4. Antibiotic
Use only when there is an indication :
Choose the narrowest spectrum drug that will be effective
Consider the risk/benefit equation
Prescribe an adequate dose
Adequate frequency
Adequate duration
9. Penicillin
Oral penicillin are penicillin V and amoxicillin
Pen V is narrow-spectrum against gram-positive Strep and others
Drug of choice for orofacial infections
Dose = 300-600 mg q6h
Amoxicillin is broad-spectrum and better absorbed orally
Dose = 250-500 mg q8h
Dental uses
dental abscesses, infections around
wisdom teeth and infections after
surgery
10. Adverse reactions of penicillin
Allergy
Diarrhea
Nausea and vomiting
Pseudo membranous colitis
Candidacies
Allergy rate is 1-10% of the population
Penicillins responsible for 75% of anaphylaxis deaths
Combine B_lactamase inhibitor:augmentin
Extended specterum:ampicillin|amoxicillin_
Penicillin: Contraindication
(None except hypersensitivity to penicillin)
11. amoxicillin
Indications
Used to treat bacterial infection such as a dental
abscess. Used prophylactically
in the prevention of infective endocarditis
Contraindications
Hypersensitivity.
Precautions
Renal disease.
Glandular fever
12. Side effect
Glossitis and tongue discolouration.
Candidiasis.
Hypersensitivity.
Gastrointestinal upset.
Pseudomembranous colitis.
Hypokalaemia
14. *Cephalosporins are bactericidal agents (which means that they kill
bacteria)
Side Effects
mild stomach cramps or upset, nausea, vomiting, and diarrhea.
Cephalosporins can also cause overgrowth of fungus normally
present in the body.
Cross allergy with penicillins
Because the cephalosporins are structurally similar to the penicillins,
some patients allergic to penicillins may be allergic to a cephalosporin
antibiotic.
15. Vancomycin
antibiotic useful for the treatment of a number
of bacterial infections. It is of the glycopeptide antibiotic class and
is effective mostly against Gram-positive bacteria.
* treatment of penicillin-resistant Staphylococcus aureus
Vancomycin should be reserved for a condition that
does not respond to metronidazole
Side effects
IV vancomycin include: local pain
nephrotoxic and ototoxic drug
Vancomycin should be reserved for
a condition that does not respond
to metronidazole
16. Tetracycline
Group includes tetracycline, doxycycline (Vibramycin, Periostat) and
minocycline (Minocin)
Broad-spectrum, bacteriostatic
Useful in treatment of periodontal disease
Widespread resistance
Host of adverse effects including: tooth staining, photosensitivity,
blood dyscrasias, GI effects
17. Tetracycline
Contraindications: Renally impaired patients should not be
treated with any of the tetracyclines except doxycycline. Accumulation
of tetracyclines may aggravate preexisting azotemia (a higher-than-normal
level of urea or other nitrogen-containing compounds in the
blood)by interfering with protein synthesis, thus promoting amino acid
degradation. The tetracyclines should not be employed in pregnant or
breast-feeding women or in children less than 8 years of age.
18. Aminoglycoside
Aminoglycosides are a group of bactericidal antibiotics, which act by
inhibiting bacterial protein synthesis. Their use is restricted because of potential
side effects, as they can cause ear and kidney damage. All the aminoglycosides
resemble each other in antibacterial activity, pharmacokinetics and toxicity.
19. Macrolides
Group includes erythromycin, clarithromycin and azithromycin
Erythromycin was the former drug of choice for penicillin-allergic/
penicillin-resistant patients
Numerous GI adverse effects
Active against gram-positive aerobic/facultative staph and strep and
gram-negative anaerobes
Contraindications: Patients with hepatic dysfunction should be
treated cautiously with erythromycin, telithromycin, or azithromycin,
because these drugs accumulate in the liver. severe hepatotoxicity
20. Clindamycin
An alternative for penicillin-allergic or penicillin-resistant patients
*Active against gram-positive and gram-negative anaerobes and
facultative/aerobic bacteria
*Dose = 150-300 mg q6h
23. Antibiotic adverse reaction
Overall incidence is 6-7%
Possible reactions include:
GI tract complications
Colonization of resistant or fungal strains
Cross reactions with other medications
Pseudomembranous colitis
Development of resistant bacteria and superinfection
Little concern about short-term use
24. Antibiotic prophylaxis
Indicated for patients with:
Prosthetic heart valves
History of infective endocarditis
Cardiac transplant with subsequent heart valve problem
Some congenital heart conditions
Unrepaired cyanotic disease (incl. shunts and conduits)
Repaired defect (<6 months) with prosthetic material or device
Repaired defect with residual defect at or adjacent to the site of
repair
Antibiotic Prophylaxis
25. Indicated for the following procedures:
Implant placement
Extractions
Periodontal procedures
Reimplantation of avulsed teeth
Endodontics beyond the apex of the tooth
Intraligamentary injections
Subgingival placement of fibres or strips
Placement of orthodontic bands
Polishing of teeth or implants where bleeding is expected
26. May be indicated for patients at increased risk including:
< 2 years post-surgery
Inflammatory joint disease
Immunosuppressant (incl. drug-induced, radiation-induced, HIV)
Previous joint infections
Type I diabetes mellitus
Hemophilia
Malignancy
27. Antibiotics & Implant Surgery
Two randomized controlled studies were subjected to meta-analysis
Showed a statistically significant higher number of implant failures in
the group that did not receive antibiotics
“It might be recommendable to suggest the use of one dose of
prophylactic antibiotics prior to dental implant placement
28.
29.
30.
31.
32. Indication of antifungal drugs
-Stop spread of infection
-Treat oral thrush
-Denture stomatitis
-Used in combination with antibiotic in case of
abscess
34. Side effect
-Gastrointestinal disturbances.
-Renal damage.
-Hypokalaemia.
-Myopathy and neuropathy
-Dependence.
-Respiratory depression
35. Amphotericin B
Precautions
Respiratory disease.
Pregnancy and breastfeed
Drug and alcohol abuse.
Psychoses.
Porphyria.
36. Nystatin(nystan)
Indications
Used in the treatment of
candidal infections
Contraindications
Hypersensitivity.
Side effects
Hypersensitivity.
Gastrointestinal upset
38. Fluconazole
Contraindications
Previous hypersensitivity
Best avoided during pregnancy and when breastfeeding.
Precautions
Use with caution in patients with renal and hepatic disease.
Side effects
Hypersensitivity reactions.
Gastrointestinal problems
39. ketoconazole
Mechanism
Inhibit synthesis of ergosterol
Used for the treatment of
a. systemic infections
b. mucocutaneous candida infections
c. cryptococcal meningitis
Avoid use in patients with kidney problems
40. Clotrimazole
Indicated for the local treatment of
oropharyngeal candidiasis
Usual adult dose is one lozenge five
41. Antiviral drugs
Treatment of viral infections has posed the
greatest problem of all infectious organisms
Viruses are obligate intracellular organisms
The herpes virus is of the most interest to the
dental health care worker
42. Acyclovir (Zovirax)
Indication
Used in topical , IV, oral formulations
Herpes simplex virus 1,2 (HSV)
Varicella zoster virus
And used in treatment of herpes simplex
43. Herpes Simplex
Herpes viruses are associated with “cold
sores”
Most antiviral agents are either purine or
pyramiding analogues that inhibit deoxyribonucleic
acid (DNA) synthesis
44. Adverse reactions
Topical administration: produces burning, stinging,
or mild pain in about one third of patients
Oral administration: headache (13%) is one of the
most common; other central nervous system
(CNS) and GI effects
Parenteral administration: local reactions at the
injection site are the most common
45. Side effect of acyclovir
-Stinging sensation at site of application, altered taste,
gastrointestinal
upset, renal failure, bone marrow depression, tremors and
convulsions,
lichenoid reactions, rash and urticaria
46. Penciclovir
Available topically
Shown to reduce both the duration of the lesion
and the pain of the lesions on the lips and face
associated with both primary and recurrent herpes
47. Docosanol 10%
Available topically and without a prescription
Has been shown to decrease healing time by
about a half day in patient with recurrent orolabial
herpes when started within 12 hours of the
appearance of prodromal symptoms
48. Famciclovir
Indications
Used in the treatment of herpes zoster and genital herpetic infections
Contraindications
Hypersensitivity, children.
Precautions
Renal and liver disease, pregnancy and
breastfeeding.
Side effect
Maitenance of adequate fluid intake is required
with high doses.
Fever, gastrointestinal upset, dizziness,
confusion, and hallucinations,
headache and sinusitis, rash.
49. Valaciclovir (Valtrex)
Description
An antiviral drug. It is a pro-drug for aciclovir.
Indications
Used to treat herpes simplex and varicella-zoster infections..
Contraindications
Hypersensitivity, children.
Precautions
Renal disease, pregnancy and breastfeeding.
Side effects
Glossitis, altered taste, gastrointestinal upset, renal failure, bone
marrow depression, tremors and convulsions, rash, and urticaria.
52. diazepam)Valium)
Description
A benzodiazepine sedative and anxiolytic drug with anticonvulsant
properties.
Indications
Used in dental sedation and preoperative anxiolysis (although it has
now been superseded by midazolam when intravenous techniques
are employed: for oral sedation temazepam is the drug of choice).
Also indicated in the emergency treatment of epilepsy in the dental
surgery.
53. Contraindication
Severe respiratory disease.
Severe liver disease.
Porphyria (although should be used in emergency management of
status epilepticus).
Precautions
History of drug abuse.
Severe liver disease.
Severe muscle weakness (myasthenia gravis).
Pregnancy and breastfeeding.
Unwanted effects
Xerostomia.
Respiratory depression.
Hypotension.
Visual disturbances
54. Oxazepam
Description
A benzodiazepine anxiolytic.
Indications
Used in the short term treatment of anxiety.
Effects on oral and dental structures
Xerostomia may occur.
Effects on patient management
As the drug is only used short term xerostomia should not produce
significant problems, however a preventive regimen may be considered.
The main interaction in the management of patients receiving
any benzodiazepine therapy is the use of benzodiazepine sedation.
55. Temazepam
Description
A benzodiazepine anxiolytic drug.
Indications
Used as an oral sedative for dental treatment (also used short term
to
treat insomnia).
Contraindications
Severe respiratory disease.
Severe liver disease.
Myasthenia gravis.
Precautions
Respiratory disease.
Pregnancy and breastfeeding.
56. Chlordiazepoxide (Librium)
Description
A benzodiazepine anxiolytic.
Indications
Used in the short term management of anxiety and in alcohol
withdrawal.
Effects on oral and dental structures
Xerostomia can occur.
Effects on patient management
Avoid concurrent prescription of CNS depressant agents.
60. Mechanism of action
Paracetamol inhibits prostaglandin biosynthesis under some
circumstances (e.g. fever), but not others. The difference from
other NSAIDs is still under investigation
Adverse effects
The most important toxic effect is hepatic necrosis leading to
liver failure after overdose, but renal failure in the absence of
liver failure has also been reported after overdose. There is no
convincing evidence that paracetamol causes chronic liver
disease when used regularly in therapeutic doses (4 g/24
hours). Paracetamol is structurally closely related to phenacetin
65. Celebrex
Description
A selective COX-2 inhibitor.
Indications
Pain and inflammation in osteoarthritis or rheumatoid arthritis
Effects on oral and dental
structures
Stomatitis, sinusitis and taste
disturbances can occur.
Effects on patient management
If patient develops celecoxib-induced
stomatitis then the drug
should be stopped and a full blood
count carried out
66. Acetaminophen
Indications
Pain and inflammation associated with musculoskeletal disorders,
e.g. rheumatoid arthritis, osteoarthritis, and ankylosing
spondylitis.
Postoperative analgesia.
Effects on oral and dental
Patients on long-term NSAIDs such as acemetacin
may be afforded
some degree of protection against periodontal
breakdown. This arises
from the drug’s inhibitory action on prostaglandin
synthesis.
l
67. NSAID contraindications
Gastric ulcers
Bleeding dyscrasias or concerns
Significant renal disease
asa (or other NSAID) hypersensitivity
Combination of severe asthma, nasal polyps and multiple allergies
Can lead to ARDS
Pregnancy
Especially in the 3rd trimester
Children
asa only
Elderly
Concurrent use of certain other drugs
71. Opioid
Usually used for analgesia for moderate to severe pain in dentistry
Other opioid effects:
Sedation
Mood alteration
Antitussive
Respiratory depression
Nausea and vomiting
Constipation
72. NALOXONE
It is N-allyl analogue of oxymorphone
have a high affinity for mu receptor
,and
lower affinity at delta and kappa
sites. It selectively antagonizes the
respiratory depression produced by
opioids.
NALTREXONE
It is a pure antagonist and chemically
related to naloxone. It is more potent
than
naloxone and because of its longer
duration of action, it can be used as
maintenance
drug for morphine addicts.
