Dental Medications

There are several types of medications that are used to manage a variety of diseases involving the oral cavity (mouth) that are part of good dental care. The medications discussed in this article have pharmacological properties that are used to treat conditions such as pain, anxiety, and infections, amongst others.

It is important to always communicate all dental signs and symptoms to your dentist, so that appropriate management and choice of medications can be made.

One of the most commonly reported dental complications involves various levels of pain. Due to this fact, pain management is an important goal for all dentists and patients.

Non-narcotic analgesics are the most commonly used drugs for relief of toothache or pain following dental treatment as well as fever. The commonly-used medications used are:

• ibuprofen (Advil, Nuprin, Motrin), acetaminophen (Tylenol), and aspirin (for example, Bayer);
  
  
• corticosteroids such as Orabase-HCA, Oracort, and Oralone are anti-inflammatory medications that are used to relieve discomfort and redness of the mouth;
  
  
• and for severe pain conditions, narcotic analgesics such as codeine or hydrocodone (Vicodin) may be given. Codeine formulations usually include acetaminophen for increased efficacy, for example, Vicoprofen and Tylenol #3.

Note: Ibuprofen occasionally causes xerostomia (dry mouth) that may increase oral plaque and dental caries (cavities).

Topical anesthetics come in ointments, sprays, or liquids. Topical anesthetics are used to prevent pain on the surface level of the lining of the mouth. They also can be used to reduce pain from superficial sores in the mouth or to numb an area before an injectable local anesthetic is given.

• Commonly used topical anesthetics include Anbesol and Orajel.
• Local anesthetics are injected into the deeper tissues of the mouth and work by inhibiting the impulses from pain-sensing nerves and hence are used to reduce pain especially in procedures involving drilling, and cutting of the tissue. Common local anesthetics are 2% lidocaine hydrochloride and 2% mepivacaine (Carbocaine).
• General anesthetics are inhaled and include anti-anxiety agents, such as nitrous oxide, that help to ensure relaxation during dental visits and often may be used along with local anesthetics.

Note: Anesthetics are used for temporary pain relief, and should not be used for long durations of time.

Dental infections include infections that develop after dental surgery, for example:

• periodontal infections,
• dental abscesses,
• infections around wisdom teeth, and
• other conditions.

Antibiotics such as penicillin and amoxicillin (Amoxil) are used for a variety of infections that may result after dental procedures. Erythromycin (Benzamycin, Emgel, Ery, Ilotycin, Staticin) is usually prescribed when patients have allergies to penicillin or amoxicillin (Amoxil).

• Clindamycin (Cleocin HCL) often is used in the treatment of serious infections caused by susceptible anaerobic bacteria and hence is effective for dental abscesses in bone and soft tissue that doesn't respond adequately to penicillin or erythromycin.
• Chlorhexidine (marketed as Peridex, PerioChip, and PerioGard amongst others) is an antibiotic used to control plaque and gingivitis in the mouth, or in periodontal pockets (the space between your gum and tooth). Chlorhexidine comes as a chip, which is used as an adjunct to scaling and root planing procedures for reducing the depth of pockets around the teeth in patients with adult periodontitis or as a rinse, which provides antimicrobial activity between dental visits.
• Tetracyclines, such as doxycycline (marketed as Atridox) are used to help treat periodontal disease.
• Another use of antibiotics in dentistry is for preventing bacteria that are always present on the surface of tissues around teeth from spreading into the blood. This is especially important in patients with some types of defective or artificial heart valves since blood-born bacteria have a tendency to settle on the valves and cause serious infections. The antibiotics may be given orally, intramuscularly, or even intravenously. They usually are begun immediately before the dental surgery and are continued for no more than a few doses, for example, less than a day or so.

Note: Chlorhexidine may cause staining of the tooth, tooth filling, and dentures, or other mouth appliances. Tetracycline use during tooth development phases (from the last half of pregnancy through eight years of age) may cause permanent discoloration (yellow, gray, brown) of teeth.

Antifungals are used for the treatment of candidiasis in the oral cavity. Certain antifungal medication such as nystatin (Mycostatin) is used to treat Candida albicans infection in the mouth, including thrush, and denture stomatitis.

• Nystatin (Mycostatin) comes in lozenges/troches and oral suspension.
• When taking the oral suspension, patients are instructed to take one half of the dose on each side of the mouth, retaining the suspension as long as possible by swishing it around, before swallowing.

Fluorides

Fluoride which is available in most over-the-counter toothpaste is used to prevent tooth decay. Prescription-strength fluoride (Acidul) is also available if prescribed by a physician.

Antiseptics

Antiseptics are available as over-the-counter mouth rinses that are used to reduce plaque and gingivitis and kill germs that cause bad breath.

Benzodiazepines

Benzodiazepines such as diazepam (Valium) are used for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety. It works by relaxing the patient during dental procedures such as temporomandibular joint disorders.

Saliva substitutes

Saliva substitutes such as Moi-Stir, Mouth Kote, Optimoist, Saliva Substitute, Salix, and Xero-Lube are used for treating dry mouth, an occasional complication of autoimmune diseases or occasionally unassociated with other diseases. They usually come as sprays and are used as needed.