Therapeutic Drugs in Oral Medicine Flashcards
what to check for drug prescribing in mucosal disease
SDCEP Drugs in Dentistry Guidance covers these:
Non-Steroid Topical Therapy
* For inconvenient lesions with discomfort
Steroid Topical Therapy
* For disabling immunologically driven lesions
non-steroidal topical tx for oral mucosal lesions can be
4 options
chlorhexidine mouthwash
benzdamine mouthwash/spray
OTC remedies - igloo, listerine, bonjela (good for use now and then)
anything else the pt finds helpful - aloe vera (check not harming themself more e.g. aspirin, bleach)
chlorhexidine mouthwash for oral mucosal tx instructions
if necessary dilute 50% with water if needed (taste)
preferable Plain 10ml 3x day for 2-3 days
Then 2xday for another 2-3days
Lower levels of pain as well as being antiseptic/antibac
risk of dental staining if followed by heavy pigmented foods (advise last at night), risk allergy - check
benzdamine mouthwash/spray for oral mucosal tx instructions
Useful topical anaesthetic/pain relief
Advise before meal times, particularly in ulcerative lesion cases
Non steroidal anti inflammatory
possiblby psychological effect - pt finds green things help?
are steroid based topical tx of oral mucosal lesions avaible OTC?
no
3 methods of oral steroids delivery
hydrocortisone mucoadhesive pellet
betamethasone mouthwash
beclomethasone metered dose inhaler (MDI/Puffer)
* CFC-free preparations, e.g. ‘Clenil Modulite’
topical steroids
why is hydrocotisone delivered in mucoadhesive pellet and not in same way as betamethasone or beclomethasone?
lower potency than betamethasone/beclomethasone – thus needs more contact and duration to have effect
Allow tablet to dissolve over the ulcer, adhere to area by gel that forms – protects the area, give pt relief from discomfort and holds drugs in contact
topical steroid
what is a common tx for oral ulceration where immunological cause suspected?
e.g. aphthous uclers, Lichen Planus
betamethasone mouthwash
topical steroid
is betamethasone mouthwash licenced for oral ulceration?
no
supply pt with a tailored information leaflet
not designed for use in mouth
betamethsone mouthwash instructions
1mg (2 tablets) dissolved in 10mls water (2 tsp water)
* 2 mins rinsing
* Twice daily
Refrain from eating/drinking for 30 min after use
DO NOT SWALLOW
Do not rinse after use
Good as flexibility as mouthwash – can adjust concentration and frequency of rinsing, so increasing potency and effect of drug and so improve clinical effect
things to include in PIL and explain to pt when prescribing betamethasone mouthwash for oral uclers
This is an accepted and proven effective treatment for the condition
Licenced for other medical conditions
* above 12 years of age
* Use with caution below this age
Explain dose range and frequency of use
* Explain hazards of exceeding the standard dose
* Safe to use as directed without standard steroid side effects risk
* – diabetes, osteoporosis, adrenal suppression, etc
* No Steroid card needed if used properly
Add any known side effects – small oral candida risk
Add special instructions
* MUST spit out to avoid systemic steroid effects
* Do not rinse mouth after use
Example PIL on British and Irish Society for Oral Medicine BISOM
is beclomethasone MDI licenced for oral ulceration use?
no
dental prescribing for beclomethasone MDI for oral ulceration
Dental Prescribing 50mcg/puff device (any stronger – GP liaise)
Position device correctly – exit vent directly over ulcer area
* 2 puffs
* 2-4 times daily
Don’t rinse after use
* Dry powder sticks to wet mucosa, concentrated steroid delivered to small area where drug needed
* Good for isolated lesions (not widespread – use mouthwash)
Must be a Pressurised Device, NOT a breath activated device – brown not blue
items for PIL and explaination to pt for beclometasone MDI
This is an accepted and proven effective treatment for the oral condition
Licensed for other medical conditions – asthma and COPD
Instruct to discard the manufacturer’s PiL (confusion)
Explain dose range and frequency of use
* X puffs, Y times a day
Explain technique used for oral lesions – different from use for lung conditions
* Direct to area steroid required
Add any known side effects – small oral candida risk
Add special instructions
* Do not rinse mouth after use or effect will be lost
systemic tx for oral medicine by
specialists only
