DENTAL

ROSHETTA
 Mouth preparation drugs.
 Anti-edematous.
 Sedative
 Muscle relaxants.
 Analgesics.
 Antibiotics.
 Antifungal.
 Antiviral.
 Corticosteroids.
 Vitamins.
 Hemostatic drugs
 Emergency drugs.
 Emergency cases.
 Tests
 Medical compromised patient
 Roshetta
 Mouth preparation drugs
The active ingredient of drugs and it is action:
 Benzydamine (NSAIDs): has local analgesics and anti-inflammatory action. (Tantum MW – BBC spray)
 Hyaluronic acid: anti-inflammatory – promote healing and decrease duration of ulcers – mediator for periodontal
regeneration. (Aftamed – Gengigel – Orovex H)
 Chlorhexidine: antimicrobial agent with no resistance – substantivity (last for 12 hours) – gold standard for gingivitis and
periodontitis - causes discoloration (if used for long time > 4 weeks) of teeth and tongue. (Hexitol – Orovex – Verolex)
 Povidone iodine: it is antiseptic to be used in cases after surgery/ extraction – infected & dry socket – less significant in
plaque reduction (1% concentration) (Betadine Mw)
 Hydrogen peroxide: antibacterial gram –ve bacteria) & foaming action so it is highly recommended in cases of
Pericoronitis – long use > 3 days causes fungal infection & black hairy tongue.
Ulcers – localized inflammation:
Mouth wash (M.W):
o Gengigel (115) / Aftamed (108) M.W (hyaluronic acid = promotes healing of ulcers and decreases its duration) expensive
o Tantum verde M.W (NSAIDS) + tetracycline / tetracid 250 mg caps. 5ml x4 minor ulcers – pocket – aggressive P.
o Tantum verde M.W + betasone 0.5 mg tab. 5ml x4 recurrent multiple ulcers.
o Epirelefan amp + phenadone syrup + 100 ml saline 5ml x4 major ulcers / immunity ulcers.
o Lidocaine viscous 2% oral sol + Benadryl (diphenhydramine = antihistaminic & potent L.A) / phenadone syrup +
Maalox plus = ant acid (1:1:1) 5 ml x4 multiple ulcers / viral ulcers.
o Rifampicin (antibiotic with antiviral action) = Rifam susp used as M.W & swallow 5ml x3 viral ulcers.
 It is category C (pregnancy) and cause temporary teeth discoloration.
Gel:
o Oracure oral gel (lidocaine gel = not used with children below 6 years as it causes methemoglobinemia).
o Aftamed oral gel / Aftamed junior. (hyaluronic acid = not harmful if swallowed so can be used with children)
o Gengigel oral gel / Gengigel baby. (hyaluronic acid)
o Kenalog in orabase / Kenacort A orabase (triamcinolone = corticosteroid)
o MEBO ointment (it is from natural ingredient) effective for burns and ulcers.
o Protopic 0.1 % ointment (tacrolimus) used orally 1x3 / 4 (as in case of lichen ulcer resistant to steroids).
Spray:
o B.B.C oral spray (benzocaine = analgesic / benzydamine =NSAIDS / cetalkonium = antibacterial) not used with children below 6y.
o Aftamed spray.
Paint:
o Salvix-L + tetracycline 250 mg caps 1x3 after meal (it is carcinogenic)
Aggressive periodontitis / severe periodontitis / pocket / diabetic patient (high susceptibility of attachment loss)
M.W that contains CHX + Hyaluronic acid:
o Orovex - H 80 LE
Gingivitis / periodontitis:
M.W that contains chlorhexidine:
o The previous (expensive)
o Orovex (CHX + S.F) 45 LE / Parodontax (CHX + S.F) 35 LE
o Verolex (CHX + H2O2) 30 LE
o Hexitol (CHX) 1x3 for 2 weeks. 15 LE
Pericoronitis:
M.W that contains H2O2 (foaming action + X – anaerobic MOs)
o H2O2 30% (one spoon + 20 ml warm water) x 4 for 3 days only then warm salty water as M.W.
‫ ايام ثم مضمضة ماية دافية بملح‬3 ‫غطا علي ربع كوب ماء دافي اربع مرات يوميا لمدة‬
o Verolex M.W.
Bleeding gum:
o Verolex M. W (H2O2: stop bleeding / CHX: treat inflammation)
o Oxymeria M. W Causes of bleeding gum:
Blood disorder (anemia, hemophilia, leukemia..)
 Tannic Acid: stop bleeding esp. in cases of blood disorder.
Bleeding disorder
 Oxyquinol: anti-septic with mild fungistatic and bacteriostatic drugs.
Inflammation: gingivitis …/ hormonal changes.
o Gum.C M. W (Vit. C)
Scurvy: vit.C deficiency.
o Omit.C oral spray (Vit. C)
Fungal infection:
o Nystatin / mycostatin oral susp used as M.W for 2 min then swallow 5mlx4 x2weeks
o Daktarin oral gel / miconaz oral gel 1x4 x 2 weeks.
Then after treatment instruct your patient for good oral hygiene & may use Oxymeria MW that has fungistatic activity.

Ahmed Hesham
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 Viral infection:
o Rifampicin (Rifam susp) used as M.W & swallow 5ml x3 / Lidocaine viscous 2% oral sol + Benadryl + Maalox plus.
o Cream for lip: R/ zovirax cream 1x5x10 days. Or R/ penciclovir each 2 hours x 4 days.
Tooth sensitivity: M.W contains Sodium Fluoride (S.F)
o B-fresh M.W 18 LE
o EZA –flour M.W. 6.35 LE
o DG-wash. 17 LE
o Orovex delicate (not contains CHX) 45 LE
After surgery / dry/ infected socket:
o Betadine M.W. (antiseptic) used the day after surgery.
o Antibiotic mouth path: used as irrigation & mouth wash in cases of infected socket:
 Tetracycline 250 mg caps Or Dalacin C 300 mg caps + (dissolved in Tantum or saline)
o Bivatracin spray (topical antibiotic spray composed of bacitracin + neomycin)
In cases of dehiscence
o Betadine M.W. + benzoin Co (‫(صبغة جاوي‬

Tooth paste:
The active ingredient in tooth paste and it is action:
 Chlorohexidine 0.1% (the gold standard antiplaque): used for gingivitis & periodontitis. DG care tooth paste
 Stannous fluoride (double action: enamel remineralization – broad spectrum antibiotic effect with modulation of the
microbial composition of biofilm (decrease gingival inflammation) Parodontax – Sensodyne
 Sodium fluoride: enamel remineralization (decrease sensitivity) Sensodyne
 Potassium nitrate: decrease tooth sensitivity by interfering with nerve end impulse in dentinal tubule. Sensodyne
Tooth paste for inflamed gum: + soft brush.
R/ DG care tooth paste (CHX gel)
R/ Parodontax tooth paste (stannous fluoride)

Tooth paste for sensitivity:

R/ Sensodyne rapid action (stannous fluoride + sodium fluoride)
o Leave on your teeth for 5- 20 min, brush your teeth, split the excess then use S.F -M. W not water
‫ دقايق – ثم‬3 ‫ دقيقة – ثم تغسل االسنان يالفرشاة لمدة‬20 – 5 ‫يترك علي االسنان من‬
‫استخدم المضمضة وليس الماء‬

Whitening tooth paste:

R/ Theramed whitening power (toothpaste + mouth rinse)
R/ close up diamond R/ Crest 3D white. R/ depurdent tooth paste.
o Use it for 2-3 days per week then complete your routine oral care with sensitivity tooth
paste and M. W.

Children tooth paste:

R/ single / crest / Colgate kids (less fluoride) + soft brush

Ahmed Hesham
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 Anti-edematous drugs
Indication: It is preventive and curative for edema
o To prevent or cure edema in cases of surgery (impaction) or trauma (include also trauma to nerve – trauma to PDL as in
cases of TFO or over instrumentation in endo).
o In cases of hematoma.
Precautions:
o Avoid using it to treat edema due to infection, as it may lead to spread of infection.as it is proteolytic enzymes that will
destroy the fibrous chain that enclose infection.
o Avoid using it during eating, as it will digest protein in food instead of inflammatory condition.
o Sensitivity: anaphylactic shock is common in cases of injection (α-chymotrypsin amp) so you must make sensitivity test
before each injection.
Dose: One or two tabs 3 times daily 1 hour before eating or 2 hours after eating.
Tab  Ambizem - g tab (1 or 2 tab x3) (30 tab = 42.75)
 Alphintern tab (1 or 2 tab x3) (30 tab = 36)
 Newbezim tab (1 or 2 tab x3) (20 tab = 24)
Syrup  Maxillase syrup. (5ml x 3)
Gel  Reparil gel N (Aesin = ant edematous & ant inflammatory) (1x3)
o Used in cases of TMJ pain (muscle spasm) – edema.
 Hemoclar gel (1x3)
o Used in cases of hematoma (anticoagulant action) – edema & pain (anti-inflammatory)
Amp  α-chymotrypsin amp (1x2)

Sedative
Sedative Anticonvulsant Antidepressant
Diazepam Carbamazepine Amitriptyline
Tegretol 200 mg tab - Tegretol CR 200 mg divitab
Long acting anxiolytics (it has extended release so to be used twice) Tricyclic
Indication: antidepressant
The safest and most used: 1- Trigeminal neuralgia. Neuralgia –
Used in cases of: Stress reduction – muscle Dose: Start with 100 x2 then increase 200 x 4 migraine
spasm - 1st line during epilepsy attack (800 - 1200 mg as maximum)
Use the smallest dose – shortest time (less 2- Stress
than 4 weeks) At bed time and before procedures by 2hours.
R/ Valpam 5 mg tab 3- TMJ pain + (bruxism) Tryptizol 25 mg tab
Preoperative sedation: At bed time and / or before 1/2 tab at bed time for 2 weeks. Amitriptine 50 mg
procedures by 2hours. Precautions: aplastic anemia so CBC each two weeks caps
Muscle spasm / anxiety: 5mg x3 (2 – 10 mg x3 /x4)
Gabapentin 75 up to 150 mg in
R/ Calmepam 1.5 / 3mg tab (bromazepam)
Preoperative sedation: At bed time / before procedure Gaptin 300 mg caps single or divided
R/ Valpam 2mg/5mg syrup 5ml x3 Neuralgia & neuropathic pain dose.
R/ Neuril 10 mg /2ml amp 1x1 (1st d) then 1x2 then 1x3
Emergency drug in cases of seizure
Contraindicated with: glaucoma – sleep
apnea – severe respiratory depression –
children < 6 years
Contraindication: Pregnancy (category D) – liver & renal disease.

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 Muscle relaxants
Definition and classification: They are drugs that reduces the muscle tone either by:
Directly
Periphery (neuro muscular blockers) Centrally
(on contractile mechanism)
 Competitive blockers:
d-tubocurarine, atracurium, gallamine, Diazepam / Baclofen / Chlorzoxazone Dentrolene
mivacurium Methocarbamol / Cyclobenzaprine Quinine
 Depolarizing blockers: succinylcholine, Tizanidine
decamethonium

Indication: muscle spasm

o TMJ muscular problem.
o Myofascial pain dysfunction syndrome.
o Bruxism.
o Trigeminal neuralgia.
Precautions:
o Overdose: lead to muscular hypotonia, drowsiness, respiratory depression, coma and convulsions.
o Baclofen:
 Stimulates gastric acid secretion (avoid it in peptic ulcer)
 Abrupt discontinuation can be associated with withdrawal syndrome: hallucinations and seizures.
o Chlorzoxazone + paracetamol (Myolgin): fatal hepatocellular toxicity.
o Use with caution in patients with epilepsy and psychiatric disorders.
o Avoid using it in combination with opioids and benzodiazepine.
o Avoid using it with pregnancy (category C) except cyclobenzaprine (multi-relax).

The most commonly muscle relaxants that used in dentistry:

o Baclofen: used in cases of neuralgia, multiple sclerosis.
Rx: baclofen 10 mg tab 5 mg (1/2 tab) 3 times daily for 3 days 10 mg 3 times daily for 3 days
15 mg 3 times daily for 3 days 20 mg 3 times daily for 3 days (max 80 mg / day)
o Chlorzoxazone (250) + ibuprofen (200) (Myofen)
o Chlorzoxazone + Paracetamol (Myolgin - parafon)
Rx: myofen tab (1 tab - three times daily =T.i.d)
o Methocarbamol (500) + diclofenac K (50 mg) (Dimra)
o Methocarbamol (750) + ibuprofen (400) (ibuflex)
o Methocarbamol (400) + paracetamol (325) (methorelax)
Rx: Dimra tab (1 tab - 3 times daily = T.i.d)
Maximum dose: 1500 mg x4 (for 2 /3 days only) – but the half of maximum dose or less is sufficient.
o Cyclobenzaprine (very strong: causes drowsiness so to be used at bedtime & if patient improved change to other) (multi-relax)
Rx: multi-relax 5 mg tab (1 tab - three times daily =T.i.d)
Rx: multi-relax 10 mg tab (1 tab - one time before sleeping)
o Tizanidine (Sirdalud - Roysan)
Rx: sirdalud 2 mg tab (1 tab - three times daily =T.i.d)
Rx: sirdalud 4 mg tab (1 tab - three times daily =T.i.d)
increase gradually each 3 days (Maximum dose 36 mg per day divided each 8 hours)

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 Analgesics
Use the Lowest effective dose for the shortest period
Injection only for 2 days
Strong analgesics in cases of severe pain:
1- Injection:
Ketorolac: one of the strongest NSAIDS (30 mg similar to10 morphine)
You can mix DEXA amp with it as single shot (DEXA + Ketolac)
Ketolac 30 mg amp 1x2 Ketolac 10 mg tab 1x4
Adolor 30 mg amp 1x2 Adolor 10 mg tab 1x4
FAM 30 mg amp 1x2 FAM 10 mg tab 1X4
IV: 30 mg as single dose – IM: 60 mg as single dose 20 mg after IV/IM then 10 mg x4
Maximum: 120 mg daily Maximum: 40 mg daily
Always begin with parental route (oral route only as continuation of IV/IM if necessary)
Duration of therapy should not exceed 5 days.
Contraindicated with renal impairment
2- In cases patient refuses injection.
o Combination of ibuprofen + paracetamol = strong anti-inflammatory & analgesic action
Brufen 400 mg tab + Panadol 500 mg tab 1x3 Brufen 600 + novaldol 1gm 1x3
Megafen / cetafen 1x3 cetafen plus (+ caffeine) 1x3
Moderate to severe pain:
Strong anti-inflammatory action
Brufen
Brufen 200 – 400 -600 tab 1x3 Brufen 600 sachets 1x3
Spididol 400 – 600 sachets 1x3
Dose: 1200 – 1800 mg / day divided (1x3 /1x4)
Lowest risk of causing GI bleeding
Maximum dose 3.2 gm/day
Avoid with hepatic impairment
ketoprofen
Ketoprek 75 mg caps (rapid action - 6-8 hours) 1x3 / 1x4 (maximum dose 300 mg / day)
Strong analgesic action
Diclofenac K: rapid onset – short duration
Maximum dose 200 mg / day = 4 tab
Cataflam 25 - 50 mg tab 1x3 Catafast 50 mg sachets 1x3
Oflam 25 -50 mg quick tab 1x3
Cataflam 75 mg amp 1x2
Chronic pain: that requires analgesic for long time (TMJ pain) Or peptic ulcer cases
Using selective COX II inhibitor to avoid peptic ulcers (weak analgesics –fewer side effects)
Xefo (lornoxicam) 8 mg 1x2 /1x3 Maximum dose 24 mg / 1st day (as loading dose) then 16
Xefo 8 mg vial IM/IV 1x2 not more 2 days
Mobitil 7.5 / 15 mg tab 1x1 / 1x2 Maximum dose 15 mg / day
Mobitil 15 mg amp 1x1
Celecox 200 mg caps 1x1 / 1x2 Maximum dose 400 mg
Has cerebrovascular side effects so to be avoided in cases of heart disease.
Not used with children below 12 years.
Bone disease: dry / infected socket –TMJ.
 Sulindac: the safest NSAIDs for treating osteoarthritis in older people. (Rudac 200 mg 1x2)
o Elevate liver enzymes (not used with hepatic patient)
 Indomethacin 50 mg caps 1x2/ 1x4 with meal for short period (very strong)
o Has high risk of GI complication (peptic ulcer) & CNS side effect.
o Not used < 15 years - Maximum dose 200 mg / day / for maximum 2 weeks.
Migraine:
 Naproxen 500 mg x2 (used in combination with sumatriptan = treximet)
Diabetic patient:
 Sulindac: prevent cataract……………………………..Rudac / HiDac 200 mg tab 1x2 (max dose 400 mg day)
 Paracetamol.
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 Paracetamol:
 Used with (peptic ulcer / TMJ – pregnancy & lactating mother (6months) – baby (1year) – falvism - diabetes –
renal impairment – hepatic patient)
Injectmol 1gm/100 ml IV infusion
Novaldol 1gm tab strong analgesic
Panadol joint In cases of TMJ
Hepamol / paralex plus (methionine + paracetamol) For hepatic patient

weighing Dose per administration Max. daily dose

< 10 kg 7.5 mg / kg 30 mg / kg
10 -33 kg 15 mg / kg 60 mg / kg (max. 2 gram)
33 -50 kg 15 mg / kg 60 mg / kg (max. 3 gram)
> 50 kg 1 gm 4 gram
Minimum interval: 4 hours / max single dose 1 gram / toxic dose > 7 gram in adult – 150 -200 mg /kg in child
Antidote: N-acetylcysteine (NAC) within 8 hours (loading dose 140 mg/kg then 70 mg.kg every 4 hours for 17 doses)
Children:
 Injection / suppository 1x2.
 Suspension: must be used within 2 weeks. (1x3 - from 3 -7 days - then 1x2)
Avoided < 3 years (It is better
Declophenac K
Catafly 2mg /ml susp. to be used after 6 years)
Dose: 0.5 – 2 mg / kg /day
Healthy child
ibuprofen Brufen 100 mg/5ml susp. (5ml x 3)
ibuprofen
Megafen-N 100mg/5ml susp
+paracetamol
Medical Dose 20 mg/kg/day
Cetal 250mg/5ml susp.
compromised Paracetamol
(falvism – Reyes Cetal 120 mg supp
syndrome) 1x2
In cases of vomiting

Special consideration:

Disease / condition Preferred drug

Pregnancy paracetamol
1st -2nd trimester: most NSAIDs are category C
3rd trimester: all NSAIDs are category D
Children Paracetamol
Ibuprofen is the most appropriate NSAIDs for children
Renal disease Paracetamol
All NSAIDs should be avoided: Ibuprofen, Sulindac, aspirin are the least
nephrotoxic risk.
Renal stone / colic Diclofenac is strongest in case of renal colic
High CV risk (coronary disease) Paracetamol
All NSAIDs should be avoided: naproxen is the least CVS risk
High GI risk (ulcers – bleeding) Paracetamol
Selective COX II inhibitor: Xefo
Or use ibuprofen with misoprostol or proton pump inhibitor (omeprazole)
Asthma and COPD Paracetamol
NSAIDS are avoided in case of NSAIDs sensitivity.
8-20% experience bronchospasm after NSAIDs
Patent ductus arteriosus Indomethacin or ibuprofen
Primary dysmenorrhea Mefenamic acid (ponstan forte 500 at once then 250 x4 for 3 days) –
Not recommended below 14 years / not more than 1 week
Naproxen (naprofen 500 mg tab 1x2 or 5oo mg at once then 250 x4
maximum dose 1250 / day

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 Antibiotics
Indication of antibiotics: only bacterial infection
 Acute infection:
o Cellulitis: diffuse swelling. / Involvement of facial space.
o Osteomyelitis. / Infected socket. / Severe Pericoronitis.
o Acute gingivitis: ANUG / Severe periodontitis (aggressive periodontitis, refractory periodontitis).
 After trauma / surgery (impaction, Naocl accident…)
 Prophylactic: immunocompromised patient (DM, corticosteroids, radiation) – heart disease - rheumatoid arthritis.
Situations AB is not necessary or contraindicated:
o Chronic well localized abscess. / Dry socket. / Mild Pericoronitis.
o Chronic gingivitis / mild to moderate periodontitis. / Fungal and viral infection.
Penicillin:
 Broad spectrum penicillin: is most effective against odontogenic infection esp. acute one
o Amoxicillin + clavulanic acid (mostly oral (better bioavailability than ampicillin) – used after meal).
o Ampicillin + sulbactam (mostly injection – less absorbed orally (absorption is impaired by food so 2 hours after meal)).
 Action: act on cell wall (nucleus remain act as spores that may lead to recurrent infection)
 Indication: almost all cases esp. acute infection (anti strept)
 Duration: at least 5 days / 3 days after S&S disappear (5-10 days).
5 days 7 days 10 days
pharyngitis- sinusitis – bronchitis. tonsillitis. typhoid – pneumonia – UTI.
 Dose:
25 mg/ kg: mild case 50 mg/kg: sever case 100 mg / kg: severe and we use injection.
 Form:
Oral : Tab / caps Suspension (susp) X3 Vial X2 (not divided)
(X2 / X3) according to concentration. All oral is susp: must be used within 2 weeks IM (3cm) IV (5-10 cm)
 Drug interaction:
o Increase oral anticoagulant action (warfarin) = increase INR …tendency of bleeding.
o Bacteriostatic drugs (tetracycline - erythromycin) decrease action of bactericidal (penicillin).
 Side effects:
o Allergic reaction 10%.
o Pseudo membrane colitis. (stop and give metronidazole = flagyl)
o Gastrointestinal upset: nausea –vomiting- diarrhea.
o Candida infection with long use.
 Contraindication:
o Allergy to penicillin: ask him if he had previous allergy – make sensitivity test – asthmatic patient must be tested for
each injection - change to erythromycin (1st considered) or clindamycin.
o Infectious mononucleosis: amoxicillin causes AB induced skin rash.
o Cholestatic jaundice / liver problem (not absolute contraindication but just take your precautions, cephalosporin
(not metabolized in livre) is more safe than penicillin in this case.)
o Severe renal impairment: need dose adjustment
 Crcl 10-30 ml/min: 250 -500 mg/12 hrs. ● Crcl < 10 ml/min: 250 -500 / 24 hrs.
Adult Child
Dose 25- 50 mg/kg may reach 100 mg in case of injection Child weight = age x 2 + 8
Tab R/ Hibiotic / Curam / Augmentin 1gm tab 1x2 susp Below 6 years
R/ Hibiotic / Curam / Augmentin 625mg tab 1x3 R/ Clavimox 312.5 mg 5ml x3
Cheap 1-gram AB: Clavimox (16 tab = 61) 6-9 years
Clasynmo (20 Tab =77) – Augram (14 =54) R/ Clavimox 457 mg 5ml X3
Vial R/ Augmentin / CURAM 1.2 gm vial 1x2 9-12 years
used within Ampicillin + sulbactam R/ Hibiotic 600 mg 5ml X 2 / X 3 according
2 hours in to weight (if < 40 kg so 600 x 2)
Dose in severe case: 1.5 to 3gram x 4 (maximum
room
temperature dose 12 gram – maximum sulbactam dose 4 gram)
or 4 hours if R/ Unictam / UNASYN 3 gm vial 1x2 (used in severe Vial Dose in severe case: 300 mg/kg / day
refrigerated. infection as loading dose in 1st day then decrease divided to 4 doses
dose) Unictam 750 mg vial 1x2
R/ Unictam / UNASYN 1.5 gm vial 1x2 Unictam 375 mg vial 1x2
Note: injection is preferred in cases of severe
infection or surgery to be used in 1st 2 /3 days then
move to oral AB from the same category.
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 Cephalosporin:
Action, drug interaction, side effects (allergy) the same as penicillin.
1st generation: anti-gram +ve (anti-staph) & some gram -ve Questionable
 Indication: many cases esp. chronic / stubborn infection (anti-staph).
 Dose: 25-50 mg /kg
o Velosef: susp: 125 -250 mg x2 / Tab: 500 mg – 1gm x2 / Vial: 250 – 500 – 1gm x2
o Ceporex: susp 125 -250 mg x2 / Tab: 500 – 1gm x2 / Vial: 500 -1 gm x2
3rd generation: mainly anti-gram –ve
o Suprax: 200 mg tab 1x2 (400 mg / day as single dose or divided every 12 hours) 8 mg /kg / day
o Ceftriaxone: 1- 2 gm IV/IM in single daily dose or every 12 hours. 50 - 75 mg / kg /day or every 12 hours.
Used in cases of surgical prophylaxis
o Cefotax: 250 - 500- 1 gm - 2gm vial IV x3 50 – 200 mg / kg / day every 8 hours
o Fortum (ceftazidime): 250 -500 – 1 gm vial x2 / x3 30 - 50 mg / kg every 8 or 12 hours
May reach to 2 gm x 3 IV / IM in cases of life threatening infection esp. in medical compromised patient.
Used in cases of pulmonary infection / COVOID infection
Clindamycin:
Indication:
 Can be used in all cases instead of penicillin (allergy case as 2nd choice after erythromycin).
 Most affective against anaerobic infection:
o Pericoronitis – abscess – ANUG.
o Bony infection (infected socket / osteoradionecrosis / osteomyelitis): due to its high affinity to bone.
Side effects:
 Pseudo membrane colitis: diarrhea with abdominal cramps & pain (stop and use flagyl)
 Hypotension, jaundice, metallic taste.
Notes:
 No significance drug interaction: It is only AB safe with warfarin.
 Avoid using it with nervous colon / ulcerative colitis.
 It is bactericidal in large doses.
 No dose adjustment needed in renal patient.
Dose: 16- 20 mg/kg = 3 - 4 equal doses per day.
 R/ DALACIN - C 300 mg caps 1x3 / 4 x7 R/ DALACIN – C 600 mg amp1x3 (max dose 1.8 g/d)
 R/ CLINDAM – 300 mg caps 1x3 / 4 (cheap)
Metronidazole
Indication: affective against anaerobic infection.
 H- pylori – pseudo membrane colitis. - Pericoronitis – ANUG.
 Aerobic & anaerobic infection: sinusitis – aggressive periodontitis. (not used alone)
o Combination with spiramycin: spirazole forte 1x2 before meal.
o Combination with (penicillin + clavulanic acid): flagyl + Hibiotic 1 gm tab 1x2
Precautions:
 Pregnancy during 1st trimester (teratogenic).
 Alcohol consumption up to 3 days / patient treated with disulfiram in the past two weeks.
Drug interaction: increase concentration of phenytoin (anti-epilepsy) – alcohol – disulfiram.
Side effects: metallic taste, xerostomia, nausea & vomiting.
Dose: 35 -50 mg/kg/ day divided in 3 – 4 doses. max dose 4 g/ day.
 R/ Flagyl / Amrizole: 250 - 500 mg tab 1x3 for 7- 10 days.
 R/ Flagyl / Amrizole: 125 mg /5ml susp 5ml x3
Macrolides:
Action: very strong (act on ribosomes) / anti –gram +ve.
Uses: 1st in cases of penicillin allergy / renal impairment (no dose adjustment) – very safe in pediatrics.
Erythromycin: 30 -50 mg/kg 1x3x5
 Dose: erythromycin 200 mg/5ml susp 5ml X 3 X 5 days before meal by one hour.
Azithromycin: 10 – 15 mg /kg 1x1x3
 Xithrone 200 mg /5ml susp 1x1 before meal for 3 days.
May be used with cyclosporine associated
 Zithrokan 500 mg 3 caps 1x1x3 before meal by 1 hour.
 Neozolid 600 mg 1x1x3
gingival enlargement
Linezolid
Used in cases of resistant infection – wound infection – skin infection – bacteremia / septicemia.
R/ Averozolid 600 mg tab 1x2 (1 to 2 week)

Ahmed Hesham
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 Tetracycline /doxycycline:
It is bacteriostatic: avoid using it before bactericidal AB.
Contraindicated: pregnancy (category D - teratogenic) and children < 9y (discoloration of teeth).
Indication:
 Aggressive and refractory periodontitis: due to high concentration in GCV and high substantivity.
 H-pylori infection.
 Locally:
o In treating ulcers: mixed with Tantum M. w.
o Conditioning root: in case of periodontal surgery.
o Avulsed tooth: soaking it in doxycycline for 5 min before implantation (double/ triple revascularization rate)
Tetracycline (tetracid) Doxycycline (Vibramycin)
Short acting 1x4 Long acting 1x1 (high lipid solubility)
Affected by food: chelation with metals e.g. ca, Mg, Less chelation (not cause teeth bleaching)
Fe, Al (teeth bleaching) So used before meal
fanconi syndrome (Nephrotoxic metabolite esp. expired tetracycline) Absence
Avoided in hepatic and renal failure No dose adjustment needed
Photosensitivity: severe sunburn
Dose:
Tetracycline 250 mg caps 1x4 before meal with full glass of water Doxycycline (Vibramycin) 100 mg caps 1x2 in 1st day then 1x1 for
to avoid esophageal ulcer. 8 days or 1x2 in severe cases
Avoid food, calcium rich product (milk) drugs contains metal (iron) – use sun protective cream

Fluoroquinolones:
Indication: in cases of resistant infection – sinusitis – skin & skin fracture infection.
Contraindication: pregnancy (cartilage damage) & children.
Side effect: significant toxicity, muscle weakness and mental clouding – renal impairment (except Moxifloxacin – metabolized in liver)
Drug interaction: potentially fatal drug interaction with cardiovascular drugs.
Ciprofloxacin (2nd G) 250 -500 mg caps 1x2 / 1x3 - used in triple mix antibiotics.
rd
Tavanic (3 G) 500 mg tab 1x1 - used in cases of sinusitis.
Moxifloxacin (4th G) 400 mg tab 1x1 - used in odontogenic infection (only effective against anaerobic mos.)
Quinabiotic (4th G) 320 mg tab 1x1
Triple Antibiotics Mix
Composition: Tetracycline 250 mg caps + ciprofloxacin 500 mg + flagyl 500 mg tab + mix with saline / L.A
Indication:
 Used as intracanal medication in cases of:
o Revascularization case (open apex) - Non-vital pulpectomy - Disinfection of teeth with periapical abscess.
Preventive / Prophylactic Antibiotics
Indication:
 Patient with high risk of infective endocarditis:
o History of infective endocarditis.
o Prosthetic heart valve.
o Congenital heart disease.
o Heart transplant.
o Rheumatic heart disease.
 Medically compromised patient /immunodeficiency:
o Cancer – HIV – radio & chemotherapy…
o Diabetes mellitus
o Hepatic patient.
 Patient with artificial joint infection (late stage)

Amoxicillin 2 g Hibiotic 1 g x2
Adult Clindamycin 600 mg clindam 300 x2
azithromycin 500 mg Zithrokan 500 mg tab x1
Oral 1 hour before procedure
Amoxicillin 50 mg/kg
child Clindamycin 20 mg /kg
azithromycin 15 mg /kg
Unictam 3 gram x1
Injection 30 min before procedure Adult Dalacin c 600 x1
Ceftriaxone 1gm IV x1 / 50 mg/kg for child

Ahmed Hesham
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 Antifungal:
Topical Antifungal:
Indication: used in treatment of 1ry candidiasis (mild cases)
 Thrush –erythematous – hypertrophic candidiasis.
 Geographic tongue.
 Candida associated lesion:
4 times /
o Denture stomatitis. 2 weeks
o Median rhomboid glossitis: topical antifungal + corticosteroids.
o Angular chelitis: topical antifungal + corticosteroids + vit b complex.
Nystatin
Dose: R/ Nystatin or mycostatin oral susp 5ml X4 (rinse for 2 min then swallow)
Few drops of nystatin can be added to water used for soaking the denture.
Child > 1 year: 4-6 drops x4 Child < 1 year: 2 drops x4
Precautions Diabetes (as it contains sucrose)
Pregnancy and lactating mother (category C)
Miconazole
Dose R/ Daktarin or Miconazole 2% oral gel (4 times /day/2weeks)
Precautions Pregnancy & lactating mother (1st 6 months) – severe liver disease.
Topical cream for skin infection:
It is combination of (antifungal + antibiotic + corticosteroids)
 R/ Kenacomb cream
 R/ Polyderm cream
Systemic antifungal:
Indication: 2nd candidiasis / mucocutaneous candidiasis (moderate to severe cases)
Fluconazole
st
1 line of High bioavailability – fewer hepatic enzyme interaction – better GI tolerance – widest therapeutic
treatment index.
Dose: R/ Diflucan 50 mg tab / 100 mg tab
 1st day: 100 mg X2 (loading dose)
 7-14 days: 100 mg X1
Children > 6 R/ Diflucan 25mg/5ml syrup
months  1st day: 6mg /kg
 7-14 days: 3mg / kg
Precautions Pregnancy & liver disease (ask for liver function tests before prescribing systemic antifungal)
Drug Decrease Warfarin metabolism (increase anticoagulant = increase bleeding)
interactions: Increase effect of sulfonylurea = hypoglycemia.
Increase effect of phenytoin (anti-epileptic)
Cimetidine (TTT for peptic ulcer) decrease effect of fluconazole.
Itraconazole
Used in refractory cases to fluconazole. (broader spectrum)
Dose R/ Itracon 100 mg Caps
Children > 3 years  100 mg X2 X 7-14 days. - should be taken with food (ideally acidic: orange juice)
Precautions The same.
Avoid getting pregnant while taking it & after 2 months from last dose.

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 Antiviral:
Indication: used in TTT of viral infection.
Herpes simplex:
 It is self-limited disease (7-14 days) but using antiviral decrease infectivity, pain, size and duration.
 Treat early as possible (1st 72 hours of onset)
Acyclovir (zovirax):
Adult R/ Acyclovir 200 mg tab X5 X (7-10 days)
R/ Zovirax 400 mg tab X3 X (7-10 days)
Child 15 mg/kg (child< 12 years = 100 mg X 5 X (7-10 days)
R/ Zovirax 200 mg susp (3ml X5 X (7-10 days)
RHL Systemic TTT is effective more than topical but decrease days to 5 days or use single dose (Famciclovir)

Topical Zovirax 5% topical cream 1 x5 x 4 days

Penciclovir 1% every 2-hour x 4 days
Docosanol 1x 5 x10 days (its OTC – used in start of lesion – prevent virus fusion with cells).
Precautions Pregnancy (category B) & renal failure

Famciclovir:
Preferred in cases of immunocompromised patient & older patients:
 Higher bioavailability (simpler dose than acyclovir) & more effective.
 More effective in cases of Herpes Zoster & decreasing post-operative herpetic neuralgia.
Adult R/ Eaclovir 500 mg tab 1X2 X (7-10 days)
RHL Single dose: Famciclovir 1500 mg x1
R/ Eaclovir 500 mg 3tab x1
Precautions Pregnancy & renal failure

Herpes zoster:
 More serious than herpes simplex so increase dose of antiviral / use more effective drug.
o R/ zovirax 400 mg tab 1 x 5 x 7-10 days.
o R/ Eaclovir 500 mg tab 1 X 3 X 7-10 days.

Corticosteroids:
It is potent anti-inflammatory & immunosuppressive drugs.
Action:
 Carbohydrate metabolism:
o It has anti-insulin effect (increase blood glucose & decrease its uptake = hyperglycemia)
o Resistance to stress: by increasing blood glucose level (adequate supply to brain)
o Precautions: diabetes mellitus
 Protein metabolism:
o Increase protein catabolism (delay wound healing – wasting of muscle – increase capillary fragility)
 Lipid metabolism:
o Increase fatty acid in blood (used for energy production) – long tern corticosteroids (centripetal obesity)
 Electrolyte & water balance:
o Na -water retention & K exertion (increase blood pressure) – long term usage (Na retention & hypokalemia -
expanded extracellular fluid volume (hypertension).
 Blood:
o Increase RBCs (help in cases of anemia) – platelets & 1972 factors (increase viscosity - coagulation X embolism) –
neutrophils.
o Decrease lymphocyte (reduce immunity, increase fungal infection) – monocytes – basophils & eosinophils.
o Potentiate VC effect of adrenaline & angiotensin II.
 Effect on bone (osteoporosis)
o Decrease absorption of ca and phosphate from intestine (anti-vitamin D)
o Decrease osteoblast number and their function. Decrease bone formation
o Increase osteoclast activity indirectly (PTH induce osteoclast to increase Ca in blood). bone resorption

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  Effect on skin
o Decrease fibroblast proliferation: skin thinning and easy rupture.
o Long term topical: skin atrophy – topical steroid addiction (red skin syndrome: itching –redness – swelling after withdrawal)
 Immunosuppressive & Anti-inflammatory & anti-allergic:
o Impair migration of WBCs & its secretion (cytokines)
o Impair arachidonic acid & phosphlipidase metabolism (PG & leukotrienes)
o Inhibit lysosomal breakdown (histamine –bradykinin)
o Inhibition of T-lymphocyte activation and proliferation & production of plasma cells.
o Decrease capillary permeability (decrease inflammatory edema)
Indication:
 Ulcers: major aphthous ulcers.
 Oral manifestation of immunity disease (lichen planus – lupus erythematosus – behcets disease -pemphigus …)
 Mucocele: inralesional cortisone to decrease mucocele size.
 Allergy / anaphylactic shock.
 Nerve injury / bell's palsy / Post herpetic neuralgia.
 Before / after surgery (decrease edema & increase recovery)
Usage in dentistry: start with topical.
Topical Intralesional Systemic
Topical corticosteroids:
 Used 4 times / day (after meal & at bed time – take nothing by mouth at least one hour after topical steroids).
 Decrease duration of treatment as possible to avoid:
o Mucosal atrophy.
o Candida infection.
o Perioral dermatitis.
o Increase potential for systemic absorption.
 Tapering gradually: decrease daily dose (2 times instead of 4) then alternate day.
Mouth wash
Orazone syrup 5ml for 2 min then spit out x4
Tantum verde M.W + betasone 0.5 mg tab. 5ml for 2 min then spit out x4 recurrent multiple ulcers.
Epirelefan amp + phenadone syrup + 100 ml saline 5ml for 2 min then spit out x4 major ulcers / immunity ulcers.
Gel
Kenalog in orabase gel: avoid rubbing it (irritation) & eating for 30 min.
Intralesional:
Used in severe / stubborn cases (in combination with topical or systemic or alone).
 R/ Epirelefan amp + L.A (to decrease pain during injection) + insulin syringe.
o Submucosal insertion of needle in periphery of lesion then inject slowly during withdrawal.
Infiltration:
In cases of periapical periodontitis (after endodontic treatment – patient cannot touch tooth)
 R/ Dexa amp + L.A (periapical infiltration)
Systemic corticosteroids:
Low potency & short acting < 12 hours Moderate (12 -36 h) High potency & long acting > 48 h
Cortisol = Hydrocortisone Prednisone Dexamethasone
 Solucortef 100 mg vial  Solupred 5 – 20 mg tab  Dexamethasone 8 mg amp
 Hostacortin 5mg tab  Fortecortin 8 mg amp
syrup  Epidron 4 mg vial.
 Xilone 5 mg syrup syrup
 Xilone forte 15 mg syrup  Phenadone 0.5 mg syrup
Prednisolone  Apidone 0.5 mg syrup
 Hostacortin H 5 mg tab Betamethasone
Triamcinolone  Betasone tab 0.5 mg
 Epirelefan amp
 Kenacort A vial.
- It is short acting. Prednisone is a prodrug and
- It has mineral corticoid action (increase blood converted to prednisolone
pressure) (active compound) in liver.
o more used in children and emergency So in hepatic patient give
cases prednisolone (Hostacortin H)

Ahmed Hesham
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 Children;
Parental: 1cm/10 kg
Oral: 5 mg syrup 2mg/kg/ day 0.5 mg syrup: 0.1 mg/kg/ day (divided on 3)

4 times per day Once or twice In cases of allergy 4-8 mg IM/IV then
100 – 500 mg / 6 h / IM – IV 5-60 mg/day orally (phenadone / apidone =
For max 3 days then reduce gradually For 5 days then tapered over contains antihistaminic)
5 days
20 mg hydrocortisone = 5 mg prednisone = 750 mcg dexamethasone
Gradual withdrawal:
TTT more than 2 weeks or dose more than 40 mg prednisone.
Steroid tapering dose:
60 (3d) – 40 (3d) – 20 (3d) - 10 (3d) – 5 (3d)
Activity Equivalent oral
Agent Forms available
Anti-inflammatory Topical Salt retaining dose (mg)
Hydrocortisone 1 1 1 20 Oral – injectable - topical
Prednisone 4 0 0.3 5 Oral
Prednisolone 5 4 0.3 5 Oral – injectable
Triamcinolone 5 5 up to 100 0 4 Oral – injectable – topical
Dexamethasone 30 10 0 0.75 Oral – injectable – topical
Betamethasone 25-40 10 0 0.6 Oral – injectable – topical
Fludrocortisone 10 0 250 2 oral

Daily cases in dentistry:

 Patient complains from severe pain that NSAIDs not sufficient:
 Before / after surgery: may be used instead of α-chymotrypsin to avoid sensitivity.
o R/ Dexamethasone amp + Ketolac amp (1x1 or 1x2x 2 days)
 Allergy after L.A:
o R/ Dexamethasone amp or Solucortef 100 mg vial.
o R/ Avil amp
 Anaphylactic shock:
o Adrenaline 1: 1000 0.3 -0.5 ml IM then
olucortef 100 mg vial 1 or 2-amp IV.
 Nerve injury: (depend 1st on vit B-complex)
o R/ Neurovit tab 1x1
o R/ Solupred 5 mg tab (1st 5 days: 5mg x4 - 3 days: 5mg x2 - 2 days: 5mg x1)
Adverse reaction:
It is dose (>40 mg) & / or duration dependent (>2 weeks)
 Dose dependent: HTN – D.M – infection.
 Dose & duration: Cushing – osteoporosis.
Contraindication:
 D.M: as it causes hyperglycemia
 Pregnancy.
 Peptic ulcer.
 Osteoporosis: So give vit D & Ca
 HTN.
 Renal failure.
 Viral & fungal infection.
 T.B
 Angina & embolism.

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 Vitamins:
Vitamin C
 It is essential for immunity, growth & development, iron Deficiency o Decreased immunity, growth and
absorption and repair of all body tissues. iron absorption.
 Antioxidant - Decrease blood pressure – reduce heart disease o Impair wound healing.
risk – reduce uric acid level (GOUT) o Bleeding gum.
 Important for collagen synthesis: o Mobile teeth.
o Promote wound healing. o Bone pain.
o Blood vessels integrity o Risk of memory disorder.
o Periodontal ligament
o Cartilage, bone and teeth. Excess Increase oxalate = kidney stone
Sleeping problem.
Git disorder & diarrhea.
Drug interactions Decrease warfarin effect.
Decrease oral contraceptive level.
Diagnosis CBC: to exclude anemia.
Ascorbic acid test.
Dose Dose from 1 to 2 tablets - Maximum dose 2000 mg daily
R/ C-retard 500 mg caps 1x1
R/ Vitacid –C 1g effervescent 1x1
Vitamin B complex
Indication / its o Nervous injury.
deficiency o ulceration.
o Burning mouth syndrome.
o Atrophy of tongue.
Dose R/ Milga Advance 1x1 or R/ Neurovit tab 1x1
R/ Neurovit amp 1x2 x week or (alternate day for two weeks then 1 amp / week)
Vitamin E
Indication Systemic: it is strong anti-oxidant can be used to decrease side effects of other drugs and to
neutralize free radicals produced by drugs- inflammation …that may lead to cell damage / cancer.
Topically: empty the capsule content and applied topically.
 Act as antioxidant and membrane stabilizer (protect epithelium lining from breakdown by the direct effect
of chemotherapeutic agent and help the broken cells to regenerate)
 Ulcers & mucositis due to chemotherapy / chemical burn to mucosa: bleaching burn
Dose R/ vit E 1gm caps 1x1
Vitamin A
Indication  Anti oxidant.
 Promote differentiation, integrity and retard malignancy of epithelium.
 Inhibit keratinization. (leukoplakia – lichen …)
 Improve resistance to infection.
 Maintains proper bone growth.
Dose R/ A viton 50.000 I.U caps 1x1 or 1x2
Vitamin D & Ca
Indication  Periodontal disease. S.E of Ca Constipation – bloating gas – stomach
 After surgery (bone removal). upset.
 During teething. Drug Decrease absorption of iron –
 Pregnant & lactating mother. interaction tetracycline – quinolone - phenytoin
 With corticosteroids.
Dose Vit D (400 -1000 unit/day) R/ Davalindi 1000 I.U tab 1x1
R/ vidrop 2800 I.U (8 – 12 drops per day - each drop contains 100 I.U)
Ca R/ calcimate 500 mg caps 1x1 after meal
Combination R/ Decal B12 syrup (Ca + D3 + B12) - 5 cm x1 (prophylactic) - 5cm x3
(therapeutic)
R/ osteocare liquid (ca + D3 + mg + zinc)
R/ osteocare tab (ca + D3 + mg + zinc) 1x1

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 Iron
Indication  In TTT of anemia (sore mouth – ulcers –bleeding gum)
o Oral less side effects than parental (hypotension –bradycardia..)
Dose Adult: 60(boy)–120 mg R/ ferrotron caps (iron – zinc – cu – vit c – vit B complex – folic acid) 1x1 before launch
(pregnant)/day R/ Haemojet 100 mg caps 1x1
Primary prevention during
pregnancy: 30 mg / day
better absorbed on fasting (may be used after in cases of GIT upset).
Infants: 2-4 mg / kg / day For 3 months after hemoglobin returns to its normal conc.
Avoid tea after eating & after iron treatment, eat food rich in vit C (guava, meat, fish
and black honey).
Lactoferrin
Indication Regulating iron metabolism - in cases of infection (H-pylori that causes ulcers) – anti-inflammatory –
/ action antioxidant - reduce cancer - stimulating the immune system – some antiviral activity.
Dose R/ EGY-TRON (lactoferrin)
Pregnant/ lactating mother / children > 3 years: one sachet at morning and evening
Adult: 2 sachets at morning Before eating for 1 month.
R/ Sperience 1x1 sachets (lactoferrin - iron – vit c – vit B complex – folic acid - Ca) in water or milk
Omega 3
Indication Anti-inflammatory – antioxidant (prevent cancer – diabetes complication….)– depression & sleep
/ action improvement – autoimmune disease (lichen - lupus) -
Dose R/ Omega 3 plus caps 1x3
R/ OMINOX sachets 1x1 (omega 3 – lactoferrin - vit B complex – folic acid - vit c – vit E- vit A – VIT D3 –
zinc – selenium –L carnatin)
R/ TERA 1X1 (omega 3 – vit B complex – folic acid - vit c – vit E – zinc – selenium –Beta caroten)
Antioxidant:
Used to decrease side effects of other drugs and to neutralize free radicals produced by drugs- inflammation …that may
lead to cell damage / cancer.
Decrease diabetes and other chronic disease complications.
Decrease cancer incidence in case of presence of dysplastic changes. (leukoplakia.)
R/ Vit E R/ VIT C R/ Lactoferrin R/ Omega 3
R/ OMINOX sachets (omega 3 – lactoferrin - - vit c – vit E)
R/ Curcumin caps 1x1 / 1x2
R/ Thiotex forte 600 mg caps 1x1
R/ A viton caps 1x2

Hemostatic drugs:
 Consult physician before prescribing any systemic hemostatic drugs.
 Apply topical & avoid systemic as possible (Kapron & haemostop – tea bag (tannic acid))
Vit K
Action Required for synthesis of 1972 coagulation factor. (systemic action not local)
Indication in cases of vit.k deficiency – patient on warfarin - liver disease ( consult physician before prescribe it)
Dose For prothrombin deficiency (up to 25 mg)
R/ AMRI – K 10 mg amp IM 1x2 (/3 if needed) for two days before and after surgery.
R/ k1 apex 10 mg chewing tab 1x2 / 3
Reverse oral less side effects than parental
action IV: cause hypotension –cyanosis – sweeting – flushing – anaphylactic reaction
IM: severe pain & bleeding at site of injection
Ethamasylate
Action Correct abnormal platelet adhesion – maintain stability of capillary wall (systemic and local)
Indication in cases decreased resistance of blood capillary (DM – HTN)
Dose R/ Haemostop 250 mg amp IV/IM / Tab 1x3 (start with injection then orally) Usual Adult dose 500 mg 1x3
R/ Dicynone 250 mg tab/amp Child dose 250 mg 1x3
Tranexamic acid
Action Control bleeding due to excessive fibrinolytic activity (systemic and local)
Indication Used in cases of patient with high INR - hemophilia / taking anticoagulant
Dose 10 mg /kg / 3-4 times for 8- 10 day (short term use)
R/ Kapron 500 mg /5ml IV amp – Kapron 500 mg tab 1x2
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 Emergency drugs:
Adrenaline
Action  Rapid onset but short action (multiple administration)
 Vasoconstrictor action (mucosa –skin – viscera) + decrease capillary permeability (decrease edema)
 Increase H.R, COP, BP & bronchodilator
Uses  It is lifesaving (acts in few minutes)
o 1st line of TTT: anaphylactic shock
o Cardiac arrest Severe asthma. Angioedema
Dose R/ Adrenaline 1: 1000 (In cases of anaphylactic shock)
o Adult: 0.3 – 0.5 ml IM / SC
o Child <6 / patient take anti-depressant or B-blocker: half dose =0.15 ml
Re-administrated after 5 min, if no response – maximum dose 1.5 ml
R/ Adrenaline 1: 10000 slowly IV (In cases of cardiac arrest)
1ml (1:1000) 10 cm syringe (9 ml saline)
0.3 – 0.5 insulin syringe.
precautions  Avoid IV as possible (ventricular fibrillation)
 Pregnancy: decrease placental blood flow / premature labour.
 Tricyclic antidepressant
 CVS disease / diabetes (adrenalin has anti-insulin action + most DM has HTN D.T atherosclerosis) /
hypertension / hyperthyroidism.
Corticosteroids
Action - Anti-inflammatory: interfere / prevent secretion of inflammatory mediator.
- Immunosuppressive:
- Support circulation (essential for VC action of adrenalin + mineralocorticoid action)
Uses o Anaphylactic shock (100 – 200 Solucortef slowly IV after adrenaline)
o Severe allergy.
o Acute asthma.
Dose R/ Solucortef 100 mg vial 1 or 2 amp slowly IV. (Child <6 years 50 mg)
Anti-histamine
Uses Allergy (R/ Avil amp + R/ Solucortef 100 mg vial )
Dose R/ Avil amp
R/ Diphenhydramine HCL 50 mg/ml amp (Has potent L.A action)
R/ cholrpheniramine 10 mg / ml (less sedation than diphenhydramine)
Side effects Cortical depression.
Sedation
Decrease blood pressure.
Thickening of bronchial secretion. (so it is contraindicated in acute asthma cases)
Dry mouth.
Salbutamol
Uses Asthma
Dose R/ Vental inhaler: 6 puff at time inhaled separately repeated at interval of 10 – 20 min.
R/ Ventolin 0.5 mg amp IV slowly: in cases of no response after adrenaline injection.
R/ Farcolin 2 cm soln + Atrovent vial + 4 cm saline (‫)الجلسة‬
Vental inhaler Solucortef Adrenaline Ventolin
Neuril
Uses Seizures (epilepsy – drug induced: overdose LA – thyroid stroma)
Dose R/ Neuril 10 mg/2ml amp IM (or diluted in 10 cm syringe and give slowly IV)
Side effect Respiratory depression / arrest
Nitroglycerine
Uses Angina / myocardial infraction (chest pain > 20 min)
Dose R/ DINITRA 5 mg sublingual tab (act in 1-2 min & last 20 min)
 Repeat if not relieved every 5 min (not more three tabs in 15 min)
 If not relieved: give 160 – 325 mg aspirin
R/ Rivo 320 mg (chew & swallow) or R/ Aspocid 75 mg 4 tab
Glucagen (glucagon H) / glucose
Uses Hypoglycemic coma
Dose R/ Glucagen 1mg /ml vial IM / IV / SC
 Used in unconscious patient (coma) – (considered a diagnostic tool in unconsciousness & seizures
of unknown origin)
 It is short acting, repeat after 20 min, then give oral sugar.
R/ Glucose IV fusion 200 -300 ml of 10% glucose OR 50 ml of 50% dextrose (thrombophlebitis)
Ahmed Hesham
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 Emergency cases
Anaphylactic shock
Causes  Latex – LA – AB – NSAIDs – food ..etc
Clinically  The most severe reaction – within 30 min (the quicker the onset the severe the reaction)
 Sudden severe VD – severe hypotension – impaired pulse – respiratory arrest – cyanosis –sudden death.
 Increase capillary permeability (edema: angioedema) –urticaria –erythema – severe asthma- epiglottis –
airway obstruction
Edema of face hypotension pulseless
Coldness of hand & feet pallor & sweating cyanosis (X o2)
Wheeze (bronchospasm) impaired pulse death within 5 min
management o Position: flat with raised legs.
o Ventilation: 100% O2 – patent airway: emergency intubation
o Medication:
Adrenaline 1st
R/ Adrenaline 1:1000 0.3 - 0.5 IM (every 5 min – maximum 1.5 ml)
Corticosteroids + antihistamine
(not necessary in acute phase – just to prevent relapse & reduce usage of adrenaline)
R/ Solucortef 100 / 200 mg vial slowly IV / IM (every 6 hours for 24 hours)
R/ chlorophenalex 10 mg/2ml amp IM/IV OR Avil amp.
R/ allergy 4 mg tab 1x4 for 24 hours
o Call ambulance.
Allergy
Clinically  Allergy reaction acts on shock organs (smooth muscle (spasm) – BV (VD) – skin & mucous membrane
(increase permeability))
 Spasm of smooth muscle: asthma.
 VD& permeability: urticaria –fever –edema …
Management o Mild case: no TTT
o Acute case:
R/ Solucortef 100 / 200 mg vial slowly IV / IM
R/ chlorophenalex 10 mg/2ml amp IM/IV OR Avil amp.
R/ Adrenaline 1:1000 0.3 - 0.5 IM (if no response)
Asthma
Leukotrienes is the main mediator (no value for anti-histamine – aspirin increase leukotrienes)
Clinically  Bronchospasm –shortness of breath – cyanosis –bradycardia – hypotension - coma
Management o Stop procedure & clear airway (loosen tight clothes)
o Position: upright position in airy & cool place
o Ventilation: 100% O2 – ventilator –non breathing bag.
o Medication:
R/ Vental inhaler: 6 puff at time inhaled separately repeated at interval of 10 – 20 min.
OR R/ Farcolin 2 cm soln + Atrovent vial + 4 cm saline (‫)الجلسة‬
If no response R/ Solucortef 100 vial slowly IV / IM
If no response R/ Adrenaline 1:1000 0.3 - 0.5 IM
if no response R/ Ventolin 0.5 mg amp IV slowly
Adrenal crisis
Causes  Adrenal insufficiency (in 1ry more than 2nd)
Clinically hypotension
tachycardia hypovolemic shock CVS failure
fever
Risk factor Stress (pain) –infection –GA (barbiturate)
Prevention Stress reduction protocol.
Parient on corticosterids (double dose - only or with- IV preparation)
management o Intravenous fluid: 5% dextrose in normal saline (To correct volume depletion & acute hypoglycemia)
o IV corticosteroids + oral
R/ Solucortef 100 mg vial 1x4 (until the patient is well enough for reliable oral therapy)
Hypertensive crisis
Clinically History of high BP - Headache –vomiting - dizziness – epistaxis –palpitation
Diastolic BP 120 -125
management R/ capoten 25 mg sub lingual tab
Measure blood pressure after 30 min (decrease to 100-160 – if not repeat maximum 3 tab 75 mg)
R/ NITRODERM 5 mg patch (if no result with capoten)
R/ LASIX amp used only in cases of pulmonary edema

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 Hypotension
Causes Anemia – cardiac –vasovagal attack –orthostatic hypotension.
Clinically History of low BP - Headache –dizziness – blurred vision – chest pain – shortness of breath.
BP 90 - 60
management R/ Solucortef 100 mg vial
R/ Corasore 150 mg tab 1x3
R/ IV fluids.
R/ instructions: water & salt
Medical compromised patient
Hypertension
Blood pressure Treatment required Follow up / Refer to physician
≤120/80 Any required No physician referral necessary
≥120/80 but <140/90 Any required Encourage patient to see physician
≥140/90 but <160/100 Any required Encourage patient to see physician
≥160/100 but Any required- consider intraoperative monitoring Refer patient to physician promptly
<180/110 (within 1 month)
≥180/110 Defer elective treatment Refer to physician as soon as possible; if
patient is symptomatic, refer immediately
Antibiotics Avoid the use of erythromycin and clarithromycin (not azithromycin) with calcium channel blockers because the
combination can enhance hypotension.
Analgesics Avoid long-term (>2 weeks) use of NSAIDs because these agents may interfere with effectiveness of some
antihypertensive medications.
Anesthesia Modest doses of local anesthetic with 1:100,000 or 1: 200,000 epinephrine (e.g., 1 or 2 carpules) at a given time are of
little clinical consequence in patients with BP <180/110 mm Hg.
Greater quantities may be tolerated reasonably well but with increased risk.
Levonordefrin should be avoided. In patients with uncontrolled hypertension (BP >180/110 mm Hg),
Anxiety Patients with hypertension who are anxious or fearful are especially good candidates for preoperative oral sedation.
Apply good stress management protocols
Chair position Avoid rapid position changes owing to possibility of antihypertensive drug-associated orthostatic hypotension.
Pregnancy
Antibiotics Use those with FDA classification A or B unless otherwise approved by the physician
Analgesics Paracetamol is the drug of choice. If other analgesics are required, use with approval of physician.
Anesthesia The usual local anesthetics with vasoconstrictors are safe to use, provided care is taken not to exceed the
recommended dose.
Anxiety Avoid the use of most anxiolytics. Short-term use of nitrous oxide can be used, if needed, provided 50% oxygen is used
Chair Patient may not be able to tolerate a supine chair position in the third trimester.
position Watch for supine hypotension if patient is in the supine position, most likely in late third trimester.
Roll patient on left side if hypotension occurs.
Drug Category Safe with pregnancy Lactation
Penicillin B Y Y
Cephalosporin B Y Y
Clindamycin B Y Y
Antibiotic Erythromycin B Y Y
Metronidazole B Y Y (give metallic taste)
Clarithromycin C Use with caution Use with caution
Tetracycline D N N
Paracetamol B Y Y
Analgesics Aspirin C/D N N
Brufen C/D N (avoid in 3rd trimester) Y
corticosteroids Dexa / prednisone C N Y
Nystatin C Y Y
Antifungal Fluconazole C/D (single dose allowed) Y
Lidocaine ( ‫البنج‬
B Y Y
‫)الكندي‬
L.A Mepivacaine C Use with caution Use with caution
Articaine C Use with caution Use with caution
Diabetes
Antibiotics Prophylactic antibiotics generally are not required.
Antibiotics may be prescribed for a patient with brittle (very difficult to control) diabetes for whom an invasive
procedure is planned but whose oral health is poor and the fasting plasma glucose exceeds 200 mg/ dL.
Manage infections aggressively by incision and drainage, extraction, pulpotomy, warm rinses, and antibiotics
Analgesics Paracetamol is the drug of choice.
Avoid use of aspirin and other NSAIDs in patients taking sulfonylureas because they can worsen hypoglycemia
Anesthesia For diabetic patients with concurrent hypertension or history of recent MI or with a cardiac arrhythmia, the dose of
epinephrine should be limited to no more than two cartridges containing 1 : 100,000 epinephrine
Drugs Patient advised to take usual insulin dosage and normal meals on day of dental appointment; information confirmed with
patient at appointment

Ahmed Hesham
18
 Hepatitis
Antibiotics Antibiotic prophylaxis in severe liver disease patient (more susceptible to infection).
Avoid use of metronidazole and vancomycin.
Analgesics Hepamol or paralex plus is the drug of choice – paracetamol with caution.
Anesthesia Articaine - Epinephrine 1 : 100,000, in a dose of no more than 2 carpules
Bleeding Consult physician for (vit K replacement – Kapron if needed)
Blood tests HCV Ab - HBS Ag – liver enzymes function test
Drugs L.A: Lidocaine – Mepivacaine.
metabolized Analgesics: Aspirin – Acetaminophen – Ibuprofen.
by liver Sedatives: Diazepam (Valium) – Barbiturates.
Antibiotics: Ampicillin – Tetracycline – Metronidazole - Vancomycin
Patient with end stage renal disease
Antibiotics Antibiotic prophylaxis in severe cases.
Analgesics Paracetamol is the drug of choice.
All NSAIDs should be avoided: Ibuprofen, Sulindac, aspirin are the least nephrotoxic risk.
Anesthesia Articaine - Epinephrine 1 : 100,000, in a dose of no more than 2 carpules
Bleeding Use topical hemostatic agents
Appointment Avoid dental care on day of hemodialysis (especially within first 6 hours afterward); best to treat on day after

Ahmed Hesham
19
 CBC (complete blood count)
It gives an idea about the systemic condition, diagnosis of certain diseases which might affect the dental treatment plan (bleeding disorders)
– ulcers / gastritis due to anemia
RBCS Male female
RBCs: 4.5 -6 4 - 5.5
 Decreased: anemia.
 Increased: polycythemia, dehydration (decrease plasma level)
Hct: percentage of blood occupied by RBCs. 45% 36%
 Decreased: anemia, leukemia, pregnancy (additional fluid in blood).
 Increased: polycythemia.
RDW: RBCs distribution width 11.5 -14.5 %
 Increased (greater variation in RBCs sizes = anisocytosis): chronic iron deficiency anemia resulting in
abnormal hemoglobin synthesis.
Hgb: 13 -18 11.5 -16
 Decreased: iron deficiency anemia.
 Increased: polycythemia.
MCV: Mean Corpuscular volume 80 – 90
 Decreased: iron deficiency anemia.
 Increased: macrocytic normochromic anemia = pernicious anemia & foliate deficiency anemia.
 Normal: aplastic anemia – sickle cell anemia.
MCH: Mean Corpuscular Hemoglobin 27 – 32
 Decreased: microcytic hypochromic anemia = iron deficiency anemia.
 Increased: macrocytic normochromic anemia = pernicious anemia & foliate deficiency anemia.
 Normal: aplastic anemia – sickle cell anemia.
MCHC: Mean Corpuscular Hemoglobin concentration 34 % (31-36 %)
 Decreased: iron deficiency anemia.
 Normal: pernicious anemia & foliate deficiency anemia – aplastic anemia – sickle cell anemia.
WBCs:
TLC = total leukocyte count: 4.5 -11
 Decreased = leukopenia:
o Aplastic anemia / VIT B12 & folate deficiency.
o Chemotherapy / radiotherapy - HIV / AIDS / TB.
o Lupus / rheumatoid.
 Increased = leukocytosis:
Differential:
Neutrophils: 40 -75 2 - 7.5
o Band: 0-11
o Segmented neutrophils: 40-75
 Neutrophilia: bacterial infection, acute inflammation.
 Neutropenia: cyclic neutropenia OR agranulocytosis (painful necrotizing oral ulceration D.T bacterial invasion)
Eosinophils: 0-3 0 - 0.5
 Eosinophilia: allergic reaction, parasitic infection.
Basophils: 0-1 0 – 0.1
 Basophilia: allergic reaction, chronic inflammation.
Lymphocytes: 24 – 44 1.5 - 4
 Lymphocytosis: viral infection (EBV = infectious mononucleosis), other bacterial ($, TB) leukemia, arthritis.
Monocytes: 3-6 0.1 - 0.8
 Monocytosis: chronic infection – (pregnancy isch.ch by pro inflammatory condition)
Platelets: 150.000 – 400.000 / cmm
 Increased = thrombocytosis:
 Decreased = thrombocytopenia: bleeding tendency = gum bleeding

Ahmed Hesham
20
 Iron deficiency anemia: microcytic hypochromic anemia:
 Most common type of anemia esp. in cases of pregnancy.
 Causes:
o Blood loss: heavy menstruation.
o Impaired iron absorption: Consumption of tea with meal (tannic acid interferes with iron absorption), constipation…
o Inadequate iron intake.
o Increased iron requirement: pregnancy.
 Signs & symptoms:
o Anemia: pallor (esp. nails and mucosa are obvious more than skin) – fatigue – headache – angina – shortness of
breath.
o Iron deficiency: brittle nails & koilonchyia (spoon / flattened nails) – sparse hair - oral (Angular chelitis – glossitis &
sore mouth / ulcers – increase bleeding (low oxygen tension affect interaction between platelets and endothelium)
= gum bleeding - delayed wound healing. (iron is imp for epithelia integrity)).
 Investigation:
1. For diagnosis of anemia.
o CBC:
 Decrease in: RBCS – Hct – Hgb – MCV – MCH – MCHC.
 Increase in: RDW.
o Iron profile:
 Decrease Serum iron (50 -150 µg/dl) & Serum ferritin 15-300 ng/ml.
 Decrease Transferrin saturation less than 105 (normally 35% = serum iron/ total iron bonding)
 Increase Total iron bonding capacity. 310/340 µg/dl
2. For the cause:
o Stool analysis: for parasites.
o Fecal occult blood test: blood in stool (bleeding in digestive tract due to ulcers, inflammatory bowel disease…)
o Endoscopy.
3. For follow up:
o CBC every month.
o Serum ferritin every 3 months.
 Treatment:
o Prophylactic: oral iron 2mg/kg/day.
o Curative:
 Treat the cause. Avoid extraction and GA if
 Blood transfusion if Hgb < 7 gm/dl. Hgb <10gm/dl.
 Iron therapy.
 Folic acid & vit b12 supplement.
 General instructions.
Oral iron Parenteral iron
IM: iron dextran 100 mg/day
Iv: iron sucrose 100 mg/day
Maximum 2 amp / day = 200 mg
Dose 30 mg/day
Only in 100 ml saline, slowly Iv for 2 hours.
Not glucose: cause irritation and thrombophlebitis.
Ringer: ca will decrease effect of iron.
Depend on dose the patient needs:
6 months after it returns to Patient needs = kg x 0.24 x (normal Hgb – patient Hgb (for each litre)) + 500 (to
Duration
normal level. compensate body iron storage)
EX: 70 x 0.24 x (120 -80) + 500 = 1172 almost 1200 / so patient needs 12 amp.
Malabsorption.
Indication Mild cases: Hgb > 9 gm/dl Intolerance to oral iron.
Severe cases: Hgb 7-9 gm/dl.
Allergy: anaphylaxis.
Side GIT upset.
Abscess. (if IM)
effects Dark stool.
Discoloration & necrosis of muscle. (if IM)
Ferrous sulphate: less side
effects. Low risk of allergy:
R/ Ferrofol caps R/ frerroject.
1x1 before launch

Ahmed Hesham
21
 Roshetta for iron deficiency:
R/ Ferrofol caps (ferrous sulphate + folic acid) or ferrotron caps (iron + folic acid +B complex + cu + zinc + vit c)
o 1x1 before launch = better absorbed on fasting (may be used after in cases of GIT upset).
R/ EGY-TRON (lactoferrin)
o Pregnant/ lactating mother / children > 3 years: one sachet at morning and evening
o Adult: 2 sachets at morning Before eating for 1 month.
R/ Folic acid 5 mg tab. 1x1
R/ Neurovit IM amp. 1x week (for one month) then 1 amp per month (for 3 months)
Instructions:
o Avoid tea after eating & after iron treatment.
o Eat fruits rich in vit C (guava), meat, fish and black honey.

Polycythemia:
 Relative polycythemia (decrease in plasma but normal RBCS volume – no oral changes): dehydration, excessive
diarrhea / vomiting - Diabetic ketoacidosis.
 Absolute polycythemia: Increase in RBCs – Hgb – Hct –WBCs – platelet (with platelet dysfunction) with
decrease serium iron.
 2nd polycythemia due to:
o Increate erythropoietin hormone to compensate for hypoxic state.
 People living in high altitude. (with low atmospheric pressure) - Congenital heart disease - Pulmonary
disease. Heavy smoking.
o Some tumors that release erythropoietin like substance (brain tumor).
 Features:
o Purplish-red face and extremities. (due to increased RBCs).
o Bone pain, secondary to bone marrow hyperplasia.
o Bleeding-bruising (petechial & ecchymosis) as a result of platelets dysfunction.
o Thrombosis as a result of increased blood viscosity.
o Oral features:
 Purplish-red oral mucosa.
 Varicosities in the ventral aspect of tongue.
 Bleeding from gingiva due to:
 Increased number of platelets is accompanied by defective function.
 Disseminated intravascular coagulation, which consumes clotting factors.
 Petechial and ecchymosis.
 Dental management:
o Special attention to local hemostasis is require. (gel foam)
o Early appointment: to make him wait after dental treatment to ensure there is no bleeding.
o CBC: no treatment should be carried out unless Hgb is below 16 g /dl & hematocrit below 47%
and the patient's physician should be consult.

Ahmed Hesham
22
 H pylori tests
Required in cases of multiple ulcers, halitosis, gastritis ...etc.
 Stool antigen test: most used to know if positive or not.
 Blood antibody test
Viruc C & B tests
to avoid infection – drugs precautions - lichen planus & HCV….
 HCV Ab
 HBs Ag
Bleeding tests
Prothrombin time: 12 -15 sec
prolonged PT test in case of treatment with oral anticoagulant drugs such as warfarin. - Liver disease
Partial prothrombin time: 60 -85 sec
INR: Normal INR= 1-2 - Most dental surgery can be done under INR < 3.0
DM tests
HbA1c test = glycosylated hemoglobin (within last 3 months)
Good control: 5.5 – 6.8 %
Fair control: 6.8 – 7.6 %
Poor control > 7.6 %
Serum calcium level test
Normal level : 9-11 mg/dl
Causes of hypercalcemia: Hyper-parathyrodism - Multiple myeloma - Paget's disease - Cancer to bone.
Causes of hypocalcemia: Hypo-parathyrodism - Vitamin D deficiency - Pregnancy

liver function tests

to determine liver function / degree of destruction – in case of prescribing antifungal drugs.
AST: Asparate Aminotransferase (SGOT) Test = 10-40 IU /liter
ALT: Alanine aminotransferase (SGPT) (Serum transaminases) Test = 9:30 IU /liter

Ahmed Hesham
23
 Roshetta
Heading
 Prescriber’ s name, address, phone number, license number, DEA number and NPI
 Patient information: name: address:
 Age: the age of the child < 12 years - the age in years and months < 5years + weight.
 Date: must be written or it is not legal
Body:
 Rx: referring to “prescription”. Rx is the Latin meaning “recipe” or “take thou” or “take thus” or “to take”
 Medication prescribed
1- Drug name: Hibiotic – Cataflam ..
2- Concentration / strength: 1 gm – 500 mg - 75 mg..
3- Formulation: caps – tab – amp – vial – syrup – susp.
4- Duration: 5 days …
 Instructions to the pharmacist. For example: Dispense 10 capsules.
Closing:
 Signature (Sig): directions to the patient (take one capsule three times daily after meals) written in Arabic.
 Signature of prescriber.
 Substitution permissible.
Abbreviation
Tab= tablet Caps: capsule amp= ampule susp = suspension
supp = suppository eff = effervescent
Kg = kilogram GM = gram mg = milligram ml = milliliter
IV = intravascular IM= intramuscular SC = subcutaneous

Rx Vibramycin 100 mg caps

Disp: 10 caps
Sig: take 1 capsule every 12 hours for 1st day then 1x1 for 8 days (1x2 for 1st day then 1x1 for 8 days)
‫ ساعة اول يوم – بعد كدة كبسولة في اليوم‬12 ‫كبسولة كل‬

1- After surgery / Trauma / Sodium Hypochlorite Accident:

 In this case we need to prevent infection – decrease edema – decrease inflammation and pain.
 So prescribe 1- broad spectrum AB 2- anti edematous 3- anti-inflammatory (NSAIDs)
 In 1st two days: start with injection (rapid effect) then complete with oral route of the same category.
1st two days
st
R/ Unictam 3 gm vial 1x2 in 1 day (as loading dose in severe case)
R/ Unictam 1.5 gm vial 1x2 in 2nd day.
R/ α – chymotrypsin amp 1x2 for 2 days.
R/ Dexamethasone amp 1x2 instead of α – chymotrypsin (in cases of allergy)
R/ Ketolac amp 1x2 for 2 days.
After injection
R/ Hibiotic 1 gm tab 1x2 for 4 days.
R/ Alphintern tab 1x3 1 hour before meal for 4 days.
R/ Ketolac tab 1x3 for 4 days.
R/ Betadine M.W 1x3 from the 2nd day (in cases of surgery).
Fomentation:
Cold in 1st day to avoid edema & decrease pain.
Hot in 2nd day to decrease edema.
2- Cellulitis / acute infection
 In this case we need antibacterial & localize infection – decrease inflammation and pain.
 The same as above except anti-edematous (avoid it in infection to prevent its spread)
Adult Child
R/ Unictam 3 gm vial 1x2 in 1st day R/Unictam 1.5 g vial 1x2 in 1st day
(as loading dose in severe case) (as loading dose in severe case)
R/ Unictam 1.5 gm vial 1x2 in 2nd day. R/ Unictam 750 mg vial 1x2 in 2nd day.
R/ Ketolac amp 1x2 for 2 days. R/ Ketolac amp 1/2 x2 for 2 days.
R/ Dexamethasone amp 1x2 R/ Dexamethasone amp 1/2 x2
(in cases of severe pain – healthy patient) (in cases of severe pain – healthy patient)
R/ Hibiotic 1 gm tab 1x2 R/ Hibiotic N 457 ml susp 5ml x3
R/ flagyl 500 mg tab 1x3 (in cases of abscess) R/ Flagyl 125 mg/5ml susp 5ml x3
R/ Brufen 600 mg tab 1x2 R/ Brufen 1mm mg/ 5ml susp 5ml x3
Hot fomentation.
Ahmed Hesham
24
 3- Infected / dry socket
Infective: Curettage – irrigation (saline – betadine) – remove any sharp bone – irrigation with saline + ‫صبغة جاوي‬
Dry socket: the same but less curettage + Zoe Pack superficial in 1st 2 mm.
1st day: R/ Unictam 3 g vial 1x2 or R/ Dalacin c 600 mg vial 1x2
R/ Ketolac + Dexa amp 1x2
2nd day R/ Hibiotic 1gm vial 1x2 or R/Dalacin c 300 mg tab 1x3
R/ Cataflam 50 mg tab 1x3
R/ Betadine M.W 1x3
4- Severe periodontitis / aggressive p.
Scaling and root planning is mandatory.
R/ Vibramycin 100 mg caps 1x2 for 1st day then 1x1 for 7-8 days.
R/ Orovex –H M. W 1x3
5- Pericoronitis / ANUG
 Using cotton pellet with H2O2 (3 % full strength) to remove pseudo membrane and the debris.
 Avoid prolonged exposure to sun.
 Avoid use of dental floss or interdental cleaner or overzealous brushing
R/ Clindam 300 mg caps 1x3. Or spirazole forte 1 x2
R/ Brufen 400 mg tab 1x3 (more anti-inflammatory action than Cataflam)
R/ H2O2 30% (one spoon + 20 ml warm water) x 4 for 3 days only
‫ ايام‬3 ‫غطا علي ربع كوب ماء دافي اربع مرات يوميا لمدة‬
R/ Verolex M.W or Orovex M.W 1x3 after H2O2
6- TMJ clicking / pain
1- Sedative: to decrease stress and help to sleep.
2- Muscle relaxants: in severe cases start with strong one as (multi-relax –Dimra –sirdalud) for one weak if improved
change to myofen.
3- NSAIDS: selective COX II inhibitor are recommended to avoid peptic ulcers.
4- Hot fomentation 5 min followed by cold for 1 min to make disturbances in inflammatory cycle.
5- Stent: upper, hard 2 mm, cover all teeth.
6- Instructions:
o Restriction of all mandibular movement to function in a pain-free range of motion.
o Avoid sleeping with hand free still in your ear.
o Recommending a soft diet with small spoon (eg, eggs, yogurt, soup, ground meat).
o Avoid chewing gum or eating salads, large sandwiches or fruit that is hard or not sliced into small bites.
Adult:
R/ Tegretol CR 200 mg tab 1/5 to 1 tab at bed time (not in all cases)
R/ Multi-relax 10 mg tab 1 tab at bed time, to avoid drowsiness at day)
R/ Xefo 8 mg tab 1x2
R/ Reparil gel 1x3
Hot fomentation for 5 min + cold fomentation for 1 min
Upper Night guard – hard – 2mm
Children:
R/ Maxillase syrup 5ml x3.
R/ Cetal 250 mg/5ml susp 5ml x3.
R/ voltaren gel 1x3
Hot fomentation for 5 min + cold fomentation for 1 min
If > 6years: Upper Night guard – soft – 2mm
Stool analysis id mandatory to determine cause.
7- Patient with severe gag reflex
R/ Tegretol CR 200 mg tab 1/5 to 1 tab at bed time (not in all cases)
Day before visit & 2hours before visit
R/ Primperan amp 2 hours before visit alone or with R/ Cortigen B6 amp
Instruction for the patient: No eating before visit - Never blink during working (Stephen cohen)
8- Hepatic patient (need extraction/ surgery)
In this case we need
1- Consult physician for bleeding tendency and ability to describe medication to reduce bleeding if needed:
Systemic hemostatic agent: R: Amri-K 10 mg amp for two days before and after surgery.
R/ Kapron 500 mg / 5ml amp 1x2
Local hemostatic Kapron amp / haemostop amp ‫افضيه علي الشاش او القطن‬
Cold & wet tea bag (contains tannic acid) applied topically on extraction site.
2- Prophylactic antibiotic and analgesics:
R/ Hibiotic 1 gm tab 1x2
R/ paralex plus tab 1x3

Ahmed Hesham
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 9- Severe anxiety patient
In this case we need to apply stress reduction protocol + sedative drugs.
R/ Valpam 5 mg tab at bed time and before procedures by 2hours,
R/ Neuril 10 mg amp IM in cases of seizure (emergency)
10- Nerve injury
In mild case just: VIT.B complex
R/ Neurovit tab 1x1 / 1x2 daily (according to case) or Neurovit amp 1x2 weekly
Moderate case: + systemic corticosteroids
R/ Solupred 5 mg tab for 2 weeks (1st week: 1x4 - 2nd 4 days: 1x2 - 3rd 3 days: 1x1)
R/ Gaptin 300 mg caps 1x1 (in cases of pain)
11- Bell's palsy: refer to specialist
Corticosteroids: R/ Solupred 20 mg tab (1x4 x5 days - 1x2x3 days - 1x1x2 days)
Vit.B complex + antioxidant (omega 3 – lactoferrin.):
R/ Neurovit tab 1x2 weekly
R/ omega 3 plus 1x3
Anti-edematous: R/ Ambizem –G 1x3
12- Migraine: refer to specialist
Analgesics (NASIDs): R/ Naproxen 500 mg x2 (esp. menstrual migraine)
Antiemetic:
1- Metoclopramide 10 mg amp.
2- neurazine 50 mg amp (antimigraine action: decrease pain (antipsychotic) + vomiting(antiemetic)) - can be used alone
in moderate case
Sumatriptan: not to exceed 100 mg / dose – additional dose after 2 hours – max. dose 200 mg / day – not more than 2-3days
/week.
R/ Imigran 50 mg / 100 mg x1
R/ treximet (sumatriptan + naproxen)
OR
Ergotamine: R/ Amigraine tab 1 to 3 tab daily to arrest attack (ergotamine (V.C) + dipyrone (pain killer) + caffeine)
R/ metograine (ergotamine (V.C) + paracetamol + caffeine (facilitate ergot absorption) + metoclopramide)
(not take sumatriptan & ergotamine together - separate between them by 24 hours)
Contraindicated with pregnancy - uncontrolled HTN – heart disease.
13- Ulcers
We 1st need to determine the cause so ask for: CBC – H-Pylori tests to exclude anemia – H-pylori infection
In most ulcer cases it will respond to topical treatment.
Topical anti-inflammatory
R/ Tantum verde M.W + tetracycline / tetracid 250 mg caps. 5ml x4 minor ulcers.
R/ Epirelefan amp + phenadone syrup + 100 ml saline 5ml x4 major ulcers / immunity ulcers.
Topical analgesics:
R/ Oracure gel 1x4
Topical antifungal: in cases of ulcers superimposed by fungal infection
R/ Nystatin oral susp 5ml x4
For immunity:
R/ Sperience sachets 1x1 (lactoferrin-iron–vit c–vit B complex–folic Acid-Ca) (help also in cases of H-pylori –iron
deficiency)
Or R/ Immuguard Sachets 1x1 (take at least 30 min before meal)
For iron deficiency:
R/ or ferrotron caps 1x1 before launch
R/ EGY-TRON (lactoferrin) 1x2
Instructions:
- Avoid spicy & hot food - avoid stress – drink more water – soft gum (increase salivation: immunoglobins)
- Eat vegetables that rich in folic acid.
14- Oral lichen planus:
Corticosteroids: start with the weakest to strongest.
Topical corticosteroids. R/ Epirelefan amp + phenadone syrup + 100 ml saline 5ml for 1 min x4
Intralesional: R/ Epirelefan amp + LA amp
Low dose systemic steroid with NSAIDS: R/ Solupred 5 mg (10 -20 mg) + Brufen 400 1x3 for two weeks.
Topical immunosuppressive (in cases of steroids resistance) R/ Protopic 0.1 % ointment (tacrolimus) used orally 1x3 / 4
Topical antifungal: in cases of ulcers superimposed by fungal infection R/ Nystatin oral susp 5ml x4
For immunity & antioxidant: R/ OMINOX sachets 1x1 (omega 3 – lactoferrin - vit B complex – folic acid - vit c – vit E-
vit A – VIT D3 – zinc – selenium –L carnatin)
Anti-keratosis & anti-oxidant: in cases of classic lichen planus (Wickham striae)
R/ A – VITON 50.000 I.U caps 1x2
Ahmed Hesham
26
 15- Ulcers & mucositis in patient taking chemotherapy:
Chemotherapy affect the malignant cells and other cells that are rapidly dividing like the bone marrow and the mucosal
lining. R/ VIT E 1gm capsule 1x3 (empty its content on ulcer – act as antioxidant & membrane stabilizer)
R/ Kenalog orabase 1x4 in severe cases.
16- Fungal infection:
Start topical:
Oral R/ Nystatin oral susp 5ml X4 (rinse for 2 min then swallow)
Skin R/ calamine lotion 1X3
R/ Daktacort cream 1x3 after good dryness (keep the site dry).
For immunity:
R/ Sperience sachets 1x1 (lactoferrin-iron–vit c–vit B complex–folic Acid-Ca) (help also in cases of H-pylori –iron
deficiency)
Or R/ Immuguard Sachets 1x1 (take at least 30 min before meal)
Instructions:
- Avoid spicy & hot food - avoid stress – drink more water – soft gum (increase salivation: immunoglobins)
- Eat vegetables that rich in folic acid.
17- Angular chelitis:
It is a mixed infection (fungal + bacterial) – may be due to loss of VD – Vit.B12 deficiency
R/ Kenacomb cream 1 X 4 (antifungal + antibacterial + steroidal anti-inflammatory)
R/ Milga Advance 1x1
18- Herpes simplex
Systemic antiviral: to decrease infectivity, pain, size and duration.
R/ Acyclovir 200 mg tab X5 X (7-10 days).
Pain management & supportive care:
R/ Lidocaine viscous 2% oral sol + Benadryl + Maalox plus (1:1:1) 5 ml x4. OR R/ Oracure gel 1x4
R/ if analgesic required esp. in cases of prodromal symptoms: Brufen is preferred.
For recurrent herpes labials:
R/ Zovirax 5% topical cream 5x 4 days.
For immunity:
R/ Sperience sachets 1x1 (lactoferrin-iron–vit c–vit B complex–folic Acid-Ca) (help also in cases of H-pylori –iron
deficiency)
OR R/ Immuguard Sachets 1x1 (take at least 30 min before meal)
19- Herpes zoster
Systemic antiviral:
R/ Eaclovir 500 mg tab x3 X (7-10 days).
Pain management & supportive care:
R/ Lidocaine viscous 2% oral sol + Benadryl + Maalox plus (1:1:1) 5 ml x4. OR R/ Oracure gel 1x4
R/ Brufen tab 400 mg 1x3
R/ Milga advance 1x1
For skin lesion:
R/ Lidoderm or EMLA 5% cream
R/ K permanganate 1/8000 ‫ دقايق‬10 ‫ مرات يوميا لمدة‬3 ‫ ملعقة علي نص كوب ماء وعمل كمادات‬2
Post herpetic neuralgia: refer to specialist.
R/ Gaptin 300 mg caps 1x1 as 1st line of TTT
Or R/ Amitriptine 50 mg caps 1x1 /1x2 as 2nd line of TTT
20- Teeth sensitivity / high caries index
R/ Tooth mousse plus / MI paste plus. (not available in market except some dental company)
 Used at night after tooth brushing and let on your teeth.
 The best to be used in sensitivity or high caries index patient – can be swallowed (milk products not tooth
paste) - used also in dry mouth cases)
R/ Sensodyne rapid action.
 Leave on your teeth for 5- 20 min, brush your teeth, split the excess then use S.F -M. W not water
R/ OROVEX delicate M.W / EZA-Flour M.W 1X3
21- H- Pylori Infection:
oral H. pylori may cause: halitosis, glossitis, burning mouth syndrome, recurrent aphthous stomatitis and dental caries.
1st line of treatment: triple therapy for 14 days
Proton pump inhibitor: NEXICURE 40 mg tab 1x1
Amoxicillin: IBIAMOX 500 mg caps 2x2
Clarithromycin: KLACID 500 mg tab 1x2
2nd line: triple + flagyl 500 mg tab or levofloxacin instead of clarithromycin.

Ahmed Hesham
27
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Ahmed Hesham
28