Dental Pharmacology & Safety

Drugs Used in Dentistry: Pharmacology and Safety

A comprehensive dental pharmacology reference covering antimicrobials, analgesics, anti-inflammatory drugs, local anaesthetics and prescribing precautions.

Dr. Rockson Samuel

Dr. Rockson Samuel

Founder & Chief Dentist · Indira Dental Clinic; DentalReach

9 min read122,496 views
  • patient safety
  • infection control
  • Analgesics
  • infective endocarditis
  • dental infections
  • dental abscesses
  • antifungals
  • drug prescribing
  • Local Anaesthetics
  • antivirals

Drugs Used in Dentistry: FDA Status, Pharmacology and Safety

Scope: FDA approval describes United States regulatory status. Availability, approved indications, formulations, schedules and prescribing rules vary internationally. Verify current product information, local formularies and professional guidance before prescribing.

This extensive guide covers a wide array of FDA-approved drugs commonly used in dentistry, including antibiotics, antifungals, antivirals, analgesics, anti-inflammatory drugs, and various other medications. The aim is to provide dental professionals with a detailed reference to enhance their clinical practice and optimize patient care.

1. Antibiotics

Antibiotics are essential in managing bacterial infections in dentistry. They are prescribed based on the type of infection, patient history, and potential drug interactions.

1.1 Infective Endocarditis Prophylaxis

Infective endocarditis (IE) is a serious infection of the heart valves or lining. Certain dental procedures can cause transient bacteremia, increasing the risk of IE in susceptible patients. The American Heart Association (AHA) recommends antibiotic prophylaxis for patients at high risk of adverse outcomes from IE, such as those with:
  • Prosthetic cardiac valves
  • History of infective endocarditis
  • Certain congenital heart diseases
  • Heart transplant with valve regurgitation
Recommended Antibiotics:
Generic Name(s)ClassDosageIndications
AmoxicillinPenicillin Antibiotic2 g orally 1 hour before procedureHigh-risk patients with heart conditions
ClindamycinBroad-spectrum Antibiotic600 mg orally 1 hour before procedurePenicillin-allergic patients

1.2 Dental Abscess

A dental abscess is a localized collection of pus associated with a tooth. Antibiotics are used alongside drainage and removal of the source of infection.First-line Antibiotics:
Generic Name(s)ClassDosageDuration
AmoxicillinAminopenicillin500 mg every 8 hours5-7 days
Penicillin VPenicillin Antibiotic500 mg every 6 hours5-7 days
MetronidazoleAntimicrobial Drug500 mg every 8 hours5-7 days
ErythromycinMacrolide500 mg every 6 hours5-7 days
Second-line Antibiotics:
Generic Name(s)ClassDosageDuration
Amoxicillin/Clavulanic AcidPenicillin Antibiotic875 mg/125 mg every 12 hours5-7 days
CephalexinCephalosporin Antibiotic500 mg every 6 hours5-7 days
ClindamycinBroad-spectrum Antibiotic300 mg every 6 hours5-7 days
ClarithromycinMacrolide500 mg every 12 hours5-7 days

1.3 ANUG, Periodontitis, and Pericoronitis

Acute necrotizing ulcerative gingivitis (ANUG), periodontitis, and pericoronitis are inflammatory conditions of the gums and surrounding tissues. Antibiotics are used to control infection and reduce inflammation.
Generic Name(s)ClassDosageDuration
MetronidazoleAntimicrobial Drug500 mg every 8 hours5 days
AmoxicillinAminopenicillin500 mg every 8 hours5 days

1.4 Sinusitis

Sinusitis can complicate dental infections, particularly in the upper teeth. Antibiotics are indicated for bacterial sinusitis.
Generic Name(s)ClassDosageDuration
AmoxicillinAminopenicillin500 mg every 8 hours5-10 days
DoxycyclineTetracycline Antibiotic100 mg every 12 hours5-10 days

1.5 Other Dental Infections

Other dental infections may require specific antibiotics based on the type of bacteria involved.
Generic Name(s)ClassDosageIndications
CephalexinCephalosporin Antibiotic500 mg every 6 hoursDental infections
CiprofloxacinFluoroquinolone Antibiotic500 mg every 12 hoursSevere infections
DoxycyclineBroad-Spectrum Antibiotic100 mg every 12 hoursPeriodontal infections

2. Antifungals

Antifungal medications are used to treat fungal infections of the oral cavity, such as candidiasis. These drugs work by inhibiting fungal growth or killing the fungal cells directly.

2.1 Oral Candidiasis

Candidiasis can manifest as pseudomembranous or erythematous forms. Treatment typically involves topical or systemic antifungals.
Generic Name(s)ClassDosageDuration
FluconazoleAntifungal Drug100-200 mg once daily7-14 days
Miconazole Oral GelAntifungalApply 2.5 mL 4 times daily7-14 days
NystatinAntifungal Drug400,000-600,000 units 4 times daily7-14 days

2.2 Angular Cheilitis

Angular cheilitis often requires topical antifungal treatment.
Generic Name(s)ClassDosageDuration
Miconazole CreamAntifungalApply twice dailyUntil resolved
Sodium Fusidate Cream/OintmentAnti-inflammatoryApply twice dailyUntil resolved

3. Antivirals

Antiviral medications are essential in managing viral infections of the oral cavity, such as herpes simplex and herpes zoster.

3.1 Herpes Simplex Infections

Herpes simplex virus can cause recurrent oral and labial lesions. Antivirals are used to reduce the duration and severity of outbreaks.
Generic Name(s)ClassDosageDuration
AciclovirAntiviral Drug200 mg 5 times daily5 days
Penciclovir CreamAntiviralApply every 2 hours while awake4 days

3.2 Herpes Zoster

Herpes zoster (shingles) requires prompt antiviral treatment to limit complications.
Generic Name(s)ClassDosageDuration
AciclovirAntiviral Drug800 mg 5 times daily7 days
ValaciclovirAntiviral Drug1 g 3 times daily7 days

4. Analgesics and Anti-inflammatory Drugs

Pain management is a critical component of dental care. Analgesics and anti-inflammatory drugs are used to alleviate odontogenic pain and manage associated conditions.

4.1 Odontogenic Pain

Odontogenic pain refers to pain originating from the teeth, jaws, or surrounding structures. Over-the-counter and prescription analgesics are used to manage this type of pain.
Generic Name(s)ClassDosageDuration
ParacetamolAnalgesic500-1000 mg every 4-6 hoursAs needed
IbuprofenAnalgesic200-400 mg every 4-6 hoursAs needed
AspirinAnalgesic325-650 mg every 4-6 hoursAs needed
DiclofenacNSAID50 mg every 8 hoursAs needed

4.2 Pain from Dental Surgery

Post-operative pain management is essential for patient comfort after dental procedures.
Generic Name(s)ClassDosageDuration
HydrocodoneAnalgesic5-10 mg every 4-6 hoursAs needed
DiflunisalNSAID500 mg every 12 hoursAs needed

5. Sedatives and Anxiolytics

Sedatives and anxiolytics are often used in dental procedures to manage anxiety and discomfort.

5.1 Dental Procedures

Sedatives help in calming patients during dental treatments.
Generic Name(s)ClassDosageIndications
DiazepamBenzodiazepine5-10 mg orally 1 hour before procedureAnxiety management
MidazolamBenzodiazepine1-5 mg IV or IM before procedureSedation during procedures
TriazolamBenzodiazepine0.25-0.5 mg orally before procedureAnxiety management

6. Miscellaneous Drugs

Various other medications are used in dentistry for specific conditions.

6.1 Dry Mouth

Cholinergic agonists can help stimulate saliva production in patients with dry mouth.
Generic Name(s)ClassDosageIndications
CevimelineCholinergic Agonist30 mg orally three times dailyDry mouth (xerostomia)
PilocarpineCholinergic Agonist5 mg orally three times dailyDry mouth (xerostomia)

6.2 Gum Bleeding

Management of gum bleeding may involve antibiotics and antiseptics.
Generic Name(s)ClassDosageIndications
ChlorhexidineAntisepticRinse with 15 mL twice dailyGum disease management
ClarithromycinMacrolide Antibiotic500 mg every 12 hoursGum infections

6.3 Oral Ulceration and Inflammation

Oral ulcers and inflammation can be caused by various factors, such as trauma, infections, or autoimmune conditions. Topical and systemic agents are used to promote healing and reduce discomfort.
Generic Name(s)ClassDosageDuration
Chlorhexidine MouthwashAntisepticRinse with 10 mL twice dailyUntil resolved
Benzydamine MouthwashAnti-inflammatoryRinse with 15 mL every 1.5-3 hoursUntil resolved
Lidocaine Ointment/GelLocal AnestheticApply to affected areaAs needed

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Topics

References

  1. [1]American Dental Association Science & Research Institute, University of Pittsburgh, University of Pennsylvania. Acute Dental Pain Management Guideline American Dental Association Clinical Guidelines. 2024. Available at: source
  2. [2]Carrasco-Labra A, et al.. Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults Journal of the American Dental Association. 2024. Available at: source
  3. [3]Lockhart PB, Tampi MP, Abt E, et al.. Evidence-based clinical practice guideline on antibiotic use for urgent management of pulpal- and periapical-related dental pain and intraoral swelling Journal of the American Dental Association. 2019. Available at: source

Written by

Dr. Rockson Samuel

Dr. Rockson Samuel

Founder & Chief Dentist · Indira Dental Clinic; DentalReach

Dr. Rockson Samuel is a dental surgeon, healthcare content strategist, and Founder and Chief Dentist of Indira Dental Clinic in Vellore, India. With formal training in dentistry, management and digital marketing, he works across clinical practice, dental publishing, professional education, community development and international dental media. As Community Leader at DentalReach, he develops evidence-informed resources for dentists and contributes to global dental events, digital strategy and professional communication.

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