Dental and Pharyngitis Pharm Flashcards
What causes dental plaque
bacterial biofilm
Define gingivitis
inflammation of the gums with redness, swelling, and provoked bleeding
Define periodontitis
Gingival inflammation accompanied by loss of supportive connective tissue including the periodontal ligament and alveolar bone
What prescription is helpful for gingivitis treatment?
Chlorhexidine Gluconate
What and how does chlorhexidine gluconate work
basically all bacteria + yeast; bacteriostatic at low doses and bacteriocidal at higher doses
What are the indications for chlorhexidine gluconate?
Gingivitis and periodontitis
What is chlorhexidine gluconate used to treat gingivitis?
oral rinse swish for 30 seconds with 15 mL; repeat twice daily
How is chlorhexidine gluconate used for periodontitis treatment?
periodontal chip - 1 chip inserted into a periodontal pocket with a probing pocket >=5mm (up to 8 chips);
Treat every 3 months
dislodges < 48 hrs, replace
dislodges > 7 days, fully treated
What are the adverse effects of chlorhexidine gluconate
Toothache, URI, sinusitis
What are the active ingredients in OTC mouthwash
Cetylpyridinium chloride
Chlorhexidine
Essential oils
Fluoride
Peroxide
Which OTC mouthwash ingredient reduces bad breath
Cetylpyridinium chloride
Which OTC mouthwash ingredient helps control plaque and gingivitis?
Chlorhexidine and essential oils
Which OTC mouthwash ingredient helps prevent tooth decay
Fluoride
Which OTC mouthwash ingredient helps whiten teeth
Peroxide
What population should not use mouthwash and why
Children <6 due to risk of ingestion
How is dental calculus (calcified dental plaque) prevented?
Tartar control toothpastes
What ingredients are in tartar control toothpastes?
Zinc salts
Pyrophosphate
Sodium Hexametaphosphate
What are the mechanisms of topical fluoride
- Enhance remineralization of carious lesions before they become cavities
- Inhibition of demineralization
- Destroy enzymes in bacteria that produce acids that erode the teeth
Outline the fluoride supplement guidelines ages <6 months
None
Fluoride supplement guidelines 6 months - 3 years
<0.3ppm = 0.25 mg/day
Fluoride supplement guidelines 3 years to 6 years
<0.3ppm = 0.5mg/day
0.3-0.6ppm = 0.25mg/day
Fluoride supplement guidelines 6-16 year
<0.3ppm = 1mg/day
0.3-0.6ppm = 0.5mg/day
What to note about gingivitis vs periodontitis AB treatment
Gingivitis: need to cover anaerobes if ulcerative vs simple (clindamycin, metronidazole, Augmentin)
Periodontitis:
Stage I-2 = topical
Stage 3-4 = oral
Immunocompromised = IV
What are common dental pain medications
NSAIDs
Acetaminophen
Opioids
What must be avoided when treating dental pain
XR or long acting opioids
What should be done if dental pain is due to infection
Surgery to remove infected tissue
What does postoperative pain lasting >3 days indicate
alveolar osteitis
What is the preoperative pain management for acute dental pain
NSAIDs single dose 30-60 minutes prior to dental procedure +/- chlorhexidine gluconate
What is the postoperative pain management for acute dental pain
- Chlorhexidine gluconate
- Ice/heat/rest
- NSAID +/- acetaminophen on scheduled basis
Mild - NSAID (400) or Acetaminophen (325)
Moderate - NSAID (800) + Acetaminophen (500)
Severe - NSAID (800) + Acetaminophen (325) + low dose opioid (no more than 3 days)
What are the classifications of chronic oral face pain
- temporomandibular disorders
- Persistent idiopathic facial pain
- Atypical odontalgia
*often associated with psychosocial problems
What are the pharmacotherapy treatments for chronic oral facial pain
Carbamazepine
Lamotrigine
Baclofen
Tricyclic Antidepressants
What medications cause Xerostomia
SSRI
Sulfonylureas
Respiratory agents (anticholinergics)
Thiazides
CCB
Urinary Antispasmodics
NSAIDs
Opioids
Ophthalmologic agents
Non-pharm treatments of Xerostomia
Increase hydration
Humidification
Avoidance of irritating triggers
OTC medications to treat Xerostomia
- Saliva substitutes:
- Mouth Kote
- Oasis mouth spray
- Biotene gel
- Salivart - Mucosal lubricants
- Saliva Stimulants
Rx med for Xerostomia
Pilocarpine
1. related to head-neck cancer treatment - 5-10 mg PO tid, may take 12 weeks to help
2. related to Sjogren’s - 5mg PO qid, may take 6 weeks to help
Pilocarpine MOA
Cholinergic agonist
Increases parasympathetic activity
Increases secretion from salivary glands
What are adverse issues of bruxism
- Jaw muscle hypertrophy
- Tooth wear and crack development
- Pain
What are potential drug related causes
- Antipsychotics
- SSRI
- SNRI
Fluoxetine, Venlafaxine, Sertraline
Symptoms onset 3-4 weeks and take 3-4 weeks to subside after cessation
What does “meth mouth” look like
Blackened
Stained
Rotting
Crumbling
Falling apart
Potential etiology of meth mouth
Acidic nature of meth
Dry mouth - less protective saliva
Increased carbonated beverages
increased grinding
Not properly cleaning teeth
Treatment of choice for pharyngitis
Penicillin
Penicillin VK dosing
Adults: 500mg BID
Children: 50mg/kg/day in 3 doses
- both 10 days
Penicillin benzathine dosing
Adults: 1.2 million units IM once
Children (<27kg): 0.6 million units IM once
Amoxicillin dosing
Adults: 500mg TID
Children: 40-50mg/kg/day
- both 10 days
How to treat epiglottitis if not maintaining airway
immediate endotracheal intubation
Maintain airway and less than 6
endotracheal intubation
Maintaining airway and >6
individual decision of intubation vs observation
Adults without severe respiratory stress and <50% airway obstruction
Closely monitor in ICU w/o artificial airway
Most common organisms - epiglottitis
H. influenza type B
Strep pneumoniae
GA strep
Staph aureus
What should be done prior to AB administration for epiglottitis
Blood culture and (if intubated) epiglottic culture
What empiric therapy for epiglottitis
Ceftriaxone or cefuroxime + vancomycin for 7-10 days
If allergy, Vancomycin + quinolone OR carbapenem
Who gets DTaP and who gets Tdap
DTaP - peds (Infanrix, Daptacel)
Tdap - 7 or older (Boostrix, Adacel)
At what ages do babies get DTaP
2, 4, and 6 months
15-18 months
4-6 years
Variations of combo DTaP vaccines
Pediarix - DTaP-IPV-HepB
Pentacel - DTaP-IPV-Hib
