Medicines and Therapeutics in Oral Medicine

Question 1

antimicrobials ‘licenced’ for use in oral diseases

Answer 1

anti-viral
anti-fungal
antibiotics

Question 2

mouthwash licenced for topical tx of oral med lesions

Answer 2

benzadamine mouthwash

Question 3

topical steroids used for oral med lesions

not licenced for use

Answer 3

inhaled steroids
steroid mouthwash

Question 4

systemic ‘medical’ tx licenced for use in oral med lesions

Answer 4

cabamazepine

Question 5

3 classical classes of medicines used for oral med lesions

Answer 5

anti-microbial
topical steroids
dry mouth medication

and others

Question 6

classification of medicines

5

Answer 6

General Sales (OTC anywhere)
Pharmacy Medicines (OTC from pharmacists only)
Prescription only Medicines
Controlled Drugs
Medical Devices

Question 7

licenced medicines definition

medicines and healthcare products regulatory agency

Answer 7

A medicine that has been proven in evidence to the MHRA to have efficacy and safety at defined doses in a child and/or adult population when treating specified medical conditions

Usually clinical trial data provided by the manufacturer

Post licence surveillance via MHRA (yellow card scheme, reporting side effects, duty of prescribers)

Question 8

unlicenced medicines definition

Answer 8

Medicines that have not had evidence of efficacy submitted for the condition under treatment
* Will be ‘licenced medicines’ – but for another condition
* ‘off-licence’ or ‘off-label’ use is at the discretion of the treating physician - Cost of new clinical trials for the new conditions too much for manufacturer to justify
* Patient must be informed that medicine is being used ‘off-licence’
* Patient must be given PIL specific to the condition under treatment
* Drug manufacturer supplied PIL will be for the licenced condition, Prescriber responsible for explaining risks and giving information to pt and ensuring pt safety for the use

Question 9

common antiviral used for oral med lesions

Answer 9

aciclovir

Question 10

aciclovir used to tx

3

Answer 10

primary herpetic gingivostomatitis
recurrent herpetic lesions
shingles (recurrent herpes zoster)

antiviral

Question 11

3 common antifungals used to tx oral med lesions

Answer 11

miconazole
fluconazole
nystatin

Question 12

antifungals used to tx what oral med lesions
commonly

Answer 12

acute pseudomembranous candidiasis
acute erythematous candidiasis

Question 13

2 topical steroids commonly used for oral med lesions

Answer 13

betamethasone mouthwash (soluble tablets)
beclomethasone metered dose inhaler

Question 14

topical steroids used for oral med lesions are to tx what commonly

2

Answer 14

aphthous ulcers
lichen planus

Question 15

‘medical device’ definition

Answer 15

means any instrument, apparatus, implement, machine, appliance, implant, reagent for in vitro use, software, material or other similar or related article, intended by the manufacturer to be used, alone or in combination, for human beings, for one or more of the specific medical purpose(s) of:
* diagnosis, prevention, monitoring,** treatment or alleviation of disease,**
* diagnosis, monitoring, treatment, alleviation of or compensation for an injury,
* investigation, replacement, modification, or support of the anatomy or of a** physiological process,**
* supporting or sustaining life,
* control of conception,
* disinfection of medical devices
* providing information by means of in vitro examination of specimens derived from the human body;

and does not achieve its primary intended action by pharmacological, immunological or metabolic means, in or on the human body, but which may be assisted in its intended function by such means.

inc dry mouth tx

Question 16

examples of medical devices used for ‘dry mouth’ tx

5

Answer 16

Salivix pastilles
Saliva orthana
Biotene Oral Balance
Artificial Saliva DPF
Glandosane

not providing a pharmacological input, only lubricant

For full list of saliva substitutes prescribable by NHS dentists see https://www.sps.nhs.uk/wp-content/uploads/2020/02/UKMI_QA_Saliva-Subsitutes_update_June-2019-1.pdf

Question 17

6 other medicines that can be used by oral med department

not antimicrobial, topical steroid or dry mouth use

Answer 17

• Tricyclic Antidepressants
• Gabapentin/Pregabalin
• Azathioprine
• Mycophenolate
• Hydroxycholoroquine
• Colchicine

Question 18

6 considerations when prescribing a drug for oral med lesions

Answer 18

• Clinical indication
• Licenced or unlicensed for this use
• Dose and route of administration
• Important warnings for the patient
• Drug interactions and cautions
• Treatment duration and monitoring

Question 19

what to include on prescription

Answer 19

• Patient’s name, Address, Age (under 18)
• Patient identifier – DoB, CHI Number
• Number of Days treatment
• Drug to be prescribed
• Drug formulation and Dosage
• Instructions on quantity to be dispensed
• Instructions to be given to the patient
• Signed – identifier of Prescriber

Key Patient information MUST be legible
AVOID abbreviations – write full instructions in INK
Only legal requirement is for dentist to SIGN prescription – this confirms all the other information is correct and has been checked.
Essentially the SAME information for Private – GDC number usually added.

Question 20

prescription validity

duration
no. items
repetition

Answer 20

Six months from date issued
More than one item on a script
More than one repeated dispensing occasion

Question 21

advantages of written instructions

4

Answer 21

Stressed patient may not remember instructions

Language issues may prevent proper understanding
* Multilingual options, large print options

Contact number for Patient Issues with the medicine

Legal protection if post-treatment course questioned

Question 22

additional advice to give pts when prescribing meds

4

Answer 22

• Take drugs at correct time and finish the course
• Unexpected reactions: STOP! and contact prescriber
• Known side-effects should be discussed e.g. Metronidazole and alcohol
• Keep medicines safe: especially from children