Medicines in dentistry - The medicine in the dental practice
Medicines in dentistry
Dentists may only prescribe medicines that they know and oversee. In practice, therefore, a limited number of medicines is used:
- Analgesics (painkillers);
- Local anesthetics (these are discussed in chapter '' Anesthesia '');
- Anti-infective agents;
- Disinfectants / antiseptics;
- Fluoride-containing agents;
- Saliva substitutes;
- Anxiolytics and sedatives.
Analgesics or pain killers are the most commonly used medicines in dentistry. Pain is a signal from the body that something is wrong. It is best to identify and treat the cause of the pain. This is possible in most cases. Painkillers are used or prescribed when the diagnosis has been made and the cause cannot be immediately remedied, or when treatment has begun, but the pain still persists. Pain relief is also used as aftercare, for example after an extraction. Painkillers fight the pain, but not the cause of the pain. Pain relief is therefore a form of symptomatic therapy.
The groups of painkillers discussed below relieve the pain without significantly affecting consciousness (at normal dosage). Many analgesics have, besides analgesics, another effect:
- Antipyretic analgesics can also fight fever;
- Anti -logistic analgesics also have an anti-inflammatory effect.
The combination of analgesic and anti-fever and anti-inflammatory properties can work very favorably.
Groups of pain killers
Chemically, different groups of pain killers can be distinguished.
- Salicylates. The best known of this group is the acetylsalicylic acid (Aspirin®). Aspirin (popularly referred to as "aspirin") is analgesic and fever-reducing. It has an analgesic effect within 30 minutes and works for three to six hours. This group of medicines influences the blood clotting mechanism. Use of these medicines is often the cause of hidden blood loss and increases the risk of stomach bleeding. Because of the influence on the coagulation mechanism, the use of painkillers from this group gives an increased chance of bleeding or extra bleeding during extractions or surgery. That is why they are rarely used in dentistry.
- Paracetamol. Paracetamol is a painkiller that can be used in conjunction with anticoagulation therapy. The medicine starts to work after about 30 minutes and the effect lasts on average for four hours. Paracetamol is a good pain reliever with a fever-resistant effect that has no stomach problems. However, this medicine also has side effects with prolonged use, such as liver damage. Paracetamol can be used in combination with caffeine or codeine to enhance the analgesic effect. Paracetamol is one of the few painkillers that can be used safely during pregnancy and when breastfeeding. No prescription is needed for most paracetamol-containing painkillers. Branded articles are often many times more expensive than generic or loco preparations.
- NSAIDs (non-steroidal anti-inflammatory drugs). Another word for this is prostaglandin synthetase inhibitors. We include ibuprofen, naproxen and diclofenac in this group. In addition to an analgesic effect, NSAIDs also have an anti-inflammatory effect. Hepatic and renal impairment are among the side effects with long-term use. The effect starts one to two hours after ingestion. The duration of action is four to six hours. Some NSAIDs, such as ibuprofen, also have a blood-thinning effect. They are therefore contraindicated in patients who use anticoagulants or have a stomach ulcer.
There are even stronger painkillers than the groups described above, such as opiates. If pain relief is necessary in dentistry, for example after extraction or alveolitis, paracetamol (with caffeine or codeine) and / or ibuprofen will often suffice. Stronger pain may require stronger painkillers, but this is rare.
The common feature of anti-infectives is that they fight infections caused by microorganisms.
The largest group of anti-infectious agents are the antibacterial agents. These serve to combat infections caused by bacteria. The group consists largely of penicillins and related substances.
Anti-infectious agents are used in dental practice for:
- Fighting acute bacterial infections and possible complications;
- As a prophylaxis in high-risk patients. With a single high dose of antibiotics just before an operation, bacteria entering the bloodstream are controlled;
- To support the treatment of severe periodontitis. Hereby it is first determined by means of a bacterial culture whether an antibiotic cure makes sense and which type of antibiotic should be used.
An important feature of these means is the spectrum. The spectrum of an anti-infectious agent is the group of pathogenic microorganisms against which the agent is active.
A distinction is made between broad-spectrum and narrow-spectrum antibiotics. In this context, broad means that the product addresses a large (broad) group of micro-organisms. Narrow means an approach to a much smaller (narrow) group of microorganisms. If it is possible to diagnose which microorganism is causing an infection, a narrow-spectrum agent must be used to prevent resistance from other groups of microorganisms.
Fungal infections in the oral cavity are treated locally with antimycotics such as nystatin. Administration forms thereof are an oral gel, rinsing agent or a lozenge. Infections with the fungus Candida albicans occur regularly in the recessed folds at the corners of the mouth, such as in the elderly and in people with dentures whose bite height is too low. Candida infections can manifest themselves in the mouth in people with reduced resistance or with reduced saliva production. Wearers of a dental prosthesis are advised to keep the prosthesis overnight in a disinfectant fluid in the case of a fungal infection in the oral cavity.
Disinfectants / antiseptics
In the mouth, agents can be used that reduce the number of microorganisms. Chlorhexidine and hydrogen peroxide are the most commonly used agents in dentistry. Chlorhexidine is used, among other things, to prevent complications after extractions, ulcers or when a patient cannot temporarily clean his mouth mechanically. Hydrogen peroxide primarily kills anaerobic bacteria and is used to combat deep-lying inflammations such as an alveolitis.
Fluoride promotes the growth of apatite crystals, which reduce the porosity of the enamel. By administering fluoride-containing agents, caries can be prevented and novice carious lesions can remineralize. Systemically ingested fluoride is incorporated into the dentin and enamel forming during the entire formation phase of the temporary and permanent teeth. This makes the teeth more resistant to caries.
In addition to the use of fluoride-containing toothpaste, the following fluoride-containing agents can additionally be used:
- Mouthwash with fluoride;
- Fluoride application with a gel, varnish or liquid;
- Fluoride tablets.
Additional fluoride-containing preparations are only used as an indication. That is, only if a (starting) problem is visible. Under normal circumstances, the fluoride in toothpaste is sufficient to protect the teeth. For example, additional measures may be needed in patients who have undergone radiation in the head and neck area and as a result produce less saliva.
Administering saliva substitutes, also referred to as artificial saliva, gives the best chance of reducing the symptoms of a dry mouth. For patients without a saliva reserve or with a different saliva composition (mucinous saliva from the glandula submandibularis is very important), the administration of artificial saliva is the only method of treatment.
Anxiolytics and sedatives
Dental surgery can cause anxiety in many patients. The dentist tries to remove excessive fear of the operation by providing information. Sometimes it is still necessary to prescribe soothing medication. Oral dosage forms (capsules, tablets) are used in regular dental practice.
When using an anxiolytic (anti-anxiety agent), the ability to drive and react is adversely affected even at low doses. When using these substances, the patient is advised to take a supervisor. For particularly tense or psycholabile patients, consultation with the treating physician is necessary. One reason is that these patients often use other psychotropic medicines.
In very special cases, such as when treating physically disabled people or people with intellectual disabilities, it may be necessary to administer an injectable sedative. Such treatment should only take place in a hospital or accredited institution.