Significance of drugs in oral diagnosis

2. • Dental practice is complicated by the
many drugs that are prescribed in the
practice of medicine in as much as those
drugs may produce unwanted side effects
that interfere with dental treatment or
may interact with drugs used in dental
treatment.
• The need to obtain a complete history
of drugs being taken by a dental patient
and to review the drugs’ actions, side
effects, and interactions is clear.

3. • The major concern in dental practice is
the suppression of corticotropin and the
ensuing reduced activity of the adrenal
cortex.
• Dental patients are exposed to stress
in the form of anxiety, trauma,
infection, and surgery. Adrenocortical
suppression reduces or eliminates a
patient’s ability to respond
physiologically to stressful stimuli,
therefore requiring supplemental doses of
steroid to be administered before
stressful dental appointments or when
conditions arise that cause stress.

4. • Other side effects of steroid
therapy that are important to the
dentist are: the interference with
fibroblastic activity, reduced
inflammatory response, antiinsulin
effect, and increased
gluconeogenesis.
• Prolonged high doses of steroids
within 2 years may require that a
booster dose be given to prevent
adverse reaction to stress.

5. • Ibuprofen, benoprofen, zomepirac,
and mefenamic acid are prescribed
extensively for arthritic pain and
for mild to moderate postoperative
dental pain.
• The mild analgesics may enhance
the effect of oral anticoagulants,
resulting in risk of serious
postoperative hemorrhage.

6. • Among the moderate analgesics in
popular use propoxyphene has a
high potential for abuse.
• The narcotics such as meperidine,
oxycodone, hydromorphone, and
morphine share the common side
effect of respiratory depression and
have a high potential for abuse.

7. • A large number of women are given
these drugs to correct a reduction in
hemoglobin or RBC count. They are also
used in the treatment of pernicious
anemia.
• The types used as antianemic drugs are
iron compounds, vitamin B12, folic acid
and liver extract.
• The iron compounds may produce teeth
pigmentation if given in liquid form. The
solution are usually acidic and may enhance
caries activity.

8. • Rapid-acting nitrites have been used for
years to relieve angina pectoris.
Nitroglycerin is in widest use.
• Propranolol, a beta-blocking agent, causes
bronchial constriction and may precipitate
heart failure. It has an additive effect on
general anesthetics and interacts with
several drugs – barbiturates,
chlorpromazine, and lidocaine.
• Use the minimum available concentration
of vasoconstrictor in local anesthetics.

9. • Drowsiness is the chief side effect of
sedatives, although dryness of the mouth
may accompany diazepam.
• Antipsychotic agents such as
chlorpromazine may cause side effects like
sedation and dry mouth.
• It may be helpful for patients distressed
by dry mouth to have prescribed for them
a moistening agent for the mouth such as
saliva substitute or a noncariogenic agent
to encourage salivary flow.

10. • Quinidine, procainamide, phenytoin, and
propranolol are drugs frequently used to
control tachycardia, atrial flutter, atrial
fibrillation, or premature contractions.
•Cardiac stimulants such as caffeine in
aspirin compound or the vasoconstrictor in
local anesthetic may initiate an arrythmia
and should be used with caution in
patients taking these drugs.
• Thrombocytopenia is associated with
quinidine. Gingival enlargement may be
related to treatment with phenytoin.

11. • Prolonged antibiotic therapy
encourages a change in oral flora,
which may encourage the
overgrowth of Candida albicans and
infection of the oral mucosa.
• Some antibiotics produce serious
side effects such as depression of
bone marrow that has been
related to therapy with
chloramphenicol.

12. • Membranous colitis has been
attributed to the use of
clindamycin and lincomycin.
• A history of continuous penicillin
therapy to prevent recurrent
rheumatic fever is an indication to
modify the regimen from penicillin
to erythromycin to prevent
bacterial endocarditis.

13. • Heparin and coumarin derivatives are
in popular use for control of
thromboembolic disease such as
thrmobophlebitis, cerebrovascular
disease, and cardiovascular disease. They
are also required in persons with a
valvular prosthesis.
• The risk of altering the level of
antiocoagulation to accommodate
surgery must be weighed against the
urgency of the surgery and the
possiblity of local control of bleeding.

14. • Different drugs are used for different
types of seizures, although phenytoin
(Dilantin), carbamazepine (Tegretol),
diazepam (Valium), and phenobarbital
are widely used individually or in
combination for management of partial
and generalized seizures.
• Additional sedation may be advisable
depending upon the past experience of
the patient, and the dosage must be
adjusted accordingly.
• The major well-known side effect of
phenytoin is gingival enlargement.

15. • Tricyclic antidepressants are in
frequent use for management of mild
endogenous depression in ambulatory
patients.
• Tricyclic antidepressants cause dry
mouth and potentiate the effects of
epinephrine and other sympathomimetic
amines in local anesthetics.
• Meperidine should be avoided
altogether and the dosage of the other
narcotics reduced by one fourth if
needed for control of severe dental
pain.

16. • Allopurinol, probenecid, sulfinpyrazone,
and ticrynafen are uricosuric agents
used in the management of persons
with gout.
• Probenecid and ticrynafen inhibit the
excretion of penicillin, prolonging the
blood level produced by each dose of
the antibiotics.
• Aspirin inhibits the action of these
drugs.

17. • Two side effects of antihistamines are
important in dental practice, sedation
and anticholinergic effect.
• Caries susceptibility and increased
predisposition to candidiasis are of
concern to the dentist in the
management of patients receiving long-
term antihistamines.

18. • Chemotherapeutic agents used in the
treatment of cancer are alkylating
agents, antimetabolites, antibiotics, and
other types of chemical agents.
• Most causes significant depression of
bone marrow with resulting leukopenia
and thrombocytopenia.
• There are two aspects to dental care
of patients treated with these drug
groups: (1) constant awareness of
complete blood count (2) managing the
stomatitis that these drugs produce.

19. • Commonly used drugs are atropine,
belladonna, hyoscyamine, and
propantheline.
• The most important side effect of
these drugs of concern in dental
practice is dryness of the mouth caused
by anticholinergic effect of the drugs
on salivary glands.
• Caries control by dietary restriction
of cariogenic agents and by the
application of topical fluorides may be
indicated when the dry mouth is
profound and prolonged.

20. •The drugs in use are diuretics,
sympathetic depressants, vasodilators,
and angiotensin antagonists.
• The side effect of diuretics that
concerns the dentists is dry mouth.
• Several of the antihypertensive agents
cause postural hypotension.
• Control of factors that tend to
elevate blood pressure during dental
appointment is advisable.

21. • The bronchial dilators are used for
the treatment of bronchial asthma and
emphysema.
• Those most often used are adrenergic
agents, isoproterenol, theophylline, and
corticosteroids.
• Tachycardia may be intensified by the
administration of local anesthetics. CNS
stimulation may also be enhanced by
the use of local anesthetics.

22. • They are used as primary and adjunctive
treatment in hypertension and congestive
heart failure. They are also used in renal
failure, glaucoma, and various forms of
edema.
• The chief concern in dental practice for
patients receiving long-term diuretic therapy
is dry mouth and its consequent discomfort
and increased susceptibility to dental caries.
• Potassium-sparing diuretics have the
potential side effect of hyperkalemia and
cardiac arrythmia, which might be influenced
by vasoconstrictors in local anesthetics.

23. • These agents are used to alter the
biologic effect of internally produced
hormones for the purpose of controlling
a pathologic process or correcting an
imbalance or for contraception.
• Postmenopausal reduction in estrogen
may be related to oral complaints of
“burning mouth” and mucosal atrophy,
although the results of treatment with
exogenous estrogen are unpredictable.

24. • There are combinations containing
barbiturates such as butalbital
(Fioranal) and hyoscyamine (Donnatal)
that are frequently prescribed for long-
term intermittent use.
• The central depressant effect of
barbiturates can be potentiated by
narcotics used for pain control,
resulting in respiratory depression as
well as loss of judgment and
coordination.

25. Source:
Oral Diagnosis. Kerr, Ash, Millard