Drugs used in dentistry

Drugs Used
In Dentistry
By : Ahmed Ali Abbas
Babylon University
College of Dentistry

DRUGS USING IN DENTISTRY
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A
Acetaminophen
Common brand names: Tylenol and Paracetamol many others
Description: Acetaminophen relieves pain and reduces fever. However, it does not
reduce inflammation. Acetaminophen does not irritate the stomach, cause ulcers or
increase bleeding time. It is the pain reliever and fever reducer of choice for children,
because it is not linked with Reye's syndrome. It also can be used safely by people
who are allergic to aspirin or to nonsteroidal anti-inflammatory drugs (NSAIDs). It
also is safe for most people with asthma who are sensitive to aspirin or NSAIDs.
Dental uses: Acetaminophen is used to treat mild to moderate pain from dental
surgery, toothache and the temporomandibular (jaw) joint (TMJ). It often is used in
combination with narcotics. It is also used for the treatment of fever from dental
infections. Acetaminophen can be found in more than
600 medicines. Some are sold over the counter. Others
are by prescription.
Dosages for dental purposes: Dosages for dental
purposes: The recommended adult dose is 650
milligrams to 1,000 milligrams every 6 hours.
According to the U.S. Food and Drug Administration
(FDA) the maximum dose is 4,000 milligrams in 24
hours. The maker of Extra-Strength Tylenol
recommends that people take no more than 3,000
milligrams per day. This dose limit was lowered from
4,000 milligrams in response to accidental overdose concerns. The company also
plans to lower the maximum daily dose for regular strength Tylenol and other adult
products containing acetaminophen.
For more severe pain, you may need an NSAID. Examples include ibuprofen,
naproxen sodium or diflunisal. Or you may need a narcotic-combination drug.
Examples include acetaminophen with codeine, hydrocodone or oxycodone.
Maximum doses of acetaminophen also apply to the narcotic combinations. In
children, acetaminophen dosing is based on age and body weight.
Concerns and possible side effects: Tell your dentist and physician about all the
medicines you take. This should include over-the-counter vitamins and herbal
supplements. Also, let your dentist know if you have had a sensitive or allergic
reaction to any medicine. If you are pregnant or nursing, or might be pregnant, talk to
your primary care doctor before starting any new medicine. This also includes
vitamins and supplements.

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Acetaminophen is one of the best tolerated of all pain relievers used in dentistry. It
has few side effects. However, an overdose can seriously damage the liver. Do not
drink alcohol while you are taking acetaminophen. This may increase the risk of liver
damage. There is a slight chance that taking acetaminophen in doses greater than
2,275 milligrams per day may increase the blood-thinning effects of warfarin
(Coumadin). If you take warfarin, avoid taking acetaminophen for a long time, or in
large doses. Discuss this with your dentist or physician.
Tell your doctor about any reaction to a prescribed medicine, no matter how minor it
might be.
Advil or Ibuprofen
Common brand names: Advil, Nuprin, Motrin and many others
Description: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It relieves
pain, reduces fever and decreases swelling.
Dental uses: In dentistry, ibuprofen is prescribed to treat
mild to moderate pain. The pain can be from dental
surgery, toothache or the temporomandibular joint
(TMJ). A 200-milligram dose of ibuprofen in liquid-gel
form has been shown to work better than 1,000
milligrams of acetaminophen. For more severe dental
pain, 400 milligrams of ibuprofen works better than 650
milligrams of aspirin, or 650 milligrams of
acetaminophen plus 60 milligrams of codeine.
Dosages for dental purposes: The prescription for
ibuprofen after dental surgery is usually 400 milligrams every 4 to 6 hours, as needed.
Or your dentist may prescribe ibuprofen on a scheduled dosing for 2 to 3 days after
surgery. This means you would take it by the clock and not just "as needed."
As with all medicines prescribed, take as ordered for maximum benefit. The
maximum daily dose should not exceed 2,400 milligrams. For pain after surgery,
ibuprofen is usually given for fewer than 5 days.
For TMJ pain related to arthritis, higher doses (600 to 800 milligrams every 6 to 8
hours) may be needed. The maximum daily dose is 3,200 milligrams.
Daily dosing for children is based on age and body weight. Prescription dosages are
different from "over-the-counter" dosages.

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For dental uses of a week or less, ibuprofen is a very safe, well-tolerated and effective
pain reliever. Side effects include abdominal pain, nausea and increased bleeding
time. Ibuprofen is less likely to cause side effects than aspirin.
NSAIDs have some black-box warnings. These are warnings on the package insert
about possible serious side effects. For ibuprofen, these include:
 "NSAIDs are associated with an increased risk of adverse cardiovascular
events, including MI [heart attack], stroke, and new onset or worsening of pre-
existing hypertension [high blood pressure]."
 "NSAIDs may increase risk of gastrointestinal irritation, ulceration, bleeding
and perforation."
Some people may take ibuprofen for many weeks or months. For example, people
with TMJ pain may need to take this drug for a long time. With long-term use, more
serious side effects can occur. They include:
 Bleeding ulcers
 Perforations of the stomach and small intestine (in 1% to 4% of patients)
 Reduced kidney function
Blood pressure should be monitored in patients taking ibuprofen.
Ibuprofen should not be given to:
 People who are allergic to aspirin or other NSAIDs
 Certain people with asthma who are sensitive to NSAIDs — In these people,
these drugs can bring on an asthma attack.
 Pregnant women, especially during the last three months of pregnancy
 People with kidney disease
 People with ulcers of the stomach or the small intestine
Avoid drinking alcohol if you are taking ibuprofen. Alcohol increases the risk of
stomach ulcers and bleeding. Ibuprofen also may interact with other drugs, including:
 Aspirin — People taking both aspirin and ibuprofen may lose the heart-
protective effects of aspirin and increase their risk of bleeding.
 Lithium (Eskalith) — If this drug is combined with ibuprofen, it can lead to
lithium toxicity.
 Warfarin (Coumadin) and other anticoagulants — Taking these with ibuprofen
can lead to increased bleeding.
 Some high blood pressure medicines, including beta blockers, ACE inhibitors
and diuretics — Combining any of these with ibuprofen may increase blood
pressure.
These interactions can be serious. Tell your doctor about any reaction to a prescribed

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medicine, no matter how minor it might be.
Ibuprofen also comes combined with other medicines. For example, it is in over-the-
counter cold and allergy medicines and prescription drugs. Make sure to read the
ingredients of any medicine you take.
Aleve or Naproxen Sodium
Common brand names: Aleve, Anaprox
Description: Naproxen sodium is a nonsteroidal anti-inflammatory drug (NSAID). It
relieves pain, reduces fever and reduces swelling.
Dental uses: In dentistry, naproxen sodium is prescribed to treat mild to moderate
pain. The pain can be from dental surgery, toothache or the temporomandibular joint.
For minor pain, take a 220-milligram dose (that is, 1 Aleve) every 8 to 12 hours. This
is roughly equal to the pain-relieving
effects of 200 milligrams of ibuprofen
(1 Advil) every 4 to 6 hours. For more
severe dental pain, such as that after
oral surgery, 440 milligrams of
naproxen sodium (2 Aleve) has been
shown to work better than 1,000
milligrams of acetaminophen. This dose
also is at least equivalent to 400
milligrams of ibuprofen (2 Advil).
Naproxen sodium (440 to 550
milligrams) is noted for having a
relatively long-lasting effect (8 to 12 hours). Naproxen sodium may also be used for
the treatment of fever.Dosages for dental purposes: The prescription for naproxen
sodium after dental surgery is usually 440 to 550 milligrams every 8 to 12 hours, as
needed. The maximum daily dose should not exceed 1,350 milligrams on the first day
of treatment. It should not exceed 1,100 milligrams on the other days. The maximum
dose depends on several factors. These include the person's age and whether or not the
tablet is an extended-release formula. Treatment for pain after dental surgery is
usually less than 5 days.
Do not give naproxen sodium to a child under age 12 unless directed to do so by a
physician or dentist. Adults over age 65 should receive lower doses. Consult your
physician or dentist. Prescription doses are different than over-the-counter doses.
Your dentist may prescribe naproxen sodium on a scheduled dosing for 2 to 3 days
after surgery. This means you would take it by the clock and not just "as needed." As
with all medicines, take it as prescribed for maximum benefit.

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For dental uses of a week or less, naproxen sodium is a very safe, well-tolerated and
effective pain reliever. Side effects can include abdominal pain, nausea and increased
bleeding time.
about possible serious side effects. For naproxen sodium, these include:
 "NSAIDs may increase risk of gastrointestinal irritation, ulceration, bleeding
and perforation."
Some people may take naproxen sodium for many weeks or months. For example,
people with TMJ pain may need to take this drug for a long time. With long-term use,
more serious side effects can occur. They include:
 Bleeding ulcers
 Perforations of the stomach and small intestines (occurring in 1% to 4% of
patients)
 Reduced kidney function
Naproxen sodium should not be given to:
 Pregnant women, especially during the last three months of pregnancy
 People with ulcers of the stomach or the small intestine
If you take this medicine and begin to have difficulty breathing or swelling of your
face, lips, tongue or throat, get medical help right away.
Avoid drinking alcohol if you are taking naproxen sodium. Alcohol increases the risk
of stomach ulcers and bleeding. Naproxen sodium also may interact with other drugs,
including:
 Aspirin — People taking both aspirin and naproxen sodium may lose the
heart-protective effects of aspirin and increase the risk for bleeding.
 Lithium (Eskalith) — If this drug is combined with naproxen sodium, it can
lead to lithium toxicity.
 Warfarin (Coumadin) and other anticoagulants — Taking these with naproxen
sodium can lead to increased bleeding.
 Some high blood pressure medicines, including beta blockers, ACE inhibitors
and diuretics — Combining any of these with naproxen sodium may increase

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blood pressure.
 Other NSAID medicines, such as ibuprofen (Advil, Motrin and others),
diclofenac (Voltaren and others), piroxicam (Feldene), etodolac (Lodine),
meloxicam (Mobic) and nabumetone (Relafen).
 NSAID combination medicines, such as Midol Extended Relief, Combunox
and Treximet.
Amitriptyline
Brand name: Elavil
Description: Amitriptyline is a tricyclic antidepressant.
Dental uses: This drug usually is used to treat depression. Amitryptiline also helps
treat some chronic (long-term) pain. It can
work for pain around the temporomandibular
(jaw) joint. It also can be helpful for some
types of facial and mouth pain.
Dosages for dental purposes: To reduce the
chance of side effects, the dose is low at first.
The typical starting dose of amitriptyline for
chronic facial pain may be as low as 10
milligrams. It should be taken at bedtime.
The dose is slowly increased over time until
the pain lessens or disappears.
Concerns and possible side effects: Tell your
dentist and physician about all the medicines you take. This should include over-the-
counter vitamins and herbal supplements. Also, let your dentist know if you have had
a sensitive or allergic reaction to any medicine. If you are pregnant or nursing, or
might be pregnant, talk to your primary care doctor before starting any new medicine.
This also includes vitamins and supplements.
Amitriptyline can make people feel sleepy and sedated. Taking amitripityline only at
bedtime and not during the day helps avoid this side effect.
Other common side effects include dry mouth, constipation and dizziness on standing.
People with eye problems, such as narrow-angle glaucoma (increased eye pressure),
should not take this drug. It can make their glaucoma worse. Amitriptyline may raise
or lower blood sugar. It may also make you sunburn more easily. People taking
amitriptyline should not drink alcohol. The alcohol-drug combination can lead to
increased drowsiness and unconsciousness. It also can produce unsafe levels of
amitriptyline in your body.

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Certain drugs can cause amitriptyline to stay in the body longer. This leads to more
side effects. These drugs include the ulcer medicine cimetidine (Tagamet), the
antifungal drugs ketoconazole (Nizoral) and fluconazole (Diflucan), and the
antidepressants fluoxitene (Prozac) and paroxitene (Paxil). This list is not complete,
and it continues to grow. These interactions can be serious.
Amitriptyline includes something called a "black box" warning. It reads:
"Antidepressants increase the risk of suicidal thinking and behavior in children,
adolescents, and young adults (18-24 years of age) with major depressive disorder
(MDD) and other psychiatric disorders."
There is a small risk for a serious heart condition (torsade de pointes) in patients who
take amitriptyline. This condition has been seen after overdoses of drugs such as
amitriptyline.
It may take a couple of weeks, after beginning to take amitriptyline, to feel better.
Continue to take this medicine even after you begin to feel better. Stopping suddenly
may lead to withdrawal symptoms. Your doctor most likely will decrease your dose a
little at a time.
might be.
Amoxicillin with Clavulanic Acid
Common brand names: Augmentin, Amoclan, Clavamox
Description: Amoxicillin with clavulanic acid is a member of the penicillin class of
antibiotics. It is classified as extended-
spectrum. This means it can kill a wider
range of bacteria than penicillin VK. It is
better absorbed than ampicillin. It has a
longer effect than either penicillin VK or
ampicillin.
Dental uses: Amoxicillin with clavulanic
acid is used to treat some dental infections
that are resistant to other penicillins. The
clavulanic acid blocks an enzyme produced
by some bacteria. The enzyme stops some
penicillin drugs from working. Amoxicillin
with clavulanic acid is used for:
 Complicated tooth infections
 Complicated root canal infections
 Complicated abscesses, especially those extending into the sinuses, gums and
bone
 Gum infections that haven't responded to other drugs
 Placement of dental implants in the upper sinus

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In certain cases, your dentist will collect a sample of the infection and send it to a
laboratory. The laboratory can test to see whether amoxicillin with clavulanic acid is
likely to work.
Dosages for dental purposes: A typical adult dose is 250 milligrams to 500
milligrams every 8 hours. It may be prescribed for 7 to 10 days.
As with all medicines, be sure to follow your doctor's prescription. Take amoxicillin
with clavulanic acid for the prescribed length of time, even if you start to feel better.
Do not stop taking it without talking to your doctor. Stopping an antibiotic too soon
may cause bacteria to become resistant to antibiotics. This means the antibiotics won't
work the next time.
Amoxicillin with clavulanic acid can make birth control pills less effective. Therefore,
you should discuss this issue with your prescribing doctor.
Amoxicillin with clavulanic acid may cause several side effects. Nearly 10% of
patients have one or more of these side effects.
People taking blood-thinning drugs (for example, warfarin) may be more likely to
bleed while taking amoxicillin with clavulanic acid.
This medicine may cause nausea, vomiting, diarrhea and yeast infections. A mild rash
is a common side effect. It is usually not serious. But you may not be able to tell if
this is a common rash or one that is a sign of an allergic reaction. Therefore, tell your
doctor about the rash. Sometimes, amoxicillin turns the tongue black. This is known
as black hairy tongue. It often goes away.
If you are diabetic, use Clinistix or Tes-Tape (not Clinitest) to test your urine for
sugar while taking this drug. Clinitest may give a false positive reading while you are
taking a cephalosporin drug.If you are allergic to this drug or another penicillin drugs,
do not take it. Allergic reactions vary. Some people get a rash. Some have a drop in
blood pressure. In others, the airway swells and they cannot breathe.Tell your doctor
about any reaction to a prescribed medicine, no matter how minor it might be.
Amoxicillin
Common brand names: Amoxil, Trimox
Description: Amoxicillin is a member of the penicillin class of antibiotics. It is called
an extended-spectrum antibiotic. That means it can kill a wider range of bacteria than
penicillin VK. It is better absorbed than ampicillin. It works longer than penicillin VK

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and ampicillin.
Dental uses: Amoxicillin is the drug of choice for people who need antibiotics before
dental treatments. These people are at risk of developing a heart infection called
endocarditis. This is a serious bacterial infection. It may be fatal. People at risk for
this infection take antibiotics before dental treatments that tend to cause bleeding.
People at risk include those who have:
 Artificial heart valves
 A history of
endocarditis
 Certain forms of
congenital heart
disease
 A transplanted
heart that has
developed valve
disease
Bleeding can occur in
treatments that:
 Puncture or cut into
mouth tissue
 Manipulate the gums or the area around a tooth root
Some people with artificial joints of the hip, knee or elbow also are given amoxicillin
before certain dental treatments.
Amoxicillin also is given to people who have abscesses, infections around their
wisdom teeth or infections that develop after surgery.
Dosages for dental purposes: If you are at risk for developing bacterial endocarditis,
your dentist or physician will prescribe a single 2-gram dose. This is taken 30 to 60
minutes before dental treatments that are likely to cause bleeding. In people at risk for
a joint infection, the dose is taken 60 minutes before the dental treatment.
The typical adult dose for dental infections is 250 milligrams to 500 milligrams every
8 hours. It may be prescribed for 7 to 10 days.
Children are given a liquid form of amoxicillin. Their dose is based on body weight.
As with all medicines, be sure to follow your doctor's prescription. Take amoxicillin
for the prescribed length of time, even if you start to feel better. Do not stop taking it
without talking to your doctor. Stopping an antibiotic too soon may cause bacteria to
become resistant to antibiotics. This means the antibiotics won't work the next time.

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Amoxicillin can make birth control pills less effective. Therefore, you should discuss
this issue with your prescribing doctor.
People taking blood-thinning drugs, such as warfarin (Coumadin) may be more likely
to bleed while taking amoxicillin.
Amoxicillin may cause nausea, vomiting, diarrhea and yeast infections. A mild rash
occurs in about 5% to 10% of children and some adults who take amoxicillin. It is
usually not serious. But you may not be able to tell if this is a common rash or one
that is a sign of an allergic reaction. Therefore, tell your doctor about the rash.
Sometimes, amoxicillin turns the tongue black. This is known as black hairy tongue.
It often goes away.
If you are allergic to amoxicillin or another penicillin drug, do not take it. Allergic
reactions vary. Some people get a rash. Some people have a drop in blood pressure. In
others, the airway swells and makes it difficult to breathe. If you take a medicine and
begin to have difficulty breathing, get medical help right away.
might be.
Ampicillin
Common brand names: Omnipen,
Polycillin
Description: Ampicillin is a member
of the penicillin class of antibiotics. It
is an extended-spectrum antibiotic.
That means it can kill more different
types of bacteria than penicillin VK.
But this is not helpful for treating
most dental infections, and ampicillin
can lead to more side effects.
Dental uses: Ampicillin can be used
to treat:
 Tooth infections
 Endodontic (root canal)
infections
 Abscesses (especially those near both the sinuses and the gums
 Gum infections
 Periodontal disease

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Ampicillin usually is not the first choice for these infections. Dentists prefer
amoxicillin, a different extended-spectrum antibiotic. That's because amoxicillin can
by taken by mouth. Ampicillin is usually given by injection. It might be used in
people who cannot take medicines by mouth.
Ampicillin also is given to people who are at risk of developing a heart infection after
certain dental treatments. This infection is called bacterial endocarditis. This is a
serious infection. It can be fatal. People at risk for this bacterial infection take
antibiotics before dental procedures that tend to cause bleeding. People at risk include
those who have:
 A history of endocarditis
 Certain forms of congenital heart disease
 A transplanted heart that has developed valve disease
Bleeding can occur in procedures that:
 Puncture or cut into mouth tissue
People who have had a total joint replacement also may be given ampicillin before
some dental treatments. This helps prevent infections in those joints.
Dosages for dental purposes: The typical adult dose for treating a mouth infection is
250 milligrams to 500 milligrams every 6 hours. It should be given for 7 to 10 days.
As with all medicines, be sure to follow your doctor's prescription. Take ampicillin
People taking blood-thinning drugs (for example, warfarin) may be more likely to
bleed while taking amoxicillin with clavulanic acid.
Ampicillin can cause nausea, vomiting, diarrhea and yeast infections. Sometimes,
ampicillin turns the tongue a black color. This is known as black hairy tongue. It often
goes away.
A mild rash is a common side effect of ampicillin. It is usually not serious. But you
may not be able to tell if this is a common rash or one that is a sign of an allergic
reaction. Therefore, tell your doctor about the rash. People who are allergic to

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penicillin or penicillin-like drugs should not take ampicillin. Allergic reactions vary.
Some people get only a mild skin rash. Some have a drop in blood pressure. In other
people, the airway swells and they cannot breathe. If you take a medicine and begin to
have difficulty breathing, get medical help right away.
might be.
Anspor Or Cephradine
Common brand names: Anspor, Velosef
Description: Cephradine is one of the cephalosporin-type antibiotics. They are closely
related to penicillin.
Dental uses: This drug is used occasionally to treat dental infections that are resistant
to penicillin VK. However, most dental infections can be treated better and at less cost
with penicillin VK.
Cephradine is used in dentistry to prevent joint infections in certain patients. This
includes people who have had total joint replacement of the hip, knee or elbow and
are having dental procedures that are likely to cause bleeding in the mouth.
Such procedures include:
 Tooth extractions
 Gum surgery
 Professional cleanings
 Orthodontic band (not
bracket) placement
Dosages for dental purposes:
The typical adult dose of
cephradine for dental infections
is 250 milligrams to 500
milligrams every 6 hours. It
should be taken for 7 to 10 days.
The recommended dose of
cephradine for patients at risk of
joint infections is 2 grams (4
capsules of 500 milligrams
each). It should be taken 1 hour
before the dental procedure. This
single-dose regimen generally
has few side effects.
As with all medicines, follow
your doctor's prescription. Take

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cephradine for the prescribed length of time, even if you start to feel better. Do not
stop taking it without talking to your doctor. Stopping an antibiotic too soon may
cause bacteria to become resistant to antibiotics. This means the antibiotics won't
work the next time. Cephradine is more likely to produce abdominal pain, diarrhea,
nausea and vomiting than penicillin VK.
Concerns and possible side effects: Tell your dentist and doctor about all the
Cephradine is more likely to produce abdominal pain, diarrhea, nausea and vomiting
than penicillin VK. If you are diabetic, use Clinistix or Tes-Tape (not Clinitest) to test
your urine for sugar while taking this drug. Clinitest may give a false positive reading
while you are taking a cephalosporin drug.
Studies estimate that 1% to 10% of people who are allergic to penicillins are also
allergic to cephalosporins. Some people get only a mild skin rash. Some have a drop
in blood pressure. In other people, the airway swells and they cannot breathe. People
with a penicillin allergy should avoid cephalosporins or use them only with extreme
caution.
face, lips, tongue or throat, get medical help right away. Tell your doctor about any
reaction to a prescribed medicine, no matter how minor it might be.
Aspirin
Common brand names: Bayer,
Bufferin, Ascriptin and many
others.
Description: Aspirin was first
marketed in 1899. It is probably
one of the most consumed drugs in
the world. Aspirin relieves pain,
reduces fever and lessens
swelling. Aspirin also is used
(under the guidance of a
physician) to help prevent heart
attack and certain types of stroke
in at-risk people. Aspirin works to
prevent these diseases because it
interferes with the cells that cause
blood clots.
Dental uses: Aspirin is used for mild to moderate dental pain. This can include pain

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from dental surgery, toothache or the temporomandibular (jaw) joint (TMJ). It often is
used combined with narcotics. Aspirin may also be used for the treatment of fever and
inflammation related to dental problems or diseases.
Dosages for dental purposes: For mild to moderate dental pain, the recommended
adult dose is 325 milligrams to 650 milligrams every 4 to 6 hours. The maximum
daily dose is 4,000 milligrams.
For more severe pain, you may need other medicines such as nonsteroidal anti-
inflammatory drugs (NSAIDs). Examples of NSAIDS include ibuprofen, naproxen
sodium or diflunisal. Or your doctor may prescribe a drug that combines aspirin with
a narcotic. Examples include aspirin with codeine or oxycodone. The maximum dose
for aspirin also applies to the narcotic-aspirin combination drugs. If you also are
taking NSAIDs, that must be taken into account in deciding your aspirin dose and
frequency.
When normally used in dentistry (for a few days), aspirin is safe and well tolerated.
Common side effects when taking aspirin for a week or less include abdominal pain,
nausea and increased bleeding time. More serious side effects can occur with long-
term use (many weeks or months), as prescribed in the treatment of arthritis. These
include bleeding ulcers and holes in the stomach and small intestines. These problems
occur in about 4% of people taking aspirin long-term. This type of dosing also can
affect the kidneys.
Avoid drinking alcohol while you are taking aspirin. Alcohol may increase your risk
of stomach bleeding.
Aspirin should not be given to children or teenagers who have a fever and also have
signs or symptoms of chickenpox or influenza. Aspirin can cause a serious condition
called Reye syndrome. This condition can be fatal.
People who have asthma, nasal polyps and chronic sinusitis are at an increased risk of
having a reaction to aspirin or other NSAIDS. If you are on long-term low-dose
aspirin therapy to prevent heart attacks and strokes, tell your dentist. Even low-dose
aspirin use may cause more bleeding during dental surgery.
Aspirin should never be placed directly on the source of the dental pain, such as the
gums. This can cause a painful sore.
might be.

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Atarax Or Hydroxyzine
Common brand names: Atarax, Vistaril
Description: Hydroxyzine is an
antihistamine drug. It is mainly used to
treat itching caused by allergies and to
control nausea and vomiting.
Hydroxyzine also relaxes people and
makes them sleepy.
Dental uses: Hydroxyzine can be used
alone in adults to reduce anxiety.
However, it is most commonly used in
children. Dentists may use it with a drug
called chloral hydrate for sedation. The
hydroxyzine makes the chloral hydrate
work better, and also helps to prevent nausea and vomiting.
Dosages for dental purposes: The adult dose of hydroxyzine ranges from 25
milligrams to 100 milligrams. The drug is taken 1 hour before a dental procedure. In
children, hydroxyzine usually is given as a syrup. It's given 30 to 60 minutes before a
dental procedure. The dose is based on body weight.
medicines you or your child takes. This should include over-the-counter vitamins and
herbal supplements. Also, let your dentist know if you have had a sensitive or allergic
Hydroxyzine is usually tolerated well. The most common side effects are drowsiness
and a dry mouth. Adults should not operate dangerous machinery or drive for up to 24
hours after taking hydroxyzine. The drug's sedative effect can be increased if you
drink alcohol or take other drugs that depress the central nervous system.
In children, hydroxyzine may be given with chloral hydrate. This combination causes
more drowsiness, confusion and lack of coordination than either drug does alone.
Watch children closely after the dental procedure, and keep them inside for the rest of
the day.
might be.

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Azithromycin
Brand name: Zithromax
Description: Azithromycin is an antibiotic. It is related to erythromycin, but it lasts
longer.
Dental uses: Dentists use this drug for people
who are allergic to penicillins and who also
need antibiotics before dental treatment.
These people are at risk of developing
bacterial endocarditis. This is a serious heart
infection. It can be fatal. People at risk for
this bacterial infection take antibiotics before
dental treatments that tend to cause bleeding.
People at risk include those who have:
 Certain forms of congenital heart
disease
 A transplanted heart that has
developed valve disease
Bleeding can occur in treatments that:
Azithromycin also is given to people who have abscesses and other dental infections.
It is used especially for infections in the sinuses, gums and bone. Azithromycin can be
used when other antibiotics have not worked.
Dosages for dental purposes: The recommended dose for preventing endocarditis is
500 milligrams. It should be taken 30 to 60 minutes before the dental treatment. For
dental infections, the dose is 500 milligrams on the first day and 250 milligrams a day
for the next 5 days. Doses for children are based on body weight.
As with all medicines, be sure to follow your doctor's prescription. Take azithromycin
Side effects of azithromycin include diarrhea, headache, nausea, abdominal pain and
vomiting. Azithromycin costs more than erythromycin.
There is a small risk for a serious heart condition (torsade de pointes) in patients who
take azithromycin. So far, azithromycin has not been shown to cause as many drug
interactions as erythromycin or clarithromycin. If you take azithromycin and begin to

17| P a g e
have difficulty breathing or swelling of your face, lips, tongue or throat, get medical
help right away.
Azithromycin can make you sunburn more easily. Be cautious with exposure to
sunlight while taking this drug. Wear protective clothing and use sunblock when you
are outdoors. Avoid tanning beds.
might be.
B
Biaxin OR Clarithromycin
Common brand name: Biaxin
Description: Clarithromycin is a macrolide antibiotic. It is related to erythromycin.
Dental uses: The main dental use of clarithromycin is in people who are allergic to
penicillins and at risk to develop bacterial endocarditis. This is a serious heart
infection. It can be fatal. People at risk for this bacterial infection take antibiotics
before dental procedures that tend to cause bleeding. People at risk include those who
have:
 Certain forms of congenital heart disease
 A transplanted heart that develops valve disease
Bleeding can occur in procedures that:
People who have a high risk of bacterial endocarditis usually
take amoxicillin before these procedures. Clarithromycin is used
for those who are allergic to amoxicillin and other relatives of
penicillin.
Clarithromycin is also used in patients with penicillin allergies
who have dental infections. These may include abscesses,
infections around wisdom teeth and infections after dental
surgery. This drug can also be used when other drugs have not
been effective.
Dosages for dental purposes: To prevent bacterial endocarditis, the recommended
dose is 500 milligrams. It should be taken 30 to 60 minutes before the dental
procedure. For dental infections, the typical dose is 250 milligrams to 500 milligrams.
Clarithromycin should be taken every 12 hours for 7 to 10 days.

18| P a g e
As with all medicines, be sure to follow your doctor's prescription. Take
clarithromycin for the prescribed length of time, even if you start to feel better. Do not
work the next time.
Clarithromycin costs more than erythromycin. However, it is less likely to cause
abdominal pain, nausea, vomiting or diarrhea. People who take it occasionally get a
strange taste in their mouths.
People who take clarithromycin have a small risk of developing a serious heart
condition (torsade de pointes). This risk increases by an unknown amount when a
dentist gives an injection of local anesthesia that contains epinephrine or
levonordefrin. These local anesthetics should be used with caution in people taking
clarithromycin. The U.S. Food and Drug Administration also warned of another risk
in 2005. It found that death rates are higher in people with stable coronary artery
disease who use clarithromycin for 14 days or more.
Clarithromycin can have bad interactions with several different drugs. For example, it
can cause certain other drugs to build up in the body. These drugs include:
 The asthma drug theophylline (brand name, Theo-Dur)
 The blood-thinner warfarin (brand name, Coumadin)
 The "statin" cholesterol-lowering drugs such as lovastatin (brand name,
Mevacor), simvastatin (brand name, Zocor) and atorvastatin (brand name,
Lipitor)
 The headache medicine ergotamine and caffeine (brand names Cafergot,
Wigraine)
This list is not complete, and it continues to grow. These interactions can be serious
and life threatening. Tell your doctor about any reaction to a prescribed medicine, no
matter how minor it might be.
Biocef Or Cephalexin
Common brand names: Keflex, Biocef
Description: Cephalexin is one of the cephalosporin-type antibiotics. They are closely
related to penicillin.
Dental uses: This drug is used occasionally to treat dental infections that are resistant
to penicillin VK. However, most dental infections can be treated better and at less cost

19| P a g e
with penicillin VK.
Cephalexin is used in dentistry to prevent joint infections in certain patients. This
includes people who have had total joint replacement surgery and are having dental
procedures that are likely to cause bleeding in the mouth. Such procedures include:
 Tooth extractions
 Gum surgery
 Professional cleanings
 Orthodontic band (not
bracket) placement
Another group of people also may
require cephalexin. These are
people who have a high risk of
developing a serious heart
infection called bacterial
endocarditis. It can be life-
threatening. People at risk for this
infection need to take antibiotics
before certain dental procedures. For people who are allergic to penicillins or
ampicillin, cephalexin is an alternative. See important note below about allergies to
penicillins and cephalosporins.
Dosages for dental purposes: The typical adult dose of cephalexin for dental
infections is 250 milligrams to 1,000 milligrams every 6 hours. This should be taken
for 7 to 10 days. The maximum daily dose of cephalexin is 4,000 milligrams.
The recommended dose for people at risk of joint infections is 2 grams (4 capsules of
500 milligrams each). It should be taken 1 hour before the dental procedure. The
recommended dose for people at risk of endocarditis is 2 grams (4 capsules of 500
milligrams each). It should be taken 30 to 60 minutes before the procedure.
As with all medicines, follow your doctor's prescription. Take cephalexin for the
prescribed length of time, even if you start to feel better. Do not stop taking it without
talking to your doctor. Stopping an antibiotic too soon may cause bacteria to become
resistant to antibiotics. This means the antibiotics won't work the next time.
Potential side effects of cephalexin include:
 Abdominal pain
 Diarrhea

21| P a g e
 Nausea and vomiting
Studies estimate that 1% to 10% of people who are allergic to penicillins are also
allergic to cephalosporins. Some people get only a mild skin rash. Some have a drop
in blood pressure. In other people, the airway swells and they cannot breathe. People
with a penicillin allergy should avoid cephalosporins or use them only with extreme
caution.
If you are diabetic, use Clinistix or Tes-Tape (not Clinitest) to test your urine for
sugar while taking this drug. Clinitest may give a false positive reading while you are
taking a cephalosporin drug.
might be.
Biotene or Saliva Substitutes
Common brand names: Moi-Stir, Mouthkote, Saliva Substitute, Salivart, Salix, Xero-
Lube, Biotene
Dental uses: Saliva substitutes are used to relieve dry mouth (xerostomia) and dry
throat in people who have little or no natural saliva. These include people who have
had radiation therapy to the head and neck. People with Sjögren's syndrome (an
immune system disorder) also have long-term (chronic) dry mouth.
Dosage for dental purposes: Saliva substitutes come in a variety of forms. They
include liquids, sprays, gels, gums and lozenges. For best results, follow the directions
on the package. For prescription medicines, follow your doctor's orders.
supplements.
More than 400 commonly used drugs can cause
dry mouth. If a certain medicine is causing the
problem, perhaps your doctor can substitute
another medicine.
Also, let your dentist know if you have had a
sensitive or allergic reaction to any medicine. If
you are pregnant or nursing, or might be
pregnant, talk to your primary care doctor before
starting any new medicine. This also includes

21| P a g e
Long-term dry mouth increases your risk of dental decay (cavities) and yeast
infections. Saliva substitutes are one treatment. Your dentist may apply fluoride
treatments to protect your teeth from the increased risk of decay. If you take saliva
substitutes in the form of sugar-free candies, be aware that consuming large amounts
of these candies may have a laxative effect.
might be.
C
Celecoxib
Brand name: Celebrex
Description: Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). But it is a
newer type than most other NSAIDs. Celecoxib is known as a selective
cyclooxygenase-2 (COX-2) inhibitor.
The older NSAIDs include aspirin, ibuprofen, naproxen sodium and diflunisal. These
drugs inhibit two enzymes called COX-1 and COX-2. This means that they suppress
the normal action of these enzymes in the body. Inhibiting COX-2 is thought to be the
way that these drugs relieve pain, reduce fever and lessen swelling and other
symptoms of arthritis. COX-1 plays a role in protecting the lining of the stomach. The
older NSAIDS block COX-1 enzymes as well as COX-2. Side effects may include
ulcers in the stomach and intestines and bleeding.
Celecoxib inhibits COX-2 but not COX-1. Arthritis patients who take it have 50% to
60% fewer stomach and intestinal problems (such as ulcers) than people who take the
older NSAIDs.

22| P a g e
About 2% of patients who take celecoxib for 6 months to a year have ulcers and
bleeding. This rate is 4% to 6% in people who take older NSAIDs for the same
amount of time.
Bleeding ulcers can lead to a hospital stay or even death. This is the major reason that
doctors may switch patients to celecoxib.
Dental uses: Celecoxib may be prescribed to treat mild to moderate pain:
 From dental surgery
 From toothache
 In the temporomandibular (jaw) joint
Celecoxib may be preferred over older NSAIDs for some patients. They include
people who have long-term pain or osteoarthritis in the jaw joint or face. They may
need to take a pain reliever for many weeks or months.
Dosages for dental purposes: The dose of celecoxib for acute pain is 400 milligrams
on the first day. Another 200 milligrams may be added on the first day if necessary.
Afterward, the dose is 200 milligrams twice a day as needed. For arthritis, the dose is
100 milligrams to 200 milligrams per day.
Long-term use (weeks or months) may harm kidney function in some people. This
occurs as often with celecoxib as with other NSAIDs. Other side effects include:
 Headache
 Diarrhea
 Abdominal pain
 Sensitivity to sun (avoid sun exposure and tanning beds)
The celecoxib label contains "black box" warnings about potential serious side
effects. They include the following:
events, including [heart attack], stroke, and new onset or worsening of pre-
existing [high blood pressure]."
 "NSAIDs may increase risk of gastrointestinal irritation, ulceration, bleeding,
and perforation."
Avoid taking celecoxib if you:
 Are pregnant, especially during the third trimester

23| P a g e
 Are allergic to aspirin, other NSAIDs or sulfa drugs — People who are
allergic to these drugs also may be allergic to celecoxib. An allergic reaction
can be just a mild rash. Or it can lead to a life-threatening closing of the
airway and a fall in blood pressure.
 Have asthma and are sensitive to aspirin or NSAIDs — For a small percentage
of people with asthma, these drugs may cause life-threatening asthma attacks.
 Have significant kidney or liver disease
People who have had ulcers in the stomach or small intestine should use celecoxib
only with extreme caution. If you take celecoxib regularly, avoid drinking alcohol. It
can increase the risk of stomach irritation or ulcers. If you take celecoxib or
ibuprofen, have your blood pressure tested often.
Celecoxib may interact in a harmful way with other medicines. For example:
 Lithium (Eskalith), a drug for bipolar disorder, can reach toxic levels if taken
with celecoxib.
 The combination of celecoxib and warfarin (Coumadin) or other
anticoagulants can lead to bleeding.
 Some high blood pressure medicines may actually raise blood pressure when
combined with celecoxib. These include beta blockers (such as propranolol,
brand name Inderal), ACE inhibitors (such as enalopril, brand name Vasotec)
and diuretics (such as hydrochlorothiazide).
 Fluconazole (Diflucan) use may significantly increase blood levels of
celecoxib.
 Aspirin use with celecoxib can increase the risk of stomach or intestinal
problems.
might be.
Cevimeline
Brand name: Evoxac
Description: Cevimeline is in a class of drugs called cholinergic agonists. It works by
increasing the amount of saliva in the mouth.
Dental uses: Cevimeline is approved to treat the symptoms of dry mouth (xerostomia)
in patients with Sjögren's syndrome. This is a disease of the immune system.

24| P a g e
Dosages for dental purposes: The recommended dose of cevimeline is 30 milligrams,
3 times per day. The maximum dose per day is 90 milligrams.
your primary care doctor before starting any
new medicine. This also includes vitamins
and supplements.
People with long-term dry mouth have an
increased risk of dental decay and yeast
infections (thrush). They should brush and
floss daily and make regular visits to a
dentist.
Common side effects from cevimeline are:
 Headache
 Sweating
 Runny nose
 Nausea
 Diarrhea
 Chills
 Excess saliva
 Changes in vision, especially at night or in low light
People with excessive sweating should drink lots of water. People with severe or
uncontrolled asthma should not take cevimeline. It may trigger an asthma attack.
People with narrow-angle glaucoma (increased eye pressure) or acute iritis
(inflammation of the iris) also should not take this drug. It may cause them to have a
glaucoma attack. Use caution when driving at night while taking cevimeline.
Certain drugs may cause cevimeline to build up in the body. This can increase its risks
of side effects. The drugs include:
 The antibiotics erythromycin (Ery-c) and clarithromycin (Biaxin)
 Some drugs used to treat high blood pressure
 Some antidepressants
 Some medicines used for Alzheimer's disease
This list is not complete, and it continues to grow. These drug interactions can be
serious.
Cevimeline may be used with caution in patients with certain types of heart disease,
kidney stones or gallstones. Your doctor or dentist should prescribe cevimeline only
after considering your full medical history and the medicines you take.

25| P a g e
might be.
Chloral Hydrate
Common brand names: Several generics available
Description: Chloral hydrate is a sedative drug that causes sleep or sleepiness. It
comes in capsules, a liquid and suppositories.
Dental uses: Chloral hydrate is used mainly to calm children who cannot cooperate
with dental treatment. It has an unpleasant taste. It is often mixed with a fruit-flavored
drink before being given to a child.
Dosages for dental purposes: The dose of
chloral hydrate is based on the child's body
weight and the amount of desired sedation. The
dose used for mild sedation or anxiety control is
5 to 15 milligrams per kilogram of weight in
children. It is given every 8 hours. Sedation will
be deeper with doses of 20 to 50 milligrams per
kilogram of weight (1 kilogram equals 2.2
pounds). When chloral hydrate is combined
with another drug to sedate your child, lower
doses of both drugs are used.
medicines your child takes. This should include over-the-counter vitamins and herbal
supplements. Also, let your dentist know if your child has had a sensitive or allergic
reaction to any medicine.
Chloral hydrate should not be used at home. In the dental office, it should be given by
someone who knows a lot about its dosing. This person should have advanced training
in deep-sedation techniques in children. Usually this person will be a pediatric dentist,
dental anesthesiologist or oral surgeon.
Children sedated with chloral hydrate must be monitored carefully. Chloral hydrate is
generally considered a safe drug. However, overdoses have led to several deaths.
Chloral hydrate often can cause nausea and vomiting. Your dentist may decide also to
give the drug hydroxyzine (Atarax or Vistaril) to reduce this side effect. Sedation may
be increased in people who already take certain drugs that depress the central nervous
system. After the dental procedure, many children will remain drowsy, uncoordinated
and have difficulty walking without help. They may be confused for the rest of the
day. They should be well supervised and avoid any physical activities.
might be.

26| P a g e
Chlorhexidine Gluconate
Common brand names: Peridex, PerioGard and many others
Description: Chlorhexidine gluconate
is the active ingredient in some dental
rinses that kill bacteria and control the
growth of fungi in the mouth.
Dental uses: These rinses kill bacteria
that grow on dental plaque (a buildup
of bacteria and bits of food on teeth).
Chlorhexidine does not prevent plaque
or tartar (calculus) from forming.
Regular brushing and flossing help to
remove plaque. Chlorhexidine can help
to treat gingivitis (gum inflammation).
These rinses may also be prescribed
after certain types of periodontal (gum)
or oral surgery.
Dosages for dental purposes:
Chlorhexidine gluconate is often
prescribed in the 0.12% strength mouth
rinse. Swish one-half ounce (15
milliliters, or about 1 tablespoon)
around your mouth for 30 seconds. Then spit it out. Do this twice daily. Do not rinse
your mouth with water after using chlorhexidine. The rinse can be used for various
lengths of time. Some people use it for 7 to 14 days. Others use it for several months.
Some brands of chlorhexidine gluconate contain alcohol. Other brands do not.
Chlorhexidine gluconate has significant side effects. They include:
 Staining of teeth and fillings, which may be permanent
 Temporary staining of the tongue and cheeks
 Increased tartar formation
 Changes in taste
 Irritation inside the mouth
 Bitter taste after rinsing
You should be told about these potential side effects before using the rinse.

27| P a g e
A dental cleaning and smoothing of rough fillings can help to decrease the staining in
some people. Some rinses may contain up to 11% alcohol. An alcohol-free rinse may
be best for some people. These would include people with xerostomia (dry mouth) or
a history of alcohol abuse.
might be.
Ciprofloxacin
Common brand names: Cipro
Description: Ciprofloxacin is one of the fluoroquinolone class of antibiotics. It is used
to treat urinary and intestinal infections, as well as infections of the lungs, skin, bones
and joints.
Dental uses: Ciprofloxacin is not commonly
prescribed for dental infections. However, it
may be used for certain mouth or periodontal
(gum) diseases. First, a culture and
sensitivity test will be done. This will show
the best antibiotic to treat the infection. For
example, ciprofloxacin can effectively treat
rare dental infections caused by
the Enterobacteriaceae group of bacteria.
Dosages for dental purposes: The typical
adult dose is 250 milligrams to 750
milligrams every 12 hours. This dose is given for 7 to 10 days. Ciprofloxacin should
not be taken with dairy products (milk, yogurt), antacids (Tums, Rolaids, Maalox,
Mylanta, Pepto-Bismol), or iron and zinc supplements. These products may slow
down the absorption of the drug into the bloodstream.
As with all medicines, be sure to follow your doctor's prescription. Take ciprofloxacin
Nausea occurs more often with ciprofloxacin than penicillin VK. Other side effects
include:
 Diarrhea

28| P a g e
 Abdominal pain
 Headache
 Dizziness
 Rash
This drug also can make people more sensitive to the sun. Severe sunburn can occur.
People prescribed this drug should try to stay out of the sun and use sunscreens when
outside.
Ciprofloxacin also may increase blood levels of the asthma drug theophylline (Theo-
Dur). This interaction can be serious and life threatening. Ciprofloxacin may increase
blood levels of caffeine. This can be a concern for people who consume large amounts
of caffeinated drinks. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) and
ciprofloxacin together may increase the risk of seizures.
Ciprofloxacin increases the risk that you will develop tendonitis or have a tendon
rupture. It could occur during your treatment or for several months afterward. This
problem can happen to people of any age. However, the risk is highest in people over
60 years old. Call your doctor right away if you develop sudden pain, swelling,
tenderness, stiffness or movement problems in any of your joints.
might be.
Clindamycin
Common brand name: Cleocin
Description: Clindamycin is a broad-spectrum antibiotic. It works particularly well
against certain types of bacteria.
Dental uses: This drug has three main uses in
dentistry.
First, it is used in people who are allergic to
penicillins and at risk to develop bacterial
endocarditis. This is a serious heart infection. It
can be fatal. People at risk for this infection
take antibiotics before dental treatments that
tend to cause bleeding. People at risk include
those who have:
 Certain forms of congenital heart
disease

29| P a g e
 A transplanted heart that develops valve disease
Bleeding can occur in treatments that:
Clindamycin is used in place of amoxicillin in at-risk patients who are allergic to
penicillin and related drugs.
Second, clindamycin is used to help prevent joint infections in people who have had
total joint replacement surgery.
Third, it is prescribed for people with dental abscesses in bone and soft tissue that
don't respond well to penicillin VK. Oral surgeons and endodontists often prescribe it
for long-lasting infections in bone.
Dosages for dental purposes: To prevent bacterial endocarditis or joint infection, the
dose is 600 milligrams (4 tablets of 150 milligrams each). It should be taken 30 to 60
minutes before a dental treatment likely to cause bleeding. Patients generally tolerate
the one-dose regimen well. For oral infections or abscesses, the dose is 150
milligrams to 300 milligrams every 6 to 8 hours. It should be taken for at least 5 to 7
days.
As with all medicines, be sure to follow your doctor's prescription. Take clindamycin
Diarrhea and abdominal pain are more common with clindamycin than with penicillin
VK. Occasionally, people treated with clindamycin or other antibiotics develop a
severe form of bloody, mucus-filled diarrhea. This is known as pseudomembranous
colitis. It can occur during or after antibiotic treatment. It is caused by excess growth
of Clostridium difficile bacteria in the intestines. These bacteria are resistant to
clindamycin.
This type of diarrhea is not common with the dental use of clindamycin. However, it
occurs more often in people who are elderly, have a history of colitis, or take
clindamycin for a long time. Treatment often begins with stopping the antibiotic you
were taking. You will be given a different antibiotic.
The clindamycin label contains a "black box" warning. It says that this drug can cause

31| P a g e
severe and possibly fatal colitis. If you have diarrhea while taking clindamycin or up
to several months afterward, contact your dentist or physician right away.
might be.
Clotrimazole
Common brand names: Mycelex, Lotrimin
Description: Clotrimazole is an antifungal drug. It is used to treat yeast infections in
the mouth, on the skin and in the vagina. Clotrimazole is available as a troche
(lozenge) for treating fungus infections in the mouth. It is more pleasant tasting than
another drug, nystatin.
Dosages for dental purposes: The typical dose is to dissolve 1 clotrimazole lozenge
(10 milligrams) in the mouth 5 times a day. Do not chew or swallow the lozenges.
Allow them to dissolve slowly and completely. This may take 15 to 20 minutes.
Clotrimazole should be used for 14 days. A cream containing 1% clotrimazole, such
as Desenex, can be applied directly to affected areas of the skin.
As with all medicines, be sure to follow your doctor's prescription. Take clotrimazole
without talking to your doctor.
Clotrimazole can cause occasional burning,
irritation and nausea. It may also cause an
increase in certain liver enzymes in the blood.
This drug should be used with caution by
people who have liver disease or impaired liver
function.
Clotrimazole lozenges are sweetened with
sugar. People using the lozenges should be sure
to brush twice a day with fluoride toothpaste.
Some people who have a high risk of developing cavities may also be given extra
fluoride treatments while using clotrimazole lozenges. For example, they may use a
fluoride rinse after brushing their teeth.
might be.

31| P a g e
D
Diazepam
Common brand names: Valium tablets, Valium injection
Description: Diazepam relaxes people and makes them sleepy. It is sometimes used to
treat seizure and anxiety disorders.
Dental uses: Diazepam helps anxious
patients relax before and during dental
procedures. It can improve sleep the night
before a procedure. Diazepam also is used
(along with nonsteroidal anti-inflammatory
drugs) to treat muscle pain and spasm in the
temporomandibular joint (TMJ).
adult dose given by mouth is 2 milligrams to
10 milligrams. It can be taken before bedtime
to improve sleep the night before a dental
procedure. It also can be taken 1 hour before
the procedure. All patients should be given
the lowest effective dose to reduce possible
side effects. For muscle relaxation in the TMJ, the dose may be repeated 2 to 4 times
per day for up to a week.
Diazepam also can be given through a vein in the arm for conscious sedation. This
produces a very relaxed, drowsy state. This type of sedation usually is done by an oral
surgeon or dental anesthesiologist. The dose varies from patient to patient but usually
is between 2 milligrams and 10 milligrams.
When given by mouth, diazepam is very safe. But it does often cause side effects,
including:
 Forgetfulness
 Impaired thinking
 Lack of coordination
Because of these effects, and because diazepam makes you sleepy, you should not
operate machinery or drive for up to 24 hours after taking it.

32| P a g e
Occasionally, diazepam may cause a dry mouth. This goes away.
Certain groups of people should not take diazepam:
 People with narrow-angle glaucoma -- It can increase the risk of a glaucoma
attack.
 People with sleep apnea
 Pregnant women -- Diazepam can increase the risk of birth defects, especially
if it is taken in the first trimester.
Diazepam given through a vein (intravenously) can produce all of the same side
effects as diazepam given by mouth. It should be administered only by people with
advanced training in anesthesiology. These include oral surgeons and dental
anesthesiologists. Patients must be properly monitored. Monitoring will include blood
pressure, electrocardiogram (EKG) and a pulse oximeter. This measures a person's
heart rate and, indirectly, breathing. Occasionally, diazepam can impair breathing. If
you are going to have any form of intravenous sedation, ask your doctor about his or
her level of training and experience with giving anesthesia.
Intravenous diazepam may cause a temporary burning feeling upon injection. It can
cause pain near the vein, which can last for more than a week.
Anyone receiving diazepam should not drink alcohol. The combination can result in
increased sedation. This can be life threatening.
Certain other drugs may cause diazepam to accumulate in the body and increase the
risks of side effects. These include:
 The antibiotics erythromycin (Eryc) and clarithromycin (Biaxin)
 Azole antifungal drugs, such as ketoconazole (Nizoral) and fluconazole
(Diflucan)
 The ulcer/gastroesophageal reflux disease drugs cimetidine (Tagamet) and
omeprazole (Prilosec)
This list is not complete and it continues to grow. These interactions can be serious.
might be.
Denavir or Penciclovir
Brand name: Denavir
Description: Penciclovir is a prescription antiviral cream.
Dental uses: Penciclovir is used to treat cold sores (herpes on the lip). It does not cure
herpes infections. It does decrease pain and itching if applied when the symptoms first
appear. Penciclovir may be prescribed along with a separate drug in pill form (for

33| P a g e
example, valacyclovir) to treat frequent cold
sores of the lip.
Dosages for dental purposes: At the first
sign of a cold sore (tingling, burning,
itching), apply cream to the affected site.
Apply every two hours while awake. Do this
for four days. Make sure to wash your hands
before and after applying the medicine.
As with all medicines, be sure to follow your
doctor's prescription. Take penicyclovir for the prescribed length of time, even if you
start to feel better. Do not stop taking it without talking to your doctor.
Potential side effects include redness, headache, itching and numbness. Do not take
penciclovir if you are allergic to famciclovir. If you take this medicine and begin to
have difficulty breathing or swelling of your face, lips, tongue or throat, get medical
help right away.
might be.
Apply penciclovir as soon as the symptoms of a cold sore start. Otherwise, it may not
be effective.
Diflucan or Fluconazole
Brand name: Diflucan
Description: Fluconazole is an antifungal
drug. It comes as a tablet and a liquid.
Dental uses: Dentists prescribe fluconazole
for the treatment of yeast infections in the
mouth. These are also known as oral
candidiasis or thrush. Fluconazole also may
be used when thrush affects the throat. It may
be prescribed to people who have a high risk
of developing yeast infections in the mouth in
order to prevent these infections. People at
high risk include those who are taking
steroids or being treated with chemotherapy

34| P a g e
or radiation therapy before a bone marrow transplant.
Dosages for dental purposes: Fluconazole is usually prescribed for thrush starting
with 200 milligrams on the first day. This is followed by 100 milligrams per day for
14 days. Preventive dosing in at-risk patients varies.
As with all medicines, be sure to follow your doctor's prescription. Take fluconazole
without talking to your doctor. Stopping fluconazole may increase your chance of
getting an infection that is resistant to antifungal medicines.
Fluconazole may cause side effects. They may include:
 Nausea
 Vomiting
 Headache
 Dizziness or seizures — Do not drive a car or operate machinery until you
know how fluconazole affects you.
 Skin rash
 Changes in taste
Fluconazole may increase certain liver enzymes and lead to liver disease. It should be
used with caution in people who have liver or kidney disease. Some people need to
have blood tests while taking fluconazole to check for liver or kidney problems.
Fluconazole should not be used by people who are known to be allergic to other
antifungal drugs. The names of these drugs also end in "azole."
To avoid major drug interactions, tell your physician and dentists that you have taken
fluconazole before you start to take any new medicine within 7 days of receiving
fluconazole.
Fluconazole can increase the concentration of certain drugs in the body. These
include:
 The blood thinner warfarin (Coumadin)
 Cholesterol-lowering "statin" drugs, such as lovastatin (Mevacor), simvastatin
(Zocor) and others
 Benzodiazepines, such as diazepam (Valium), alprazolam (Xanax) and others
This list of drug interactions is not complete, and it continues to grow. These and
many other potential drug-drug interactions can be serious. Tell your doctor about any
reaction to a prescribed medicine, no matter how minor it might be.

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Diflunisal
Common brand names: Dolobid
Description: Diflunisal is a nonsteroidal anti-inflammatory drug (NSAID). It is in the
same family as aspirin. This drug
relieves pain, reduces fever and
lessens swelling.
Dental uses: In dentistry, diflunisal is
prescribed to treat mild to moderate
pain from dental surgery, toothache
and the temporomandibular joint
(TMJ). It may also be used in
dentistry to treat osteoarthritis of the
TMJ. The drug lasts up to 12 hours.
However, it is slow to take effect. To get around this problem, dentists usually double
the first dose. Diflunisal also may be used to treat fever.
Dosages for dental purposes: The typical prescription is a first dose of 1,000
milligrams followed by 500 milligrams every 12 hours for pain, as needed. The
maximum daily dose should not exceed 1,500 milligrams. For more severe types of
dental pain, such as pain after surgery, dentists use 500 milligrams to 1,000
milligrams of diflunisal. This works better than 650 milligrams of aspirin or
acetaminophen. It is at least as effective as Tylenol with codeine. For pain after dental
surgery, it is often prescribed for fewer than 5 days. Diflunisal is not recommended
for use in children under 12 years of age.
With short-term use (less than one week), the most common side effects of diflunisal
include abdominal pain, nausea and increased bleeding time.
about possible serious side effects. For diflunisal, these include:
 "NSAIDs may increase risk of gastrointestinal irritation, ulceration, bleeding,
and perforation."
People with osteoarthritis in the jaw or other forms of arthritis may use diflusinal for
many weeks or months. With long-term use, more serious side effects can occur.

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Some may require a hospital stay. These side effects may include:
 Bleeding ulcers and perforations of the stomach and small intestines (seen in
1% to 4% of patients)
 Problems with kidney function
People with ulcers of the stomach or the small intestine should avoid diflunisal and
most NSAID drugs. Still, when used for a few days to treat dental pain, diflunisal is
generally a safe, well-tolerated and effective pain reliever. Blood pressure should be
monitored in patients taking diflunisal.
Diflunisal should not be given to:
 Pregnant women
Avoid drinking alcohol if you are taking diflunisal. Alcohol increases the risk of
stomach ulcers and bleeding. Diflunisal may also interact with these other drugs:
 Aspirin — Taking both aspirin and diflunisal may increase the risk of
bleeding.
 The manic-depression drug lithium (Eskalith) — Combined with diflunisal, it
can lead to lithium toxicity (overdose).
 Warfarin (Coumadin) and other anticoagulants (blood thinners) — They can
lead to increased bleeding.
 Some high blood pressure medicines — These include beta blockers, ACE
inhibitors and diuretics. Combining any of these with diflunisal may increase
blood pressure.
Doxycycline (Low Dose)
Common brand names: Periostat
Description: Doxycycline is a broad-spectrum antibiotic. It is in the tetracycline
family.

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Dental uses: Low-dose doxycycline may be prescribed for up to nine months for
periodontal disease. It is used to help shrink periodontal pockets and stop bone loss.
People taking this medicine also need to receive scaling and root planing in a dentist's
office. This medicine is not a substitute for proper brushing and flossing at home.
Dosages for dental purposes: The typical dose is 20 milligrams twice a day. The drug
should be taken at least one hour before a meal, or two hours after a meal. Do not take
doxycycline (or any tetracycline) with:
 Dairy products (milk, yogurt)
 Antacids (Tums, Rolaids, Maalox, Mylanta, Pepto-Bismol)
 Iron supplements
 Zinc supplements
These products reduce the amount of doxycycline that gets into the bloodstream.
As with all medicines, be sure to follow your doctor's prescription. Take low-dose
doxycycline for the prescribed length of time.
Do not stop taking it even after you begin to
feel better. Stopping an antibiotic too soon may
cause bacteria to become resistant to
antibiotics. This means the antibiotics won't
work the next time.
Concerns and possible side effects: Tell your
dentist and physician about all the medicines
you take. This should include over-the-counter
vitamins and herbal supplements. Also, let
your dentist know if you have had a sensitive
or allergic reaction to any medicine. If you are
pregnant or nursing, or might be pregnant, talk
to your primary care doctor before starting any
new medicine. This also includes vitamins and
supplements.
Side effects include:
 Making birth control pills less effective
 Nausea
 Headache
 Common cold
 Flu-like symptoms
 Vomiting
 Stomach pain
 Diarrhea — This may be severe and may occur several months after you stop
taking doxycycline. Check with your prescribing doctor before taking any
medicine to treat diarrhea.
 Vaginal yeast infections
 Severe sunburn, if you do not protect yourself — Use sunscreen and avoid
spending a lot of time in the sun.

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These side effects are not common.
Doxycycline (and all tetracyclines) should not be given to children under 8 years old
or to pregnant women. These drugs can permanently stain teeth. They also can affect
the structure of developing teeth.
Doxycycline can cause false results in some tests for sugar in the urine. Do not change
your diet or dosage of your diabetes medicine before speaking to your physician.
might be.
Doxycycline (Regular Dose)
Common brand names: Vibramycin, Vibra-Tabs and others
Description: Doxycycline is a broad-spectrum antibiotic. It is in the tetracycline
family.
Dental uses: Doxycycline is prescribed for up to two weeks for different types of
periodontal (gum) diseases. It is sometimes given to teens as well as adults.
Dosages for dental purposes: The typical adult dose is 100 milligrams to 200
milligrams once daily for up to two weeks.
Do not take doxycycline (or any tetracycline) with:
These products reduce the amount of doxycycline that gets into the bloodstream.
As with all medicines, be sure to follow your doctor's prescription. Take regular-dose
doxycycline for the prescribed length of time, even if you start to feel better. Do not
work the next time.

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Penicillin VK often is the first drug prescribed for a gum infection. If it does not go
away, the dentist may prescribe doxycycline, which has more side effects.
Doxycycline's side effects include:
 Making birth control pills less effective
 Headache
 Common cold
 Flu-like symptoms
 Nausea
 Vomiting
 Stomach pain
 Diarrhea — This may be severe and may occur several months after you stop
taking doxycycline. Check with your prescribing doctor before taking any
medicine to treat diarrhea.
 Vaginal yeast infections
spending a lot of time in the sun.
Doxycycline (and all tetracyclines) should not be given to children under 8 years old
or to pregnant women. These drugs can permanently stain teeth. They also can affect
the structure of developing teeth.
Doxycycline can cause false results in some tests for sugar in the urine. Do not change
your diet or dosage of your diabetes medicine before speaking to your physician.
might be.
Dynacin Or Minocycline
Common brand names: Minocin, Dynacin
Description: Minocycline is a broad-
spectrum, tetracycline-type antibiotic.
Dental uses: This medicine can be given
for bacterial infections, including
periodontal (gum) disease.
adult dose is 200 milligrams for the first
dose. This is followed by 100 milligrams
every 12 hours for up to 2 weeks.
As with all medicines, be sure to follow
your doctor's prescription. Take minocycline for the prescribed length of time. Do not
stop taking it even after you begin to feel better. Stopping an antibiotic too soon may
work the next time.

41| P a g e
Do not take minocycline (or any tetracycline) with:
These products reduce the amount of drug that gets into the bloodstream.
Minocycline can make birth control pills less effective. Ask your doctor about using a
non-hormone method of birth control to prevent pregnancy while using minocycline.
These methods include condoms, spermicides or a diaphragm.
Side effects of minocycline include:
 Nausea
 Vomiting
 Stomach pain
 Diarrhea
 Vaginal yeast infections (with long-term use of the drug)
using tanning beds or spending a lot of time in the sun.
 Darkening of the skin
 Grayish areas on the gums (these are permanent)
 Discoloration of the tongue
Some patients have had vertigo or felt light-headed or dizzy while taking minocycline.
If you have any of these symptoms, don't drive a car or operate hazardous machinery.
These effects may go away as you continue to take minocycline. They usually go
away quickly when you stop taking it.
Minocycline (and all tetracyclines) should not be given to children under 8 years old
or to pregnant women. These drugs can cause permanent yellow, gray or brown stains
on teeth. They also can affect the structure of developing teeth.
might be.

41| P a g e
E
Erythromycin
Common brand names: E-mycin, Eryc
Description: Erythromycin is in a group of drugs
called macrolide antibiotics. It is often prescribed
to people who are allergic to penicillin.
Dental uses: Erythromycin is prescribed to treat:
 Dental abscesses
 Infections around wisdom teeth
(pericoronitis)
 Infections that develop after dental
surgery
Dosages for dental purposes: The typical adult dosage is 250 milligrams to 500
milligrams every 6 hours, for 7 to 10 days. Dosing for children is based on body
weight.
As with all medicines, be sure to follow your doctor's prescription. Take erythromycin
 Nausea
 Vomiting
 Abdominal pain
 Diarrhea
 Sunburning more easily — Avoid exposure to sunlight and tanning beds.
There also is a small risk for a serious heart condition called torsade de pointes. The
risk may be higher when a dentist gives injections of local anesthesia that contain
epinephrine/levonordefrin to someone who is taking erythromycin.
Erythromycin should not be taken with certain other drugs:
 The asthma drug theophylline (Theo-Dur)

42| P a g e
 The blood-thinning agent warfarin (Coumadin)
 Statins, such as lovastatin (Mevacor), simvastatin (Zocor) and atorvastatin
(Lipitor)
This list is not complete and it continues to grow. Taking erythromycin with one of
these drugs can cause a bad reaction. The erythromycin causes the other drug to build
up in the body, sometimes to dangerous levels. This can be life-threatening. Tell your
doctor about any reaction to a prescribed medicine, no matter how minor it might be.
EtheDent or Sodium Fluoride
Common brand names: PreviDent 5000 Plus, EtheDent and others
Dental uses: Dentists and physicians prescribe sodium fluoride gel to prevent cavities.
It helps to add minerals to teeth (remineralize them).
This makes teeth stronger. Fluoride also inhibits
(interferes with) the process of tooth decay.
Dosages for dental purposes: One form of sodium
fluoride gel that is often prescribed contains 1.1%
fluoride. The gel should be applied to the teeth for at
least 1 minute during brushing. Adults do this once a
day. After brushing with sodium fluoride gel, be
sure to spit it out. Then, do not rinse, eat or drink for
at least 30 minutes. Do not swallow sodium fluoride gel.
Fluoride is also available in many other forms with a physician's or dentist's
prescription. These include creams, rinses, tablets, drops/liquid, lozenges, stannous
fluoride and acidulated fluoride. Physicians and dentists prescribe fluoride pills or
liquid to children who live in areas without fluoride in public water or drink only
bottled water that does not contain fluoride. This helps to strengthen teeth as they
develop.
medicines you or your child takes. This should include over-the-counter vitamins and
herbal supplements. Also, let your dentist know if you have had a sensitive or allergic
There are not many concerns or side effects when using sodium fluoride gel properly.
It can cause nausea and/or vomiting if swallowed. Swallowing too much fluoride can
cause abnormal tooth development (fluorosis) and changes in bone. For example, this
can occur in young children who swallow toothpaste containing fluoride while
brushing.
Teach your children how to brush their teeth and spit out the excess toothpaste.
Monitor children under 6 while they are brushing. If your child is under age 3, brush
the child's teeth yourself. Avoid the use of fluoride mouth rinses in children under the

43| P a g e
age of 6 because the mouth rinse could be swallowed. The American Dental
Association, American Academy of Pediatric Dentistry and the American Academy of
Pediatrics have developed prescribing guidelines for fluoride use in children.
F
Flagyl Or Metronidazole
Common brand names: Flagyl, Metryl
Description: Metronidazole is an antimicrobial
drug. It was introduced in 1959 to treat
parasitic disease.
Dental uses: Metronidazole is usually used to
treat infections caused by anaerobic bacteria.
These are bacteria that do not require oxygen to survive. It also may be used alone to
treat a dental infection called acute necrotizing ulcerative gingivitis (ANUG). It also
may be combined with penicillin VK, amoxicillin or other antibiotics to treat infected
jaw fractures and other infections.
Dosages for dental purposes: The typical adult dose of metronidazole is 250
milligrams to 750 milligrams every 8 hours. It is prescribed for 7 to 10 days.
As with all medicines, be sure to follow your doctor's prescription. Take
metronidazole for the prescribed length of time, even if you start to feel better. Do not
work the next time.
 Nausea
 Diarrhea
 Vomiting
 Abdominal pain
 Metallic taste in the mouth
 Dry mouth
Less common side effects include irritation and ulcers of the tongue, gums and inner

44| P a g e
cheeks. Tell your doctor about any reaction to a prescribed medicine, no matter how
minor it might be.
Do not drink alcohol while taking this drug. The combination can produce headaches,
flushing of the face, heart palpitations, nausea and vomiting. You should also avoid
alcohol for three days before and after you take metronidazole.
The Food and Drug Administration (FDA) has given this drug a black-box warning.
This is a warning on the package insert about possible serious side effects. The black-
box warning for metronidazole cautions that it "has been shown to be carcinogenic
[cancer-causing] in mice and rats." It recommends using the drug only as needed.
Metronidazole can increase the toxicity of certain drugs, including the manic-
depressive medicine lithium (Eskalith) and the blood-thinning agent warfarin
(Coumadin). Metronidazole can also interact with medicines used to lower
cholesterol. These and other potential drug interactions can be serious.
Floxin See Ciprofloxacin
Fluconazole See Diflucan
Percocet See Oxycodone
G
Glycopyrrolate
Common brand names: Robinul, Robinul-Forte
Dental uses: Glycopyrrolate is used to dry the mouth before certain dental procedures.
It also can be used to help with sedation.
Dosages for dental purposes: The typical adult dosage is 1 milligram to 2 milligrams.
It is given 45 minutes to 1 hour before the dental procedure.
The most common side effects of glycopyrrolate are:
 Decreased sweating
 Increased heart rate
 Blurred vision
 Dry mouth
 Drowsiness

Drugs used in dentistry

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