Dental Therapeutics

Question 1

what are corticosteroids used for?

Answer 1

chronic oral mucosal auto-immune diseases to reduce oral inflammation for mucocutaneous disorders

Question 2

what are the mucocutaneous disorders?

Answer 2

lichen planus
mucous membrane pemphigoid
pemphigus vulgaris
aphthous ulcers

Question 3

what is Lichen planus and what does it cause?

Answer 3

most common mucocutaneous disease affecting the gingiva, considered potentially premalignant, has a presumed autoimmune etiology and causes loss of epithelium with painful exposure of connective tissue

Question 4

how does lichen planus develop and what are the forms?

Answer 4

• may develop spontaneously or in response to certain drugs, oral care products, or dental materials.
• reticular, papular, bullous, ulcerative, or erythematous forms

Question 5

what is benign mucous membrane pemphigoid and what does it cause?

Answer 5

chronic autoimmune disease most common in elderly females, often causing ocular scarring and potential vision loss, with oral lesions (particularly desquamative gingivitis) present in over 90% of cases

Question 6

what is pemphigus vulgaris and what does it cause?

Answer 6

autoimmune disease that often first appears in the oral cavity, commonly presenting as painful, ulcerated gingiva (desquamative gingivitis)
* If skin lesions develop and go untreated, the resulting fluid loss and risk of infection can lead to death

Question 7

what is aphthous ulcers?

Answer 7

yellow ulcer surrounded by a red ring - very painful and occur almost exclusively on lining mucosa

Question 8

what are the two topical and two systemic corticosteroids used to treat mucocutaneous disorders?

Answer 8

• triamcinolone (Kenalog):
• clobetasol propionate (Clobex)
• prednisone
• dexamethasone

Question 9

what is triamcinolone (Kenalog) most commonly used to treat?

Answer 9

small localized lesions

Question 10

what is the most potent topical corticosteroid?

Answer 10

clobetasol propionate (Clobex)

Question 11

how does ibuprofen (NSAID) work?

Answer 11

• blocks COX enzyme pathway and reduce prostaglandin E2 production by macrophages and fibroblasts in periodontal tissues
  ** PGE2 activates osteoclastic alveolar bone resorption and induces secretion of matrix metalloproteinases involved in connective tissue destruction

Question 12

are NSAIDs used in periodontal therapy? why or why not?

Answer 12

No they are associated with significant unwanted effects, including gastrointestinal problems, hemorrhage, renal/hepatic impairment and the acceleration of bone loss once patients cease taking it (rebound effect)

Question 13

what is infective endocarditis?

Answer 13

bacterial infection of the endocardial surface of the heart usually involving the cardiac valves

Question 14

what is used to prevent infective endocarditis and what patients is this considered for?

Answer 14

Antibiotic prophylaxis should be considered in individuals who are at risk of developing infective endocarditis such as patients with
- complex congenital heart defects
- prosthetic cardiac valves
- a history of infective endocarditis
- a cardiac transplant with valve regurgitation

Question 15

what is an invasive dental procedure?

Answer 15

procedure that involves manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa

Question 16

what is the main oral antibiotic prophylactics used for dental procedures?

Answer 16

• amoxicillin 2g or
• cephalexin, azithromycin, clarithromycin if allergic to penicillins

Question 17

what are the main non-oral antibiotic prophylactics used for dental procedures?

Answer 17

ampicillin, *cefazolin, *ceftriaxone
*if allergic to penicillins

Question 18

If antibiotic prophylaxis is inadvertently not administered before a dental procedure, then it may be administered

Answer 18

up to 2 hours after the procedure

Question 19

what are odontogenic infections?

Answer 19

most common type of orofacial infection affecting the teeth and/or periodontal tissues

Question 20

how can endodontic infections occur?

Answer 20

• carious cavity/ traumatized crown
• periodontal ligament infection
• periapical infection
• infected or necrotic pulp

Question 21

antibiotics are only necessary after endodontic treatment if

Answer 21

the patient shows systemic signs of infection such as fever, malaise, cellulitis, or swollen lymph nodes or immunocompromised patients/those with a history of infective endocarditis, even if systemic symptoms aren’t present

Question 22

which antibiotics are first choice for endodontic antibiotic therapy ?

Answer 22

penicillin and amoxicillin (beta-lactam antibiotics)

Question 23

why does amoxicillin demonstrate greater efficacy and therapeutic value ?

Answer 23

1. broader spectrum and more effective than penicillin VK
2. more readily absorbed
3. not impaired by food
4. more readily available
5. greater half-life

Question 24

what is the recommended amoxicillin adult dose regimen?

Answer 24

500mg three times a day

Question 25

what are the systemic antibiotics for acute periodontal infections?

Answer 25

metronidazole tetracyclines (doxycycline or minocycline) azithromycin metronidazole + amoxicillin

Question 26

what are the acute periodontal conditions?

Answer 26

acute periodontal abscess pericoronitis necrotizing ulcerative gingivitis necrotizing periodontitis

Question 27

what causes periodontitis?

Answer 27

when harmful bacteria and a susceptible immune system interact, leading to inflammation, which in turn causes attachment loss and bone damage

Question 28

what are two types of therapy treatments for peridontitis?

Answer 28

1. Traditional Therapy: reducing plaque and bacterial load through - Patient plaque control - Mechanical/surgical debridement 2. Anti-Infective Therapy: targets pathogens more aggressively using - Local antimicrobials - Systemic antibiotics - Dental lasers

Question 29

what are the advantages of systemic periodontal antibiotic therapy?

Answer 29

- readily administered - reaches pathogens in all subgingival sites and entire oral cavity

Question 30

what are the disadvantages of systemic periodontal antibiotic therapy?

Answer 30

- lower drug dose attained in the periodontal pockets - less patient compliance - greater potential for adverser side effects and drug interactions

Question 31

Systemic antibiotics are recommended for periodontitis patients who do not respond well to

Answer 31

conventional treatment, despite receiving: - scaling and root planing (ScRP) or surgical access to clean deeper pockets - good oral hygiene at home - consistent maintenance care

Question 32

what type of approach is recommended for periodontal antibiotic therapy?

Answer 32

conservative and selective approach (most can be treated without systemic antibiotics)

Question 33

what are the major anaerobic bacteria associated with progression of periodontitis?

Answer 33

Porphyromonas gingivalis Tannerella forsythia Treponema denticola & other oral spirochetes Prevotella intermedia/nigrescens Parvimonas micra Fusobacterium nucleatum Eubacterium nodatum

Question 34

what is metronidazole active against and what is the usual dose?

Answer 34

- anaerobic bacteria - 250-500 mg three times a day for 7-14 days

Question 35

what combination was most effective in improving periodontal deep pocket sites?

Answer 35

ScRP + metronidazole

Question 36

what are the side effects of metronidazole?

Answer 36

- GI discomfort - dizziness, vertigo - metallic taste and dry mouth - peripheral neuropathy (seizures) - avoid in pregnancy and CNS disorders

Question 37

what are the drug-drug interactions for metronidazole?

Answer 37

- anticoagulants have an increased effect - cannot use with alcohol

Question 38

what are the characteristics and usual dose for amoxicillin + metronidazole?

Answer 38

- Broader spectrum of activity, synergistic effects against some periodontal pathogens, slightly better clinical results but greater risk of adverse side-effects - 250-500 mg of each three times a day for 7-14 days

Question 39

what are the characteristics and usual dose for azithromycin?

Answer 39

- active against a wide range of periodontal pathogens, well absorbed, long half life, concentrates in inflamed tissues - 250-500 mg once a day for 7-10 days

Question 40

when is adjunctive azithromycin most effective?

Answer 40

in severe periodontitis (deep pockets, 7mm), but it does not add much benefit for milder disease.

Question 41

Taking 5 days of azithromycin, as compared to no antibiotics, had an increased risk of

Answer 41

cardiovascular death

Question 42

which drugs are known to prolong heart QT intervals causing an increase risk of heart arrhythmias?

Answer 42

azithromycin and other macrolides

Question 43

what are the characteristsics of clindamycin and the usual dose?

Answer 43

- not recommended anymore, active against wide range of plaque bacteria, dangerous side effects - 150 mg three times a day for 7-10 days

Question 44

what are the side effects of clindamycin?

Answer 44

- GI discomfort - pseudomembranous colitis - maculopapular rashes and uticaria - avoid in renal dysfunction patients - avoid in GI disease patients

Question 45

what are the characteristics for tetracyclines?

Answer 45

- not used as much due to drug resistance in many oral bacteria (A. actinomycetemcomitans) - poor gastric absorption and clinical outcome in 50% of periodontitis patients

Question 46

Subgingival P. micra resistance in periodontitis increasingly more frequent in 2016 vs. 2006 for:

Answer 46

doxycycline (37.7-fold increase) clindamycin (23.7-fold increase)

Question 47

P. gingivalis resistance in periodontitis increasingly more frequent for:

Answer 47

clindamycin amoxicillin

Question 48

what are the key points to be aware of for drug prescriptions?

Answer 48

- its a legal document that the prescriber and pharmacist are responsible for - needs to be carried out in a thoughtful and deliberate way - proper prescriber patient relationship

Question 49

what is a proper prescriber-patient relationship?

Answer 49

1. patient identification 2. diagnose via medical history, examinations and tests 3. establish treatment plan 4. provide counselling 5. plan follow-up

Question 50

key elements in patient counselling?

Answer 50

1. name of drug and use 2. method, quantity, timing, duration 3. how to handle certain reactions 4. what to do if dose is missed 5. cost 6. storage

Question 51

errors to avoid in prescribing drugs

Answer 51

1. incorrect name 2. incorrect dose 3. failure to assess toxicity of drug combinations 4. allergies of the patient 5. illegible handwriting

Question 52

what are the drug categories according to legal restrictions

Answer 52

1. over the counter 2. prescription RX only 3. controlled substance

Question 53

how often can controlled drugs be refilled?

Answer 53

- schedule I: may not be prescribed - schedule II: none - schedule III, IV, V: 5 times in 6 months

Question 54

what are examples of schedule II drugs?

Answer 54

amphetamines and oxycodone

Question 55

what are examples of schedule II/IIN substances?

Answer 55

narcotics (oxycodone, Percocet) and stimulants (amphetamine, Adderall)

Question 56

what are examples of schedule IIIN substances?

Answer 56

non-narcotics like ketamine and anabolic steroids