Drugs used in dentistry

Abbreviations, Antibiotics- Amoxycillin, Amoxycillin + clavulanic acid, Amoxycillin + tinidazole, Cephalexin, Azithromycin, Erythromycin , Ciprofloxacin, Tetracycline. Metronidazole.
Analgesics- Aceclofenac, Diclofenac, Ibuprofen , Ketorolac, Tramadol, Antiviral- Acyclovir, Antifungal- Clotrimazole, Nystatin, Fluconazole, Itraconazole, Corticosteroids- Hydrocortisone, Prednisolone , Triamcinolone, Betamethasone, Clobetasole , Oral conditions and dosages

1. DRUGS USED IN DENTISTRY PRESENTED BY: DR GAYATRI MEHROTRA

2. ANTIBIOTICS ANALGESICS ANTIFUNGALS ANTIVIRALS CORTICOSTEROIDS Drugs in dentistry

3. SOME ABBREVIATIONS OD - omnie in die- once a day BD or BID – bis in die –twice a day TDS - terdie sumendum - thrice a day QID - quarter in die - four times a day Q2H - every two hrs SOS - si opus sit- if there is need DT- dispersible tablet SR - slow releasing or sustained release HS - hora somni - at bed time

4. ANTIBIOTICS Amoxycillin Amoxycillin + clavulanic acid Amoxycillin + tinidazole Cephalexin Azithromycin Erythromycin Ciprofloxacin Tetracycline Metronidazole

5. ANTIBIOTICS PENICILLINS - AMOXYCILLIN (Generic name) : Indications – Dentoalveolar abscesses Infection around the wisdom teeth or Infections that develop after surgery as antibiotic prophylaxis Duration of action- 8 hr Availability – tablet , capsule , syrup, injection

6. Generic name Brand name with dosage Pharmaceuticals Amoxycillin Cap Almox 500 TID 3-5 days Alkem Almox DT 250 TID Alkem Contraindication: hypersensitivity to penicillin

7. Generic name Brand name with dosage Pharmaceuticals Amoxycillin Cap Cipmox 500 TID Cipla Cap Novamox 250 and Cap Novamox 500 TID Cipla Adverse effects - maculopapular rash, diarrhoea , nausea, vomiting,itching

8. Generic name Brand name with dosage Pharmaceuticals Amoxycillin Cap AMX 500 mg TID Ranbaxy Cap Wymox 250 mg TID Wyeth

9. AMOXYCILLIN + CLAVULANIC ACID (Generic name): Indications – Dentoalveolar infections those are resistant to other penicillin Complicated tooth infection Complicated root canal infection Complicated abscesses, especially those extending into the sinuses, gums and bone Gum infections that haven’t responded to other drugs Placement of dental implants in the upper sinus Availability – tablet, suspension

10. Generic name Brand name with dosage Pharmaceuticals Amoxycillin + clavulanic acid Tab Augmentin 1000 TID ( amoxycillin 875 mg+ clavulanic acid 125 mg) GSK Tab Clavam 375 TID ( amoxycillin 250 mg+ clavulanic acid 125 mg) Alkem

11. Generic name Brand name with dosage Pharmaceuticals Amoxycillin + clavulanic acid Polyclav kid tab TID ( amoxycillin 200 mg + clavulanic acid 28.5 mg) Macleods Clavam forte dry syrup BID Alkem

12. Generic name Brand name with dosage Pharmaceuticals Amoxycillin + clavulanic acid Moxikind CV 625 TID ( amoxycillin 500 mg + clavulanic acid 125 mg) Mankind Moxaclav 375 TID ( amoxycillin 250 mg + clavulanic acid 125 mg) Square

13. AMOXYCILLIN + TINIDAZOLE (generic name) : Indications – For anaerobic infection For aggressive oral infection Availability- tablets Generic name Brand name with dosage Pharmaceuticals Amoxycillin + tinidazole Tab Tinimox TID ( amoxycillin 500mg + tinidazole 300 mg) DRL

14. CEPHALOSPORIN- CEPHALEXIN- 1 generation cephalosporin (generic name): Indication – To treat dental infection that are resistant to penicillin Tooth extraction Gum surgery Orthodontic band (not bracket)placement As antibiotic prophylaxis Duration of action- 6-12 hr Adverse effects- hypersensitivity, abdominal pain, nausea ,vomiting , diarrhoea Availability- tablet, capsule, syrup

15. Generic name Brand name with dosage Pharmaceuticals Cephalexin Cap Cephadex 250 BID ( cephalexin 250 mg) Cipla Tab Phexin BD 375 ( cephalexin 375 mg) GSK

16. Generic name Brand name with dosage Pharmaceuticals Cephalexin Cap Ceff 500 mg BID ( cephalexin ) Lupin Cap Cephalkem 500 mg BID Alkem

17. Macrolides – AZITHROMYCIN (generic name): Indications – Allergy to penicillin Used in odontogenic infection Duration of action- terminal elimination half life>40 hr Availability – tablet, capsule, syrup Adverse effects- nausea, vomiting, diarrhoea , epigastric distress, headache, rash Contraindication- hepatic impairment

18. Generi c name Brand name with dosage Pharmaceuticals Azithromycin Tab Azipro 250 BID ( azithromycin 250 mg) Cipla Tab Azicip 500 OD ( azithromycin 500 mg) Cipla

19. Generic name Brand name with dosage Pharmaceuticals Azithromycin Tab Azithral BID ( azithromycin 250 mg) Alembic Tab Zithium OD ( azithromycin 500mg ) Alkem

20. ERYTHROMYCIN (generic name): Indications – Allergic to penicillin In odontogenic infection Duration of action- 6-12 hrs Availability- capsule, tablet, syrup Adverse effects- nausea, diarrhoea , weakness, hypertension, reversible hearing loss Contraindication- hypersensitivity, liver disease

21. Generic name Brand name with dosage Pharmaceutials Erythromycin Tab Eromycin 500 BD (erythromycin stearate 500 mg) Akme Tab Erythro 250 QID (erythromycin 250 mg) Century

22. Generic name Brand name with dosage Pharmaceuticals Erythromycin Tab Erycin-250 QID Cipla Tab Althrocin 500mg BID Alembic

23. FLUROQUINOLONE- CIPROFLOXACIN (generic name): Indications- Certain dentoalveolar infections Periodontal (gum) diseases Duration of action- 8-12 hrs Availability- tablets, syrup Adverse effects- nausea, vomiting, epigastric distress, headache, dysphagia , tremor

24. Generic name Brand name with dosage Pharmaceuticals Ciprofloxacin Tab Ciplox ( ciprofloxacin 500 mg) BID Cipla Tab Ciplox TZ BID (ciprofloxacin 500 mg+ tinidazole 600 mg) Cipla

25. Generic name Brand name with dosage Pharmaceuticals Ciprofloxacin Tab Ciprobid 500 BID Zydus Tab Cifran 500 BID Ranbaxy

26. TETRACYCLINE (generic name): Indications- Juvenile periodontitis Periodontal abscess Desquammative gingivitis Duration of action- upto 12 hrs Availability- tablet, capsule, fibres Adverse effects-nausea, vomiting, discoloration of teeth

27. Generic name Brand name with dosage Pharmaceuticals Tetracycline Cap Hostacycline 500 BD (tetracycline hydrochloride) Aventis

28. METRONIDAZOLE (generic name) : Indications – Anaerobic infection Aggressive periodontitis Necrotizing ulcerative gingivitis Availability- tablet ,suspension Duration of action- 8 hrs Adverse effect- anorexia, nausea, metallic taste, glossitis Contraindication – pregnancy, blood dyscrasias , chronic alcoholics

29. Generic name Brand name with dosage Pharmaceuticals Metronidazole Metrogyl suspension ( metronidazole benzoate oral suspension) - Flagyl 200 mg TID Abbott

30. Generic name Brand name with dosage Pharmaceuticals Metronidazole Elyzol gel ( metronidazole gel ) Colgate Metrogyl denta ( metronidazole ) -

31. ORAL CONDITIONS AND DOSAGE LOCALIZED ODONTOGENIC INFECTION: Non allergic -penicillin and amoxicillin are the first line drug of choice Dosage -500mg t.i.d for 3-5 days depending on the severity of infection If the patient does not improve after 3 days then metronidazole 400mg b.d is given along with amoxicillin.

32. LUDWIGS ANGINA- Intense and prolonged antibiotics therapy- high dose of penicillin i.m or i.v . Combination of gentamicin and cloxacillin has been proved to be successful OSTEOMYELITIS - Emperical therapy- Regimen 1 –aqueous penicillin 2 millions units i.v 4 hourly+oxacillin 1 gm i.v ,4 hrly .

33. Regimen 2-if the patient are asymptomatic after 48-72 hrs ,then penicillinv 500mg,6 hrly and dicloxacillin 250 mg 4 hrly ,for an additional of 2-4 weeks.

34. ANUG: Metronidazole 400 mg TID Amoxycillin 500 mg TID 3% H2O2 mouthwash 2 hrly for 5-7 days

35. ANALGESICS Aceclofenac Diclofenac Ibuprofen Ketorolac Tramadol

36. ANALGESICS ACECLOFENAC (generic name) : Indications –Pain Postoperative inflammation Duration of action- upto 12 hrs, upto 24 hrs ( SR tablets) Availability – tablets Adverse effects- gastrointestinal disorders, GI bleeding Contraindication –elderly, allergic to aspirin or any other NSAID, hepatic or renal impairment

37. Generic name Brand name with dosage Pharmaceuticals Aceclofenac Tab Aldigesic - SP BID ( Aceclofenac+paracetamol+serratiopeptidase ) Alkem Tab Mahanac P BID ( aceclofenac 100mg + paracetamol 325 mg) Zuventus healthcare ltd

38. Generic name Brand name with dosage Pharmaceuticals Aceclofenac Tab Hifenac ( aceclofenac 100mg) BID Intas Tab Movace SP BID ( aceclofenac + paracetamol+serratiopeptidase ) Alkem

39. DICLOFENAC (generic name): Indication- Used in acute dental pain Availability – tablet,capsule , injection, vial, ampoule, gel Duration of action- upto 12 hr, upto 24 hrs (SR tablet) Adverse effects- gastrointestinal disorders, GI bleeding Contraindication- peptic ulcer, GI bleeding, NSAID induced allergic asthma

40. Generic name Brand name with dosage Pharmaceuticals Diclofenac sodium Tab Intagesic SP BID ( diclofenac Na+ paracetamol + serratiopeptidase ) Intas ltd Tab Neurogesic BID ( diclofenac Na + paracetamol ) Torque

41. Generic name Brand name with dosage Pharmaceuticals Diclofenac sodium Tab Reactin 50 OD ( diclofenac Na 50 mg) Cipla Dynapar AQ ( diclofenac Na inj ) Troikaa

42. Generic name Brand na me Pharmaceuticals Diclofenac potassium Tab Cipzen D PLUS ( serratiopeptidase + paracetamol + diclofenac potassium) Cipla Tab Errofen plus ( serratiopeptidase + diclofenac potassium)

43. IBUPROFEN (generic name) : Indications- Used in dentoalveolar pain Duration of action- 5-10 hrs Availability – tablet, capsule, syrup, suspension, gel Adverse effects- nausea, vomiting, indigestion, GI intolerance Contraindication-peptic ulcer, h/o hypersensitivity to aspirin

44. Generic name Brand name Pharmaceuticals Ibuprofen Tab Brufen 400 TID Abbott Tab Ibuprofen 400 TID Cadila

45. Generic name Brand name with dosage Pharmaceuticals Ibuprofen Tab Flexib TID ( ibuprofen + paracetamol ) Alkem Tab Ibugesic plus TID (ibuprofen + paracetamol ) Cipla

46. Generic name Brand name with dosage Pharmaceuticals Ibuprofen Tab Combiflam TID ( ibuprofen 500 mg+ paracetamol 325 mg) Sanofi events Tab Fenceta TID ( Ibuprofen 400 mg+paracetamol 500 mg) Alkem

47. KETOROLAC (generic name): Indications- Short term management of acute pain Pain associated with surgical procedure Duration of action- 7 hrs Availability- tablet, injection Adverse effect- vomiting, black stools have been reported Contraindication- peptic ulcers, moderate or severe renal impairment

48. Generic name Brand name with dosage Pharmaceuticals Ketorolac Tab Ketorol - DT TID ( ketorolac tromethamine 10 mg) DRL

49. Generic name Brand name with dosage Pharmaceuticals Ketorolac Tab Ketanov TID ( ketorolac 10 mg) Ranbaxy Tab Toradol TID -

50. TRAMADOL (generic name): Indications – Moderate to severe nociceptive pain Duration of action- 6 hrs Availability- tablets, capsule Adverse effects-sedation and mental clouding, dizzy, nausea, palpitations, xerostomia Contraindication- allergy, impaired renal or liver function, history of siezure disorder

51. Generic name Brand name Pharmaceuticals Tramadol Tab Calpol ( acetaminophen + tramadol hydrochloride) QID Cap Contramol QID Albott

52. TOPICAL ANALGESICS : Brand name Pharmaceuticals Dologel ( lignocaine + choline salicylate + benzalkonium chloride) DRL Mucopain ( benzocaine ) Ipca

53. ANTIVIRAL ACYCLOVIR (generic name) : Indications- Herpes labialis Herpes zoster Primary herpetic gingivostomatitis Availability- tablet, ointment, cream Adverse effect- burning, local irritation Contraindication- hypersensitivity

54. Generic name Brand name with dosage Pharmaceuticals Acyclovir Herpex 5% QID for 4 days (acyclovir) Torrent Zovirax 5% QID for 4 days (acyclovir) GSK

55. Generic name Brand name with dosage Pharmaceuticals Acyclovir Tab Herpex (acyclovir) 400mg QID for 4 days Torrent Tab Zovirax (acyclovir 200 mg) QID for 4 days GSK

56. ORAL LESIONS AND DOSAGE

57. ANTIFUNGAL Clotrimazole Nystatin Fluconazole Itraconazole

58. ANTIFUNGAL CLOTRIMAZOLE (generic name) Indications Oral candidiasis Duration of action- upto 12 hrs Adverse effects- local burning, rash, hypersensitivity Availability- tablets, ointment, cream, gel, drops

59. Generic name Brand name with dosage Pharmaceuticals Clotrimazole Candid mouth paint ( clotrimazole ) apply 4-5 times/ day Glenmark Candid gel ( clotrimazole gel) Glenmark

60. NYSTATIN (generic name) : Indications- Oral cavity candidal infection Duration of action- full beneficial effect may not be felt for 7-14 days Adverse effects-rash, diarrhoea , nausea, vomiting, steven-johnson syndrome Availability- tablet Oral thrush- the tablets can be sucked or applied after being powdered and mixed in glycerine

61. Generic name Brand name with dosage Pharmaceuticals Nystatin Nystatin oral suspension -

62. FLUCONAZOLE ( generic name): Indications – Fungal infections related to oral cavity To treat oral candidiasis or thrush Duration of action- upto 24 hrs Adverse effects- nausea, vomiting, mild transient reversible increase in liver function test Availability- capsule, tablet Contraindication- hypersensitivity to fluconazole

63. Generic name Brand name with dosage Pharmaceuticals Fluconazole Tab Fluka -150 OD ( fluconazole 150 mg) Cipla Cap Fumycin – 150 OD ( fluconazole 150 mg) Pfizer

64. ITRACONAZOLE - (generic name ) : Indication – Oral candidiasis Duration of action – 3-4 days Availability- capsule Adverse effects- GI disturbances, allergic reactions, peripheral neuropathy Contraindication- hepatic disease

65. Generic name Brand name with dosage Pharmaceuticals Itraconazole Cap Canditral 100 mg ( itraconazole ) Glenmark

66. ORAL CONDITIONS AND DOSAGE ORAL CANDIDIASIS : TOPICAL APPLICATION - Nystatin oral suspension 1,00,000 units/ml 4-5 times daily ( swish and swallow) Cream and ointment apply to affected area Candid mouth paint 4-5 times/day SYSTEMIC- Tab fluconazole OD for 7 days

67. ANGULAR CHEILITIS: candid mouth paint apply to affected are 4-5 times a day for 7 days. DENTURE STOMTITIS: Apply candid B cream on the surface of denture prior to the placement Denture should be treated with either 30 min soak in 0.12% of chlorhexidine or diluted sodium hypochlorite solution. Tab fluconazole 150 mg OD- 7 days

68. CORTICOSTEROIDS Hydrocortisone Prednisolone Triamcinolone Betamethasone Clobetasole

69. CORTICOSTEROIDS HYDROCORTISONE (generic name): Indications- Lichen planus , erythema multiforme , pemphigus , recurrent aphthae , desquammative gingivitis, osmf Adverse effects- cutaneous atrophy, susceptibility to infection, delayed healing, glaucoma Contraindication- viral infection HSV I and II, diabetes mellitus, TB, osteoporosis, pregnancy

70. Generic name Brand name with dosage Pharmaceuticals Hydrocortisone Tab Cortef 10 mg Pfizer Wycort ointment (2.5%) 3-4 times a day Wyeth

71. Generic name Brand name with dosage Pharmaceuticals Hydrocortisone Locoid ointment (hydrocortisone 0.15) 2-3 times a day Astellas Orabase HCA (0.5%) Colgate

72. PREDNISOLONE (generic name): Indications – Lichen planus , erythema multiforme , pemphigus , behcets syndrome, postherpetic neuralgia Adverse effects- hypergylcemia , muscular weakness, psychosis Contraindications- hypersensitivity, viral infection, diabetes mellitus, TB, peptic ulcer

73. Generic name Brand name with dosage Pharmaceutical Prednisolone Tab Omnacortil Macleods Tab Melpred Cipla

74. Generic name Brand name with dosage Pharmaceuticals Prednisolone Tab Deltacortril 5 mg Pfizer Tab Wysolone Wyeth

75. TRIAMCINOLONE (generic name): Indications – Lichen planus , erythema multiforme , recurrent aphthae , desquammative gingivitis, osmf , contact cheilitis Adverse effects- cutaneous atrophy, susceptibility to infection, delayed healing, muscular weakness, pyschosis Contraindication- viral infection, TB, not to be given im /iv

76. Generic name Brand name with dosage Pharmaceuticals Triamcinolone Tab Tricort (2-4 mg/ day) Cadilla Tab Ledercort (2-4 mg/day) Wyeth

77. Generic name Brand name with dosage Pharmaceuticals Triamcinolone Kenacort 0.1% (3-4 times a day ) Abbott Kenalog 3-4 times a day GSK

78. BETAMETHASONE (generic name): Indications- Lichen planus , erythema multiforme , recurrent aphthae , desquammative gingivitis, osmf , pemphigoid Adverse effects- secondary infection, delayed healing, cutaneous atrophy Contraindications- viral infection

79. Generic name Brand name with dosage Pharmaceuticals Betamethasone Tab Betnelan GSK Tab Betmet Thurs

80. Generic name Brand name Pharmaceutical Clobetasole Tenovate oinment GSK

81. ORAL CONDITIONS AND DOSAGE

82. RECURRENT APHTHOUS ULCERATION: Systemic prednisone 1.0mg/kg once a day Taper the dose after 1-2 weeks ERYTHEMA MUTIFORME: Prednisone 60mg/day Slowly tapered by 10mg/day over 6 weeks

83. LICHEN PLANUS: 0.05% fluocinonide ointment ( Lidex , 3 times a day) Lidex can also be mixed 1:1 with carboxy methyl cellulose paste or other adhesive ointment.

84. A gingival tray can also be used to deliver 0.05% clobetasol propionate with 1,00,000 IU/ml of Nystatin in orabase . Intralesional inj of triamcinolone acetonide (10-20 mg) or regimen of prednisone daily for 5 days, followed by 10-20 mg daily for an additional 2 weeks.

85. Oral submucous fibrosis : Submucosal injections of a combination of dexamethasone (4mg/ml) and 2 parts of hyaluronidase (200 usp unit/ml) diluted in 1 ml of 2% xylocaine by means of a 27 gauge dental needle, not more than 0.2ml solu /site for a period of 20 weeks)

86. Submucosal inj of triamcinolone 10mg/ml diluted in 1ml of lidocaine 2% to avoid immediate tissue irritation and to facilitate proper distribution of drug at the sites , biweekly recommended

87. TMD DISORDERS :

88. PEMPHIGUS VULGARIS : Topical corticosteroid ( 0.1% triamcinolone acetonide ) BULLOUS PEMPHIGOID : Clobetasol propionate 20-40mg/day MUCOUS MEMBRANE PEMPHIGOID: Fluocinomide (0.05%) and clobetasol propionate (0.05%) in an adhesive vehicle- 3 times a day for upto 6 months

89. SYSTEMIC CORTICOSTEROID THERAPY Predisone remains the corticosteroid drug of choice for immune based diseases. The choice of prednisone regimen is the clinicians decision to make and should be based on the specific diagnosis, the intensity of the disease and the organ systems involved

90. Systemic corticosteroid regimen I Prednisone (100-120 mg /day by mouth) 2 weeks dose of 20mg/day 10mg/day for 3 months 5mg/day for 6 months drug may be discontinued Taper dose by 20 mg/day each week Continue this for 1 month 1) Pemphigus vulgaris 2)Erosive lichen planus

91. Systemic corticosteroid regimen II Prednisone (100-120mg/day) drug is abruptly dicontinued For period of 2 weeks Pemphigus vulgaris Erosive lichen planus Stevens –Johnson form of erythema multiforme

92. Systemic corticosteroid regimen IIIA prednisone(100-120mg/day) reduce prednisone by 20 mg/day each week untill lowest prednisone level is reached For 2 weeks 1) Resistent pemphigus cases 2)Some cases of systemic lupus erythematosus or sarcoidosis

93. Systemic corticosteroid regimen IIIB prednisone(100-120 mg/day ) Reduce by 20 mg/day each week Untill prednisolone level is reached at which disease is exacerbated 2 weeks 1)Refractory cases

94. REFERENCES Burkets Oral Medicine-11 Edition-by Greenberg And Glick And Ship Oral and Maxillofacial pathology- by Marx and Stern Dental index book Antibiotics used in dental practice- A Review Med Oral Patol Oral Cir Bucal 2007 Oral candidiasis - review - Postgrad Med J 2002 Useful Medications for Oral Conditions- american academy of pediatric dentistry

95. Corticosteroids in dentistry- JIAOMR 2011 Steroids in Dentistry - A Review Int. J. Pharm. Sci. Rev. Res., 22(2), Sep – Oct 2013 Corticosteroids used in Dentistry: An Update Journal of Dental Sciences and Oral Rehabilitation, April-June 2014

96. QUESTIONS Classification of steroids? What is analgesic ceiling effect? Difference between diclofenac sodium and potassium? What is pharmacokinetics and pharmacodynamics ?

97. Role of steroids in diabetes? Antiinflammatory action of NSAID? Factors modifying drug action? Short term and long term side effect of systemic corticosteroid therapy ?

98. THANK YOU