Therapeutic Drugs in OM Flashcards
What does SDCEP drugs in dentistry cover?
- non-steroid topical therapy: for inconvenient lesions with discomfort
- steroid topical therapy: disabling immunologically driven lesions
Non- steroid topical tx of Oral mucosal lesions
- Chlorhexidine mw
- Benzdamine MW/ spray: topical anesthetic and pain relief
- OTC remedies, ie: Igloo, Listerine, Bonjela
Steroid based topical for OML
- hydrocortisone mucoadhesive pellet
- Betamethasone MW
- Beclomethasone metered dose inhaler (MDI/ puffer)
- CFC- free preparations, eg: Clenil Modulite
Hydrocortisone Mucoadhesive pellet
- allow tablet to dissolve over ulcer
Betamethasone MW
- unlicensed product: supply patient with tailored info leaflet
Betnesol tablets / Bethamethasone
- 0.5mg
- 1mg, 10ml water (2 tablets, 2 teaspoons of water)
- 2 mins rinsing
- twice daily
- refrain from eating/ drinking for 30 mins after use
- do not swallow
- do not rinse after use
Betamethasone MW PIL
- Accepted and proven to be an effective tx for the condition
- licensed for other medical conditions- use above 12 yrs of age and with caution below this age
- explain dose range and frequency of use
- explain hazard of exceeding standard dose
1. safe to use as directed without steroid side effects, eg: diabetes, osteoporosis, adrenal suppression - may have small oral candida risk
- must spit out to avoid systemic steroid effects
- do not rinse mouth after use
Beclomethsone MDI
- unlicensed product
- supply pt with tailored info leaflet
- dental prescribing 50mcg/ puff device
- position device correctly and exit vent directly over ulcer area
- 2 puffs
- 2-4 times daily
- do not rinse after use
PIL for Beclomethasone MDI
- accepted and proven for oral conditions
- licensed for other medical conditions, ie: asthma and COPD
- instruct to discard manufacturer’s PIL
- explain dose range and frequency of use
- explain technique used for oral lesions, different for lung conditions
- small oral candida risk
- do not rinse after use as effect will be lost
Systemic tx (specialist use only)
Disease modulators
- ie: Colchicine
Steroids, ie: Prednisolone
- can be pulsed for intermittent troublesome ulcers
- high dose/ short duration 30mg for 5 days
- need to ensure not used too frequently, once each month
Immune suppressants
- Hydroxychloroquine (Lichen planus)
- Azathioprine
- Mycophenolate
Immune therapy
- Adalimumab
- Enterecept
Systemic steroid risk
If prolong course/ repeated short courses over many months
- 3 months continuous
- gaps of 2 weeks/ less between pulses of prednisolone
- adrenal suppression- steroid dependancy
- should not stop steroid suddenly, should taper dose - Cushingoid features
- Osteoporosis risk
- bone prophylaxis
- calcium suppl and bisphosphonates
- DEXA bone density scan - Peptic ulcer risk
- proton pump inhibitor prophylaxis - Mood/ sleep alteration and mania
- depression risk
Aware of systemic tx
- infection risks, cancer risk, adverse drug reactions
- only used by specialist
- always communicate proposed tx to GP
- may have medical issues about which Om clinician is unaware
Pt preparation for Systemic Immunomodulatory tx
- ensure immunosuppression will not harm pt
- pre-existing medical condition not yet detected
- Blood borne virus screen: Hep B, C and HIV
- FBC
- Electrolytes
- Liver function test
- Thiopurine Methyltransferase (TPMT)- only for Azathioprine use
- Zoster antibody screen
- EBV
- Chest X-ray for previous/ active TB
- Cervical smear up to date
- Pregnancy test
Planning Immunonodulatory tx
- needs full consent from pt
- alternative tx tried/ discussed
- pt info given and pt reviewed to discuss
1. short term risk- acute drug reaction
2. long term risk- cancer risk increased - Azathioprine and skin cancer
3. effective contraception to be used and any pregnancy planned with clinical care team - tx outcome understood by pt and clinician
- trial tx- 6 months then reassess benefit/ need for tx
