Drugs and oral medicine

Prepared by: Jamal Q Ahmed

Supervised by: Prof. Ali Al Zubaidi
Aspects of drug treatment in
oral medicine
 Some drug therapy may cause oral
complications
 Drugs used for treatment of orofacial
disease
 Drug therapy may affect orofacial
managment of patient
Drugs and specific oral
complications
 Drugs which may cause oral ulceration
 NSAIDs
 Nicorandil
 Drugs which may cause alteration in taste
 ACE inhibitors, lithium salts, carbimazole,
metronidazole,penicilinamine,allopurinol.
 Drugs which causes halitosis
 Alcohol
 Disulfiram
 Cytotoxic and xerogenic drugs (indirectly)
 Isosorbide dinitrate
contd
 Drugs which may cause sialosis
 Alcohol
 Iodine components
 Thiouracil
 Sulfonamides
 Chlorhexidine
 Drugs associated with xerostomia
 Antidepressants Antihistamis
 Antipsychotic Antiparkinsoian agents
 Appetite suppressants diuretics
 Decongestants hypnotics
contd
 Drugs that may cause oral pigmentation
 Oral contraceptives
 Antimalarial drugs
 Minocycline
 Tranquilizers
 Drugs which may cause lichenoid reaction
 NSAIDs
 ACE inhibitors
 Oral hypoglycemics
 Diuretics
 Antimalarial
 Penicillamine
 gold
Contd

 Drugs which may be related to

Erythema multiform incidence
 Sulfonamides
 Anticonvulsants
 Lupus erythromatosis
 Hydralazine
 Fixed drug eruption
 salicylates
Drugs with therapeutic
purpose
 Analgesics
 NSAIDs
 Aspirin: 3 main function: antipyretic, analgesic,
reduce inflammation
 Side effects: epigastric distress, inhibition of
platelet aggregation, respiratory depression,
hypersensitivity, Rey’s syndrome
 Ibuprofen,naproxen
 Functions are like aspirin with less gastrointestinal
irritation. mainly use in chronic treatment of
osteoarthritis, gout disease,RA
Contd
 Indomethacin
 Piroxicam uses are like ibuprofen, has
long half-life so can be prescribed one a
day
 Mefnamic acids may cause diarrhea,
hemolytic anemia
 diclofenac
contd
 Acetaminophen: substitute on NSAIDs
inhibit PG synthesis in CNS. Less anti-
inflammatory property.
 Hepatic necrosis is major side effect of
toxic dose of paracetamol
 Opoids, Centrally acting analgesics (major
analgesics)

 Codeine: 30mg up to 4hourly

 Pethidine: 50-100mg,25-100mg IM,25-50mg
IV, more potent than codeine, has atropin like
effect that may cause dry mouth, doesn't cause
pupilary constriction
 Pentazocine:25-100mg, 30-6-mg i.m or i.v
 Morphine:10-20 mg i.m or i.v depress cough
reflex, produce miosis,respiratory depression,
urinary retention
Anti microbials
 Indications:
 Rapidly progressive swelling
 Diffuse swelling
 Compromised host defences
 Involvement of facial spaces
 Sever pericoronitis
 Osteomyleitis
prophylaxis
 Infective endocarditis
 Cerebrospinal rhinrrhoea
 In most facial or compound skull
fractures
 Surgery following radiotherapy
Antibiotics

 Amoxicillin, ampicillin, coamoxiclave,ampiclox

 They are usefull in most odontogenic infections, syphilis, gonorrhea
 Oxacilin is useful in submandibular sialolithiasis
 Metronidazol
 Active against anaerobic bacteria so useful in treatment of
ANUG,periodontitis
 Erythromycin: substitute of penicillin in penicillin sensitive
patients
 Clindamycin use in treatment of Osteomyleitis
 Tetracyclins anerobic infections,as mouthwash to prevent
secondary infection of oral ulceration,chlamydia
 Cephalosporins
Antifungal
 Nystatin 1000000U topically used in all
cases of oral candidosis
 amphotricinB like nystatin topically use
in all cases of oral candidiasis
 Azoles
 Itraconazole,ketoconazole,fluconazole they
are systemic antifungal drugs.
Antiviral agents
 Acyclovir
 Famciclovir
 Penciclovir
 They are used in treatment of viral
infections in immune suppressed patients
to prevent complications like herpes
simplex infection or treatment of herpes
zoster to prevent post herpetic neuralgia
Immunosuppressive agents
 Corticosteroids
 Topical steroids
 Mouth washes
 Sprays
 Pastes
 Intralesional
 lozenges
contd
 Systemic
 Prednisolone
 Before therapy monitor blood pressure, blood glucose level,
weight
 Side effects
 Adrenal suppression
 Hypertension
 Sodium and water retention
 Diabetes
 Cushing’s syndrome
 Osteoporosis
 Peptic ulceration/ muscle wasting/ fat redistribution/growth
suppression in children
contd
 Azathioprin: steroid sparing drug
 Bone marrow suppression
 Ciclosporin
 Colchicin
 thalidomide
Drugs which affect orofacial
management
 Steroids
 Anticoagulants
 Anti hypertensives
 Hypoglycemics agent