Doxy-Caps
Doxycycline (Regular Dose)
Common brand names: Vibramycin, Doxy-Caps.
Description: Doxycycline is a broad-spectrum, tetracycline-type antibiotic.
Dental uses: Doxycycline typically is prescribed for up to two weeks for different types of periodontal (gum) diseases, including periodontal disease in adolescents (juvenile periodontitis).
Dosages for dental purposes: The typical adult dose is 50 milligrams to 100 milligrams every 12 hours for up to two weeks. Doxycycline (and all tetracyclines) must not be ingested with dairy products (milk, yogurt), antacids (Tums, Rolaids, Maalox, Mylanta, Pepto-Bismol), or iron and zinc supplements, because these products greatly inhibit the absorption of tetracyclines from the gastrointestinal tract into the bloodstream.
Concerns and possible side effects: Doxycycline, like all tetracyclines, has a much higher incidence of side effects such as nausea, vomiting, abdominal pain, diarrhea and yeast infections (in women)compared with penicillin VK. Occasionally, doxycycline temporarily turns the tongue a black color, a condition known as black hairy tongue.
In addition, doxycycline and all tetracyclines should not be prescribed to children under 8 years or to pregnant women, because they can permanently stain the teeth of the growing child or fetus. Also, severe sunburn (photosensitivity) can occur in up to 10 percent of patients prescribed tetracyclines, including doxycycline, if adequate measures of sun protection (avoiding prolonged sun exposure and using sunscreens) are not undertaken.
Dolobid
Diflunisal
Common brand names: Dolobid
Description: Diflunisal is a nonsteroidal anti-inflammatory drug (NSAID) that relieves pain, reduces fever and lessens swelling and other symptoms of arthritis.
Dental uses: In dentistry, diflunisal is employed to treat pain from dental surgery, toothache and the temporomandibular joint. It is a popular drug among periodontists because of its very long duration of action, up to 12 hours. However, it is slow to take effect. To get around this problem, dentists usually double the first dose.
Dosages for dental purposes: The typical prescription is a first dose of 1,000 milligrams (two Dolobids) followed by 500 milligrams every 12 hours for pain, as needed. The maximum daily dose should not exceed 1,500 milligrams on day one and 1,000 milligrams on all subsequent days. In more severe types of dental pain such as oral surgery, 1,000 milligrams of diflunisal is superior to 650 milligrams of aspirin or acetaminophen and has at least equivalent analgesic effects to 600 mg of acetaminophen plus 60 milligrams of codeine (that is, two Tylenol #3s) or 650 milligrams acetaminophen plus 100 milligrams propoxyphene (that is, one Darvocet N-100). Diflunisal currently is not recommended for use in children. The duration of therapy for post-surgical pain varies but is usually less than five days.
Concerns and possible side effects: With short-term use (less than one week), the most common side effects include abdominal pain, nausea and increased bleeding time, with incidences about equal to those of aspirin. Diflunisal also occasionally causes a dry mouth (xerostomia). With chronic dosing (many weeks or months), as employed in the treatment of arthritis, more serious side effects can occur, often requiring hospitalization. These may include bleeding ulcers and perforations of the stomach and small intestines (seen in 1 percent to 4 percent of patients) and impairment of kidney function. Still, under the typical dental-usage scenario of a few days at most, diflunisal is generally a safe, well-tolerated and effective analgesic.
Patients allergic to aspirin or other NSAIDs (ibuprofen, naproxen sodium and many others) should avoid diflunisal. Allergic reactions can range from a mild rash to life-threatening closure of the airway and a fall in blood pressure. In addition, about 5 percent to 10 percent of patients with asthma cannot tolerate aspirin, diflunisal, related NSAIDs, or COX-2 inhibitors because they will precipitate asthmatic attacks in these so-called aspirin- or NSAID-sensitive asthmatics, which can be life threatening.
Patients with ulcers of the stomach or the small intestine should avoid diflunisal. Patients should avoid alcohol consumption during diflunisal therapy for dental pain because alcohol increases the risk of stomach ulcers and bleeding. Other drugs with which diflunisal may adversely interact include:
The manic-depression drug lithium (Eskalith), which when combined can lead to lithium toxicity
Warfarin (Coumadin) and other anticoagulants, which can lead to bleeding
Oral drugs for diabetes (ie, Diabinase and Orinase), which can lead to low blood sugar
Some high blood pressure medications, including beta blockers (propranolol, brand name Inderal), ACE inhibitors (enalapril, brand name Vasotec), and diuretics (hydrochlorothiazide, brand name Hydrodiuril). Combining any of these with diflunisal may cause elevations in blood pressure.
These interactions can be serious, so it is imperative to inform your dentist of all medications you are taking.
Diflunisal
Common brand names: Dolobid
Description: Diflunisal is a nonsteroidal anti-inflammatory drug (NSAID) that relieves pain, reduces fever and lessens swelling and other symptoms of arthritis.
Dental uses: In dentistry, diflunisal is employed to treat pain from dental surgery, toothache and the temporomandibular joint. It is a popular drug among periodontists because of its very long duration of action, up to 12 hours. However, it is slow to take effect. To get around this problem, dentists usually double the first dose.
Dosages for dental purposes: The typical prescription is a first dose of 1,000 milligrams (two Dolobids) followed by 500 milligrams every 12 hours for pain, as needed. The maximum daily dose should not exceed 1,500 milligrams on day one and 1,000 milligrams on all subsequent days. In more severe types of dental pain such as oral surgery, 1,000 milligrams of diflunisal is superior to 650 milligrams of aspirin or acetaminophen and has at least equivalent analgesic effects to 600 mg of acetaminophen plus 60 milligrams of codeine (that is, two Tylenol #3s) or 650 milligrams acetaminophen plus 100 milligrams propoxyphene (that is, one Darvocet N-100). Diflunisal currently is not recommended for use in children. The duration of therapy for post-surgical pain varies but is usually less than five days.
Concerns and possible side effects: With short-term use (less than one week), the most common side effects include abdominal pain, nausea and increased bleeding time, with incidences about equal to those of aspirin. Diflunisal also occasionally causes a dry mouth (xerostomia). With chronic dosing (many weeks or months), as employed in the treatment of arthritis, more serious side effects can occur, often requiring hospitalization. These may include bleeding ulcers and perforations of the stomach and small intestines (seen in 1 percent to 4 percent of patients) and impairment of kidney function. Still, under the typical dental-usage scenario of a few days at most, diflunisal is generally a safe, well-tolerated and effective analgesic.
Patients allergic to aspirin or other NSAIDs (ibuprofen, naproxen sodium and many others) should avoid diflunisal. Allergic reactions can range from a mild rash to life-threatening closure of the airway and a fall in blood pressure. In addition, about 5 percent to 10 percent of patients with asthma cannot tolerate aspirin, diflunisal, related NSAIDs, or COX-2 inhibitors because they will precipitate asthmatic attacks in these so-called aspirin- or NSAID-sensitive asthmatics, which can be life threatening.
Patients with ulcers of the stomach or the small intestine should avoid diflunisal. Patients should avoid alcohol consumption during diflunisal therapy for dental pain because alcohol increases the risk of stomach ulcers and bleeding. Other drugs with which diflunisal may adversely interact include:
The manic-depression drug lithium (Eskalith), which when combined can lead to lithium toxicity
Warfarin (Coumadin) and other anticoagulants, which can lead to bleeding
Oral drugs for diabetes (ie, Diabinase and Orinase), which can lead to low blood sugar
Some high blood pressure medications, including beta blockers (propranolol, brand name Inderal), ACE inhibitors (enalapril, brand name Vasotec), and diuretics (hydrochlorothiazide, brand name Hydrodiuril). Combining any of these with diflunisal may cause elevations in blood pressure.
These interactions can be serious, so it is imperative to inform your dentist of all medications you are taking.
Diazepam
Common brand names: Valium Tablets, Valium Injection
Description: Diazepam is classified as an antianxiety, sedative and hypnotic drug; it relaxes the patient, makes him or her drowsy and induces sleep.
Dental uses: Diazepam is used in dentistry to help anxious patients relax before and during dental procedures and also to improve sleep in anxious patients the night before a dental procedure. Diazepam is also used (in conjunction with nonsteroidal anti-inflammatory drugs) to treat muscle pain and spasm in the temporomandibular joint region.
Dosages for dental purposes: When given by mouth (orally), the typical adult dose can range from 2 milligrams to 10 milligrams. The dose can be administered right before bedtime to improve sleep the night before the dental procedure and then repeated one hour prior to the dental procedure to relax and sedate the patient.
For muscle relaxation in the temporomandibular region, the dose is repeated three to four times per day for up to a week. Diazepam also can be administered intravenously (through a vein in the arm) for conscious sedation (which produces a very relaxed, drowsy state), usually by an oral surgeon or dental anesthesiologist. The intravenous dose varies from patient to patient but usually is in the range of 2 milligrams to 20 milligrams given immediately before the procedure.
Concerns and possible side effects: When given by mouth, diazepam and related benzodiazepines (that is, triazolam) are considered very safe. However, drowsiness, forgetfulness, impaired thinking and lack of coordination frequently occur. Therefore patients should not operate machinery or drive automobiles for up to 24 hours after taking diazepam.
Occasionally, diazepam may temporarily cause a dry mouth (xerostomia) or turn the tongue a black color, a condition known as black hairy tongue.
Patients with narrow-angle glaucoma (increased pressure in the eye) should not take diazepam or related benzodiazepines (such as triazolam or midazolam) because these drugs can precipitate a glaucoma attack. Pregnant women should not receive diazepam or related benzodiazepines because these drugs, especially when taken in the first trimester, increase the risk of birth defects.
Intravenous diazepam can produce all of the same side effects as oral diazepam. It should be administered only by practitioners with advanced training in anesthesiology (typically oral surgeons and dental anesthesiologists). Patients must be properly monitored with a device known as a pulse oximeter, which measures heart rate and how well the patient is breathing. This is because, occasionally, intravenous diazepam can impair breathing. Patients who are to undergo any form of intravenous sedation are encouraged to ask their doctor about their level of training and experience with these techniques.
Intravenous diazepam also can cause a burning feeling on injection, and irritation (pain) around the vein that can last for more than a week. Patients should not drink alcohol during diazepam therapy because the combination can increase the severity of drowsiness, forgetfulness, impaired thinking and lack of coordination, and possibly lead to unconsciousness.
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 medications cimetidine (Tagamet) and omeprazole (Prilosec)
This list is not complete and it continues to grow. These interactions can be serious, so it is imperative to inform your dentist of all medications you are taking.
Dentinox
Dentinox Teething Gel
How to use the gel
Put a small amount of gel on a clean fingertip or pad of cotton wool. Rub the gel gently onto baby’s gum. Repeat after 20 minutes if necessary. Use when necessary during baby’s teething period.
These milk teeth generally start to push I through between six and nine months
A teething baby may have discomfort, be irritable and salivate a lot
Baby may put his hand in his mouth to touch his sore gums
Dentinox Teething Gel numbs the pan and helps to stop any infection
Dentinox Teething Gal can be used every 20 minutes if necessary
It contains Lidocaine hydrochloride 0.33% w/w which is a local anaesthetic, and cetylpyridinium chloride 0.1% w/w which is a disinfectant.
It also contains sorbitol solution 70% (non-crystallising), xylitol, ethanol, glycerol, hydroxyethylcellulose, polyethoxylated castor oils, pharmaceutical liquid flavour, hydroxypolyethoxydodecane, macrogol 300, sodium saccharin, caramel (El 50), menthol and water.
What about side effects?
There are no known side effects from Dentinox Teething Gel. However, if you think the gel is causing baby any problems, tell your health visitor, pharmacist or doctor.
What is Dentinox Teething Gel for?
Relieving pain from teething
How to store Dentinox Teething Gel
Do not store above 25°C
Do not use after the expiry date shown on the pack
Keep all medicines out of the sight and reach of children
Darvon
Propoxyphene
Common brand names: Propoxyphene is a narcotic pain reliever found in
Darvon, Darvocet N-100 and Darvon Compound-65.
Description: Propoxyphene is chemically unrelated to the codeine derivatives (codeine, hydrocodone or oxycodone). Propoxyphene is available as two preparations: propoxyphene hydrochloride (HCl) and propoxyphene napsylate. Approximately 65 milligrams of propoxyphene hydrochloride is equal to 100 milligrams of propoxyphene napsylate in terms of pain relief and side effects, with both preparations being equivalent to or slightly weaker than 60 milligrams of codeine.
When used alone at these dosages (as in Darvon), the analgesic effect is inferior to two aspirin or two Tylenol. Propoxyphene is most effective when it is combined with acetaminophen (as in Darvocet N-100) or aspirin (as in Darvon Compound-65).
Dental Uses: Propoxyphene is most commonly prescribed for relief of pain following dental surgery and for temporary relief of toothache.
Dosages for dental purposes: Generally effective prescriptions of propoxyphene include acetaminophen 650 milligrams plus propoxyphene napsylate 100 milligrams (Darvocet N-100), one tablet every four to six hours; or aspirin 389 milligrams, caffeine 32.4 milligrams and propoxyphene hydrochloride 65 milligrams (Darvon Compound-65), one tablet every four hours.
Concerns and possible side effects: Propoxyphene and other oral narcotics (codeine, hydrocodone and oxycodone) produce a relatively high incidence of dizziness, drowsiness, nausea, vomiting and constipation. Dental patients prescribed drugs containing oral narcotics should not operate dangerous machinery or drive automobiles. Alcohol consumption must be avoided while taking narcotics because the combination greatly increases the risk of drowsiness, impaired thinking and unconsciousness. Alcohol consumption also increases the risk for stomach bleeding and ulcers (from aspirin/propoxyphene combinations) and liver damage (from acetaminophen/propoxyphene combinations).
Short-term use of narcotic analgesics (a few days) for post-surgical dental pain does not lead to drug addiction. Concern among some health professionals about the ability of chronic narcotic therapy (of weeks or months duration) to lead to addiction in some patients is largely unfounded, but it is still the subject of debate.
Patients with allergies to acetaminophen should not consume Darvocet N-100, while those allergic to aspirin should avoid Darvon Compound-65. Allergic reactions can range from a mild rash to life-threatening closure of the airway and a fall in blood pressure.
Codeine
Codeine
Dental uses: Codeine is a narcotic analgesic (pain-relieving drug) that is most effective for dental pain when given in combination with acetaminophen (as in Tylenol #3) or aspirin (as in Empirin #3). It is most commonly prescribed for relief of pain following dental surgery, and for temporary relief of toothache. It occasionally is prescribed for chronic pain of the jaw (temporomandibular joint pain) or face. Codeine preparations are available in four strengths: #1 is 7.5 mg, #2 is 15 mg, #3 is 30 mg and #4 is 60 mg.
Dosages for dental purposes: Examples of generally effective prescriptions include 300 mg acetaminophen plus 30 mg codeine (Tylenol #3), two tablets every four to six hours as needed for pain; or 325 mg aspirin plus 30 mg codeine (Empirin #3), two tablets every four to six hours as needed for pain. Patients take the codeine combinations for varying lengths of time, but it usually is fewer than five days following surgery.
Concerns and possible side effects: Codeine and other oral narcotics such as hydrocodone, oxycodone and propoxyphene produce a relatively high incidence of dizziness, drowsiness, nausea, vomiting and constipation in dental-surgery patients.
Dental patients prescribed drugs containing oral narcotics should not be operating dangerous machinery or driving automobiles. Alcohol also must be avoided while taking narcotics because the combination greatly increases the risk of drowsiness, impaired thinking and unconsciousness. Alcohol consumption also increases the risk of stomach bleeding and ulcers from aspirin/codeine combinations and liver damage from acetaminophen/codeine combinations.
Short-term use of narcotic analgesics (a few days) for post-surgical dental pain does not lead to drug addiction. Concern among some health professionals about the ability of chronic narcotic therapy (of weeks or months duration) to cause addiction in some patients is largely unfounded, but is still the subject of debate.
Patients with allergies to acetaminophen should not consume preparations of Tylenol with codeine, and those with allergies to aspirin should not consume preparations of Empirin with codeine. Allergic reactions can range from a mild rash to life-threatening closure of the airway and a fall in blood pressure.
Clotrimazole
Common brand names: Mycelex, Lotrimin.
Description: Clotrimazole is an antifungal drug best known for treating vaginal yeast infections in women.
Dental uses: Clotrimazole is available as a troche (lozenge) for treating fungal infections in the mouth. It is considered by some to be the drug of choice for the treatment of candidal fungal infections (thrush) in the mouths of some patients with AIDS. It is pleasant tasting and far more palatable than nystatin.
Dosages for dental purposes: The typical dose is to dissolve one 10-milligram clotrimazole troche in the mouth five times per day for 14 days. A 1-percent clotrimazole ointment can be applied directly to the involved oral tissues four times per day for denture stomatitis.
Concerns and possible side effects: Clotrimazole can cause occasional burning and irritation on application, and occasional nausea.
Cleocin
Clindamycin
Common brand name: Cleocin.
Dental uses: Clindamycin is a broad-spectrum antibiotic, particularly effective against certain types of bacteria. It has three main uses in dentistry.
First, it is used in patients who are at risk of developing bacterial endocarditis, a serious and potentially fatal heart infection, following dental procedures likely to induce mucosal or gingival bleeding. Such procedures include dental extractions, periodontal surgery, professional cleanings, orthodontic band (not bracket) placement and some other procedures. Patients considered at risk are those with prosthetic heart valves, those with mitral valve prolapse with valvular regurgitation (a heart murmur with leaky valves) and those who previously contracted endocarditis, in addition to people with some other cardiac conditions.
Second, clindamycin is used to prevent joint infections in certain patients with prosthetic joints of the hip, knee and elbow.
Third, it is prescribed for patients with dental abscesses in bone and soft tissue that don’t respond adequately to penicillin VK or erythromycin-type drugs. It is a popular drug among oral surgeons and endodontists for chronic infections in bone.
Dosages for dental purposes: For patients at risk for endocarditis or joint infection, the recommended dose is 600 mg (two 300-mg tablets) one hour before a dental procedure likely to cause bleeding. Patients generally tolerate the one-dose regimen well.
Concerns and possible side effects: Diarrhea and abdominal pain are more common with clindamycin than penicillin VK. A severe form of bloody, mucus-filled diarrhea, known as pseudomembranous colitis, occasionally occurs during or several weeks after clindamycin therapy or therapy with other antibiotics. It is caused by an overgrowth of a clindamycin-resistant bacterium, Clostridium dificile, in the intestinal tract. This type of diarrhea requires hospitalization and antibiotic treatment (usually with metronidazole or vancomycin). This event, while relatively uncommon with the dental use of clindamycin, occurs more frequently in the elderly and in those patients with a previous history of colitis.
Patients who experience diarrhea during or up to several weeks after clindamycin therapy should immediately contact their dentist or physician.
Clarithromycin
Common brand name: Biaxin.
Dental uses: Clarithromycin is an antibiotic related to erythromycin. Its main use in dentistry is in patients who are allergic to penicillins and who are at risk of developing bacterial endocarditis, a serious and potentially fatal heart infection, following dental procedures likely to induce mucosal or gingival bleeding. Such procedures include dental extractions, periodontal surgery, professional cleanings, orthodontic band (not bracket) placement and some other procedures. Patients considered at risk are those with prosthetic heart valves, those with mitral valve prolapse with valvular regurgitation (a heart murmur with leaky valves) and those who previously contracted endocarditis, in addition to people with some other cardiac conditions.
Clarithromycin also is used in patients with allergies to penicillins who have dental infections, including abscesses, infections around third molars and infections after dental surgery. It also is used in patients in whom other drugs have proved ineffective.
Dosages for dental purposes: For patients at risk for endocarditis, the recommended dose is 500 milligrams one hour before the dental procedure. For patients with dental infections, the typical dose is 250 milligrams to 500 milligrams every 12 hours for seven to 10 days.
Concerns and possible side effects: Although more expensive than erythromycin, clarithromycin is better tolerated with respect to gastrointestinal complaints (abdominal pain, nausea, vomiting and diarrhea). It does occasionally produce abnormal taste sensations.
In addition, like erythromycin, clarithromycin causes the accumulation of a number of drugs in the body if taken concurrently. These include:
The asthma drug theophylline (brand name, Theo-dur)
The non-sedating antihistamines terfenadine (brand name, Seldane) and astemizole (brand name, Hismanal)
The blood-thinning agents warfarin and dicumarol (brand name, Coumadin)
The “statin” cholesterol-lowering drugs such as lovastatin (brand name, Mevacor), simvastatin (brand name, Zocor) and atorvastatin (brand name, Lipitor)
This list is not complete, and it continues to grow. These interactions with clarithromycin are potentially serious and life threatening. It is imperative to inform your dentist of all medications you are currently taking to avoid serious drug interactions.