The Dentist's Drug and Prescription Guide

Mea Weinberg, DMD, MSD, RPh, is a practicing periodontist and licensed pharmacist, giving her a unique position in the fields of dentistry and pharmacology. She is a clinical associate professor of Periodontology and Implantology at New York University.

Stuart J. Froum, DDS is a Diplomate of the American Board of Periodontology, Clinical Professor and Director of Clinical Research at the Department of Periodontology and Implant Dentistry, New York University Krieser Dental Center. He maintains a Private Practice limited to Periodontics and Implant Dentistry in New York City.  He has lectured nationally and internationally, has authored over 100 published research articles, and authored and contributed to five books related to periodontics and implant dentistry. He is the editor of the book “Dental Implant Complications: Etiology, Prevention and Treatment”. Dr. Froum is President Elect of the American Academy of Periodontology.

Contributors xiii

1 Introduction to pharmacology 1

I. Definition of terms 1

II. Pharmacokinetics 3

III. Pharmacodynamics 6

2 The prescription and drug names 9

I. Parts of a prescription 9

II. Generic substitution 10

III. Controlled drugs 11

IV. Principles of prescription writing 13

V. How to avoid prescription errors 19

3 Drug dosing 23

I. Basic principles of drug dosing 23

II. Pediatric patient 26

a. Penicillin VK oral suspension 27

b. How is the dose calculated if the child could swallow tablets? 27

Penicillin VK tablets 27

c. If amoxicillin were to be prescribed 28

Amoxicillin oral suspension 28

Amoxicillin chewable tablets 28

Amoxicillin capsules 29

d. Azithromycin 30

Oral suspension 30

Azithromycin tablets 30

e. Clindamycin 30

Clindamycin oral solution 30

Clindamycin capsules 30

III. Pregnant and nursing patients 31

IV. Elderly patient 35

V. Renal-impaired patient 35

VI. Hepatic-impaired patient 37

4 Formulary sections 41

I. Antimicrobials, systemic 41

a. General considerations 41

b. Antibiotics 45

Beta-lactam antibiotics 45

Cephalosporins 48

Erythromycins 49

Lincomycins 52

Metronidazole 53

Tetracyclines 54

Fluoroquinolones 56

c. Specific instructions for taking antibiotics 58

II. Antimicrobials, local 59

a. Chlorhexidine gluconate 59

b. Other mouthrinses and periodontal health products 63

III. Controlled-release drug delivery 64

IV. Antivirals/antifungal agents 65

a. Antiviral agents 65

b. Antifungal agents 68

V. Prescribing for pain control 72

a. General considerations 72

b. Aspirin 72

c. Nonsteroidal anti-inflammatory drugs (NSAIDs) 74

d. Acetaminophen 80

e. Narcotic (opioid) analgesics 83

f. Management plan for acute dental pain 90

VI. Moderate sedation 94

a. Benzodiazepines 95

b. Other agents 96

VII. Glucocorticosteroids 97

a. Topical glucocorticosteroids 97

b. Other nonsteroidal topical agents used in the management of oral lesions 100

c. Systemic corticosteroids 100

5 How to manage potential drug interactions 105

I. Introduction to drug interactions 105

II. Antibiotic-drug interactions in dentistry 110

III. Analgesic-drug interactions in dentistry 116

IV. Sympathomimetic agents and drug interactions in dentistry 119

V. Anti-anxiety drug interactions in dentistry 122

6 Evidence-based theory for drug prescribing 125

I. General considerations 125

II. Prescribing for inflammatory periodontal diseases and periodontal surgical procedures 127

a. Gingivitis 127

b. Chronic periodontitis 127

c. Ulcerative periodontal diseases 129

d. Refractory and recurrent periodontitis 130

e. Aggressive periodontitis 131

f. Periodontal therapy 132

Periodontal flap surgery: pocket reduction 132

Bone/bone substitutes grafting procedures 133

Periodontal regenerative surgery: Guided tissue regeneration (GTR) 134

III. Prescribing for dental implant surgery 135

a. Prescribing for sinus floor elevation surgery 136

IV. Prescribing for oral surgery 139

V. Prescribing for odontogenic infections 139

a. Prescribing for endodontic abscess 140

b. Prescribing for periodontal abscess 145

7 Management of the medically compromised dental patient 149

I. American Heart Association (AHA) guidelines for antibiotic prophylaxis 149

a. Prevention of infective endocarditis: Antibiotic prophylaxis for the dental patient 149

II. Antibiotic prophylaxis for total joint replacement 152

III. Cardiovascular diseases 155

a. Hypertension 155

b. Angina and other ischemic cardiac conditions 162

c. Congestive heart failure 163

d. Patient on low-dose aspirin and other antiplatelet drugs 163

e. Anticoagulated patient (patient taking warfarin or heparin) 168

f. Low-molecular-weight heparins (LMWHs) 171

g. Myocardial infarction 171

h. Cardiac arrhythmias 172

i. Valvular heart disease 172

IV. Pregnant and postpartum patient 174

V. Adrenal suppression and thyroid disease 175

VI. Asthma 176

VII. Diabetes mellitus 178

VIII. Psychiatric/neurological disorders 180

IX. Organ transplant 181

X. Liver disease 186

XI. Chronic kidney disease 187

XII. Recreational and illicit drugs 189

XIII. Bisphosphonates 191

XIV. Tuberculosis 197

XV. Bariatric surgery 198

XVI. Pheochromocytoma 200

8 Herbal and natural remedies 205

I. Herbal–drug interactions 205

II. Implications in dentistry 206

Appendix 1 209

Smoking cessation therapy 209

Appendix 2 215

Oral manifestation of drugs 215

Appendix 3 219

American Heart Association antibiotic prophylaxis guidelines 219

Appendix 4 221

List of tables 221

Appendix 5 223

Pharmacology pearls in dental practice 223

Appendix 6 225

Dental drug formulary 225

Analgesics 225

Non-narcotics 225

Narcotics 225

Antibiotics 225

Penicillins 225

Erythromycins 225

Lincomycins 226

Tetracyclines 226

Fluoroquinolones 226

Others 226

Topical antimicrobials 226

Antifungal agents 226

Antiviral agents 226

Index 227

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