2. % of various drugs used in dentistry
• 32 .6% antibiotics
• 23.2% NSAIDS
• 3.6 % vitamins
• Others-antiseptics like chx,listerine
3. Drugs used in dentistryDrugs used in dentistry
• Drugs used in emergencies
• Drugs used in outpatient basis
4. The current recommended drugs for medical
emergencies are:
• Adrenaline , 1-ml ampoules of 1:1000 solution for
intramuscular (i.m.) injection
• Glucagon, for i.m. injection of 1 mg
• Glyceryl trinitrate (GTN)
• Oral glucose /dextrose
7. Management
in severe cases
Call for an ambulance.
Secure the patient’s airway and help to restore their blood
pressure by laying the patient flat and raising their feet.
Administer adrenaline, 0.5 ml (1:1000), i.m. injection repeated
after 5 minutes if needed
Administer 100% oxygen – flow rate:10 litres/minute.
Call for an ambulance.
Secure the patient’s airway and help to restore their blood
pressure by laying the patient flat and raising their feet.
Administer adrenaline, 0.5 ml (1:1000), i.m. injection repeated
after 5 minutes if needed
Administer 100% oxygen – flow rate:10 litres/minute.
8. For milder forms of allergy:
Administer 1 chlorphenamine tablet,4 mg.(cadistin)
For children:
Chlorphenamine Tablet, 4 mg or Oral Solution, 2 mg/5 ml
Chlorphenamine can cause drowsiness. Advise patients not to drive.
For milder forms of allergy:
Administer 1 chlorphenamine tablet,4 mg.(cadistin)
For children:
Chlorphenamine Tablet, 4 mg or Oral Solution, 2 mg/5 ml
Chlorphenamine can cause drowsiness. Advise patients not to drive.
11. Angina
Signs and symptoms include:
• Chest pain
• Shortness of breath
• Fast and slow heart rates
• Increased respiratory rate
• Low blood pressure
• Poor peripheral perfusion
management
• Administer glyceryl
trinitrate (GTN) dispersible
tab
• Administer 100% oxygen –
flow rate 10 litres/minute.
• If the patient suffers more-
severe attacks of chest
pain or if there are sudden
alterations in the patient’s
heart rate, call for an
ambulance.
12. Cardiac Arrest
Signs and symptoms include:
• Loss of consciousness
• Loss of pulse and blood
pressure
• Absence of breathing
management
• Call for an ambulance.
• Adrenaline 1 mg and repeated
after 3 – 5 mins
• 2 nd dose of adr +atropine 1 mg
iv
+
• Initiate CPR, using 100% oxygen
for ventilation – flow rate: 10
litres/minute.
13. Myocardial Infarction
Signs and symptoms include:
• Progressive onset of severe,
crushing pain in the centre and
across the front of chest; the pain
might radiate to the shoulders
and down the arms (more
commonly the left), into the neck
and jaw or through to the back
• Skin becomes pale and clammy
• Nausea and vomiting are common
• Pulse might be weak and blood
pressure might fall
• Shortness of breath
• Call for an ambulance and allow the
patient to rest in a comfortable
position.
• Administer 100% oxygen – flow
rate:10 litres/minute.
• Administer GTN 1 tab sublingually
• Administer aspirin, 300-mg
dispersible tablet, orally.
• Morphine 5 mg im
For children:
• Do not use in children because,
rarely, it can cause Reye’s
syndrome
14. Epilepsy
Signs and symptoms include:
• Brief warning or ‘aura’
• Sudden loss of consciousness, the
patient becomes rigid, falls,
might give a cry and becomes
cyanosed (tonic phase)
• After a few seconds, there are
jerking movements of the limbs;
the tongue might be bitten
(clonic phase)
• There might be frothing from the
mouth and urinary incontinence
• The seizure typically lasts a few
minutes; the patient might then
become floppy but remain
unconscious
• After a variable time the patient
regains consciousness but might
remain confused
Management
• Do not try to restrain
convulsive movements.
• Ensure the patient is not at
risk from injury.
• Administer 100% O2– flow
rate10 litres/minute.
• If the epileptic fit is repeated
or prolonged (5 minutes or
longer), continue
administering oxygen and:
• Administ er diazepam 10 mg
im
15. Faint
Signs and symptoms include:
• Patient feels faint, dizzy,
light-headed
• Slow pulse rate
• Low blood pressure
• Pallor and sweating
• Nausea and vomiting
• Loss of consciousness
Management
• Lay the patient flat and, if
the patient is not
breathless, raise the
patient’s feet. Loosen any
tight clothing around the
neck.
• Administer 100% oxygen –
flow rate:10 litres/minute
until consciousness is
regained.
• Ammonia tabs crushed and
sniffed to the patients
16. 10–15 mins
•If the patient is unconscious
administer glucagon, 1 mg, i.m. injection
For children:
•Glucagon, i.m. injection
•2–18 year body-weight <25 kg ……..0.5 mg
•2–18 years body-weight >25 kg……..1 mg
•administer oral glucose (10–20 g) when the patient
regains consciousness
•If the patient does not respond or any difficulty is
experienced, call for an ambulance.
17. anxiety
appropriate regimen to produce mild sedation to aid
anxiety management is:
• Diazepam Tablets, 5 mg, 1 tablet on night before
procedure and 1 tablet 2 hours before procedure
• Advise all patients that they should not to drive.
18. Antiboitics
and infections
• Localized Infection, Non-allergy Patients:
penicillin and amoxicillin continue to be the first drugs
of choice due to their safety and effectiveness against
oral infections. ions. The usual dosage is 500mg tid. .
• for the localized, non-allergy patient, the drug of
choice is amoxicillin 500 mg tid If the patient does not
improve after 3 days then consider "piggy-backing" the
remainder of the amoxicillin with
metronidazole400mg, bid. The metronidazole is
effective against resistant anaerobic bacteria and
works well when taken with amoxicillin.
19. • Spreading Infection, Non-allergy Patients: the first drug of
choice is
Augmentin/clavum
Ampicillin +cloxacillin(megapain)
• Spreading Infection, Allergy to Penicillin Patients: the drugs
of choice are (clarithromycin) and(azithromycin) which are second
generation erythromycin drugs and are effective against oral
pathogens and are also broad spectrum like Augmentin. The best
choice in this category is azithromycin
• Clindamycin can also be used
20. DENTAL PROCEDURES CONSIDERED FOR ANTIBIOTIC
PROPHYLAXIS IN SUSCEPTIBLE PATIENTS
High risk category
• Dental extractions
• Periodontal procedures including surgery,
scaling, rootplaning and probing
• Dental implant placement, reimplantation
of teeth
• Endodontic instrumentation or surgery
beyond the tooth apex
• Subgingival placement of antibiotic fibers
or strips
• Initial placement of orthodontic bands but
not brackets
• Intraligamentary local anesthetic
injections
• Prophylactic cleaning of teeth or
implants with andanticipated
bleeding
PROCEDURES NOT RECOMMENDED FOR PROPHYLAXIS
• Restorative dental procedures with
or withoutretraction cord
• Local anesthetic injections (except for
intraligamentary)
• Intracanal endodontic procedures,
• post placement andbuildup
• Placement of rubber dams
• Postoperative suture removal
• Placement of removable orthodontic
or prosthodonticappliances
• Taking oral impressions
• Fluoride treatments
• Taking oral radiographs
• Orthodontic appliance adjustment
• Shedding of primary teeth
21. Cardiac conditions for prophylaxis
High risk
• Prosthetic cardiac valves
• Previous
bacterialendocarditis
• Complex,cyanoticcongenital
heart disease
• Surgicallyconstructed
systemicpulmonary shunts
Moderate risk
• Most other congenital cardiac
malformations not otherwise
indicated
• Acquired valvulardysfunction
• Hypertrophiccardiomyopathy
• Mitralvalveprolapsewithregurg
itation and/or thickened valve
leaflets
22. Prophylaxis
Standard
Prophylaxis
Amoxicillin
Adults, 2.0 grams;
Children
50
milligrams/kilogra
m
orally one hour
before
procedure
Cannot Use
Oral
Medications
Ampicillin
Adults, 2.0 g
IMor IV
children, 50
mg/kgIMor
IV within 30
minutes
before
procedure
Clindamycin
Adults, 600 mg;
children,
20 mg/kg orally one
hour
before procedure
Cephalexin
Adults, 2.0 g;
children,
50 mg/kg orally one
hour
before procedure
Azi/clarithromycin
Adults, 500 mg;
children,
15 mg/kg orally one
hour
before procedure
Allergic to Penicillin
Clindamycin
Adults, 600 mg;
children,
15 mg/kg IV one
hour
before
procedureCefazolin
Adults, 1.0 g;
children,
25 mg/kg IM or
IV within
30 minutes
before
Allergic to
Penicillin and
Unable
to Take Oral
Medications
23. Dentoalveolar abscess
Management
Local Measures – to be used
in the first instance
• If pus is present in dental
abscesses, drain by
extraction of the tooth or
through the root canals.
• If pus is present in any soft
tissue, attempt to drain by
incision.
Antiboitics used
If drug treatment is required, an
appropriate 5-day regimen is a
choice of:
Amoxicillin Capsules, 500 mg tds
X 5 days
Amoxiclav
Megapain
24. • Metronidazole Tablets,
400 mg tds X 5 days
For children:
• Metronidazole Tablets,
200 mg, orOral
Suspension, 200 mg/5
ml
• advise patient to
avoid alcohol
(metronidazole has a
disulfiram-like
reaction with
alcohol).
• The anticoagulant
effect of warfarin
might be enhanced
by metronidazole.
25. • Erythromycin is an
alternative to the
penicillins:Erythromycin
(erythrocin) Tablets, 500mg
bd X5 days
• Also clindamycin(clincin)
300 mg tid
For children:
• Erythromycin Tablets, 250
mg, or
• Oral Suspension, 125 mg/5
mldaily
• Clindamycin is not
recommended for the routine
treatment of oral infections
because it is no more
effective against anaerobes
than the penicillins and can
cause the serious adverse
effect of antibiotic-associated
colitis more frequently than
other antibiotics.
• The empirical use of
antibiotics, such as
clindamycin, cephalosporins,
co-amoxiclav or other broad-
spectrum antibiotics, over
amoxicillin, metronidazole and
erythromycin for most dental
patients can also be done
26. Odontogenic and space infections
The primary treatment of odontogenic
infections has been surgical
Antibiotics are a necessary adjunctive therapy
in many infections to hasten complete
the antibiotic must be effective against
Streptococcus and anaerobes
27. • A. Very effective
• 1. Peniccilin
– Tab clavum /augmentin
– megapain
• 2. Clindamycin
• 3. Metronidazole (alone or
in combination with
penicillin)
• B. Effective
• 1.Erythromycin/azithromyn
• 2. cefexime
• Parenreral
– Clavum iv od
– Cefazolin iv bd
– Ceftriaxone iv bd +
– Metronidazole iv tid
28. • In the penicillin-allergic
patient, clindamycin is
the second drug of
choice. In the penicillin-
allergic patient,
clindamycin is the
second drug of choice.
• The first-generation cephalosporins
have the same effect on the
microbial population causing
odontogenic infections that
penicillindoes.
• The second-generation drug cefoxitin
is more active against the anaerobic
bacteria but loses some of the anti-
streptococcal activity of the first-
generation drugs.
• The third-generationcephalosporins
are generally effective against
anaerobes but also have increased
effectivenessagainst streptococci
• Thus the second- and third-
generation drugs are not highly
desirable
29. ANUG
management
local Measures – to be used in
the first instance
in anug undidemeer LA-do
debridement
3 % h2o2 mouthwash 2 hourly
for 5 -7 days then switch to
Chx mouthwash 0.2% bd for 15
days
Medications
• If drug treatment is required, an
appropriate 3-day regimen is:
• Metronidazole Tablets, 400mg tid
• For children:
• MetronidazoleTab 400mg, or
Oral Suspension, 200 mg/5 ml
Or
• Amoxicillin Capsules, 500mg, or
Oral Suspension 125 mg/5 ml
• Have a day gap re schedule for the
treatment outcome
30. Sinusitis
• Local Measures – to
be used in the first
instance
• Advise the patient to
use steam
inhalation. Do not
recommend the use
of boiling water for
steam inhalation in
children.
• If drug treatment is required, an
appropriate regimen is:
• Ephedrine Nasal Drops, 0.5 % 1 drop into
each nostril up to three times daily when
required
Advise patient to use for a maximum of 7
days. In adults and children, the dose of
ephedrine nasal drops can be increased to
2 drops 3 or 4 times daily, if required.
If an antibiotic is required, an appropriate 7-
day regimen is a choice of:
Amoxicillin Capsules, 500mg tds
Doxycycline Capsules, 100 mg. 2 capsules on
the first day, followed by 1 capsule daily
31. Pseudomembranous candidiasis
Local Measures – to be used in the
first instance
• Advise patients who use a
corticosteroid inhaler to rinse their
mouth with water or brush their
teeth immediately after using the
inhaler.
• If drug treatment is required, an
appropriate 7-day regimen is a choice
of:
• Fluconazole Capsules, 50mg(fluzone)
• lf fluconazole and miconazole are
contraindicated, an appropriate
regimen is a choice of:
• Amphotericin b 10mg (fungisome).
1 lozenge dissolved slowly in the
mouth after food four times daily
for 10 days
Advise patient to continue use for 48
hours after lesions have healed.
• Nystatin Oral Suspension,100,000
units/ml. 1 ml after food four times
daily for 7 days
32. Denture Stomatitis
Advise the patient to:
• clean their dentures thoroughly (by
soaking in chlorhexidine mouthwash or
sodium hypochlorite for 15 minutes
twice daily; note that hypochlorite
should only be used for acrylic dentures)
and brush their palate daily to treat
the condition;
• leave their dentures out as often as
possible during the treatment period;
• not wear their dentures at night
If dentures themselves are identified as
contributing to the problem, ensure
the dentures are adjusted or new
dentures are made to avoid the problem
recurring.
• If drug treatment is
required, an appropriate
7-day regimen is a choice
of:
• Fluconazole Capsules,
150 mg per weekly
• Miconazole Oromucosal
Gel24 mg/ml (daktarin)
If fluconazole andmiconazole
are contraindicated, an
appropriate regimen is a
choice :Amphotericin
Lozenges, 10 mg
• Nystatin Oral Suspension,
100,000 units/ml
33. Angular cheilitis
• Miconazole Cream, 2%
Advise patient to continue
use for 10 days after lesions
have healed.
Nystatin Ointment(mycostatin)
(100,000 units per g) Apply to
angles of mouth four times
daily
Sodium Fusidate Ointment,
2% qid X 10 days
• An appropriate regimen for
unresponsive cases is a
choice of:
Hydrocortisone (1%) and
Miconazole (2%) Cream bid
X 7 days
34. Herpetic gingivostomatitis
Aciclovir Tablets, 400 mg X 5 times
/day X
For children:
Aciclovir Tablets, 200 mg, or
Oral Suspension 200 mg/5 ml
.
Aciclovir Cream, 5% Apply to
lesion every 4 hours for 5 days
Aciclovir cream can be applied
for up to 10 days, if required
Penciclovir Cream, 1%
Apply to lesions every 2 hours
during waking for 4 days
35. Varicella-zoster Infections
• In patients with herpes
zoster (shingles), systemic
antiviral agents reduce pain,
and reduce the incidence of
post-herpetic neuralgia and
viral shedding
• Aciclovir is the drug of
choice. However, valaciclovir
and famciclovir are suitable
alternatives
• Aciclovir Tab 800 mg X5/day
X7 days.
36. Odontogenic pain
• For mild to moderate
odontogenic or post-
operative pain, an
appropriate 5-day
regimen is:
Paracetamol Tablets,
500 mg X4/day daily
• For children:
Oral Suspension 120
mg/5 ml or 250 mg/5
ml
• For mild to moderate
odontogenic, post-operative or
inflammatory pain, an
appropriate 5-day regimen is:
Ibuprofen Tablets, 400 mg x4 /day
• For children:
• Ibuprofen Oral Suspension,100
mg/5 ml
37. • For mild to
moderate
odontogenic or
inflammatory pain,
an appropriate 5-day
regimen is:ipobrufin
+pcm(flexon)
• Or ketorolac 10 mg
tid
• For moderate to severe
inflammatory or post-
operative pain, an
appropriate 5-day
regimen is:
• Codep(codine +pcm) tid
• Diclofenac Tablets, 75
mg three times daily
• Tramadol 50 mg tid
38. Trigeminal neuralgia
• If a patient with
trigeminal neuralgia
presents in primary
care, control quickly
by treatment with
carbamazepine(tegret
al)
• Carbamazepine
Tablets, 200 mg bd
x10 days(tegretal) can
be increased to 600
mg bd
• Baclofen 5 mg tid for 3
days and increased up to
10 mg tid for 3 days
• Phenytoin 300 -600 mg
bd
• Gabapentin and
oxycarbamazepine can
also be prescribed
• LA injections at pain
sites
39. MPDS
Pharmacotherapy
•Ibuprofen400mgtd+diazepam
10 mg bd
•Naproxen 500 mg bd or
celecoxib 100 mg bd
•Amytryptaline 10 mg od(triad)
•Chlorzoxazone 500 mg
tid(lorzone)
• tizanidine 2 mg tds
•Chymoral forte qid
•Pepsa 10 mg tid x 5 days
50 % of patients get relieved by this
treatment
Psychological counselling
Trigger point injections
0.5 -1 ml of LA injection
covering the conical area
around the trigger zone(0.5 ml
of procaine or 1 ml of
lignocaine)
Botulism toxin patch or injection(botox)
Capsaicin patch
0.025%-0.075% used
It it’s a substance p depleter so
there is decreased nerve
sensitisation
Used 4 times a day for atleast 2
weeks
40. Oral ulcers
Causes of mouth ulcers.
● Local causes:
– trauma
– burns
● Drugs
● Recurrent aphthous stomatitis
● Malignant ulcers
● Systemic disease:
–blood disorders
– gastrointestinal disorders
–mucocutaneous disease
– connective tissue disease
– vasculitides
–infective diseases
● Others
• Lichen planus
• Kenakort topical
• Tacrolimus 0.003%
topical
• Careage –
multivitamin
• lycostar-antioxidant
• If large lichen ulcer …
prescribe 20 mg tds x
5 days later tapered
to 20 mg bd and then
10 mg bd and 5 mg
bd and 5 mg od x 5
days prednisolone
41. Mouth ulcerations-
overall management
• Local Measures – to be used in
the first instance
• Antimicrobial Mouthwashes
Chlorhexidine Mouthwash, 0.2%
1 minute with10 ml twice daily
• Hydrogen Peroxide Mouthwash,
6% Rinse mouth for 2 minutes
with 15 ml diluted in half a glass
of warm water three times daily
• Tetracycline mouthwash (now
using doxycycline) is effective
in some patients with
recurrent aphthous stomatitis.
Local Analgesics
• Lidocaine 5% ointment can be
applied to the ulcer
Benzydamine Mouthwash, 0.15% 2
hourly as required
Advise patient that benzydamine
mouthwash can be diluted with an
equal volume of water if stinging
occurs.
• Advise patient to spit out
mouthwash after rinsing.
• The mouthwash is usually given for
not more than 7 days.
42. • Betamethasone Soluble
Tab,500 umg 1 tablet
dissolved in 20 ml water as a
Triamcinolone ointment_ Apply a
thin layer to dried mucosa four
times daily
Systemic corticosteroids in cases
of immune mediated
mucocutaneous ulcerations
43. Management of traumatic ulcers
•Remove aetiological factors and
prescribe a chlorhexidine 0.2%
mouthwash.
•Maintenance of good oral hygiene and
the use of benzydamine (absorb)
(tantum)or hot saline mouthbaths may
help
•Most ulcers of local cause heal
spontaneously in about 1 week if the
cause is removed and suchsupportive care
given.
44. Aphthous ulcers
Information to be given to the patients
• These are common
• The cause is not known
• Children may inherit ulcers from
parents
• Aphthous ulcers are not thought to
be infectious
• Some deficiencies or diseases may
predispose toulcers
• No long-term consequences are
known
• Blood tests and biopsy may be
required
• Ulcers can be controlled but rarely
cured
Management of aphthae
• Any underlying predisposing factors
should betreated where possible, and
the aphthaecontrolled with:
• chlorhexidine 0.2% aqueous
mouthwash, or
• topical corticosteroids such as
hydrocortisonehemisuccinate 2.5 mg
pellets, or
• 0.1% triamcinolone acetonide in
Orabase usedfour times daily or
• 0.3% tricaine gel oe kenacort
• in adults, tetracycline rinses 4 -5 /day
45. Dry mouth
Treat systemic or local
disease if present
Local Measures – to be
used in the first instance
• Advise the patient to
take frequent sips of
water
• Prilocarpine (salagen) 5
mg tid
• Saliva-stimulating Tablets
(SSTs)Eg .prescription of
sst like neutrasal and
caphosol
46. OSMF
• Removal of habits is the most important
factor
• Treatment is usually done with
• Hyaluronidase mixed with hydrocortisone and
lignocaine and injected intralesionally
• Vit A and B and E tabs(careage)
• Lycostar-antioxidant(vit A ,C ,E, zinc ,selinium
,lycopene)
47. Drugs to be avoided in pregnancy
• Aminoglycosides
• Tetracyclines
• floroquinolones
48. References
• Textbook of pharmacolgy:K D .Tripathi
• Emergencies in dental office:Malamed
• Textbook of oral medicine:Burkit
• CIMS-drugs and dosage
• Journal of drugs used in dentistry:scottish
