drugs in dentistry

Drugs used in dentistry

Drugs used in dentistry

Drugs used in emergencies

Drugs used in outpatient basis

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

The current recommended drugs for medical emergencies are:

Oxygen
Salbutamol inhaler, 100 µg per actuation
Chlorphenamine
Parenteral midazolam /diazepam
Aspirin, 300-mg dispersible tablets
Morphine
Ammonia tabs


Signs and symptoms include:

• Generalized itching (urticaria), particularly of hands and feet

• Rhinitis, conjunctivitis
• Abdominal pain, vomiting, diarrhea.

• Flushing, but pallor might also occur

• Marked upper airway (laryngeal) oedema and bronchospasm, causing stridor and wheezing

Anaphylaxis

Managementin 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.


Allergy
For milder forms of allergy:

Administer 1 chlorphenamine tablet,4 mg.(alermin)

For children:
Chlorphenamine Tablet, 4 mg or Oral Solution, 2 mg/5 ml

Chlorphenamine can cause drowsiness. Advise patients not to drive.

acute severe asthma
• Inability to complete sentences in one breath
• Respiratory rate >25 per minute
• Tachycardia (heart rate >110 per minute)

Life threatening asthma

• Cyanosis or respiratory rate <8 per minute
• Bradycardia (heart rate <50 per minute)
• Exhaustion, confusion, decreased conscious level

Salbutamol 4 puffs (if patients own puff available)

Oxygen 10 liters/min
Hydrocortisone 100 mg iv
Ventilation if needed


Angina

Signs and symptoms include:

• Progressive onset of severe, crushing pain in the center 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
treatment
Call for an ambulance and allow the patient to rest in a comfortable position.
Administer 100% oxygen – flow rate:10 liters/minute.
Administer GTN 1 tab sublingually
Administer aspirin, 300-mg dispersible tablet, orally.
Morphine 5 mg /im

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

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


If the patient remains conscious and cooperative
administer oral glucose (10–20 g), repeated, if necessary, after 10–15 / minutes

If the patient is unconscious

administer glucagon, 1 mg, i.m. injection
For children:
Glucagon, i.m. injection
2–18 year or 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.

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.

Antiboiticsand 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.
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 the remainder of the amoxicillin with metronidazole400mg, bid. The metronidazole is effective against resistant anaerobic bacteria and works well when taken with amoxicillin.

Antibiotics and oral infection

Spreading Infection, Non-allergy Patients: the first drug of choice is
Augmentin/clavum/375mg/ 625 mg/ 1 gm.
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 5oo mg. once daily

DENTAL PROCEDURES CONSIDERED FOR ANTIBIOTICPROPHYLAXIS IN SUSCEPTIBLE PATIENTS

High risk category
Dental extractions

Periodontal procedures including surgery, scaling, root planing

Dental implant placement, reimplantation of teeth

Endodontic instrumentation or surgery beyond the tooth apex

Intraligamentary local anesthetic injections
Prophylactic cleaning of teeth or implants with anticipated bleeding

PROCEDURES NOT RECOMMENDED FOR PROPHYLAXIS

Restorative dental procedures with or without retraction cord
Local anesthetic injections (except for intraligamentary)
Intra canal endodontic procedures,
post placement and buildup
Placement of rubber dams
Postoperative suture removal
Placement of removable orthodontic or prosthodontic appliances
Taking oral impressions
Fluoride treatments
Taking oral radiographs
Orthodontic appliance adjustment
Shedding of primary teeth


Allergic to Penicillin

• 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


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

• 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 gel

Amphotericin Lozenges, 10 mg

Nystatin Oral Suspension,
100,000 units/ml

Miconazole Cream, 2%

Advise patient to continue use for 10 days after lesions have healed.
Nystatin Ointment
(100,000 units per gm) Apply to angles of mouth four times daily
Sodium Fusidate Ointment, 2% four times X 10 days
An appropriate regimen for unresponsive cases is a choice of:
Hydrocortisone (1%)
Miconazole (2%) Cream twice daily X 7 days


Aciclovir Tablets, 400 mg X 5 times /day for ten days

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

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


Triamcinolone ointment_ Apply a thin layer to dried mucosa four times daily
Systemic corticosteroids in cases of immune mediated mucocutaneous ulcerations