Understanding the role of pharmacology in prosthodontics is imperative because this is one of the most neglected parts of research even though there are a large number of dental patients suffering from systemic diseases which have to be taken care of before the commencement of dental treatment. Another main reason is that the prosthodontist may have to deal with a medical emergency arising on the dental chair.

1. PHARMACOTHERAPEUTICS
FOR PROSTHETIC
DENTISTRY
PRESENTED BY:-
DR. ARATI
1st year MDS
DEPT. OF PROSTHODONTICS,CROWN &
BRIDGE AND IMPLANTOLOGY

2. CONTENTS
 Introduction
 Definition
 Classification
Conclusion
 Reference
1

3. INTRODUCTION
• PHARMACOLOGY :-
Greek: Pharmacon – Drug
Logos – science
- Pharmacology is the science of drugs. In broad sense, it deals
with interaction of exogenously administered chemical molecules
(drugs ) with living systems.
• DRUG :- ( Drogue – a dry herb in French )
- ‘A Drug is any substance or product that is used or intended to be
used to modify or explore physiological systems or pathological
states for the benefit of the recipient.’
2

4. Classification
1. Drugs used directly for therapeutic purpose.
A. Drugs causing localized effect in the oral cavity.
- Local Anesthetics
- Agents for Gingival Retraction & astringents
- Hemostatic agents
- Sialogogues
- Antisialogogues
- Mouth rinses containing local anti-infective agents
- Topical fluorides
3

5. B. Drugs used for systemic pharmacological effects
- Analgesics
- Steroids
- Antibiotics
- Antianxiety drugs
- Centrally acting muscle relaxants
- Vitamins and minerals
4

6. 2. Drugs which influence the success of prosthodontic
treatment
- Drugs causing Xerostomia(Dry mouth)
- Drugs which cause changes in oral flora
- Drugs affecting gingiva & oral mucosa
- Drugs causing sialorrhoea
- Drugs affecting bones or residual ridge
- Drugs causing hypoglycemic shock
5

7. A. DRUGS CAUSING LOCALIZED EFFECT IN THE ORAL
CAVITY.
1.LOCALANESTHETICS
Local anesthesia is defined as loss of sensation in a circumscribed
area of the body caused by depression of excitation in nerve endings
or inhibition of the conduction process in peripheral nerves.
CLASSIFICATION:-
DEPENDING UPON THEIR COMPOSITION:-
Esters:- Amides:-
COCAINE LIDOCAINE
PROCAINE BUPIVACAINE
CHLOROPROCAINE DIBUCAINE
6
[Stanley F Malamed :- 6th edition]

8. BASED ON MODE OF APPLICATION :-
A. INJECTABLE:- B. TOPICAL:-
7
1.Soluble
COCAINE
LIDOCAINE
2.Insoluble
BENZOCAINE
BUTYLAMINOBENZOATE
1.Lower potency,
short duration
• PROCAINE
• CHLOROPROCAINE
2.Intermediate
potency and
duration
• LIDOCAINE
• PRILOCAINE
High potency, long
duration
• TETRACAINE
• BUPIVACAINE
• RUPIVACAINE

9. PROPERTIES OF AN IDEAL ANAESTHETIC:-
1.Action must be reversible.
2. It should not be irritating to the tissue to which it is applied.
3. It should not cause any permanent alteration of nerve structure.
4. Its systemic toxicity should be low.
5. Should have rapid onset of action.
6. It should have enough potency to give complete anesthesia without
the use of harmful concentrated solutions.
8

10. 7. It must be effective regardless of whether it is injected into the
tissue or is applied locally to mucous membranes.
8. It should not interfere with the healing of tissue.
9.It should be stable in solution and readily undergo
biotransformation in the body.
10. It should be either sterile or capable of being sterilized by heat
without deterioration.
9

11. Mechanism of Action
10

12. • PRECAUTIONS:-
 Care should be taken with the use of amides in patients with
Hepatic Disorders.
 Care should be taken with use of ester group in any suspected
genetic based plasma pseudo-cholinesterase deficiencies.
 Allergy to methyl paraben, which is used as a preservative should
be kept in mind.
 Least possible volume should be used.
 Solution should be deposited slowly.
 Aspiration must be done before injection.
11

13. COMPLICATIONS:-
1) Resulting from absorption of anesthetic solution:-
1.Toxicity
2. Idiosyncrasy
3. Allergy
4. Anaphylactic Reaction
5. Infections caused by contaminated solutions
6. Local irritation or tissue reaction.
12

14. 2)Resulting from insertion of the needle:-
1.Syncope
2. Muscle Trismus
3. Pain or hyperalgesia
4. Edema
5. Infection
6. Broken needle
7. Prolonged anesthesia
8. Hematoma
9. Sloughing
13

15. VASOCONSTRICTING AGENTS:-
They are an integral and necessary part of most local anesthetics.
Can be grouped into 3 categories:-
1.Pyrocatechin derivatives- Epinephrine
Nor epinephrine
2. Benzol derivatives- Levonordefrin
3. Phenol derivatives- Phenylephrine
14

16. USE:-
Vasoconstrictor is added
e.g. Adrenaline( 1:50,000 to 1:200,000) or
Phenylephrine( 1:2,000)
1.Prolongs duration of action of LAs by decreasing their rate of
removal from the local site into the circulation
2. Reduces systemic toxicity of LAs : rate of absorption is reduced
& metabolism keeps the plasma concentration lower.
15

17. Vasoconstrictors as accepted by the Council on Dental
Therapeutics, American Dental Association
16
Drug Concentration mg/ml
Milligrams in
1.8ml
cartridge
Maximum
recommended
dose (mg)
Epinephrine 1:200,000 0.005 0.009 0.2
Levonordefrin 1:100,000 0.01 0.018 0.2
Nor-
epinephrine
1:50,000
1:20,000
1:30,000
0.02
0.05
0.033
0.036
0.09
0.059
0.2
1.0
0.34
[Felpel P. Leslie – A review of pharmacotherapeutics for prosthetic dentistry, Part I, JPD, 77(3); 1997.]

18. 2.AGENTS FOR GINGIVAL RETRACTION &
ASTRINGENT
ASTRINGENTS:-
 Aluminum chloride- is the most widely used agent - it is irritating
& may cause local tissue damage in conc. >10%.
 Ferrous sulfate- is the only astringent accepted by Council on
Dental Therapeutics but it is irritating & causes staining(due to its
iron content).
17
[2011, Journal Of Interdisciplinary Dentistry]

19. Agents for gingival retraction and astringents
18
Drug Official or trade
name
Manufacturer Concentration Preparation
form
Aluminum acetate Burrow’s solution - 5% Solution
Aluminum
chloride
Hemodent* Premier Dental
Products
0.9-1.8mg/inch Retraction cord
Aluminum sulfate Pascord Pascal
Van R Dental
Products
0.48-1.45mg/inch
1.0mg/inch
Retraction cord
Retraction cord
Epinephrine Gingibraid
Gingi-Par
Surgident 0.5mg/inch Retraction cord
Ferrous sulfate Astringedent* Ultradent
Products
15.5% Solution
Zinc chloride - - 8-20% Retraction cord
*Accepted by the Council on Dental Therapeutics, American Dental Association [Felpel P. Leslie –JPD, 77(3); 1997.]

20. 3. HEMOSTATIC AGENTS
 They are agents that reduce or control blood flow.
 Epinephrine may be applied topically as a local hemostatic agent.
 It is most effective in the control of superficial capillary bleeding
but will not control bleeding from larger vessels.
 Absorption is rapid from sites of trauma.
19

21. Thrombin:-
 Is a blood clotting factor that maybe applied as a powder or a
liquid on sites that are free of clotted blood.
 Thrombin must not be injected because of extensive intravascular
clotting that may result in death.
 Absorbable gelatin sponge is available as a powder or porous
sheet.
 The hemostatic properties of absorbable gelatin sponge are
improved by soaking it in a thrombin solution before application.
20

22. Hemostatic Agents
21
Drug/Product Trade name Manufacturer concentration
Absorbable gelatin
sponge
Gelfoam* Upjohn -
Aluminium chloride Hemodent Medical Products 5%-10%
Epinephrine Adrenalin Parke-Davis 1:100000
Ferric subsulfate Monsel’s solution - 20%
Oxidized cellulose Surgicel * Johnson & Johnson -
Cellulose Oxycel Becton-Dickinson -
Thrombin Thrombostat Parke-Davis -
*Accepted by the Council on Dental Therapeutics, American Dental Association
[Felpel P. Leslie –JPD, 77(3); 1997.]

23. 4.AGENTS FOR TREATING XEROSTOMIA
1.SIALOGOGUES:-
 Xerostomia may result from disease states like Sjogren’s
syndrome, rheumatoid arthritis, diabetes insipidus, pernicious
anemia, from radiation, as a side effect of a wide variety of drugs,
or from natural aging.
 It may lead to complications that reduce denture wearing time &
cause difficulty in swallowing, loss of taste, difficulty in speaking,
stomatitis, burning tongue, rampant caries & periodontal disease.
 The treatment rationale for xerostomia is- to activate muscarinic
cholinergic receptors of the parasympathetic nervous system to
increase salivary flow.
22

24.  Pilocarpine, a naturally occurring cholinergic agonist, produce a
short duration increase in salivary flow without any side effects,
suggesting that it may possess same degree of selectivity as
salivary gland cholinergic receptors.
 Use of pilocarpine limited to- Sjogren’s syndrome
 Not used in patients with drug induced xerostomia
 Treatment of chronic xerostomia limited to oral rinses & saliva
substitutes.
23

25. Over the counter saliva substitutes:
24
Trade name Manufacturer Dose form Lubricating ingredient
Entertainer’s secret KLI Corp. Solution, Pump spray Carboxymethylcellulose
Glandosane Kenwood Solution, Pump spray Carboxymethylcellulose
Moi-Stir* Kingswood Lab Pump spray, swabsticks Carboxymethylcellulose
Orext Young Dental Solution, Pump spray Carboxymethylcellulose
Saliva substitute* Roxane Solution Carboxymethylcellulose
Salivart* Gebauer Spray Carboxymethylcellulose
Xero-Lube* Scherer Solution, Pump spray Carboxymethylcellulose
Optimoist Colagte-palmolive Solution, Pump spray Hydroxyethylcellulose
Salix Scandinavian
Pharmaceuticals
lozenges Carboxymethylcellulose
Hydroxypropylmethyl
cellulose
MouthKote II Parnell Solution Mucopolysaccharide
Saliva Orthana Orthana kimisk
Fabrik kastrup
Spray, lozenges, gum Mucin
*Accepted by the Council on Dental Therapeutics, American Dental Association[Felpel P. Leslie –JPD,1997.]

26. 3. MOUTH RINSES CONTAINING FLUORIDE:-
 Useful in- controlling plaque formation & reducing caries
formation, especially in patients with xerostomia, part of the anti
caries activity of fluoride is from an antibacterial effect.
 Mechanism of antibacterial effect is complex but is, in part,
caused by the suppression of enzymatic pathways involved with
bacterial glycolysis.
 Fluorides become more effective in acid medium, as occurs in
vicinity of cariogenic plaque.
25

27. Mouth rinses containing fluoride
26
Trade name Manufacturer OTC Ethanol(%) Fluoride(%)
ACT* Johnson & Johnson Yes 7 0.02
Fluorigard* Colgate-Palmolive Yes 6 0.02
Oral-B Fluorinse* Oral-B Lab No 0 0.2
MouthKote F/Rt Parnell Yes 0 0.04
Oral-B Anticavity Orachem Pharmaceuticals No 0 0.05 , 0.2
Rinse* Oral-B lab Yes 0 0.05
Point-Two Colgate Oral Pharm No 6 0.09
Prevident * Colgate Oral Pharm No 6 0.2
Reach * Johnson & Johnson Yes 7 0.02
[Felpel P. Leslie –JPD, 77(3); 1997.]
OTC, Over the counter.
*Accepted by the Council on Dental Therapeutics, American Dental Association
t - Contains benzyl alcohol.

28. 5. ANTISIALOGOGUES
 Agents used to decrease salivary secretion .
 They are cholinergic antagonists & thus block the same receptors
that are activated by the Sialogogues or cholinergic agonists.
 For reduction in salivary flow, oral administration of Atropine,
Scopolamine, or Methantheline & Propantheline should precede
the clinical procedure by 1 to 2 hours, one-half to 1 hour, or one-
half hour respectively.
 Atropine - is prototype anticholinergic drug.
 A reduction in salivary flow for 4-6 hours after oral
administration.
27

29. ANTISIALOGOGUES
28
Drug Trade name Manufacturer Dose(mg) Duration (hr)
Atropine
sulfate*
- - 0.2-0.4 4-6
Belladonna - - - -
Tincuture* - - 0.4-0.6 4-6
Scopolamine - - - -
Methantheline Banthine Schiapparelli searle 50-100 5-6
Propantheline Pro-Banthine Schiapparelli searle 15-30 5-6
*Accepted by the Council on Dental Therapeutics, American Dental Association

30. 6. MOUTH RINSES CONTAINING LOCAL ANTISEPTIC
AGENTS
 Mouth rinses that contain local antiseptic agents also have a
variety of other ingredients, including flavoring agents,
sweeteners, dyes, preservatives and wetting agents.
 Mouth rinses are acidic with a pH ranging from 4.2 to 8.2 and
many contain ethanol which is a local antiseptic agent.
 Phenolic derivatives such as thymol have limited usefulness and
objectionable taste.
29

31.  Cetylpyridinium, a surface-active agent, is a quaternary
ammonium derivative that has slight bacteriostatic activity but has
bitter and unpleasant after taste.
 Povidone-iodine, an iodophore, is a halogen-releasing compound
combined with a surface active agent. It is probably the most
effective antibacterial agent.
 The iodophores do not stain or sting as iodine solutions do, but
they have an unpleasant taste.
30

32.  2% to 4% chlorhexidine, a biguanide is most effective against
gram-positive organisms, less effective against gram-negative
organisms and fungi, and ineffective against spores and viruses.
 Chlorhexidine digluconate, at concentrations of 0.12%, is used for
treating gingivitis and suppression of the formation of plaque.
 Chlorhexidine protein and is slowly released, a desirable
characteristic for plaque control.
 Undesirable effects include a reversible, altered taste perception,
especially to salt; staining of teeth, tongue, and margins of anterior
restorations that cannot be removed by burnishing with toothpaste;
and local irritation if applied to abraded tissue.
 Chlorhexidine containing mouth rinses are useful adjuncts that
may facilitate healing after insertion of dentures.
31

33. 7.TOPICAL FLUORIDES
Various topical fluoride preparation
32
Drug name Dosage form Concentration
recommended
Acidulated phosphate
fluoride
Topical solution,
Topical gel,
Mouth rinse,
Prophylaxis paste
1.23% in 1% phosphoric acid
1.23% in 1% phosphoric acid
0.02-0.04%
1.2%
Amine fluoride Dentifrice,
Mouth rinse
1.6%
2.5%
Sodium fluoride Topical solution,
Mouth rinse,
Dentifrice
2%
2.5%
0.2%( weekly)
Sodium monofluoro-
phosphate
Dentifrice 0.76-0.8%
Stannous fluoride Topical solution,
Mouth rinse,
Prophylaxis paste,
Dentifrice,
gel
8%
0.1%
8%
0.4%
0.4%

34. B. Drugs used for systemic pharmacological effects
1.Analgesics
 Analgesia or pain is an ill defined, impleasant sensation, usually
evoked by an external or internal noxious stimulus.
 Analgesic is a drug that selectively relieves pain by acting on the
CNS or on the peripheral pain mechanisms, without significantly
altering consciousness.
 Classification:-
 1. Opioid/ Narcotic/ Morphine like analgesics.
 2. Non opioid / Non-narcotic / Aspirin like / Non steroidal anti-
inflammatory analgesics.
33

35. NON STEROIDALANTI- INFLAMMATORY ANALGESICS
Classification:
1.Analgesic and anti-inflammatory.
2. Analgesic but poor anti-inflammatory.
1. Analgesic and anti-inflammatory:
a. Salicylates- e.g. Aspirin, salicylamide.
b. Pyrazolone derivatives – e.g. Phenylbutazone, oxyphenbutazone.
c. Indole derivatives – e.g. Etodolac, indomethacin.
d. Propionic acid derivatives – e.g. Ibuprofen, naproxen, ketoprofen,
fenoprofen.
e. Anthranilic acid derivatives – e.g. Mephenamic acid, enfenamic acid.
f. Aryl-acetic acid derivatives – e.g. diclofenac.
g. Oxicam derivatives – e.g. piroxicam.
h. Pyrrolo-pyrrole derivatives – e.g. ketorolac
34

36. 2. Analgesic but poor anti-inflammatory:
a. Para aminophenol derivatives – e.g. Paracetamol
(Acetaminophen).
b. Pyrazolone derivatives – E.g. Metamizol, Propiphenazone.
c. Benzoxazocine derivatives – E.g. Nefopam.
Mechanism of Action: -
Phospholipase A2
Cyclo-oxygenase Lipoxygenase
35
Phospholipids
LeukotrienesProstaglandins
Arachidonic acid

37. SIDE EFFECTS:
i) They cause gastric irritation if severe gastric ulceration
occult blood loss iron deficiency anemia.
ii) NSAID’s prolong bleeding time because of the inhibition of
cyclo-oxygenase results in decrease formation of thromboxane
A2, a compound that causes platelet aggregation.
• Hypersensitivity to aspirin is common and manifests as rhinitis,
urticaria, bronchoconstriction, and laryngeal edema.
• Aspirin causes a dose dependant hepatotoxicity.
• Salicylism is a toxic reaction to long-term use of high doses of
aspirin. This reaction might occur during the treatment of arthritis
or a result of drug overdose.
36

38. STEROIDS
The adrenal cortex secretes steroidal hormones like glucocorticoids
from the zona fasciculate, mineralocorticoids from the zona
glomerulosa and androgens from the zona reticularis.
Glucocorticoids are:
37
Short Acting
Hydrocortisone
Cortisone.
Intermediate
Acting
Prednisolone
Methyl
prednisolone
Long acting
Triamcinolone.
Paramethasone.
Dexamethasone.
Betamethasone.

39. Mineralocorticoids are:
a. Fludrocortisone.
b. Aldosterone.
Mechanism of Action:
• Corticosteroids inhibit phospholipase A2, an enzyme involved in
the formation of arachidonic acid.
• As a result the formation of both prostaglandins and leukotrienes
is inhibited by corticosteroids, which may account for their greater
anti-inflammatory effect compared to the NSAID’s.
• Suppression of growth factors necessary for cell growth and the
suppression of the influx of cells of inflammation into tissues offer
additional inflammatory effects.
38

40. • Application of topical steroid preparations provides temporary relief of
symptoms associated with inflammation and ulcerated lesions in the
oral cavity such as recurrent aphthous stomatitis.
• These topical ointments include Triamcinolone acetonide 0.1%,
hydrocortisone acetate 1% and Betamethasone dipropionate 0.05%.
• Topical use of steroids is usually well tolerated but some patients may
develop a secondary erythematous candidiasis or pseudomembranous
candidiasis (thrush) if predisposing conditions like xerostomia,
systemic and/or topical use of antibiotics, corticosteroid asthma
inhalants, prostheses and cigarette smoking are present in them.
39

41. ANTIBIOTICS
Therapeutically, antibiotics are used in dentistry either to treat oral
infections, most of which are caused by aerobic gram positive cocci
and anaerobic microorganisms, or as a prophylaxis to prevent
bacterial endocarditis caused by α-haemolytic streptococci or as a
prophylactic regimen for dental procedures in patients who have
prosthetic heart valves and other high risk patients.
40

42. Prophylactic regimen for dental procedures in patients who are
at risk*
41
Drug standard regimen Dosing regimen
Amoxicillin
Patients allergic to
Amoxicillin/Penicillin:-
Erythromycin
Clindamycin
3.0gm orally 1 hr. before procedure;
then 1.5gm 6 hrly after initial dose.
Erythromycin ethylsuccinate 800mg
or erythromycin stearate 1.0gm orally
2hr before procedure; then half the
dose 6 hrly after initial dose.
300mg orally 1hr before procedure
and 150mg 6 hrly after initial dose.
Felpel P. Leslie -Part II, JPD, 77(3); 1997.

43. Alternate prophylactic regimens for dental procedures in
patients who are at risk
42
Drug Dosing Regimen
Patients unable to take oral
medications:- Ampicillin
Patients allergic to ampicillin/
amoxicillin/ penicillin and unable to
take oral medications:- Clindamycin
Intravenous or intramuscular
administration of ampicillin, 2.0gm,
30 min before procedure; then
intravenous or intramuscular
administration of ampicillin 1.0gm or
oral administration of amoxicillin
1.5gm 6 hrly after initial dose
Intravenous administration of 300mg
30 min before procedure and an
intravenous or oral administration
150mg 6hr after initial dose

44. Patients considered high risk and not
candidates for standard regimen
Ampicillin, gentamicin
Patients allergic to ampicillin/amoxicillin/
penicillin and considered high risk
Vancomycin
Intravenous or intramuscular administration of
amoxicillin and ampicillin 2.0gm plus
gentamicin 1.5mg/kg (not to exceed 80mg) 30
min before procedure, followed by amoxicillin
1.5gm orally 6hr after initial dose
alternatively, the parenteral regimen may be
repeated 8 hrly after initial dose
Intravenous administration of 1.0gm over a
1hr period, starting 1hr before procedure; no
repeated dose necessary
43

45. ANTIFUNGAL
• Most common drugs used in dentistry to treat fungal infections of
the oral cavity are nystatin (mycostatin) and amphotericin B.
• They have a dose-dependent fungistatic or fungicidal effect on
several fungi, including candida albicans. C. albicans causes oral
moniliasis (thrush) and can also infect prosthetic devices.
• Nystatin is not absorbed, tablets are usually held in the mouth for
several minutes until they dissolve, colonized dentures can be
treated by soaking them in a solution of nystatin. Nystatin tablet
may be crushed and suspended in glycerine for application in
mouth
44

46. • Clotrimazole (Mycelex), a fungistatic can be used in a dose of 10 mg
troches dissolved in the mouth five times a day. Since Nystatin and
Clotrimazole are not appreciably absorbed from the gastrointestinal
tract, the topical route is preferred for their administration.
• Oral Fluconazole (Diflucan) in a dose of 50 to 100 mg/day and
Itraconazole (Sporanox) 200mg/day are broad-spectrum antifungal
agents that are effective in treating oropharyngeal and esophageal
candidiasis (Yagiela et al., 2004e).
45

47. ANTIANXIETY AGENTS :-
• These are an ill-defined group of mild CNS depressants which are
aimed to control the symptoms of anxiety, produce a restful state of
mind without interfering with normal mental or physical function.
• CLASSIFICATION:-
1.Benzodiazepines – E.g. Diazepam, Alprazolam.
2. Others – E.g. Antihistamines like promethazine and hydroxyzine,
β-blockers like propranolol.
46

48. • Antianxiety agents are perhaps most appropriately used in clinical
dentistry for those patients who become usually apprehensive to
the stress.
• The safest and most popular drugs for such clinical situations are
the benzodiazepines.
• Dentists require an anxiolytic effect that is rapid in onset and short
in duration, rapidity to onset is less important than prolonged
duration to a physician.
• Diazepam(2-10mg) is one of the most popular of the
benzodiazepines for clinical dentistry and serves as a prototype for
the class.
47

49. CENTRALLY ACTING MUSCLE RELAXANTS
CLASSIFICATION:-
1. Mephenesin group – E.g. Chlorzoxazone, Methocarbamol,
Mephenesin.
2. Benzodiazepines – E.g. Diazepam.
3. GABA derivative – E.g. Baclofen.
These are drugs which reduce skeletal muscle tone by selective
action in the CNS, without altering consciousness. They selectively
depress spinal and supraspinal polysynaptic reflex involved in the
regulation of muscle tone without significantly affecting
monosynaptically mediated stretch reflex.
48

50. • These drugs are sometimes used in treating TMJ disorders, but
their efficacy is not consistent, or well established.
• They are also used for acute muscle spasms, releaving anxiety and
tension, tetany etc.
• All these drugs cause slight sedation that may contribute to their
muscle relaxant effect.
• Centrally acting muscle relaxants can be abused, and dependence
occurs, because of which prolonged administration should be
avoided and doses should be tapered off to avoid withdrawal
symptoms in a patient who is dependent.
49

51. VITAMINS & MINERALS
• Are important for body function
• 2 types:
1. Fat soluble – Vitamin A, D, E & K.
2. Water soluble – B complex and C
• Vitamin A – Play an important role in maintenance of normal mucosa,
keratinization of mucosal tissue including oral mucosa.
RDA :- 800 – 1000 micrograms
• Long standing deficiency may cause hyperplasia of the gums, as well
as generalized gingivitis
50

52. • Vitamin D – Classified as sterol
2 forms - D2 or Ergocalciferol
D3 or Cholecalciferol
Vitamin D increases absorption of calcium from the intestinal tract and
promotes the deposition of calcium and phosphate by specifically acting
on bone cells.
• Dose 0.1mg
• Vitamin B complex –
• Niacin causes pellagra characterized by stomatitis, glossitis.
Desquamative
lesions reported in gingiva including ulceration interdental papilla.
- Dose 6.6mg/kcal
• Vitamin B6 – deficiency causes cheilosis, glossitis, stomatitis.
- Dose 2mg 51

53. • Vitamin B12 – deficiency causes cheilosis, angular stomatitis,
glossitis, sore throat & anemia.
• RDA is 3.0 microgram.
• Food sources are kidney, heart, milk, eggs, liver and green leafy
vegetables.
• Vitamin C – deficiency causes scurvy.
- Dose 6mg/day
MINERALS
• Sodium and potassium help to maintain water and electrolyte
balance.
- Dose 5g & 1g respectively.
• Calcium and phosphorous. - Dose 1.7 & 1.2 mg respectively.
52

54. 2. Drugs which influence the success of prosthodontic
treatment:-
a. Drugs causing Xerostomia(Dry mouth)
 Antihistamines [ Diphenhydramine (Benadryl), Promethazine
(Phenergan)
Pheniramine (Avil)]
 Antiparkinsonian agents [Levodopa, Amantadine, Promethazine]
 Tricyclic antidepressants[Imipramine, desipramine, trazodone. ]
 Antiarrhythmic drugs [ Quinidine, procainamide, disopyramide]
 Antihypertensive drugs
53

55. b. Drugs causing changes in Oral Flora
ANTIBIOTICS
• Use of most antimicrobial agents causes some alteration in
normal microbial flora of the body.
• Lack of competition may allow even a normally non pathogenic
component of flora, which is not inhibited by the drug to
predominate and invade.
• Suprainfection is commonly associated with broad /extended
spectrum antibiotics such as tetracycline, chloramphenicol,
ampicillin and newer cephalosporins.
• Suprainfection are most common when the host defense is
compromised.
- Corticosteroid therapy, Leukemia's, AIDS, Diabetes
• Sites – Oropharynx, respiratory tract
54

56. c. DRUGS AFFECTING GINGIVA & ORAL MUCOSA
• GINGIVAL HYPERPLASIA – refers to an increase in size of a
tissue or an organ produced by an increase in the number of its
component cells.
- Drugs - Phenytoin – Antiepileptic
- Nifedipine – Ca channel blockers
- Cyclosporine – immunosuppressive agent
• NSAID’s – chemical burns of the oral tissues are common
occurrences that may be accidental or from misuse of products
that are being used for self medication. The ‘aspirin burn’
represents the typical example. Aspirin is detrimental to dentures.
Agranulocytosis caused by its prolonged consumption can account
for low tissue tolerance and subsequent ‘sore spots’ under
dentures.
• LICHENOID DRUG ERUPTIONS
• ANTICANCER DRUGS [ Alkylating agents, Antimetabolites ] 55

57. d. DRUGS CAUSING SIALORRHOEA
• Excessive salivation causes difficulty in impression making and can
affect retention of dentures.
• CHOLINERGIC DRUGS
Classified as
– Direct acting drugs - includes derivatives of choline and pilocarpine.
They produce their effect by acting like acetylcholine.
- Indirect acting drugs - Physostigmine
- Neostigmine
They produce their effect by inhibiting the enzyme cholinesterase.
• Adverse effects – Salivation, Lacrimation, Urination, Confusion.
56

58. e. DRUGS AFFECTING BONE
• CORTICOSTEROIDS
- Drugs - Hydrocortisone
- Cortisone
- Prednisolone
- Uses - Acute adrenal insufficiency
- Addison‘s disease
• HEPARIN - Used as an anticoagulant - These drugs manifest
osteoporosis but their role in resorption of alveolar bone is not
known.
• VITAMIN D - Influences the absorption of Ca from
gastrointestinal tract & its subsequent deposition in bone. It leads
to bone loss including alveolar bone.
57

59. f . DRUGS CAUSING HYPOGLYCEMIC SHOCK
• Insulin – is used therapeutically to treat diabetes mellitus.
• In diabetics taking insulin, hypoglycemic reactions may result from
failure to eat, stress or inadvertant administration of too large a dose of
insulin.
• The other symptoms include sweating, weakness, hunger, tachycardia,
mental confusion, headache.
• Dental appointments for patients taking insulin should not interfere
with meals, stressful situations should be minimized.
58

60. 59

61. CONCLUSION
• Understanding the role of pharmacology in prosthodontics is
imperative because this is one of the most neglected parts of
research even though there are a large number of dental patients
suffering from systemic diseases which have to be taken care of
before the commencement of dental treatment.
• Another main reason is that the prosthodontist may have to deal
with a medical emergency arising on the dental chair.
60

62. REFERENCES
1. Felpel P. Leslie – A review of pharmacotherapeutics for prosthetic
dentistry, Part I, JPD, 77(3); 1997.
2. Felpel P. Leslie - A review of pharmacotherapeutics for prosthetic
dentistry, Part II, JPD, 77(3); 1997.
3. Tripathi D.K. – Essentials of medical pharmacology, 4th Edition –
1999.
4. Jagadeeshwaran AR, Arora D, Kumar VA, Kumar GR, Balamurugan
T, Prabu PS. Pharmaco-prosthodontics revisited. Journal of pharmacy &
bioallied sciences. 2012 Aug;4(Suppl 2):S338.
5. Mohan M, Gupta A, Shenoy V, Parolia A. Pharmacological agents in
dentistry: a review. British journal of pharmaceutical research. 2011 Jul
1;1(3):66.
6. Guggenheimer J, Moore PA. Xerostomia: etiology, recognition and
treatment. The Journal of the American Dental Association. 2003 Jan
1;134(1):61-9.