pharmacology, Rational drug prescription in Dentistry

1. Rational
Prescribing
Practices and
Prescription Writing
In Dentistry

2. Prescribing privileges are controlled by the state licensing
boards
- Delegated powers by the state legislatures
• Professions with prescribing privileges:
 Physician
 Dentist
 Podiatrist
 Veterinarian
 Optometrist
 Nurse Practitioner or Midwives
 Physician’s assistants
 Pharmacists

3.  How are we different from Quacks?
 Does our training distinguish us?
 Or is it because we use science in our clinical
practice?
 How much are we influenced by the medical
representatives in our prescribing habits?
 Ask these questions to yourself and search for
honest answers.

4.  we commonly prescribe antibiotics and
analgesics.
 How often are we aware why we prescribe a
particular
antibiotic or pain-killer?
 How much are we contributing to the problem
of antibiotic resistance?

5.  Have you ever asked
yourself whether your
children be able to fight their
infections in the future with
so many resistant bacteria
around?

6. Too many commercials(companies).
Too many drugs.
Many Dosage forms.
Too many generics for each drug

7. Rational use of drugs requires that patients
receive medications :
Appropriate to their cclliinniiccaall nneeeeddss.
In ddoosseess that meet their own
requirement
For an aaddeeqquuaattee ppeerriioodd ooff ttiimmee,,
And at lloowweesstt ccoosstt to them and their
community (WHO 1985).

8. AApppprroopprriiaattee iinnddiiccaattiioonn..
The decision to prescribe drug(s) is entirely
based on medical rationale and that drug
therapy is an effective and safe treatment

9. AApppprroopprriiaattee ddrruugg..
The selection of drugs is based on
 eeffffiiccaaccyy..
 ssaaffeettyy..
SSuuiittaabbiilliittyy..
 ccoosstt ccoonnssiiddeerraattiioonnss..
SSttoorraaggee CCoonnddiittiioonn.

10. AApppprroopprriiaattee ppaattiieenntt..
 No ccoonnttrraa--iinnddiiccaattiioonnss exist
the aaddvveerrssee rreeaaccttiioonnss is minimal,
the ddrruugg iiss aacccceeppttaabbllee to the patient.

11. AApppprroopprriiaattee iinnffoorrmmaattiioonn..
regarding his or her condition and the
medication(s) that are prescribed. Patients
should be provided with
rreelleevvaanntt,,
aaccccuurraattee,,
 iimmppoorrttaanntt
cclleeaarr iinnffoorrmmaattiioonn

12. AApppprroopprriiaattee mmoonniittoorriinngg..
The aannttiicciippaatteedd and uunneexxppeecctteedd effects of
medications should be aapppprroopprriiaatteellyy
mmoonniittoorreedd..

13. The nnuummbbeerr ooff ddrruuggss per prescription is often
mmoorree tthhaann nneeeeddeedd, with an average of 2.4 up
to 10 drugs, while generally one or two drugs
should be sufficient.
WWrroonngg ddrrug for a specific condition.
Drugs ooff ddoouubbttffuull eeffffiiccaaccyy..
Drugs of uunncceerrttaaiinn ssaaffeettyy ssttaattuuss.
Use of drugs in wwrroonngg ddoossaaggee and dduurraattiioonn..

14. In case of analgesics we need to know which
one will be appropriate for patients needs so
that he will get relief from his pain.

15. In case of antibiotics we should choose a
proper antibiotic which will take care of his
condition and assist his body in early
resolution of his ailment.

17. We should also know exactly in which
circumstances/ medical conditions preventive
prophylactic cover is needed.

18. we have a professional responsibility for
emergency dental care. When patients come
with trauma, acute spread of infection, or
hemorrhage, it is our duty to render
treatment so that he gets relief in a
reasonable time.
 d In many acute deennttaall ccoonnddiittiioonnss,,
eexxttiirrppaattiioonn ooff tthhee ppuullpp oorr eexxttrraaccttiioonn ooff tthhee
ttooootthh wwiillll bbee nneecceessssaarryy..

19. Prescribing antibiotics is an adjunct in
many such situations. When it is clinically
indicated, it is definitely of therapeutic
benefit to the patient.
 AAccccoorrddiinngg ttoo tthhee AAmmeerriiccaann DDeennttaall
AAssssoocciiaattiioonn,, tthhee ffoolllloowwiinngg gguuiiddeelliinneess sshhoouulldd
bbee oobbsseerrvveedd wwhheenn pprreessccrriibbiinngg aannttiibbaacctteerriiaall
ddrruuggss::

20. But ssyysstteemmiicc aannttiibbiioottiiccss should be used with
caution because of the possibility of ttooxxiicciittyy,,
ssiiddee eeffffeeccttss, the ddeevveellooppmmeenntt ooff rreessiissttaanntt
strains of microbes, aanndd aalllleerrggiicc reactions.

21. 1- Make an aaccccuurraattee ddiiaaggnnoossiiss;;
2- Use aapppprroopprriiaattee aannttiibbiioottiiccss and ddoossiinngg
sscchheedduulleess;;
3- Consider using nnaarrrrooww--ssppeeccttrruumm antibacterial
drugs (Clindamycin, Metronidazole, penicillin V
Potassium) in ssiimmppllee iinnffeeccttiioonnss to minimize
disturbance of the normal micro flora, and
preserve the use of bbrrooaadd--ssppeeccttrruumm ddrruuggss
(ampicillin, amoxicillin, erythromycin,
tetracycline, etc.,) for more complex infections

22. 4- Avoid uunnnneecceessssaarryy uussee of antibacterial drugs in
treating viral infections;
5 - If treating eemmppiirriiccaallllyy, revise treatment
regimen based on patient progress or test
results;
6 - Obtain thorough kknnoowwlleeddggee of the ssiiddee eeffffeeccttss
and ddrruugg iinntteerraaccttiioonnss ooff an antibacterial drug
before prescribing it;
7 - Educate the patient regarding proper use of the
drug and stress the importance of completing
the ffuullll ccoouurrssee ooff tthheerraappyy (that is, taking all
doses for the prescribed treatment time).

23. American Academy of Pediatric Dentistry
(AAPD) has given recommendations for
clinical guideline on appropriate use of
antibiotic therapy.
 Conservative use of antibiotics iiss iinnddiiccaatteedd ttoo
mmiinniimmiizzee tthhee rriisskk ooff ddeevveellooppiinngg rreessiissttaannccee ttoo
ccuurrrreenntt aannttiibbiioottiicc rreeggiimmeennss.

24. Whenever an antibiotic is prescribed to a
ffeemmaallee ppaattiieenntt taking oral ccoonnttrraacceeppttiivveess to
prevent pregnancy, the patient must be
advised to use aaddddiittiioonnaall tteecchhnniiqquueess ooff bbiirrtthh
ccoonnttrrooll dduurriinngg aannttiibbiioottiicc tthheerraappyy and for at
least 1 week beyond the last dose as the
aannttiibbiioottiicc mmaayy rreennddeerr tthhee oorraall ccoonnttrraacceeppttiivvee
iinneeffffeeccttiivvee..

25. American Academy of Pediatric Dentistry
recommends the following general principles
when prescribing antibiotics for the pediatric
population.

26. When a child presents with aa ffaacciiaall sswweelllliinngg
secondary to a dental infection, he should
receive immediate dental attention.

27. Depending on clinical findings, treatment
may consist of treating or eexxttrraaccttiinngg the
tooth/teeth in question with aannttiibbiioottiicc
ccoovveerraaggee..

28. SSeevveerriittyy ooff tthhee iinnffeeccttiioonn, the aabbiilliittyy ttoo oobbttaaiinn
aaddeeqquuaattee aanneesstthheessiiaa, and the mmeeddiiccaall ssttaattuuss
ooff tthhee cchhiilldd should be taken into
consideration.

29. Bacteria can gain access to the ppuullppaall ttiissssuuee
through caries, exposed pulp or dentinal
tubules, ccrraacckkss iinnttoo tthhee ddeennttiinn, and ddeeffeeccttiivvee
rreessttoorraattiioonnss..
While rendering treatments like ppuullppoottoommyy,
ppuullppeeccttoommyy, or eexxttrraaccttiioonn, aannttiibbiioottiicc tthheerraappyy
usually is not indicated

30. If the dental infection is contained within the
ppuullppaall ttiissssuuee or the immediately surrounding
tissue. In such a case, there will be no
systemic signs of an infection (i.e., no fever
and no facial swelling).

31. Viral conditions such as acute primary
hheerrppeettiicc ggiinnggiivvoossttoommaattiittiiss should not be
treated with antibiotic therapy unless there is
strong evidence to indicate that a secondary
bacterial infection exists.

32. Analgesics are another group of drugs
commonly prescribed by dentists.
 Our pain management goals should be:
 PPaaiinn MMaannaaggeemmeenntt GGooaallss
TToo mmaaiinnttaaiinn mmaaxxiimmaall ppaattiieenntt ccoommffoorrtt..
TToo mmiinniimmiizzee uunnwwaanntteedd ddrruugg ssiiddee eeffffeeccttss..
TToo rraappiiddllyy rreettuurrnn iinnjjuurreedd ttiissssuuee ttoo ffuunnccttiioonn..

33. Pre-procedural analgesia can be employed for
delaying the onset of postoperative pain and
to reduce its magnitude.
 But it has disadvantages like GI upset in
patient with empty stomach and GI upset in
anxious patient.
Ibuprofen 400mg ½ hour before appointment
can be prescribed for this purpose.

34. Step 1: Define the patient’s problem
 Make specific && AAccccuurraattee ddiiaaggnnoossiiss..
 Step 2:Consider the pathophysiological
implication of the diagnosis
 Step 3: Specify the therapeutic objective .

35. Step 4: Select the Drug of choice
Step 5: Determine the appropriate dosing
regimen.
Step 6: Devise a plan for monitoring the
drug’s action and determine an end point for
therapy.
Step 5: Give information, instructions and
warnings (patient education).

37.  Y. M. Dailey1 and M. V. Martin :Are antibiotics being used appropriately for
emergency dental treatment? British Dental Journal OCTOBER 13 2001,
VOLUME 191, NO. 7, PAGES 391-393
 American Academy of Pediatric Dentistry (AAPD). Clinical guideline on
appropriate use of antibiotic therapy for pediatric dental patients. Chicago
(IL): American Academy of Pediatric Dentistry (AAPD); 2005. 3 p.
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The American Dental Association
 Marcos Luciano Pimenta Pinheiro, Filipe Polese Branco, Maria Cristina
Volpato, Eduardo Dias de Andrade: Analgesic choice in dentistryPart II : The
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