Drug Prescribing for dentistry

Question 1

what is dental abscess management?

Answer 1

Local measures to be used in the first instance
● If pus is present in a dental abscess, drain by extraction of the tooth or through the root canals.
● If pus is present in any soft tissue, attempt to drain by incision.

Question 2

if local measures are ineffective what is dental abscess management?

Answer 2

● Amoxicillin: 500mg TID for 5 days (better absorbed than Pen V)
● Penicillin V: 250mg 2 tablets 4x daily for 5 days
● Metronidazole: 400mg TID for 5 days

Question 3

what is second line antibiotics?

Answer 3

● Clindamycin 150mg 4x daily for 5 days

Question 4

what is necrotising ulcerative gingivitis and pericorinitis management?

Answer 4

Local measures to be used in the first instance
● In the case of necrotising ulcerative gingivitis, remove supra-gingival and subgingival deposits and provide oral hygiene advice.
● Due to the pain associated with NUG, the patient may only be able to tolerate limited debridement in the acute phase.
● In the case of pericoronitis, carry out irrigation and debridement.

Question 5

what is necrotising ulcerative gingivitis and pericorinitis management if local measures ineffective?

Answer 5

● Metronidazole 400mg TID for 3 days
● Amoxicillin 500mg TID for 3 days

Question 6

what is sinusitis management?

Answer 6

Local measures to be used in the first instance
● Advise the patient to use steam inhalation

Question 7

what is sinusitis management if local measures ineffective?

Answer 7

Local measures ineffective or persistent and severe symptoms (first line antibiotics)
● Ephedrine nasal drops 0.5%: 1 drop each nostril for max 7 days
● Pen V 250mg 4x daily for 5 days
● Doxycycline 100mg: 2 capsules on the first day then 1 daily for 7 days

Question 8

what is management of Pseudomembranous and erythematous candidiasis?

Answer 8

● If a patient is using a corticosteroid inhaler, in the first instance, advise them to rinse their mouth with water or brush their teeth immediately after using the inhaler

● Consider use of a spacer
● For superficial infections, prescribe systemic fluconazole or miconazole for topical application
● Note that fluconazole interacts with many drugs. If fluconazole or miconazole are contraindicated, prescribe nystatin.

Question 9

what is local measures of denture stomatitis?

Answer 9

● Brush the palate daily to treat the condition
● 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)
● Leave their dentures out as often as possible during the treatment period.

Question 10

if Pseudomembranous and erythematous candidiasis management is ineffective what do you?

Answer 10

● Fluconazole 50mg: 1x daily for 7 days
● Miconazole gel 20mg/g: pea size amount after food 4x daily

Question 11

what do you give if fluconazole and miconazole are contraindicated?

Answer 11

● Nystatin 100,000 units/mL: 1mL after food 4x daily for 7 days

Question 12

what is angular chelitis treatment?

Answer 12

● Miconazole cream 2%: apply to angles of mouth 2x daily
● Sodium fusidate ointment 2%: apply to angles of mouth 4x daily

● Miconazole (2%) and hydrocortisone (1%) cream

Question 13

what is Herpes simplex infection management?

Answer 13

Local measures to be used the first instance
● Advise the patient to avoid dehydration and alter their diet (to include soft food and adequate fluids) and use analgesics and an antimicrobial mouthwash.

Question 14

what mouthwash of choice for herpes simplex infection?

Answer 14

● Chlorhexidine mouthwash 0.2%: 10mL 2x daily for 1 minute
● Hydrogen peroxide mouthwash 6%: 15mL 3x daily for 2 minutes

Question 15

what do you give immunocompromised patients with herpes simplex infection?

Answer 15

● Aciclovir tablets 200mg: 5x daily for 5 days
● Aciclovir cream 5%: 5x daily for 5 days

Question 16

what is Varicella zoster infections management?

Answer 16

● Aciclovir tablets 800mg: 5x daily for 7 days

Question 17

what is Mucosal ulceration management?

Answer 17

● If ulceration has been present 3 weeks or more, refer the patient for urgent care
● If ulceration is recurrent and self-limiting, advise the patient to use 0.2% chlorhexidine mouthwash*
● Recommend optimal analgesia, including prescription of topical analgesics (e.g. benzydamine oromucosal spray)
● Fix ill fitting dentures
● Prescribing a topical steroid.
● In cases of primary herpetic gingivostomatitis or herpes zoster infection, if the symptoms are severe or the patient is immunocompromised, consider prescribing antiviral agents like aciclovir or penciclovir

Question 18

what is appropriate mouthwashes for mucosal ulceration and inflammation management?

Answer 18

● Sodium chloride: dilute with an equal volume of water
● Chlorhexidine 0.2%: 10mL 2x daily for 1 minute
● Hydrogen peroxide mouthwash 6%: 15mL 3x daily for 2 minutes
● Doxycycline dispersible tablets 100mg: 4x daily for 2 minutes

Question 19

what are local analgesics for severe pain for ulceration and ulceration management?

Answer 19

● Benzydamine mouthwash 0.15%: 15mL every 1.5 hours
● Benzydamine spray 0.15%: 4 sprays every 1.5 hours
● Lidocaine ointment 5%
● Lidocaine spray 10%

Question 20

what are topical corticosteroids applied for ulceration and inflammation management?

Answer 20

● Clenil modulite
● Betamethasone
● Hydrocortisone

Question 21

what is dry mouth management?

Answer 21

Local measures to be used in the first instance
● Advise the patient to take frequent sips of cool drinks, suck pieces of ice or sugar-free fruit pastilles, or use sugar-free chewing gum to provide symptomatic relief.

Question 22

what is Artificial saliva preparations?

Answer 22

● Artificial saliva gel, spray, pastilles
● AS saliva orthana spray
● BioXtra Gel
● Glandosane aerosol spray
● Saliveze oral spray

Question 23

what is topical fluoride you give for dry mouth?

Answer 23

● Sodium fluoride 0.619% (2800ppm)
● Sodium fluoride 1.1% (5000ppm)
● Sodium fluoride mouthwash 0.05%: 10mL for 1 minute

Question 24

what are important warnings for drugs?

Answer 24

● All penicillins (including amoxicillin and Pen V): Can result in hypersensitivity reactions, including rashes and anaphylaxis, and can cause diarrhea. Do not prescribe to patients with a history of anaphylaxis, urticaria or rash after penicillin
● Metronidazole: do not prescribe to patients taking warfarin, alcohol or pregnant
● Clarithromycin: do not prescribe to patients taking warfarin, statins, or pregnant
● Fluconazole and miconazole: do not prescribe to patients taking warfarin or statins