Miscellaneous

In this section we cover the importance of antibiotic prophylaxis, impart knowledge about the effects of addictive substances, emphasize on the calculation of dose and the normal laboratory values which are helpful in assessing the patient's medical status, prescription abbreviation and the importance of writing the prescription.

The medico-legal and ethical principles upon which the practice of dentistry is based, especially those relating to treatment of patients are also indicated.

Antibiotic Prophylaxis

The goal of antibiotic therapy is to aid the body's defence to clear the tissues of microbial pathogens by achieving antibiotic level in the infected area equal to or greater than the MIC (minimum inhibitory concentration).

Prevention of Bacterial Endocarditis

Dental procedures where endocarditis prophylaxis is recommended

1. Dental extractions.
2. Periodontal procedures- surgery, scaling and root planing, probing and recall maintenance.
3. Endodontic instrumentation or surgery beyond the apex.
4. Sub-gingival placement of antibiotic fibres or strips.
5. Initial placement of orthdontic bands and not brackets.
6. Intraligamentary local anaesthetic injections.
7. Prophylactic cleaning of teeth or implants where bleeding is anticipated.

Dental procedures where endocarditis prophylaxis is not recommended

1. Restorative dentistry (operative, prosthodontic) with or without retraction cords.
2. Local anaesthetic injections (non-intraligamentary).
3. Intracanal endodontic treatment.
4. Placement of rubber dam, removable prosthodontic or orthodontic appliance.
5. Postoperative suture removal.
6. Taking oral impressions, radiographs.
7. Shedding of primary teeth.

Prophylactic regimens for dental procedures

Prophylaxis for dental patients with Total Joint Replacement

For the first two years after a joint replacement, all patients may need antibiotics for all high-risk dental procedures. After two years, only high- risk patients may need to receive antibiotics for high-risk procedures.

Incidence stratification of Bacteremic Dental Procedure

Higher Incidence

1. Dental extractions.
2. Periodontal procedures including surgery, sub gingival placement of antibiotic fibres/strips, scaling and root planing.
3. Dental implant placement and replantation of avulsed tooth.
4. Endodontic instrumentation.
5. Initial placement of orthodontic bands and not brackets.
6. Intraligamentary and intraosseous local anaesthetic injections.
7. Prophylactic cleaning of teeth or implants where bleeding is anticipated.

Lower incidence

1. Restorative dentistry (operative, prosthodontic) with or without retraction cords.
2. Local anaesthetic injections (nonintraligamentary and intraosseous).
3. Intracanal endodontic treatment.
4. Placement of rubber dam, removable prosthodontic or orthodontic appliance.
5. Postoperative suture removal.
6. Taking oral impressions, radiographs.
7. Shedding of primary teeth.

Suggested antibiotic prophylaxis regimen

Herbs and Dental Health

Many drugs used in dentistry have their origin in the plant world. Lidocaine and novocaine, derived from cocoa plant (erythroxylum coca); opiods from poppy (papever somniferum); Clove oil which contains eugenol is essential oil of Eugenia caryophyllus; thymol from thyme (thymus vulgaris); are a few to mention.

Chewing sticks as miswak (s.persica) are commonly used in South Asian countries. Studies have suggested that miswak users have shown significant low dental calculus in the posterior sextant but fails in the anterior region.

Camelia and other plant are rich in fluoride. Fagara zanthoxyloides and massularia acuminata reduces acid production and bacterial growth.

Commercial toothpastes have been made from neem (azadiracta indica) and arak (s.persica). Powdered plant used in abrasive dentrifrices include sweet flag root, gum resin of myrrh, yellow dock root.

Essential oils of plants are used in commercial mouthwashes. Ex: Listerene uses thymol, menthol, eucalyptus and methyl salicylate all derived from plants.

Normal Laboratory Values in Adults

Haematologic Examinations

Chemical Constituents of Blood

Urine Analysis

Substance Use Disorders

It is important that the dentist be aware of a patient's substance use history. Some patients may not reveal their history of substance abuse out of shame or fear of judgement or because they fail to understand the importance of this information in their treatment. The following table shows dental implications for people suffering from substance abuse.

Length of time drug abuse can be detected in urine

Cessation of Tobacco Use

Dentists can play an important role in making people aware of the ill effects of tobacco.They are the first health care providers exposed to the signs and symptoms of oral cancer and other disease that are caused by the use of either smoked or smokeless tobacco.

The following are the drugs used to aid in tabacco cessation:

Signs and Symptoms may include; Oral sores that do not heal, red or white patches on the oral mucosa, lumps in the head and neck region, difficulty in chewing and swallowing or making tongue or jaw movements.

Weights and Measures

Common metric measurements and their abbreviations.

Common Metric Equivalent

Measures of Volume

Measures of Weight

Sample Prescriptions and Prescription Abbreviations

A prescription is a written or verbal order for medication to be used for the diagnosis, prevention or treatment of a specific patient disease by a licensed physician, dentist or veterinarian.

Sample Prescription

1) Rx

Amoxicillin 500mg
Dispense 4 capsules
Sig:Take 2 tablets with water 1 hr
before the dental appointment
Substitution: permitted 
not permitted

	Signature
Refill: 0x   1x    2x   3	DEA:

2) Rx

Sodium fluoride oral solution 0.5 mg flouride/1ml
Dispense 50 ml
Sig: Give one half dropper ful once daily
Substitution: permitted
not permitted

	Signature
Refill:   0x 1x   2x     3	DEA:

 

Prescription abbreviations

Legal Implications of using Drugs in Dentistry

Choosing dental products that are Food Safety and Standards Authority of India and/or IDA approved, is a wise choice concerning their safety and efficacy for approved uses. However, the dentist must show that the product was indicated by a particular patients needs. Uses of approved dental products in non-approved ways or use of non-approved products may be considered as negligence in some malpractice actions, but allowed under standards of resonableness in other situations. The dentist must be able to justify decisions on a scientific basis.

Calculation of Paediatric Doses

Paediatric doses based on formal experiments or the experience of the prescriber are better than those calculated according to a general rule or formula.

Unfortunately, optimal paediatric doses have not been established for most drugs. Thus, where possible, doses for younger children and especially for infants, should be learned as such and not based merely on a formula; doses calculated with a formula (as a fraction of the adult dose based on the body weight or body surface area) are very unreliable for premature infants, but more reliable for children at least 2 years old.

Dosage rules involving a fraction of the adult dose

A General Rule of Dosage

Clark's Rule

Young's Rule

Fried's Rule

Paediatric dose calculations based on body weight

A more reliable method of paediatric dose calculation than the preceding dosage rules is the dosage on a given amount of drug per pound or kilogram of body weight.

NOTE: Round off all body weights in kilograms to the nearest whole number

Example: The parenteral dose of erythromycin injection is 10 mg/kg/24 hours. Calculate the daily dose of this drug for a 44-pound child

Step1: Convert the weight of the child in Kgs

Step2: Multiply client's weight by the dose

Child's dose = 20kgs X 10 mg/kg

      = 200mg/24 hrs

Paediatric dose calculations based on surface area

A newer and possibly more accurate method of paediatric dose calculation is based on body surface area. Although this method is not as widely used or accepted as calculations based on body weight, most if not all drugs may have their dosage expressed per square meter of body surface area (m²). This method of relating the surface area of individuals to dosage is simplified using a surface area nomogram in dose calculations.

Example

The doctor has ordered an antibiotic whose average adult dose is 250 mg per day. What would the dosage for this medication be on a child who has a length of 120 cm and weight of 40 kg?

First you must determine the BSA. One method is using the West Nomogram.

Using a straight edge (such as a ruler or piece of paper), align the straight edge so it intersects at the child's height and weight. Doing so will create an intersection in the BSA scale. The boxed in scale is to be used only if the child is of normal height and weight.

Next, enter the BSA value of 1.2 (determined from nomogram) and the adult dose of 250 into the calculator

In this example, 173 mg of medication would be given

Drugs Controller of India

The National Human Rights Commission(NHRC)has described the manufacture, distribution and sale of unsafe drugs and medical devices as a violation of human rights.

The Drugs and Cosmetics Bill was passed by the Central Legislative Assembly and it received the assent of the Governor General on 10th April, 1940 and thus became the Drugs and Cosmetics Act, 1940.

The Drugs and Cosmetics Act, 1940 is a consumer protection legislation, which is mainly concerned with the standards and quality of drugs and regulates the import, manufacture, sale and distribution of drugs and cosmetics.