Dental rotation period in Iraq Paediatric dental department Seminar About RX in paediatric dentistry

1. Rx in Pediatric
dentistry
‫اعداد‬
:
‫حكمت‬ ‫عامر‬ ‫محمد‬
‫اشراف‬
:
‫سهيل‬ ‫محمد‬ ‫انعام‬ ‫د‬

2. Prescription Formatting
Heading
Body
Closing

3. Current Prescription Formatting
 Heading
 Name, address, and telephone number of the
prescriber
 Name, sex and age of the patient
 Date of the prescription

4. Current Prescription Formatting
 Body
 The Rx symbol
 Name
 Dose size or concentration (liquids) of the drug
 Amount to be dispensed
 Directions to the patient

5. Body
1. Selecting the Drug
 Medication Allergies
 Availability
 Cost
2. Name of the drug
 KEEP IT SIMPLE
Multiple drugs per prescription can add to confusion
 Be caution with similar drug names
 Avoid use of abbrevations

6. Body
3. Dosing
Be familiar with drugs and their various dosing strengths and dosage forms
When in doubt, use references
Weight – based dosing
Always convert patient weight to correct units (kg)
Liquid medications
One product may be available in a number of concentrations Be familiar with
various product concentrations
Indicate BOTH concentration and dose of medication
Example: Cephalexin suspension 125 mg/ 5 ml… 1 teaspoon/ every 8 h

7. Body
3. Dosing
Decimal points
Avoid trailing zeros.
EX. 5 mg vs. 5.0 mg; can be mistaken for 50 mg
Always use leading zeros.
EX. 0.8 ml vs. .8 ml; can be mistaken for 8 ml

8. Body
4. Dosage Form of the drug
 Tablets = Tab
 Capsule = Cap
 Syrup = Syr
 Sol = Solution
 Suspension = Susp
 Injection = Inj
 supp. = Suppository
 SR, XR, XL = Slow/extended release
 crm = Cream
 ung., oint = Ointment

9. Body
5. Route of administration
 P.O. = by mouth
 S.L. = sublingually, under the tongue
 Top. = topically, locally
 p.r. = rectally
 p.v. = vaginally
 Inh. = inhalation, inhale
 SC, subc, subq = subcutaneous
 i.m., IM = intramuscular
 i.v., IV = intravenous

10. Body
5. Frequency, time and duration of the drug
 In Iraq
 Once daily = 1*1 at bedtime
 Twice daily = 1*2 before meal for 7 days
 Three times a day = 1*3 after meal for 14 days
 Globally
e.g. of frequency e.g. of timing

11. Closing
Prescriber’s signature
Refill instructions
To avoid interrupting maintenance therapy, practitioners
can authorize refills on a written prescription
Refills authorized are valid only for life of the prescription –
1 year

12. Examples of RX

13. Pre-Op RX in pediatric dentistry
 Premedication aims at controlling or diminishing anxiety
 Depending on the degree of anxiety
 Facilitate dental procedures
 most commonly used agents grouped to hypnotics, anti-anxiety agents, and
narcotics.

14. Conscious Sediation
 Hypnotics
 Produces sedative effects through a depressant action on the sensory cortex.
 Chloral hydrate and the short acting barbiturates, secobarbital and pentobarbital are employed quite
often for premedication
 Anti-anxiety agents
 It reduces preoperative anxiety by producing a state of subdued emotional responses without the loss
of mental alertness.
 They are hydroxyzine and diazepam (Valium).
 Most effective when used in coniunction with nitrous oxide-oxygen sedation.
 Narcotics
 Morphine, Meperidine (Demerol) and alphaprodine (Nisentil) been mentioned most often as useful
and effective narcotics for premedication.
 Behavior control by analgesic properties and the production of a euphoric state in the patient.

15. Conscious Sediation
 N2O/O2
 Nitrous oxide/oxygen inhalation as a safe and effective technique to reduce
anxiety
 Induces opioid peptide release in the brain stem leading to the activation of
descending noradrenergic neurones, which results in modulation of the nociceptive
process in the spinal cord

16. Conscious Sediation
 These drugs administered by different methods
 Inhalation , IV, IM, Oral, Rectal
 Comparison of midazolam and diazepam
 MIDAZOLAM
• Short half-life 1-4 hours
• Rapid metabolic transformation
• In the outpatient setting, midazolam would be preferred
• Quicker recovery
• Greater amnesia
• Midazolam in combination with opioids or other sedative agents:
cautious use in view of possible respiratory depression leading
to inadequate oxygenation
 DIAZEPAM
• long half-life 20-100 hours (including active
metabolites)
• Some diazepam metabolites are active

17. Conscious Sediation
 Contraindications of midazolam
 Under the age of one year (or weight < 12 kg)
 Any form of acute disease
 Severe respiratory insufficiency
 Neuromuscular diseases as myasthenia gravis
 Porphyria
 Allergy to BZD
 Sleep apnoea
 Tonsillar hypertrophy
 Liver – hepatic dysfunction

18. Requirements for C.S.
 Oral team
 At least on additional person
trained in Basic Life Support must
be present in addition to the
dentist
 A dental nurse
 Safe environment
 Oxygen delivery system
 Emergency equipment and drugs
 Equipment for venous cannulation
 Monitoring
 Qualified dentist to monitor
continuously until the patient meets
the criteria for recovery
 Accurate monitoring of physiological
parameters:
 Level of consciousness (verbal
contact)
 Oxygenation (pulse oxymetry)
 Blood-pressure monitoring
 Ventilation
 Circulation
• Sedation records

19. Dosages of commonly used Conscious Sedation
Drugs
 Oral
 Children under 25 kg of weight shall have
0.3-0.5 mg midazolam per kg
 Maximum dose 12 mg
 Children over 25 kg of weight shall have 12
mg midazolam
 Oral mixtures given approximately 20-30 mn
before the treatment
 Rectal
 Children under 25 kg of weight shall have
0.3-0.4 mg midazolam per kg
 Maximum dose 10 mg
 Children over 25 kg of weight shall have 10
mg midazolam
 Rectal solution
 administered approximately 10-15 mn before
the treatment
 Nasal 0.2 mg/kg
 Maximum dose 10 mg
 A benzodiazepine antagonist, flumazenil,
may be used to reverse benzodiazepine
effects

20. Post-operative RX
 Analgesics
 Antibiotics
 Antiviral Agents
 Topical Corticosteroids

21. Analgesics
 Mild/Moderate Pain
 Acetaminophen
 Forms: suspension, tablet, rectal suppository, injectable
 Suspension available as 125 mg/ 5 ml and 250 mg / 5 ml
 Children < 12 years: 10-15 mg/kg/dose every 4-6 hours as needed (maximum daily dose
75 mg/kg, but not to exceed 4,000 mg/24 hours)
 e.g. child weighs 10 kg, dose = 10 kg * 10 mg = 100 mg which equals 4 ml of 125 mg/ 5 ml every
4-6 hrs or 2 ml of 250 mg/ 5 ml every 4-6 hrs
 Children > 12 years and adults: 325-650 mg every 4-6 hours , OR 1,000 mg 3-4 times daily
as needed (maximum daily dose 4,000 mg) **can take 500 – 1000 mg tablet 3-4 times
daily

22. Analgesics
 Mild/Moderate Pain
 Ibuprofen
 Forms: suspension, tablet, injectable
 Suspension available as 100 mg/ 5 ml and 200 mg / 5 ml
 Infants and Children < 12 years: 4-10 mg/kg/dose every 6-8 hours as needed (maximum
single dose 400 mg)
 e.g. child weighs 10 kg, dose = 10 kg * 4 mg = 40 mg which equals 2 ml of 100 mg/ 5 ml every 6-8
hrs or 1 ml of 200 mg/ 5 ml every 6-8 hrs
 Children > 12 years : 200-400 mg every 4-6 hours as needed (maximum daily dose 3,200)
 Adults: 200-400 mg/dose every 4-6 hours as needed
OR 600-800 mg every 6-8 hours as needed (maximum daily dose 3,200)

23. Analgesics
 Mild/Moderate Pain
 Naproxen
 For acute pain, naproxen sodium may be
preferred because of increased solubility leading to faster onset, higher peak concentration,
and decreased adverse drug events
 Forms: suspension, tablet
 Suspension available as 125 mg/ 5 ml and 250 mg / 5 ml
 Children and adolescents: 5-7 mg/kg every 8-12 hours as needed (maximum daily dose
1,000 mg)
 e.g. child weighs 10 kg, dose = 10 kg * 5 mg = 50 mg which equals 2 ml of 125 mg/ 5 ml every 8-
12 hrs or 1 ml of 250 mg/ 5 ml every 8-12 hrs
 Adults: Initial dose of 500 mg, then 250-500 mg every 12 hours
OR 250 mg every 6-8 hours as needed (maximum daily dose 1,250 mg on day 1, then
1,000 mg/day thereafter)

24. Antibiotics
 Systemic Antibiotics
 Amoxicillin
 Forms: Suspension, chewable tablet, tablet, capsule
 Suspension available as 125 mg/ 5 ml , 250 mg / 5 ml and 500 mg / 5 ml
 Infants > 3 months, children, and adolescents < 40 kg:
20-40 mg/kg/day in divided doses every 8 hours (maximum single dose
500 mg)
OR 25-45 mg/kg/day in divided doses every 12 hours (maximum single
dose 875 mg)
 e.g. child weighs 10 kg, dose = 15 kg * 20 mg = 300 mg/3 = 100 mg every 8
hrs which equals 4 ml of 125 mg/ 5 ml or 2 ml of 250 mg/ 5 ml every 8 hrs or 1
ml of 500 mg / 5 ml
 Adolescents and adults: 250-500 mg every 8 hours
OR 500-875 mg every 12 hours

25. Antibiotics
 Systemic Antibiotics
 Amoxicillin clavulanate potassium (Augmentin)
 Forms: Suspension, chewable tablet, tablet
 Suspension available as 125 mg/ 5 ml , 250 mg / 5 ml and 500 mg / 5 ml
 Children > 3 months of age up to 40 kg: 25-45 mg/kg/day in doses
divided every 12 hours (maximum single dose 875 mg; maximum daily
dose 1,750 mg) (prescribe suspension or chewable tablet due to
clavulanic acid component)
 e.g. child weighs 20 kg, dose = 20 kg * 30 mg = 600 mg/2 = 300 mg every 12
hrs, which equals 12 ml of 125 mg/ 5 ml or 6 ml of 250 mg/ 5 ml every 12 hrs
or 3 ml of 500 mg / 5 ml
 Children > 40 kg and adults: 500-875 mg every 8 hours (prescribe tablet)

26. Antibiotics
 Systemic Antibiotics
 Azithromycin
 For patients with Type I allergy to penicillin and/or cephalosporin antibiotics
 Caution: This drug can cause cardiac arrhythmias in patients with pre-existing cardiac
conduction defects
 Forms: Tablet, capsule, suspension, injectable
 Suspension available as 100 mg/ 5 ml , 200 mg / 5 ml and 300 mg/ 5 ml
 Children > 6 months up to 16 years: 10-12 mg/kg on day 1, single dose, (maximum
500 mg), followed by 5-6 mg/kg once daily for remainder of treatment (2-5 days)
 e.g. child weighs 30 kg, dose = 30 kg * 10 mg = 300 mg which equals 7.5 ml of 200 mg/ 5 ml
on day 1 and dose = 30 * 5 = 150 mg which equals 3.5 ml of 200 mg/ 5 ml once daily for
remainder of treatment (2-5 days)
 adults: 500 mg on day 1, single dose, followed by 250 mg daily as a single dose
(maximum 250 mg) for 2-5 days

27. Antibiotics
 Topical Antibacterial/Antimicrobial Agents
 Chlorhexidine gluconate
 Forms: Dental solution 0.12% (118 mL, 473 mL)
 Usual dosage for gingivitis/periodontitis and stomatitis
Children ≥ 8 years and adults: Rinse with 15 mL 2 times daily (after breakfast and
before bed) for 30 seconds and expectorate.
 Mupirocin
 Important: For external use only; not for use in patients < 2 months of age
 Forms: Ointment 2%; cream 2%
 Usual dosage for localized impetigo or skin infection
Children and adults: Apply a small amount of ointment to the affected area 3 times
daily for 5-10 days. If no clinical response after 5 days, then reevaluate

28. Antifungal Agents for Candidiasis
 Systemic antifungal agent for oral candidiasis
 Fluconazole
 Forms: Suspension 10 mg/mL, 40 mg/mL; tablet: 50 mg, 100 mg, 150 mg, 200
mg; injectable: 100mg/50 mL, 200 mg/100 mL, 400 mg/200 mL.
 Usual dosage
Infants, children and adolescents: Single dose of 6-12 mg/kg/dose followed by 3
mg/kg/dose once daily for 7-14 days (maximum single dose 400 mg)
Adults: Single dose of 200 mg on day 1, then 100-200 mg/dose once daily for 7-
14 days

29. Antifungal Agents for Candidiasis
 Topical or transmucosal agents for oral candidiasis
 Nystatin
 Forms: Suspension (100,000 units/mL)
 Usual dosage
Infants: 200,000 units (2 mL) 4 times daily; ½ of dose placed in each side of
mouth. Use for 7-14 days.
Children and adults: Swish 400,000-600,000 units (4-6 mL) 4 times daily for
several minutes and swallow; continue at least 48 hours after symptoms resolve.
Use for 7-14 days.

30. Antifungal Agents for Candidiasis
 Topical agents for angular cheilitis
 Nystatin
 Forms: Ointment, cream (100,000 units/g)
 Usual dosage
For all ages: Apply a thin layer to corners of mouth 2-4 times daily for 7-14 days
or until complete healing.

31. Antiviral Agents
 systemic agents for herpes labialis
 Valacyclovir
 Forms: Tablet 500 mg, 1,000 mg
 Usual dosage
Children ≥ 12 years and adults: 2,000 mg every 12 hours for 1 day (2 doses); initiate
at first signs or symptoms of infection (maximum daily dose 4,000 mg for one-day
regimen)
 Topical agents for herpes labialis
 Acyclovir with hydrocortisone
 Forms: Cream (5% acyclovir with 1% hydrocortisone)
 Usual dosage
Children ≥ 6 years and adults: Apply a thin layer on the lesion 5 times daily for 5 days

32. Topical Corticosteroids
 Use for noninfectious ulcers and mucocutaneous lesions,
including aphthous ulcers, localized contact allergic reactions,
and symptomatic benign migratory glossitis.
 Triamcinolone acetonide (medium potency
corticosteroid)
 Forms: Dental paste or ointment 0.1%
 Usual dosage
Children, adolescents and adults: Apply paste to ulcers 2-4 times daily,
after meals and at bedtime; not to exceed 14 day course.
 Avoid eating or drinking for 30 minutes after application

33. Review
How to
write RX
Pre-Op
RX
Post-Op
RX

34. Always Remember You
are a Doctor too !!