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Oral Medications 1
Goals of AP
To prevent post-tx microbial
II. Antibiotic Prophylaxis (AP)
complications (local)
Principles of AP Principles of AP
Benefit>risk Choice of abx based on single
Abx must be present in most likely organism to cause
blood/target tissue before infection
organism entry Must be a favorable cost:benefit
Loading dose of abx must be used
Potential Harm…
Potential Harm
Incr risk of abx-induced allergy
Incr risk of super infection
Selection of abx resistant micro-
organisms
Encouragement of less meticulous
surgery/dentistry ?
Oral Medications 2
Dental Procedures
Extractions (51- Dental prophy (0-
58%) 40%)
Incidence of Bacteremia Perio surg (36- Endo (0-15%)
88%)
Sc/rp (8-80%)
Daily Exposure
It’s All Relative….
Brushing (0-26%) Irrigation device
Flossing (20- ( 7-50%)
58%) Toothpicks (20-
Chewing (17- 40%)
51%)
Oral Medications 3
Chain of Events Bacteria
Endothelial Vegetations 2,345 cases from
damage colonized by 1933-1987
Platelet circulating bact → Strep (56.4%)
aggregation thrombosis Staph ( 24.9%)
Fibrin deposit Replication
Nodular sterile Enlargement of
vegetations thrombosis
Your Role
Ask pt if he/she
Remember… had a consult w/
MD to determine
It is inappropriate to type and
significance of
prescribe Abx w/o Good murmur
Cause! It is YOUR team’s
obligation to
determine
whether the pt
requires Abx
coverage
Cianciola & Beach Periodontal Cianciola & Beach Periodontal
Group Group
Oral Medications 4
High Risk- Abx Recommended
Prosthetic heart valves
AHA Abx
Recommendations How Can You Help?
Amox 2g PO 1hr prior
($1.50) Good oral hygiene reduces the
Clindamycin 600mg PO likelihood of infective
1hr ($3.88) endocarditis and other
Cephalexin 2g PO 1hr bacteremias in the at risk pts
($2.14)
Azithromycin 500mg PO
1hr ($18)
Clarithromycin 500mg
PO 1hr ($5.10)
Oral Medications 5
Prosthetic Joints Life truly is a Beach!
All pts during the 1st 2yrs post-op
Immunocompromised pts
Pts w/ co-morbidities
Previous joint infection
Hemophilia
HIV
Type I Diabetes
Malignancy
Drugs 1-10
Vicodin
III. The Top 20 Most Lipitor
Prescribed Drugs…
Synthroid
Atenolol
Amoxicillan
Lisinopril
HCTZ
Furosemide
Albuterol inhaler
Alprazolam (Xanax)- anxiety
Cianciola & Beach Periodontal Cianciola & Beach Periodontal
Group Group
Oral Medications 6
New Medications Drug References
Why are Med Hx updates important? ADA Guide to Dental Therapeutics
There are about 20-30 new meds www.ada.org/prof/resources/pubs
introduced each year!
Pts are living longer
Drug Information Handbook for
Pts are taking more meds
Dentistry
There are more than 800 generic drugs
There are more than 2,500 brand name
drugs!
DiMatteo 2006
DiMatteo 2006
Oral Medications 7
IV. Drugs and Oral Xerostomia
Manifestations
Antidepressants/antipsychotics
Antihypertensives
Can you hit the
target but still not Antihistamines
win? Anticholinergics
Decongestants
Oral Medications 8
LP Histology Lichenoid Lesions
Epithelium-R Allopurinol
CT-L Antimalarials
Lymphocytes
attacking
Beta-blockers
Bismuth / Pepto-Bismol
Catopril (ACE inhibitor)
Carbamazepine / Tegretol
Chlorothiazide
Cimetidine / Tagament
Cianciola & Beach Periodontal Cianciola & Beach Periodontal
Group Group
Erythema-multiforme Erythema-multiforme
Oral Medications 9
Erythema-multiforme BMMP Lesion
Like Lesions
Sulfonamides Bullae
Penicillins Ulcers
Pain
Barbituates
Salicylates
Subepithelial
clefting
Epi peels away
from CT
Auto Ab vs. the
basement
membrane
Oral Medications 10
(Insert cute picture here) Pemphigus Vulgaris
Skin or mucosa
Large bullae,
rupture, ulcers
Remission
uncommon
Can be lethal
Oral Medications 11
Nonspecific Vesiculo-
ulcerative Mucositis Oral Pigmentation
Minocycline
NSAIDs, Naproxen pigmentation
Methyldopa
Penicillamine
Propranolol
Spironolactone
Thiazides
Tolbutamide
Oral Medications 12
Post-Surgical Gingival Overgrowth
Calcium channel blockers
Cyclosporine
Phenytoin
Sodium valproate
Biliary diseases
Oral Medications 13
Alcoholic Liver Disease Alcoholic Liver Disease:
How much does it take?
Steatosis- fatty change (>80%) Males-40g
Usually asymptomatic, reversible Females-lower threshold
Alcoholic hep (10-15%) How many beers?
After an acute bout of drinking 3 beers (15g ETOH each)
May be reversible, may progress How many glasses of wine?
Cirrhosis (10-15%) 2 glasses (18g ETOH each)
Irreversible and lethal if no liver How much liquor?
transplant done
2 drinks (17g ETOH each)
Cianciola & Beach Periodontal Cianciola & Beach Periodontal
Group Group
ETOH habits?
Drugs?
Nutritional status
Key events
Treatment
Oral Medications 14
Acetominophen Induced VI. Bisphosphonates
Liver Toxicity
Key events
Rate of toxic metabolites >detox
Cell death via disruption of Ca2+
homeostasis
Treatment
N-acetylcysteine w/in 10hrs
Oral or IV
Bisphosphonates Osteoporosis
Bone sparing drugs Low or decreasing bone mass
Used to tx osteoporosis and bone Increased risk for bone fractures
cancer Risk factors:
IV tx for cancer pts to decrease Smoking
pain and fracture associated w/ Age
bone cancer Medications
Systemic disease
Oral Medications 15
AAP’s Position Who can get ONJ
AAP Clinical Statement on Cancer pts that are:
Bisphosphonates Females
Older
AAP Press Release on Serious
Edentulous regions
Oral Post-surgical Complications
Combo cancer therapy
associated w/ IV Bisphosphonates
Blood dyscrasias / metastatic disease
FDA’s statement may be viewed
Anemia coagulopathy
from this site, too
Surgical dental procedures
Prior infection
Oral Medications 16
Thank you, it’s been a
whale of a time!
Oral Medications 17