Comprehensive Guide to FDA-Approved Drugs Used in Dentistry

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)	Class	Dosage	Indications
Amoxicillin	Penicillin Antibiotic	2 g orally 1 hour before procedure	High-risk patients with heart conditions
Clindamycin	Broad-spectrum Antibiotic	600 mg orally 1 hour before procedure	Penicillin-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)	Class	Dosage	Duration
Amoxicillin	Aminopenicillin	500 mg every 8 hours	5-7 days
Penicillin V	Penicillin Antibiotic	500 mg every 6 hours	5-7 days
Metronidazole	Antimicrobial Drug	500 mg every 8 hours	5-7 days
Erythromycin	Macrolide	500 mg every 6 hours	5-7 days

Second-line Antibiotics:

Generic Name(s)	Class	Dosage	Duration
Amoxicillin/Clavulanic Acid	Penicillin Antibiotic	875 mg/125 mg every 12 hours	5-7 days
Cephalexin	Cephalosporin Antibiotic	500 mg every 6 hours	5-7 days
Clindamycin	Broad-spectrum Antibiotic	300 mg every 6 hours	5-7 days
Clarithromycin	Macrolide	500 mg every 12 hours	5-7 days

Also read: Postoperative Pain Relief in Dentistry- Part 2

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)	Class	Dosage	Duration
Metronidazole	Antimicrobial Drug	500 mg every 8 hours	5 days
Amoxicillin	Aminopenicillin	500 mg every 8 hours	5 days

1.4 Sinusitis

Sinusitis can complicate dental infections, particularly in the upper teeth. Antibiotics are indicated for bacterial sinusitis.

Generic Name(s)	Class	Dosage	Duration
Amoxicillin	Aminopenicillin	500 mg every 8 hours	5-10 days
Doxycycline	Tetracycline Antibiotic	100 mg every 12 hours	5-10 days

1.5 Other Dental Infections

Other dental infections may require specific antibiotics based on the type of bacteria involved.

Generic Name(s)	Class	Dosage	Indications
Cephalexin	Cephalosporin Antibiotic	500 mg every 6 hours	Dental infections
Ciprofloxacin	Fluoroquinolone Antibiotic	500 mg every 12 hours	Severe infections
Doxycycline	Broad-Spectrum Antibiotic	100 mg every 12 hours	Periodontal 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)	Class	Dosage	Duration
Fluconazole	Antifungal Drug	100-200 mg once daily	7-14 days
Miconazole Oral Gel	Antifungal	Apply 2.5 mL 4 times daily	7-14 days
Nystatin	Antifungal Drug	400,000-600,000 units 4 times daily	7-14 days

2.2 Angular Cheilitis

Angular cheilitis often requires topical antifungal treatment.

Generic Name(s)	Class	Dosage	Duration
Miconazole Cream	Antifungal	Apply twice daily	Until resolved
Sodium Fusidate Cream/Ointment	Anti-inflammatory	Apply twice daily	Until 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)	Class	Dosage	Duration
Aciclovir	Antiviral Drug	200 mg 5 times daily	5 days
Penciclovir Cream	Antiviral	Apply every 2 hours while awake	4 days

3.2 Herpes Zoster

Herpes zoster (shingles) requires prompt antiviral treatment to limit complications.

Generic Name(s)	Class	Dosage	Duration
Aciclovir	Antiviral Drug	800 mg 5 times daily	7 days
Valaciclovir	Antiviral Drug	1 g 3 times daily	7 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.

Also read: Pain to pain-free: Journey of local anesthetic delivery systems in dentistry

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)	Class	Dosage	Duration
Paracetamol	Analgesic	500-1000 mg every 4-6 hours	As needed
Ibuprofen	Analgesic	200-400 mg every 4-6 hours	As needed
Aspirin	Analgesic	325-650 mg every 4-6 hours	As needed
Diclofenac	NSAID	50 mg every 8 hours	As needed

4.2 Pain from Dental Surgery

Post-operative pain management is essential for patient comfort after dental procedures.

Generic Name(s)	Class	Dosage	Duration
Hydrocodone	Analgesic	5-10 mg every 4-6 hours	As needed
Diflunisal	NSAID	500 mg every 12 hours	As 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)	Class	Dosage	Indications
Diazepam	Benzodiazepine	5-10 mg orally 1 hour before procedure	Anxiety management
Midazolam	Benzodiazepine	1-5 mg IV or IM before procedure	Sedation during procedures
Triazolam	Benzodiazepine	0.25-0.5 mg orally before procedure	Anxiety 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)	Class	Dosage	Indications
Cevimeline	Cholinergic Agonist	30 mg orally three times daily	Dry mouth (xerostomia)
Pilocarpine	Cholinergic Agonist	5 mg orally three times daily	Dry mouth (xerostomia)

6.2 Gum Bleeding

Management of gum bleeding may involve antibiotics and antiseptics.

Generic Name(s)	Class	Dosage	Indications
Chlorhexidine	Antiseptic	Rinse with 15 mL twice daily	Gum disease management
Clarithromycin	Macrolide Antibiotic	500 mg every 12 hours	Gum 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)	Class	Dosage	Duration
Chlorhexidine Mouthwash	Antiseptic	Rinse with 10 mL twice daily	Until resolved
Benzydamine Mouthwash	Anti-inflammatory	Rinse with 15 mL every 1.5-3 hours	Until resolved
Lidocaine Ointment/Gel	Local Anesthetic	Apply to affected area	As needed

6.4 Temporomandibular Joint Disorders

Temporomandibular joint (TMJ) disorders can cause pain, limited movement, and joint sounds. Muscle relaxants and anti-anxiety medications are sometimes used to manage these conditions.

Also read: Death due to local anesthesia : A rare complication

Generic Name(s)	Class	Dosage	Duration
Chlorzoxazone	Muscle Relaxant	250-500 mg every 6-8 hours	As needed
Cyclobenzaprine	Muscle Relaxant	5-10 mg every 8 hours	As needed
Diazepam	Benzodiazepine	2-10 mg every 6-8 hours	As needed

6.5 Dental Caries Prevention

Fluoride products are used to prevent dental caries and promote remineralization of tooth enamel.

Generic Name(s)	Class	Dosage	Indications
Sodium Fluoride	Cariostatic Agent	0.5% gel or varnish applied by dentist	Caries prevention

6.6 Saliva Substitutes

Saliva substitutes are used to alleviate symptoms of dry mouth.

Generic Name(s)	Class	Dosage	Indications
Saliva Substitute	Various formulations	As needed	Dry mouth (xerostomia)

Conclusion

This comprehensive guide to FDA-approved drugs used in dentistry provides a detailed reference for dental practitioners. Understanding the pharmacological management of various dental conditions is essential for providing effective patient care. Always consider patient-specific factors, including allergies, comorbidities, and current medications, when prescribing any drug. Regularly consult updated clinical guidelines and pharmacological resources to ensure the best outcomes for patients.

Dental Emergencies

Dental emergencies require prompt treatment to alleviate pain and prevent complications. Dentists may prescribe various medications to manage these situations effectively.

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 acute dental pain.Recommended Medications:

Generic Name(s)	Class	Dosage	Duration
Paracetamol	Analgesic	500-1000 mg every 4-6 hours	As needed
Ibuprofen	Analgesic	200-400 mg every 4-6 hours	As needed
Aspirin	Analgesic	325-650 mg every 4-6 hours	As needed
Diclofenac	NSAID	50 mg every 8 hours	As needed

Dental Abscesses

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)	Class	Dosage	Duration
Amoxicillin	Aminopenicillin	500 mg every 8 hours	5-7 days
Penicillin V	Penicillin Antibiotic	500 mg every 6 hours	5-7 days
Metronidazole	Antimicrobial Drug	500 mg every 8 hours	5-7 days
Erythromycin	Macrolide	500 mg every 6 hours	5-7 days

Second-line Antibiotics:

Generic Name(s)	Class	Dosage	Duration
Amoxicillin/Clavulanic Acid	Penicillin Antibiotic	875 mg/125 mg every 12 hours	5-7 days
Cephalexin	Cephalosporin Antibiotic	500 mg every 6 hours	5-7 days
Clindamycin	Broad-spectrum Antibiotic	300 mg every 6 hours	5-7 days

Oral Trauma

Dental trauma, such as avulsed teeth or lacerations, may require specific treatments.Medications for Oral Trauma:

Generic Name(s)	Class	Dosage	Indications
Tetanus Toxoid	Vaccine	Single dose	Unimmunized patients with dirty wounds
Amoxicillin	Aminopenicillin	500 mg every 8 hours	Prophylaxis for high-risk patients
Chlorhexidine	Antiseptic	Rinse with 10 mL twice daily	Wound irrigation and maintenance

Remember, the choice of medication depends on the specific emergency, patient factors, and the dentist’s clinical judgment. Always consult reliable sources and consider the latest evidence-based guidelines when managing dental emergencies.