Botanicals and Dietary Supplements in Dentistry Flashcards
what are the motivations for dietary supplement use
- safe = natural
- optimal health
- autonomy
- access
- cost
-hope - quick fix
- frustration/mistrust
why ask about CAM and DS use
- assess potential beneift
- minimize harm form drug induced nutrient depletion
- identify and assess potential harm
- adverse events, toxicities
- potential drug interactions
how do you communicate about supplemtns
- use specific terminology to avoid misunderstandings
- avoid negative terminology or tone
- stress importance of the information
- display openness to hearing about use
what did Dr. Samuel Hahnemann do
- dissatisfied with harm of standard therapies
- devised hemopathy
- almost replaced allopathic medicine by civil war
what are the two primary tenets of homeopathy
- law of similars
- law of infinitesimal dose
what is the law of similars
- let like be cured by likes
what is the law of infinitesimal dose
- the more dilute the stronger the remedy
- substance imparts energy or resonance to solvent
what is done in true homeopathy
illness specific to person so treatment is indivudalized
what does it mean in practical terms for healthcare professionals
- # 1 safety concerns
- # 2 lack of or delay of effective treatment
what does X or D mean
dilution factor of 10
what does C mean
dilution factor of 100
what are the 4 G’s
- garlic
- ginger
- ginkgo
- ginseng
what are the supplements with increased bleeding risk
- the 4 G’s
- fish oil
- feverfew, horse chestnut,
- coumarin containing herbs
what are the concerns with garlic
definite effects
- absolutely stop 7-10 days before procedures/surgeries
what are the concerns with ginger
usually only seen with doses greater than 4g a day
what are the concerns with ginkgo
definite antiplatelet effects, stop 7-10 days before procedures/surgeries
what are the concerns with ginseng
variable effects, stop 7-10 days before procedures/surgeries
what is the concern with fish oil
only an issue with doses greater than 4g a day
what are the possible effects of DS
additive, synergistc or opposing
what are the examples of pharmacodynamic interactions
- red yeast rice vs statins
- saw palmetto vs finasteride
what are the pharmacokinetic interactions
DS affects the absorption, distribution, metabolism or elimination
what is the example for absorption - provide the interaction and outcome
piperine affects P-glycoprotein in gut to increase absorption
- higher drug levels (phenytoin, propranolol, theophylline)
what is the example for distrubution
- fennel increases tissue penetration and increase volume of distribution of ciprofloxacin
- decreased blood concentration and activity of ciprofloxacin
what is the example for metabolism
- St. John’s wort induced CYP450 3A4
- lower drug levels of 3A4 subtrates
what is the example for elimination
- kudzu inhibits active transport of methotrexate
- increased blood concentration of methotrexate
what are the inhibitors and inducers of 3A4
- inhibitors: echinacea, ginkgo, goldenseal, grapefruit, kava
- inducers: echinacea, garlic, St. John’s wort
what does THC do to the liver enzymes
inducer of 1A2
what does CBD do to liver enzymes
- 2D6 inhibitor
- 3A4 inhibitor
what is the effect for warfarin on cannabis/cannabinoid
- increased levels or THC or CBD
what are the effects of alcohol on cannabis/cannabinoid
may increase THC levels
what are the effects of theophylline on cannabid/cannabinoids
decreased levels of smoked things
what are the effects of indinavir on cannabid/cannabinoids
no effect of smoked things
what are the effects of docetaxel on cannabid/cannabinoids
no effect on infusions
what are the effects of clobazam on cannabid/cannabinoids
increased clobazam with CBD in treated children
what are the effects of CNS depressants on cannabid/cannabinoids
additive effects with alcohol, barbituates and benzos
how should DS drug interactions be handled
- determine signficance
- pick course of action and educate patient
what is are the options for clinical management of interactions
- prime questions: what is the clincial significant of the interactions
- avoid entirely
- avoid temporarily
- monitor and manage
what are the uses of Co enzyme Q and where is it foudn
- in toothpastes and mouth rinses
- rinses and oral gels do NOT benefit plaque formation or gingivitis
- 100mg orally per day increased salivary secretion in patients with dry mouth
- most often used for CVD or to reduce adverse effects of statins
what are the uses and effects of alpha-lipoic acid
- 200mg three times daily orally improves burning mouth syndrome
- usually used for diabetic neuropathy or to help control blood glucose
- very well tolerated, reduced blood sugar is possible
- tell patients with DM to monitor blood sugar more often when starting to take
how is tumeric used and what is it used for
- as a mouth rinse 400mg in 80mL water used to swish and spit 6x day versus iodine solution in patients undergoing radiation therapy for head and neck cancer
-used for tolerable and intolerable oral mucositis
what are the uses of chamomile
- extract for recurrent aphthous stomatitis
- oral rinse used prophylactically and after mucositis deveopment in radiotherapy and systemic chemotherapy
what are the uses of tea tree oil
- wide antibacterial and antifungal activity
- more active against pathogenic than endogenous bacteria
- used topically for toenail fugnus
- used in mucosal and dental products
- toxic if taken orally- 10mg
what are the herbal blends used in toothpastes
- neem oil
- TTO, oregano, lavender, other essential oils
- mulitple herbs with anti inflammatory action
what is neem oil active against
strep mutans
what does valerian do and what are the interactions of it
- anxiolytic, smooth muscle relaxer
- inhibition of GABA breakdown
- 300-450mg extract given in three divided doses
- additive effects with any CNS depressant
what is Kava used for and what is the current recommendation for it
- extremely effective in clinical trials for anxiety and insomnia
- current recommendation is do NOT use- classified as WTB
what does clove oil do
counterirritant/anesthetic effect, antibacterial; oil extract or 1-5% solution for mouthwaste, toxic when taken orally
- category III
what does teat tree oil do
antibacterial/antifungal
what does lavender oil do
antibacterial
- calming in aromatherapy usewh
what does peppermint oil do
antibacteria/antiviral, 10% oil in ethanol solution topically for migraine headaches
- antispasmodic in smooth muscle: 1-2 enteric coated capsules TID
what is the 2nd most prevalent cannabinoid in the cannabis plant
cannabidiol
what are the dental uses for CBD
TMJ
- 10% CBD topical ointment with masseter muscle massage 2 times daily for 2 weeks
