct bearing on the dose than any other factors, especiallyin the
calculation ofpaediatric doses. The rule governing the calculationof pediatricdoses for newborns and young infantswith a
normal lean body mass and normal body developmentis called the Clark’s rule. For toddlers, we need to use Fried’s rule, and
for older children Young’s rule is used.

7. ➢ An antibiotic is a chemical substance produced by various species of microorganisms (bacteria, fungi,
and actinomycetes) that suppress the growth of other microorganisms and may eventually destroy them.
➢May be: Synthetic drugs, Naturally obtained drugs

8. ANTIMICROBIAL
AGENT
DOSAGE
ADULT CHILDREN
AVAILABILITY
AMOXICILLIN 0.5-2g oral/i.m./i.v every 6
hrs
25-50mg/kg/day Amoxylin, Novamox,
Synamox
250, 500mg capsule
125mg/5ml dry syrup 250,500 mg/vial inj.
AMPICILLIN Same as Amox Same as amox Ampilin, Roscillin, Biocilin
250,500 mg cap
125,250 mg/5ml dry syr,
100 mg/ml pediatric drops
250,500 mg and 1 g per vial
inj
CLAVULANIC ACID 500mg amoxicillin + 125mg
clavulanic acid.
250mg amoxicillin+125mg
clavulanic acid TDS.
Augmentin, Enhancin,
Amonate 375mg, 625mg tab.

9. CEPHALEXIN 0.25-1g 6-8 hourly, 25-100 mg/kg/day cephaxin spoidex,
alcephalin 250,500 mg
cap,
125 mg/5 ml dry syr.,
100mg/ml pediatric drops
CEPHADROXIL Dose: 0.5-1g BD 30 mg/kg /day : droxyl 0.5,1g tab,
250mg kid tab
Cefadrox 0.5g cap,
250mg/5ml syrup,
125mg/5ml syrup and.
ERYTHROMYCIN 250-500 mg/ 6 hourly (8
mg max)
30-60mg/kg/day Erysafe 125, 250, 500 mg
tab,Althrocin 250, 500
mg tab, 125 mg kid tab
125mg/5ml and
250mg/5ml dry syr.
100mg/ml ped. Drops.
METRONIDAZOLE 400- 800 mg, 30-50 mg/kg/day. Flagyl, metrogyl,
aldezole 200, 400 mg tab,
200mg/5ml susp., 500mg/100 ml i.v.
infusion.

10. SITUATION ANTIBIOTIC REGIMEN
Standard
Prophylaxis
Amoxicillin Adults, 2.0 grams; children,50 milligrams/kilogram
orally one hour before
procedure
Cannot Use Oral
Medications
Ampicillin Adults, 2.0 g IM or IV;
children, 50 mg/kg IM or
IV within 30 minutes
before procedure
Allergic to Penicillin Clindamycin Adults, 600 mg; children,
20 mg/kg orally one hour
before procedure
Cephalexin or cefadroxil Adults, 2.0 g; children,
50 mg/kg orally one hour
before procedure
Azithromycin or
clarithromycin
Adults, 500 mg; children,
15 mg/kg orally one hour
before procedure
Allergic to
Penicillin and Unable
to Take Oral
Medications
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
ANTIBIOTIC PROPHYLACTICREGIMENS FOR CERTAIN DENTALPROCEDURES

11. ❖ Analgesic is a drug that relieves pain by acting in the central nervous system or on peripheral pain mechanisms.
Widely prescribed for pain relief, especially after dental surgical proceduressuch as to treat pulpal inflammation,
gingival infections, periapical infections, dental extractions, and in teething.
Non-steroidal anti-inflammatorydrugs
Classified as
Opioid analgesics

13. Ibuprofen:
Dose&Availability:
Brufen, emflam, ibusynth, 200, 400, 600
mg tab
Brufamol kid DT 200mg
Ibugesic 100mg/5ml susp.
Paracetamol :
Dose: Infants 50 mg, children (1-3 years) 60-80
mg, (4-8 years) 240-320 mg, (9-12 years) 300-
600 mg Adult.
Availability: Crocin, Metacin, Paracin 500mg
tab, 125mg/5ml syrup, 150 mg/ml paed. drops.
Ultragin, Pyrigesic 500 mg tab, 125 mg/5ml
syrup. Neomal, Fevastin febrinil 300mg/2ml inj.
Piroxicam:
Dose:
20mg BD for two days followed by 20 mg
OD.
Availability: Dolonex, Pirox 10,20 mg cap,
, 20 mg/ml inj. In 1 and 2 amps.

14. Acute Paracetamol Poisoning:
• Specially in small children(>150 mg/kg or >10g in adult)
Fatal at >250mg/kg.
•Nausea, vomiting, abdominal pain,
• hepatic tenderness and leads to centrilobular hepatic necrosis,
•renal tubular necrosis and hypoglycemia.
•causes coma in 12-18 hours and jaundice in 2 days.
•Fulminating hepatic failure and death occurs if plasma levels are above
200ug/ml at 4 hours and 30ug/ml at 15 hours.
•Paracetamol is not recommended in premature infants (<2kg) for fear of
hepatotoxicty.

15. Treatment :
➢Induce vomiting and gastric lavage.
➢Activated charcoal is given orally to cause further absorption.
➢ N-acetylcysteine 150mg/kg infused i.v. over 15 min followed by
same dose over next 20 hours. Alternatively 75mg/kg orally may be
given every 4-6 hours for 2-3 days.It replenishes the glutathione
stores in liver and prevents the toxic N-acetyl-benzoquinone-imine
from binding to other cellular constituents.

16. Opioid Analgesics
➢Opium is a dark brown resinous material obtained from poppy (Papaversomniferum)
➢With the advent of recent safer alternatives and the problems associated with the addiction
and adverse effects of the opioids, their use has been limited to poorly localized visceral pain
and very severe pain.
➢Classification:
Synthetic
Opiate
Semi-
synthetic
Opiate
Natural
Opiate

17. Tramadol
Dose: 50-100 mg oral/ i.m./ slow i.v. infusion 4-6 hourly.
1-2 mg/kg ( in children 4 to 16 years)
Drug name: contramal, domadol, tramazac 50mg cap and
50mg/ml inj. In 1 and 2 ml amps.
Fentanyl
In the past associated with neurolept anaesthesia in combination with
Droperidol.
Available as trofentyl 50ug/ml, fentanyl citrate inj in 2 ml amp and 10 ml vial.

18. Local Anaesthetics
➢ Local anaesthesia has been defined as a loss of sensation in a circumscribed area of the body caused by a
depression of excitation in nerve endings or an inhibition of the conduction process in peripheral nerves.
➢ An important feature of local anaesthesia is that it produces this loss of sensation without inducing a loss
of consciousness.

21. Classification Definition Chemical Substance
Class A Agents acting at the receptor site on external surface of
nerve membrane
Biotoxins (e.g. tetrodotoxin and saxitoxin)
Class B Agents acting at receptor sites on internal surface of
nerve membrane
Quaternary ammonium analogues of lidocaine
(scorpion venom)
Class C Agents acting by a receptor independent physico-
chemical mechanism
Benzocaine
Class D Agents acting by combination of receptor and receptor-
independent mechanism
Most clinically useful local anaesthetic agents(e.g.
articaine, lidocaine, mepivacaine, prilocaine)
CLASSIFICATION OFLOCALANAESTHETIC SUBSTANCESACCORDINGTO BIOLOGICALSITE AND MODE OF ACTION

22. Composition
• Lignocaine hydrochloride- 24.64 mg
• Adrenaline bitartrate - 0.0125 mg
• Sodium chloride/modified Ringer’s solution -
6mg/ml
• Sodium metabisulfide - 0.5mg/ml
• Methyl paraben - 1mg/ml
• Thymol - 1mg/ml
• Water

23. Local anaesthetic agents used in paediatric practice are as follows:
Lidocaine:
•It is an amide type of agent having rapid onset of action and producing more profound
anaesthesia.
•Maximum recommended dose: 4.4 mg/kg without adrenaline
:7mg/kg with adrenaline
•Duration of Pulpal anaesthesia: 60 min
Soft tissue anaesthesia:2-3 hours.

24. Availability:
• Xylocaine, Gesicain 4% topical solution,
•2% Lidocaine jelly, 5% ointment,
•1% and 2% injection(with or without adrenaline),5% heavy for spinal anaesthesia and
100mg/ml spray (10 mg per puff).
Mepivacaine:
•Mepivacaine 3% produces pulpal anaesthesia:25 min and soft tissue anaesthesia: 90 min
• It was a popular drug till lidocaine came to picture.
•This drug requires additional caution when being administered to young children.

26. a) Inhalational anaesthetics.
b) Intravenous anesthetics.
➢A combination of inhalation and intravenous anesthetics, often with opioids added
for pain relief and neuromuscular blockers for muscle paralysis, is called
balanced anesthesia.
General Anaesthetic Agents

27. INHALATIONALANAESTHETICS
Halothane
causes unconsciousness but provides little pain relief;
often administeredwith analgesics.
Has a pleasant smelland is therefore often the
anesthetic of choice when mask induction is used with
children.
It may be toxic to the liver in adults.
Nitrous oxide
Used with other drugs as thiopental to produce
surgical anesthesia.
The fastest induction and recovery time.
Safest inhalation anesthetic because it does not
slow respiration or blood flow to the brain.
relatively weak anesthetic, not suited for major
surgery.
may be used alone for dental anesthesia, should
not be used as a primary agent in more extensive
procedures.

28. Enflurane
Less potent, but
produces a rapid
onset of anesthesia
and possibly a faster
recovery.
Not used in patients
with kidney failure.
Isoflurane
Not toxic to the liver
but can induce
irregular heart
rhythms
Sevoflurane
works quickly
can be administered
through a mask since
it does not irritate the
airway.
On the other hand,
sevoflurane can
cause renal damage.
Desflurane
•a second-
generation
version of
isoflurane,
•irritating to
the airway
and
therefore
cannot be
used for
mask
(inhalation)
inductions,
especially
not in
children.

29. INTRAVENOUS ANAESTHETICS
➢Ketamine,
➢Thiopental (a barbiturate),
➢Methohexital (Brevital),
➢Etomidate,
➢Propofol (Diprivan),

30. •A)Drugs for medical emergencies:
•The use of pharmacological measures for behavior management and
the uncooperative nature of substantialmajority of the patients, puts
the pedodontic practice at a greater risk.
•These drugs can prove to be life-saving when a situation arises.
•A practice requires a complete set of emergency drugs which are as
follows:

31. Drug group Common example Purpose
Parenteral preparation
Analgesic
Anticonvulsant
Antihistamine
Antihypoglycemic
Corticosteroid
Narcotic antagonist
Sympathomimetic
Vagolytic
Morphine sulphate
Diazepam, midazolam
Diphenhydramine, chlorpheniramine
50% dextrosein water, glucagon
Methylprednisolone,
Naloxone
Epinephrine
Atropine
Emergency pain relief
Convulsions
Allergic reactions
Hypoglycemia
Allergic reactions and anaphylaxis
Opioid overdose
Anaphylactic shock
Bradycardia,asthma
Oral preparations
Antihistamine
Antihypoglycemic
Vasodilator
Diphenhydramine, chlorpheniramine
Candy, fruitjuice, sugar
Nitroglycerine
Allergic reactions
Hypoglycemia
Cardiac arrest
Inhaledpreparation
Bronchodilator
Oxygen
Respiratory stimulant
Metaproterenol
Epinephrine bitartrate
Aromatic ammonia
Asthma, anaphylaxis
COPD, respiratory distress, cardiac arrest
respiratory distress

32. B) Nutritional supplements
❖Mineral supplements
i. Calciumglubionate:
• indicated in deficient serum calcium levels.
• Dose : 800-1200 mg/day.
• Available as calcium Sandoz,oscal syr 1.8g/5ml.
ii. Calciumlactate:
• indicated in deficient serum calcium levels.
•Dose: 400-500 mg/day in 3-6 divided doses.
•Available: tablets325, 500 mg.
iii. Ferrous sulphate:
•indicated in iron deficiency anaemia, for prophylaxisand in preterminfants (not before 2 months of age).

33. Dose:
For iron deficiency anaemia- 6mg elemental iron/kg/day in three divided doses.
For prophylaxis- 1-2 mg/kg/day in 2-3divided doses.
Availability: Durovit, Fezocar drops, Syrup iberol, syr fezocar, cap Elferri-TR,
150 mg tab, pediatricdrops 75mg (15mg iron)/0.6ml in 50ml,
125mg (25mg iron)/1ml in 50ml, 45mg(15mg iron)/0.6ml in 60ml.

34. Vitamin supplements
Vitamin B-complex:
i. these formulations comprise of water soluble vitamin B1,B2,B3,B6,B12
and indicated along with antibiotics, prohylactically in Ariboflavinosis, and malnutrition.
i. Individual preparations of each vitamin are also available for selected deficiencies.
ii. Vitamin D: indicated to prevent or treat rickets.
Dose: 10mcg/day, 400 IU/24 hour
Availability: calciferol,
ergocalciferol liq.8000 IU/ml in 60 ml.