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Dental Medications

Pain Management and Infection Control in Dentistry

Popular Medications

There are many different medications for common issues in dentistry. An entire book could be written about the subject. The focus of the material presented here is to provide a professional review of common medications that most patients are familiar with including prescribed compounds that are formulated to fight certain oral diseases, pain control (management), anxiety relief and medications used to prevent and treat certain infections.

When discussing the need for medications, patients should, first of all, inform their dentist about existing health conditions. Secondly, patients should fully understand the reasons a certain medication has been recommend or prescribed.

The first list we will review will be medications used to treat mild or moderate pain from dental surgery, toothache and temporomandibular joint problems. The common medications are as follows:

Medication Name (Brand - Type) Recommended Dosage Concerns and Side Effects
1) Acetaminophen (Tylenol) Recommended adult dose is 650mg-1000mg every 4-6 hours, with a maximum dose of 4000mg/day. For more severe pain, a narcotic combination may be used Acetaminophen is the best tolerated of all the analgesics used in dentistry with few side effects. However, an overdose can produce severe liver damage
2) Aspirin (Bayer) Adult dose is 650mg-1000mg every 4-6 hours,with a maximum dose of 4000mg/day. Abdominal pain, nausea and increased bleeding time. People with ulcers could not take aspirin.
3) Ibuprofen (Advil, Nuprin, Motrin) 400mg every 4-6 hours, with a maximum dose of 2400mg/day With short term use (less than 1 week) the most common side effects include abdominal pain, nausea, and increased bleeding time(Although incidences of these effects are lower when compared to aspirin) Occasionally Ibuprofen may cause xerostomia (dry mouth).
4) Codeine - Hydrocodone (a synthetic codeine closely related to codeine) These are narcotic analgesics (pain relieving drugs) that is most effective when given in combination with Acetaminophen (as in Tylenol #3) and Ibuprofen (as in Vicoprofen)
Hydrocodone is approximately 6 times more powerful than codeine, so that 10mg of hydrocodone provides the same pain relief as 60mg of codeine.
Dosage for Dental Purposes: 300mg acetaminophen plus 30 mg codeine(Tylenol #3), two tablets every 4-6 hours as needed for pain.
325mg aspirin plus 30mg codeine(Empirin #3), two tablets every 4-6 hours as needed for pain.
Acetaminophen 500mg plus hydrocodone 5mg(Vicodin or Lortab 5/500) one or two tablets every 4-6 hours.
Acetaminophen 750 plus hydrocodone 7.5mg (Vicodin E.S.) one tablet every 6 hours
Ibuprofen 200 mg plus hydrocodone 7.5mg(Vicoprofen) one tablet every 4-6 hours
Codeine, hydrocodone, and other oral narcotics produce relatively high incidence of dizziness, drowsiness, vomiting, and constipation in dental-surgery patients. Dental patients prescribed drugs containing oral narcotics should not drive automobiles or operate dangerous machinery. Alcohol consumption should also be avoided because the combination will increase all their side effects.

The next group outlines antibiotics which are used for many dental infections, including dental abscesses, infections around wisdom teeth, infections that develop after dental surgery, periodontal infections and pericornitis. The common antibiotics are as follows:

1) Penicillin V K ( Pen-Vee K, V-Cillin K) Adult dose is 250-500 mg every six hours for 7-10 days Possible nausea, vomiting, and diarrhea. Occasionally, Penn V K can temporarily turn the tongue a black color, a condition called black hairy tongue. Allergic reactions can range from a mild rash to life-threatening closure of the airway and a fall in blood pressure.
2) Amoxicillin (Amoxil) An extended spectrum member of the penicillin class. It can kill a wider range of bacterium than Penn VK( doses are the same), along with better absorption and it has a longer effect When prescribed for a week or more, amoxicillin produces a higher incidence of nausea, vomiting, diarrhea and yeast infections in women than penicillin VK. About 10% of the patients develop a rash and reaction. They can become life threatening.
3) Erythromycin ( E-Mycin) Usually prescribed to patients with penicillin allergies. Doses for dental purposes: Adult dose is 250-500 mg every 6 hours for 7-10 days Side effects are the same as amoxicillin and penicillin but more common
4) Clindamycin (Cleocin) A broad spectrum antibiotic particularly effective for dental abscesses in bone and soft tissue that doesn't respond adequately to penicillin or erythromycin type drugs. It is very popular among oral surgeons and endodontists for chronic infections. Doses for dental purposes: 600 mg immediately then 300mg every 6-8 hours. Diarrhea and abdominal pain are much more common than clindamycin or penicillin.

Other miscellaneous dental medications may include the following:

Nystatin (Mycostatin): An anti-fungal drug used to treat Candida Albicans, an infection in the mouth, including monoliasis, thrush, and denture stomatitis. It is used as 2-3 ml (1/2 teaspoon) of a suspension held in the mouth and swished for at least 5 minutes before swallowing.

Diazepam (Valium): Classified as an anti-anxiety sedative and hypnotic drug. It relaxes the patient and makes them drowsy and induces sleep. Diazepam is also used in conjunction with non-steroidal anti-inflammatory drugs to treat muscle pain and spasm in the temporomandibular joint region. The dosage ranges from 2-10mg administered the night before treatment to improve sleep then repeated one hour prior to their dental procedure to relax and sedate the patient.

Saliva substitutes (Xero-Lube): Used for symptomatic relief of dry mouth and dry throat in patients whose saliva levels are low or absent. They are taken as often as needed, usually in the form of a spray.

Although there are many different medications at the dentists' disposal, this sums up the list of many of the common medications used daily in dentistry.

Wisconsin Reconstructive Implant Dentistry
Wisconsin Prosthodontics
Bruce Winter, DDS
Winter Dental Associates
Hampton Dental Associates
5323 W. Hampton Avenue
Milwaukee Wisconsin WI 53218
(414) 464-9021

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