This document discusses the dental management of patients taking medications for various systemic disorders. It covers 12 categories of systemic disorders and their related medications. For each medication, it notes relevant dental considerations like oral manifestations, treatment modifications, and drug interactions. The document provides an extensive but not exhaustive list of medications used to treat cardiovascular, pulmonary, gastrointestinal, and other conditions. It also discusses medications for issues like salivary gland disorders, orofacial pain, infections, and oral lesions. The overall aim is to guide dentists in managing patients who take various medications.

1. In The Name Of God

2. MANAGEMENT PATIENTS WITH SYSTEMIC DISORDERS
THAT TAKING MEDICATION IN DENTISTRY
DR.MAHMOUD RAHMANI

3. SYSTEMIC DISORDERS
1. Cardiovascular disease
2. Pulmonary disease
3. Gastrointestinal disease
4. Endocrine and metabolic disease
5. Renal disease
6. Immunologic disease
7. Hematologic and oncologic disease
8. Bleeding and clotting disorders
9. Infectious diseases
10. Neurologic,behavioral,and psychiatric disorders
11. Sexually transmitted diseases
12. Neuromuscular diseases

4. DENTAL MANAGEMENT
1. Medical considerations
2. Treatment planning modifications
3. Oral manifestation

5. CARDIOVASCULAR DISEASE
1. Hypertension
2. Ischemic heart disease
3. Cardiac arrhythmias
4. Valvular heart disease
5. Heart failure

6. HYPERTENTION
• diuretics
1. Thiazide diuretics(chlorothiazide,hydrochorothiazide)
2. Loop diuretics (furosemide/Lasix)
3. Potassium-sparing diuretics(Teriamterene-H)
4. Aldosterone reseptor blockers(spironolactone/aldactone)
Dry mounth,lichenoid reactions

7. HYPERTENTION
• Beta blockers
1. Nonselective(propranolol/inderal)
2. Cardioselective(metoral50,atenolol,bisoprolol/concor)
Taste change reactions,lichenoid reactio

8. HYPERTENTION
• Angiotensin-converting enzyme inhibitors(captopril,enalapril)
• Angiotensin receptor blockers(losartan/losar,valsartan)
Angioedema of lips,face,tongue-taste cha

9. HYPERTENTION
• Calcium channel blockers(diltiazom,verapamil,amlodipine,nifedipine)
Gingival hyperplasia

10. HYPERTENTION
• Alpha1 blockers(prazosin,trazosin)
• central Alpha2 agonists(methyldopa*)
Dry mouth,taste change

11. HYPERTENTION
• Direct vasodilators(hydralazine,minoxidil).>hostpital
Luposlike oral and skin lesions,lymphaden

12. ISCHEMIC HAERT DISEASE
• Nitrates(nitroglycerin,isosorbide dinitrate)
Dry mouth ,lymphadenopathy

13. ISCHEMIC HAERT DISEASE
• Platelet aggregation inhibitors(aspirin,plavix/osevix)
Increased bleeding but not clinically significant with daily doses <325mg

14. CARDIAC ARRHYTHMIAS
• Sodium canal blockers(Quinidine)
• digitalis(digoxin)
Bitter taste,petechiae,gingival bleeding,oral ulcerations
Hypersalivation(toxicity)

15. PULMONARY DISEASE
• Theophylline
• Corticoid broncodilator
Adverse drug intraction with erythromycin and azithromycin
candidiasis

16. GASTROINTESTINAL DISEASE
• Proton pump inhibitor(omeprazole/ezonium,pantoprazole,lansoprazole)
May reduce absorption of penicillin,ketoconazole,and itracona

17. IMMUNOLOGIC DISEASE
• Sulfasalazine/mesalamine
Intra oral pigmentation,increased infection,delayed healing,prolonged bleed

18. ORGAN AND BONE MARROW TRANSPLANTATION
• Immunosuppressives(azathioprine,cyclophosphamide,methotrexate/Ebetrex,cyclosp
orine)
• Systemic glucocorticoids(PREDNISOLONE,CORTISONE,…..)
Increased infections,delayed healing,prolonged bleeding,gingival hyperp
ADRENAL SUPPRESSION

19. NEUROLOGIC DISORDERS
• PHENYTOIN
• CARBAMAZEPINE(TEGRETOL)
• VALPORIC ACID/depakine
GINGIVAL HYPERPLASIA,DELAYED HAEALING,LEUKOPENIA
,GINGIVAL BLEEDING,STEVENS-JOHNSON SYNDROME
+ DRUG INTRACTION WITH ERYTHROMYCIN
+ DRUG INTRACTION WITH ASPIRIN,NSAID

20. NEUROLOGIC DISORDERS
Sertraline,Diazepam,Oxazepam,Alprazolam,Clonazepam,Fluoxetine/Prozac
,Zolpidem,citalopram
Dry mouth

21. DIABETIC PATIENTS
• Metformin,Glibenclamide,Glipizide,Zipmet*
Dry mounth,lichenoid reactions

22. HEMATOLOGIC DISORDERS
• Varfarin
• Heparin
• IVIG,…..

25. PREGNANT PATIENT AND BREAST FEEDING

26. RENAL DISEASE
• Acute renal fialure
• Chronic renal failure
• Dialysis
• Organ transplantation

28. MEDICATIONS FOR SALIVARY GLAND DISORDERS
• Salivary gland infection
• Salivary gland hypofunction
• Salivary gland hyperfunction(sialorrhea)
• Protection of salivary glands during head and neck radiotherapy

29. SALIVARY GLAND INFECTION
• Cap.amoxicillin 500mg Tid. /. cap.co.amoxi.celav 625mg tid

30. SALIVARY GLAND HYPOFUNCTION
• Tab.pilocarpine 5 mg. Tid
• Tab cevimeline 30 mg tid

31. SALIVARY GLAND HYPERFUNCTION(SIALORRHEA)
• Tab.Glycopyrrolate 1mg
• Tab .Atropine. 30-60 min before dental pros..

32. PROTECTION OF SALIVARY GLANDS DURING HEAD AND
NECK RADIOTHERAPY
• Tab. amifostine

33. MEDICATIONS FOR OROFACIAL PAIN
• Nociceptive orofacial pain
• Neuropathic orofacial pain
• Specific classes of analgesics for orofacial pain

34. MEDICATIONS FOR OROFACIAL PAIN
• Carbamazepine/Tegretol
• Oxycarbamazepine
• Gabapentin
• Baclofen
• Lamotrigine
• ……………..
• Clonazepam
• Amitriptyline.Nortriptyline
• Imipramine
• …………
• Opoids(pethidine,oxycodone,morphin)

35. ANTIBIOTIC THERAPIES FOR
IMMUNOCOMPROMISED PATIENTS
• Dental–alveolar infections in immunocompromised patients
• Prophylactic antibiotics in immunocompromised patients

36. ANTIBIOTHIC PROPHYLAXIS FOR INFECTIVE
ENDOCARDITIS AND PROSTHETIC JOINTS

37. MEDICATIONS FOR ORAL LESIONS
• Ulcerations
• Vesiculobullous conditions

38. ANTIVIRAL MEDICATIONS
• Acyclovir
• gancyclovir

39. ANTIFUNGAL MEDICATIONS
• Nystatin
• Fluconazole
• Ketoconazole
• itraconazole

40. • Carbamazepine/tegretol
• Nortiptyline
• Fluoxitine
• Imiperamine
• gabapantine
• Cyclobenzaprine
• Zinc sulfate/acid folic
• Azatioperine
• Cyclosporine
• Bromhexine/hidroxizine/diphenhydramine
• Midazolam/triazolam
• Pilocarpine/sevimelin
• Miconazole/ketokonazole/itraconazole/felokonazole

41. THANKS FOR YOUR ATTENTION
Happy new year