The document discusses various drugs used in pediatric dentistry, including their routes of administration, mechanisms of action, and side effects. It focuses on local anesthetics like lidocaine, analgesics like aspirin and acetaminophen, antibiotics, and emergency drugs. Local anesthetics work by depressing nerve endings and inhibiting nerve conduction, while analgesics relieve pain either peripherally or centrally. The most common routes of drug administration in dentistry are oral, intramuscular, and intravenous.

1. DRUGS USED IN
PEDIATRIC DENTISTRY
Dr Alvi Fatima
MDS II
Department of Pediatric Dentistry

2. CONTENTS
• INTRODUCTION
• ROUTE OF ADMINISTRATION OF
DRUGS
• AGENTS USED TO CONTROL PAIN
• LOCAL ANASTHESIA
• ANTIBIOTICS
• ANTI-FUNGAL AGENTS
• EMERGENCY DRUGS
• CONCLUSION
• REFERENCES

3. INTRODUCTION
• The overwhelming majority of
pharmacologic agents used in dentistry are
used to control anxiety and pain.
• Antimicrobial agents are an important
adjunct in the management of infection in the
oral cavity

4. • The second most commonly group of drugs used
in dentistry after local anesthetics are the
antibiotics.
• Antimicrobials are substances that kill or suppress
the growth or multiplication of microorganisms
whether bacteria, viruses or fungi.
• Also some other drugs may be used to control
bleeding and Tetanus toxoid if immunization
protocol is not complete, where a booster dose
may be required.

5. ROUTE OF
ADMINISTRATION OF
DRUGS
• The choice of appropriate route in a given
situation depends on drug as well as the patient
related factors.
• Factors governing choice of route

6. • Physical and chemical properties of the drug
(solid/liquid/gas; solubility, stability, pH, irritancy)
• Site of desired action- localized and approachable or
generalized and not approachable
• Rate of extent of absorption of the drugs from different
routes
• Effect of digestive juices and the first pass metabolism on
the drugs.
• Rapidity with which the response is desired (routine
treatment or emergency).
• Accuracy of dosage required (iv and inhalation can provide
fine tuning).

7. Oral Route
• Oral ingestion is the oldest and
commonest mode of drug administration.

8. Advantages
• Convenience.
• Economy.
• Lack of Toxicity.
• Non-invasive or painless

9. Disadvantages
• Action is slower and thus not suitable for
emergencies
• Unpalatable drugs are difficult to administer;
drug may be filled in capsules to circumvent
this.
• May cause nausea and vomiting

10. • Cannot be used for
uncooperative/unconscious/vomiting patient
• Certain drugs are not absorbed (streptomycin)
• Others are destroyed by digestive juices
(penicillin G, insulin) or in liver
(nitroglyrcerine, lidocaine)

11. Intramuscular Route
• The intramuscular route of drug
administration involves injection of
the drug into a skeletal muscle mass.

12. Advantages
• Absorption from an injection deep into
a large muscle mass is much faster and
more dependable than absorption from
the oral route.

13. Technical Advantages.
• Requires no special equipment except a
syringe and needle.
• Little or no patient cooperation is
required,

14. Disadvantages
• Onset.
• Effect.
• Trauma.
• Intravenous Access.
• Liability Costs.

15. Subcutaneous Route
• Occasionally, the subcutaneous route of ad-
ministration is utilized in pediatric dentistry
for conscious sedation. In this situation, the
drug is injected into the subcutaneous or
sub-mucosal space, not into muscle.

16. Advantages
• Site. For dental procedures, some drugs
may be injected submucosally within the
oral cavity, usually into the buccal
vestibule. This may be less objectionable to
some patients and parents than multiple
injection sites, and it may be more
comfortable and convenient for the dentist
to perform.

17. Disadvantages
• Technical Disadvantages.
• The rate of absorption is slower with the
subcutaneous route than with the other
parenteral routes. Blood supply to the
subcutaneous tissue often is sparse
compared with muscle. Within the oral
cavity, however, vascularity is abundant,
and absorption is seldom a problem.

18. • Tissue Slough. Because the drug is
deposited close to the surface of the skin
or mucosa, the possibility of tissue
sloughing is present. For this reason, only
nonirritating substances should be given
subcutaneously, and large volumes of
solution should not be injected.

19. The Intravenous Route
• The intravenous route is the optimal and
ideal route for administration of conscious
sedation.

20. Advantages
• Titration. Among the parenteral routes, only the
intravenous route allows exact titration to a desired
drug effect. Because the drug is injected directly
into the blood stream, absorption is not a factor.
Within a few circulation times, the intravenous
drug will exert its maximal effect. Small,
incremental doses may be given over a relatively
short period of time until the desired level of
sedation is achieved, thus avoiding under- or
overdosing

21. • Test Dose. With the intravenous route, a
very small initial test dose can be
administered, and a short period of time is
allowed to pass to observe for an allergic
reaction or extreme patient sensitivity to
the agent.

22. • Intravenous Access. In the event of a
medical emergency, administration of
emergency drugs is almost always best
accomplished through the intravenous
route.

23. Disadvantages
• Technical Disadvantages. Establishment of
intravenous access (venipuncture) is techni-
cally the most difficult skill that must be mas-
tered in the practice of conscious sedation.
Placing and maintaining an intravenous cath-
eter in children can be difficult even for a
seasoned pediatrician. The procedure requires
both training and extensive practice.

24. • Potential Complications. Because potent
drugs are injected directly into the blood
stream, the intravenous route carries an in-
creased potential for complications.

25. Agents used to control pain
and anxiety

26. LOCAL ANESTHESIA
• Transient 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

27. Topical Anesthesia
Available in different forms:
• Gel ( most effective type).
• Liquid
• Spray.

28. Technique:
• The mucosa at the site of the intended needle
insertion is dried with gauze.
• A small amount of the topical anesthetic
agent is applied to the tissue with a cotton
swab.
• Topical anesthesia should be produced in 30
seconds.
• The dentist should prepare the child for the

29. • Effective to a depth of 2-3 mm .
• Effective in reducing the discomfort of the
initial penetration of the needle into the
mucosa.

30. Disadvantage
• It’s disadvantages are the taste may be disagreeable
to patient and the length of application time may
increase apprehension in the pediatric patient.
• When applying topical anesthetics to the soft tissue
use the smallest effective amount to avoid
anesthetizing the pharyngeal tissues ( cause
gaging).
• Not known to produce systemic toxicity in adults
but can produce local allergic reactions.

31. Content of L.A. Solution:
1. Local anesthetic agent.
2. Vasoconstrictors.
3. Reducing agents.
4. Preservatives.
5. Fungicide.
6. Vehicle.

32. Reducing Agent
• Sodium metabisulphite.
Preservative
• Methylparaben.
• It increases the shelf life of the anesthetic
solution.
• Acts as a bacteriostatic agent.
Fungicide
• Thymol.
Vehicle
• Modified Ringer’s solution / Distilled
Water to give volume.

33. Local anesthetic agent
Esters
Esters of Benzoic Acid
Cocaine, Butacaine, Benzocaine, Tetracaine
Esters of Para Aminobenzoic Acid
Procaine, Chloroprocaine, propoxycaine
Amides
Bupivacaine, lidocaine, articaine, prilocaine

34. Vasoconstrictors
Adrenaline in the concentration of 1:50000
to 1:200000 is commonly used.
1:200000 means….
1 gm in 200000 ml
Or
1mg in 200 ml (0.02 mg/ml)

35. Function of Vasoconstrictors:
1. Delays absorption of LA from the site.
2. Provides blood less field.
3. Prolongs the action .
4. Reduces the systemic toxicity.
Contraindication: Thyrotoxicity, Asthma
and haypertension

36. Metabolism of LA:
Ester Group:
They are hydrolyzed in the plasma by the
enzymes pseudocholinesterase .
Amide Group:
Primary site of biotransformation is in liver.
Excretion: from kidney.

37. Complications OF LA:
1) Systemic Complications
• Toxicity.
• Syncope.
• Allergic Reaction.
• Vasoconstrictors effects.

38. Syncope:
Signs and Symptoms:
• Child become pale and cold .
• Pulse is rapid.
• The pupils are dilated or constricted.
• Drop of blood pressure.

39. • Allergic Reaction:
• Uncommon.
• Manifestations: edema, eczema or
ertecharia.
• Anaphylactic shock : more sever form of
allergy >> Med. Emergency.

40. • Vasoconstrictors Effects:
Patients with ischemic heart diseases and
hypertension are at high risk of toxicity if
LA administrated intravascularly.

41. • 2) Local Complications:
• Broken needle.
• Hematoma.
• Trauma of the nerve causing Paresthesia.
• Sloughing .
• Soft tissue injury.

42. ANALGESICS

43. • The agents used for pain relief are termed
analgesics.
• Analgesic drugs should relieve pain
without significantly altering consciousness.
• It act either in the periphery at the site of
pain perception, or centrally in the brain and
spinal cord.

44. CLASSIFICATION
Divided into 2 groups:
1. Non-Narcotic Analgesics
Act in the periphery at the nerve endings.
2. Narcotic Analgesics
Act at central nervous system.

45. Classification
A. Nonselective COX inhibitors (traditional
NSAIDs)
1. Salicylates: Aspirin.
2. Propionic acid derivatives: Ibuprofen,
Naproxen, Ketoprofen, Flurbiprofen.
3. Fenamate: Mephenamic acid.
4. Enolic acid derivatives: Piroxicam,
Tenoxicam.
5. Acetic acid derivatives: Ketorolac,
Indomethacin, Nabumetone.
6.Pyrazolone derivatives: Phenylbutazone,
Oxyphenbutazone.

46. B. Preferential COX-2 inhibitors
Nimesulide, Diclofenac, Aceclofenac,
Meloxicam, Etodolac.
C. Selective COX-2 inhibitors
Celecoxib, Etoricoxib, Parecoxib.
D. Analgesic-antipyretics with poor
antiinflammatory action
1. Paraaminophenol derivative: Paracetamol
(Acetaminophen).
2. Pyrazolone derivatives: Metamizol (Dipyrone),
Propiphenazone.
3. Benzoxazocine derivative: Nefopam.

47. Side effects
• Gastrointestinal upset
• Rash
• Headache
• Dizziness
• Eye problems
• Hepatic dysfunction and
• Renal dysfunction

48. Non-Narcotic Analgesics
• Useful for mild to moderate pain
• Lesser degree of toxicity and side effects
• Absence of drug dependence
• The standard prototype drugs in this class are
aspirin, acetaminophen, and nonsteroidal
anti-inflammatory drugs (NSAIDs).

49. ASPIRIN
• Analgesic, Antipyretic & Anti-inflammatory
Effects.
• RESPIRATORY SYSTEM
-Increases rate & depth.
• GIT
- Irritates the gastric mucosa causes epigastric
distress, nausea & vomiting
- Promotes the local back diffusion of the
acid acute ulcers, erosive gastritis,
microscopic haemorrhages

50. • Dosage. The recommended dosage for an-
algesia and antipyretic purposes in children
is 10—15 mg/kg/dose given at 4-hour
intervals up to a total of 60—80
mg/kg/day, with a maximum limit of 3.6
gm/day.

51. Acetaminophen
• Acetaminophen (i.e paracetamol) is the
most common analgesic used in pediatrics.
• It does not inhibit platelet function
• Causes less gastric upset, and
• Has not been implicated in Reye's
syndrome.

52. Disadvantages
• It has no clinically significant anti-
inflammatory properties.
• Toxicity as a result of over dosage may
result in acute liver failure with serious or
fatal hepatic necrosis.
• 15 gm in an adult to produce liver damage
• More than 3 gm for a child under 2 years of
age

53. • Dosage. The recommended dosage for
acetaminophen is
• Adult: 300-650 mg every 4 hours
• Children: 10-15 mg/kg/dose every 4-6
hours
• Maximum dose: 1000 mg every 6 hours

54. • Relatively few clinical drug trials evaluating NSAIDs
in children.
• FDA approved for children are:
– Ibuprofen (PediaProfen, Children's Advil) 4-10
mg/kg every 6 hours
– Naproxen (Naprosyn) 5-7 mg/kg two to three times
per day
– Tolmetin (Tolectin) 5—7 mg/kg three to four times
per day.
• Both ibuprofen and naproxen are available in oral

55. Narcotic Analgesics
• interact with opioid receptors in the
central nervous system.
• pharmacologic effects characteristic of
the narcotics:
– analgesia,
– sedation, and
– cough suppression.

56. Serious drawbacks
• Sedation,
• Respiratory depression, and
• Dependence and abuse

57. • Many narcotic analgesics available, including:
– morphine,
– meperidine (Demerol),
– fentanyl (Sublimaze),
– codeine,
– oxycodone (Percodan), and
– hydromorphone (Dilaudid).
• Most of these drugs must be administered
parenterally.

58. Antibiotics
• Antibiotics are among the most frequently
prescribed medication for the treatment as well
as prevention of bacterial infection in modern
medicine.
• Antibiotics cure disease by killing, injuring, or
inhibiting the growth of bacteria at very low
concentrations.
Antibiotics and its use in pediatric dentistry: A review
International Journal of Applied Dental Sciences 2018;
4(2): 310-314
58

59. • The word antibiotic came from the
word “antibiosis” a term coined in
1889 by Louis Pasteur which means
a process by which life could be
used to destroy life.
59

60. Definition
• Antibiotics are the substances produced by the
micro-organisms, which suppress the growth
or kill other micro-organism at very low
concentration without causing any harm to the
host.
• The term antibiotic means “against life”.
K D TRIPATHI,ESSENTIALS OF
MEDICAL PHARMACOLOGY
60

61. Antibiotics are used in dentistry for two
major reasons:
• To control oral infection, and to prevent a
bacteremia precipitated by dental manipulations
from causing severe systemic sequelae.
• Children have different susceptibilities to oral
and systemic diseases than adults, and that the
metabolism of drugs is often vastly different in
the pediatric patient.
61

62. Oral infections are classified as odontogenic
and non-odontogenic.
62
• Odontogenic infections are the most frequent
and begin affecting periodontal and dental
structures.
• Non-odontogenic infections start in extra
dental structures, such as mucosa, glands,
tongue, etc.

63. • These infections are usually localized and
respond well to treatment.
• They can spread to remote regions and cause
serious problems compromising even the
patient’s life.
63

64. Drug dosage
1. CLARKS RULE:
CHILD DOSE = WEIGHT(POUNDS) x ADULT DOSE
150
2. YOUNGS RULE:
CHILD DOSE = AGE OF CHILD x ADULT DOSE
AGE +12
64

65. 3. Fried’s Rule
CHILD’S DOSE = AGE IN MONTHS X ADULT DOSAGE
150

66. Mechanism of Action
• Inhibit cell wall synthesis
• Cause leakage from cell membranes
• Inhibit protein synthesis
• Inhibit DNA gyrase

67. • Interfere with DNA function
• Interfere with DNA synthesis:
• Interfere with intermediary metabolism:
• Cause misreading of m-RNA code and
affect permeability:

68. Classification of Antibiotics

69. Based on Organism of Action:
• Antifungal:
– Griseofulvin, Amphotericin B, Ketoconazole etc.
• Antiviral:
– Idoxuridine, Acyclovir, Zidovudine etc.
• Antiprotozoal:
– Chloroquine, Pyrimethamine, etc.
.
69

70. Based on Spectrum of Activity:
• Narrow sprctrum:
– Penicillin G, Streptomycin, Erythromycin.
• Broad Spectrum:
– Tetracyclin , chloramphenicol.
70

71. Based on Type of Action
• Bacteriostatic:
– sulfonamides, Erythromycin, tetracyclin.
• Bacteriocidal:
– penicillins , aminoglycosides,
cephalosporins, cotrimoxazole,
metronidazole. 71

72. β-lactam Antibiotics
• β-lactam antibiotics are useful and frequently
prescribed antimicrobial agents that share a
common structure and mechanism of action of
inhibiting the synthesis of the bacterial
peptidoglycan cell wall.
• β-lactam antibiotics include Penicillins and
Cephalosporins.
72

73. • Amoxicillin is an extended spectrum Penicillin
group of antibiotics. It became first available in
1972. It is on the World Health Organization’s list
of Essential Medicines, the most important
medication needed in a basic health system.
• It is one of the most commonly prescribed
antibiotics in children.
73

74. THERAPEUTIC USES:
• Dental prophylaxis in patients at risk of
endocarditis (single dose)
• For the treatment of pulpal, periapical and
periodontal infection.
• Upper respiratory tract infection due to
Streptococci, Pneumococci H. influenza
• Infection of skin and soft tissues due to
streptococci and susceptible staphylococci.
74

75. CONTRAINDICATION
• Penicillin allergy
• Hypersensitivity reaction (anaphylaxis or
Steven Johnson syndrome)
• Kidney disease
75

76. • Dosage:25-50mg/kg(div 8hours)- maximum
1500mg/day.
• Side effects: Rash, Diarrhoea.
• Trade name:
– Capsules: novamox(CIPLA), mox (REXEL),
wymox(WYETH), (250,500mg).
– Dispersable tablets:
novamox(125,250mg)wymox(250mg).
– Tablets : NovamoxLB(CIPLA)(250mg, 500mg),
Mox(REXEL)(125mg, 250mg, 500mg)
– Syrups: Novamox(CIPLA)(125mg, 250mg/5ml),
mox(REXEL)(125mg/250mg/5ml)
– Drops:novamox(CIPLA)(100mg/ml)
– Injections:Mox(REXEL), Hipen(CADILA)(250mg,
500mg)
76

77. AAPD Guidelines
• Forms: Suspension, chewable tablet, tablet,
capsule.
• Usual oral dose
77
children >3 months of age
upto 40 kg
20-40 mg/kg/day in divided
doses every 8 hours
OR 25-45 mg/kg/day in
divided doses every 12
hours
Children >40 kg and adults 250-500 mg every 8 hours
OR
500-875 mg every 12 hours

78. • Cephalosporins were discovered in 1945 by
the Italian pharmacologist Giuseppe Brotzu
and were first sold in 1964.
• They are indicated for the prophylaxis and
treatment of infections for children who are
allergic to penicillin group of drugs.
78

79. • First generation cephalosporins are active
predominantly against gram positive bacteria,
and successive generations have increased
activity against gram negative bacteria.
79

80. Cephalexin
• Dosage:25-50mg/kg(div 6hours)
• Side effects: nausea ,diarrhoea , dizziness.
• Trade name:
– Capsules: sporidex, ceff (250,500mg).
– Dispersable tablets: sporidex, ceff(250mg)
– Syrups: sporidex, ceff syrup(125mg/5ml,
250mg/5ml)
– Drops: Phexin(100mg/ml)
80

81. AAPD Guideline
• Forms: Suspension, tablet, capsule
• Usual oral dosage
81
Children >1 year 25-100 mg/kg/day in
divided
doses every 6-8 hours
(maximum 4g/day)
Adults 250-1000 mg every 6 hours
(maximum 4g/day)

82. Cefadroxil
• Dosage:30mg/kg(div 12hours)
• Side effects: nausea ,diarrhoea , dizziness.
• Trade name:
– Dispersable tablets: droxyl, (125,250mg)
wymox(250mg).
– Tablets: cefadaur, kidrox(125mg)
– Drops :cefadaur, kidrox(100mg/ml)
82

83. NITROIMIDAZOLE
• Nitroimidazoles are imidazole heterocyclic
compounds with a nitro group that have been
used to combat anaerobic bacterial and
parasitic infection .
• The most common example is metronidazole.
83

84. METRONIDAZOLE
• Metronidazole was introduced in 1959 and is one
of the mainstay drugs the treatment of anaerobic
and certain parasitic infection.
• Metronidazole is a 5-nitroimidazole available for
oral administration or as suppository; also
formulated as hydrochloride for intravenous use,
and as benzoate in an oral suspension and also a
dental gel.
84

85. THERAPEUTIC USES:
• Acute necrotizing ulcerative gingivitis
(Vincent’s Stomatitis)
• Pericoronitis and pericoronal abscess
• Chronic aggressive periodontitis
• Periapical and periodontal abscess
85

86. • Dentoalveolar abscess
• Cellulitis and Space infections
• Osteomyelitis
• Infected sockets
• Gastro-duodenal ulcers caused by
Helicobacter pylori
• Surgical prophylaxis

87. • Dosage:30-50mg/kg/day(div 6hr)
• Side effects: nausea ,headache, metallic
taste, paresthesia , transient leukopenia
• Trade name:
– Tablets: metrogyl, aristogyl (200-400mg).
– Suspension: flagyl, metrogyl susp
– Injections: metrogyl, metronidazole
IV(500mg/100ml infusion) 87

88. AAPD Guidelines
• Forms: Tablet, tablet extended release, capsule,
injectable
• Usual oral dosage:
• For anaerobic skin and bone infection:
88
Children 30/mg/kg/day in divided
doses every 6 hours
(maximum 4 g/24 hours)
Adolescents and adults 7.5 mg/kg every 6 hours
(maximum 4 g/24 hours)

89. • Forms: Tablet, tablet extended release, capsule,
injectable
• Usual oral dosage:
89
For periodontal disease,
including necrotizing
ulcerative gingivitis. (for
adolescents and adults)
250 mg every 6-8 hours for 10
days OR 500 mg every 8hours
for 8 days
For aggressive oral infections,
may be used in combination
with amoxicillin
250 mg 3 times/day with
amoxicillin (250-375 mg
3times/day) for 7-10 days

90. TRIPLE ANTIBIOTIC PASTE
• In reducing dental infections. The infection of
the root canal system is considered be a
polymicrobial infection, consisting of both
aerobic and anaerobic bacteria.
• Because of the complexity of the root canal
infection, it is unlikely that any single antibiotic
could result in effective sterilization of the
canal.
• More likely, a combination would be needed to
address the diverse flora encountered.
90

91. • The combination that appears to be most
promising consists of Metronidazole,
Ciprofloxacin, and Minocycline.
• This triple antibiotic regimen was first tested by
Sato et al. in 1996.
91

92. • In recent years, the Cariology Research Unit of the
Niigata University has developed the concept of
“Lesion sterilization and tissue repair (LSTR)” therapy
that employs the use of a combination of antibacterial
drugs, Metronidazole 500 mg, Ciprofloxacin 200 mg,
and Minocycline 100 mg (3 mix used in1:1:1 ratio)
for disinfection of oral infectious lesions, including
dentinal, pulpal, and periradicular lesions. A carrier of
equal amounts of macrogol ointment and propylene
glycol (MP) are mixed together resulting in an opaque
mix (MP used in a 1:1 ratio). 92

93. • The antibiotic paste is left in the tooth for a
period of 4 weeks to allow complete
disinfection of any necrotic tissue. After this
period the tooth is re-entered for further
treatment.
93
Hoshino E, Takushige T. LSTR 3Mix-MP method-better
and efficient clinical procedures of lesion sterilization and
tissue repair (LSTR) therapy. Dent Rev. 1998; 6:57-106.

94. USE OF TRIPLE ANTIBIOTIC PASTE
• Regenerative endodontic treatments
• In healing of large periradicular lesions
• Killing common endodontic pathogens from
necrotic/infected root canals in vitro.
• In order to sterilize the infected root dentine,
especially the layers
• Traumatized immature tooth with a periapical
lesion
94

95. ANTIBIOTIC PROPHYLAXIS
• Most oro-facial infections are odontogenic in
origin, and are of self-limiting nature
characterized by spontaneous drainage.
• The causal bacteria are generally saprophytes.
• Bacteremia is anticipated in the blood
following invasive dental
95

96. • INFECTIVE ENDOCARDITIS (IE) is an
uncommon but a life threatening complication
resulting from bacteremia .
• The vast majority of cases of IE caused by oral
microflora can result from bacteremia associated
with routine daily activities such as tooth
brushing, and chewing.
• However, antibiotic prophylaxis is
recommended with certain procedures.
96

97. z • RECOMMENDATIONS:
• The conservative use of antibiotics is indicated
to minimize the risk of developing resistance to
current antibiotic regimen.
• Antibiotic prophylaxis is given prior to dental
procedures in children having the following
conditions.
97

98. • Patients with cardiac conditions
• Patients with compromised immunity
• Patients with shunts, indwelling vascular
catheters, or medical devices
• Patients with prosthetic joints
98
International Journal of Applied Dental
Sciences,2018,4(2),310-314Antibiotics
and its use
in pediatric dentistry: A review

99. ANTIFUNGAL AGENTS

100. • Candida species, especially Candida albicans,
is often found on the healthy mucous mem-
branes of the body
• Candidiasis is common in children receiving
oncology treatment, particularly during
periods of severe immunosuppression and
neutropenia.
• The clinical management of oral candidiasis in
children is similar to that in adults and consists
principally of antifungal agents.

101. • Oral and esophageal candidiasis is
usually treated with topical
suspensions or troches of antifungal
agents

102. • Nystatin. is available as an oral suspension
(100,000 units/mL), tablet (500,000 units),
and pastille/troche (200,000 units). A dose
of 1-3 million units/day in three to five
divided doses for 10-14 days is
recommended.

103. • Clotrimazole. available only as a 10-mg
troche for intraoral application
• The recommended dose is one troche
dissolved slowly in the mouth five times a
day for 14 days
• Liver toxicity has been reported
• linical studies have not been conducted to
establish the safety of the drug for children
below 3 years of age.

104. • Ketoconazole. is reserved for treating more
severe infections.
• A single daily tablet (200 mg) of 3.3-6.6
mg/kg taken with food for 10—14 days
• Hepatotoxicity is associated with
ketoconazole
• Limited to children 2 years of age or older

105. Emergency Drugs

106. The current recommended drugs for medical
emergencies are:
• 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
106

107. Oxygen
107
• Oxygen is indicated for every emergency except
hyper-ventilation.
• This should be done with a clear full face mask
for the spontaneously breathing patient and a
bag-valve-mask device for the apneic patient.
• Oxygen should be available in a portable
source, ideally in an “E”-size cylinder which
holds over 600 liters.

108. • A flow rate of 6 to 10 liters per minute is
appropriate for most adults.
• If the patient is unconscious and apneic, it
should be delivered by a bag-valve-mask
device where a flow rate of 10 to 15 liters per
minute is appropriate.
• A positive pressure device may be used in
adults, provided that the flow rate does not
exceed 35 liters per minute.
108

109. Epinephrine
• Epinephrine is the drug of choice for the
emergency treatment of anaphylaxis and
asthma which does not respond to its drug of
first choice, albuterol or salbutamol.
• Epinephrine has a very rapid onset and short
duration of action, usually 5 to 10 minutes
when given intravenously.
109

110. • Initial doses for the management of
anaphylaxis are 0.3 to 0.5 mg
intramuscularly or 0.1 mg intravenously.
• These doses should be repeated as necessary
until resolution of the event.
• It can be a drug with a high risk if given to a
patient with ischemic heart disease.
110

111. Nitroglycerin
• This drug is indicated for acute angina or
myocardial infarction. It is characterized by a
rapid onset of action.
• For emergency purposes it is available as
sublingual tablets or a sublingual spray.
• One tablet or spray (0.3 or 0.4 mg) should
be administered sublingually.
111

112. • Relief of pain should occur within minutes.
• If necessary, this dose can be repeated twice
more in 5-minute intervals.
• Systolic blood pressures below 90 mmHg
contraindicate the use of this drug.
112

113. Injectable Antihistamine
• An antihistamine is indicated for the
management of allergic reactions.
• Mild non-life threatening allergic reactions
may be managed by oral administration, life-
threatening reactions necessitate parenteral
administration.
• Two injectable agents may be considered,
either diphenhydramine or chlorpheniramine.
113

114. • They may be administered as part of the
management of anaphylaxis or as the sole
management of less severe allergic reactions,
particularly those with primarily dermatologic
signs and symptoms such as urticaria.
• Recommended doses for adults are 25 to 50
mg of diphenhydramine or 10 to 20 mg of
chlorpheniramine.
114

115. Albuterol (Salbutamol)
• Albuterol (salbutamol) is the first choice for
management of bronchospasm.
• When administered by means of an inhaler, it
provides selective bronchodilation with
minimal systemic cardiovascular effects.
115

116. • It has a peak effect in 30 to 60 minutes,
with a duration of effect of 4 to 6 hours.
• Adult dose is 2 sprays, to be repeated as
necessary.
• Pediatric dose is 1 spray, repeated as
necessary.
116

117. Aspirin
• Aspirin (acetylsalicylic acid) is one of the more
newly recognized life-saving drugs, as it has
been shown to reduce overall mortality from
acute myocardial infarction.
• The purpose of its administration during an
acute myocardial infarction is to prevent the
progression from cardiac ischemia to injury to
infarction.
117

118. • The purpose of its administration during
an acute myocardial infarction is to
prevent the progression from cardiac
ischemia to injury to infarction.
• Contraindications.
– hypersensitivity to aspirin,
– severe asthma or
– history of significant gastric bleeding 118

119. Oral Carbohydrate
• An oral carbohydrate source, such as fruit
juice or non-diet soft-drink, should be readily
available.
• Its use is indicated in the management of
hypoglycemia in conscious patients.
119

120. Conclusion
• Drugs used in Pediatric Dentistry are
growing and changing at an unprecedented
pace. Remarkable contributions have been
made recently both in understanding drug
action at molecular level as well as in
developing more selective drugs. The Pediatric
dentist should be updated with all these
advances and thereby applying the knowledge
in their practice.

121. References
• KD Tripathi :Essentials of medical
pharmacology; Jaypee brothers.
• Guideline on antibiotic prophylaxis for dental
patients at risk for infection; AAPD 2014-2015
121

122. • Antibiotics and its use in pediatric dentistry: A
review Dr. Trophimus Gnanabagyan Jayakaran,
Dr. Vishnu Rekha C, Dr. Sankar Annamalai and
Dr. Parisa Norouzi Baghkomeh. International
Journal of Applied Dental Sciences 2018; 4(2):
310-314
• Haas D. A. (2006). Management of medical
emergencies in the dental office: conditions in
each country, the extent of treatment by the
dentist. Anesthesia progress, 53(1), 20–24.
doi:10.2344/0003-
3006(2006)53[20:MOMEIT]2.0.CO;2
122