page46
Prescribing in dental practice
The following is a list of topics of particular relevance to
dental surgeons.
Advice on the drug management of dental and oral
conditions has been integrated into the BNF.
For
ease of
access,
guidance on such conditions
is
usually identified by means of
a relevant
heading
(e.g.
Dental
and Orofacial
Pain)
in the appropriate
sections of the BNF.
General guidance
Prescribing by dental surgeons,
p.
6
Oral side-effects of drugs,
p.
13
Medical emergencies in dental practice,
below
Medical problems in dental practice,
p.
28
Drug management of dental and oral conditions
Dental and orofacial pain, p.
257
Neuropathic pain,
p.
272
Non-opioid analgesics and compound analgesic
preparations,
p.
257
Opioid analgesics,
p.
263
Non-steroidal anti-inflammatory drugs,
p.
631
Oral infections
Bacterial infections,
p.
321
Phenoxymethylpenicillin,
p.
333
Broad-spectrum penicillins (amoxicillin and
ampicillin),
p.
336
Cephalosporins (cefalexin and cefradine),
p.
341
Tetracyclines,
p.
347
Macrolides (clarithromycin,
erythromycin and
azithromycin), p.
352
Clindamycin,
p.
354
Metronidazole,
p.
367
Fusidic acid p.
735
Fungal infections,
p.
695
Local treatment,
p.
695
Systemic treatment,
p.
373
Viral infections
Herpetic gingivostomatitis,
local treatment,
p.
696
Herpetic gingivostomatitis, systemic treatment,
p.
392 and p.
696
Herpes labialis,
p.
739
Anaesthetics, anxiolytics and hypnotics
Anaesthesia, sedation, and resuscitation in dental
practice,
p.
776
Hypnotics,
p.
208
Peri-operative anxiolytics,
p.
783
Local anaesthesia,
p.
794
Oral ulceration and inflammation, p.
693
Mouthwashes, gargles and dentifrices, p.
697
Dry mouth, p.
698
Minerals
Fluorides,
p.
613
Aromatic inhalations, p.
203
Nasal decongestants, p.
691
Dental Practitioners’ Formulary, p.
972
Changes to Dental Practitioners’ Formulary, p.
973
Medical emergencies in dental practice
This section provides guidelines on the management of
the more common medical
emergencies which may
arise in dental practice.
Dental surgeons and their staff
should be familiar
with standard resuscitation proce-
dures, but in all circumstances it is advisable to summon
medical
assistance as soon as possible.
For
an algo-
rithm of the procedure for cardiopulmonary resusci-
tation,
see inside back cover.
The drugs referred to in this section include:
Adrenaline Injection (Epinephrine Injection),
adr-
enaline 1 in 1000,
(adrenaline 1 mg/mL as
acid
tartrate),
1-mL amps
Aspirin Dispersible Tablets 300 mg
Glucagon Injection,
glucagon (as hydrochloride),
1-
unit vial (with solvent)
Glucose (for administration by mouth)
Glyceryl Trinitrate Spray
Midazolam Buccal Liquid, midazolam 10 mg/mL
or
Midazolam Injection,
midazolam (as hydrochloride)
2 mg/mL,
5-mL amps,
or 5 mg/mL,
2-mL amps
Oxygen
Salbutamol Aerosol Inhalation, salbutamol 100 micr-
ograms/metered inhalation
Adrenal insufficiency
Adrenal
insufficiency may follow prolonged therapy
with corticosteroids
and can persist
for
years
after
stopping.
A patient
with adrenal
insufficiency may
become hypotensive under the stress of
a dental
visit
(important:
see also p.
444 for details of corticosteroid
cover before dental
surgical
procedures under general
anaesthesia).
Management
.
Lay the patient flat
.
Give oxygen (see section 3.6)
.
Transfer patient urgently to hospital
Anaphylaxis
A severe allergic reaction may follow oral or parenteral
administration of
a drug.
Anaphylactic reactions
in
dentistry may follow the administration of
a drug or
contact with substances such as latex in surgical gloves.
In general, the more rapid the onset of the reaction the
more profound it tends to be.
Symptoms may develop
within minutes and rapid treatment is essential.
Anaphylactic reactions
may also be associated with
additives
and
excipients
in foods and medicines (see
Excipients,
p.
2).
Refined arachis
(peanut)
oil,
which
may be present in some medicinal products, is unlikely
to cause an allergic reaction—nevertheless it is wise to
check the full
formula of preparations which may con-
tain allergenic fats or oils (including those for topical
application,
particularly if they are intended for use in
the mouth or for application to the nasal mucosa).
26
Prescribing in dental practice
BNF 61
Prescribing in dental practice