drugs use to treat oral diseases

3.  FATIMA KHAN
 REBEIAAZIZ
 ELSA MUSTAFA
 FATIMA BHATTI
 MADIHAASLAM

4.  Analgesics to control pain
 Antibiotics
 antiviral
 Antifungal
 corticosteroids

5.  Drug that relieve pain without loss of
consciousness
 Types
 Non steroidal anti-inflammatory drug
 Opioids

7. Analgesics effect against mild to moderate pain
 Anti inflammatory
 Anti pyretic
 Anti platelet activity

8. Classification
A. Non selective COX inhibitors (traditional NSAIDs)
 Salicylates: Aspirin
 Prop ionic acid derivatives: Ibuprofen, Naproxen,
Ketoprofen, Flurbiprofen.
 Aryl-acetic acid derivatives: Diclofenac, Aceclofenac.
 In dole derivative: Indomethacin.
B. Preferential COX-2 inhibitors
 Nimesulide, Meloxicam, Nabumeton.
C. Selective COX-2 inhibitors
 Celecoxib, Etoricoxib, Parecoxib.
D. Analgesic-antipyretics with poor antiinflammatory
action
Para aminophenol derivatives: Paracetamol

9. Mechanism of action of NSAIDs
1. Anti inflammatory effect
 due to the inhibition of the enzymes that produce
prostaglandin H synthase (cyclooxygenase, or COX),
which converts arachidonic acid to prostaglandins, and
to TXA2 and prostacyclin.
2. Analgesic effect
 A. The analgesic effect of NSAIDs is thought to be
related to: the peripheral inhibition of prostaglandin
production
3. Antipyretic effect
 The antipyretic effect of NSAIDs is believed to be
related to inhibition of production of prostaglandins
induced by interleukins

11. Contraindications of nsaids
 Gastric ulcers
 Bleeding dyscrasias or concerns
 Significant renal disease
 asa (or other NSAID) hypersensitivity

12. 1 Aspirin:
 Mechanism of action
 The anti pyretic and anti inflammatory effect
salicylates are primarily due to the blockage of
prostaglandin synthesis
2 Ibuprofen
 Is a derivatives of phenyl prop ionic acid in doses
of 2.4g daily equivalent of 4 g aspirin in anti
inflammatory effect. Oral ibuprofen is often
prescribed in lower doses (<2.4g/d) at which it
has analgesics but not anti inflammatory efficacy.

13.  Acetaminophen Indications Pain and
inflammation associated with musculoskeletal
disorders, e.g. rheumatoid arthritis, osteoarthritis,
and ankylosing spondylitis. Postoperative
analgesia. Effects on oral and dental Patients on
long-term NSAIDs such as acemetacin may be
afforded some degree of protection against
periodontal breakdown. This arises from the
drug’s inhibitory action on prostaglandin
synthesis.

14. Mechanism of action
 Paracetamol inhibits prostaglandin
biosynthesis under some circumstances (e.g.
fever), but not others.
Adverse effects
 The most important toxic effect is hepatic
necrosis leading to liver failure after overdose

15.  Usually used for analgesia for moderate to severe
pain in dentistry
 Other opioids effects:
 Sedation
 Respiratory depression
 Nausea and vomiting
DRUGS
 codeine
 oxycodon
 morphine

16.  use to relieve severe pain max analgesia
occurs in 1o-20 mins with I/v routes controlled
released tablets given for chronic pain route
 determines time interval or frequency of
administrative

17.  Also called anti bacterial are a type of
antimicrobial drug used in the treatment and
prevention of bacterial infections
 They may either kill or inhibit the growth of
bacteria

18.  Bactericidal
 Penicillin's
 Metronidazole
 Cephalosporin's
 Bacteriostatic
 Clindamycin
 Erythromycin
 Tetracycline's

20. 1 Penicillin
 Oral penicillin are penicillinV and amoxicillin
 PenV is narrow-spectrum against gram-
positive Strep and others
 Drug of choice for orofacial infections
 e.g. dental abscesses, infections around
 wisdom teeth and infections after
 surgery
 Dose = 300-600 mg

21. Adverse effect of penicillin
 Allergy
 Diarrhea
 Nausea and vomiting
 Candidacies
 Penicillin's responsible for 75% of
anaphylaxis deaths
 Penicillin: Contraindication
 (none except hypersensitivity to penicillin)

22.  Amoxicillin is broad-spectrum and better
absorbed orally
 Dose = 250-500 mg q8h
Indications
 Used to treat bacterial infection such as a dental
 abscess. Used prophylactically
 in the prevention of infective endocarditis
Contraindications
 Hypersensitivity.
Side effects
 Glossitis and tongue discoloration.
 Candidacies.
 Gastrointestinal upset

23. 3. Metronidazole
FOR OBLIGATE ANAEROBES effective
against against becteriodsspecies esp. in
periodontal infection
Drugs
flagyl and gramex
Avoid in pregnancy

24.  Cephalosporin's are bactericidal agents (which
means that they kill bacteria)
 More resistance to penicillase
 Gram +ve coccus
 Gram –ve rods
 Cephazolin
 Claforan

25.  Side effects
 GI upset
 Can also cause overgrowth of fungus normally
present in the body.
 the cephalosporin's are structurally similar to
the penicillin's,
 some patients allergic to penicillin's may be
allergic to a cephalosporin
 antibiotic.

26. 5. Clindamycin
 An alternative for penicillin-allergic or
penicillin-resistant patients
 *Active against gram-positive and gram-
negative anaerobes and
 facultative/aerobic bacteria
 *Dose = 150-300 mg

27. 6. Macrolides
 Group includes
erythromycin, clarithromycin and azithromycin
 Erythromycin was the former drug of choice for
penicillin allergic
 penicillin-resistant patients
 Numerous GI adverse effects
 Active against gram-positive aerobic/facultative
staph and strep and
 gram-negative anaerobes
Contraindication
 Patients with hepatic dysfunction

28.  Broad-spectrum, bacteriostatic
 Useful in treatment of periodontal disease
 Widespread resistance
 Host of adverse effects including: tooth
staining, photosensitivity,
 blood dyscrasias, GI effects
Contraindications:
 Renally impaired patients
 Lactating or pregnant women's

29.  GI tract complications
 Cross reactions with other medications
 Colonization of resistant or fungal strains

30. Antibiotic prophylaxis
 Indicated for patients with:
 Prosthetic heart valves
 History of infective endocarditis
 Implant placement
 Extractions
 Periodontal procedures

31.  An antifungal medication, also known as
an antimycotic medication, is
a pharmaceutical fungicide or fungi static used to
treat fungal infections
 Groups
Polyenes
 Amphotercin b and nystatin
azole
 Ketoconazole
 Miconazole
 fluconazole

32. Indication of antifungal drugs
 Stop spread of infection
 Treat oral thrush
 Denture stomatitis
 Used in combination with antibiotic in case of
abscess

33. Mechanism of action
Binding to ergo sterol of fungal membrane
Indications
 Used to treat candidal infections
Contraindication
 Hypersensitive drug
Side effect
 -Gastrointestinal disturbances.
 -Renal damage.
 -Hypokalaemia.
 -Myopathy and neuropathy
 -Respiratory depression

34. Mechanism of action
 Binding to ergo sterol of fungal membrane
Indications
 Used in the treatment of candidal infections
Contraindications
 Hypersensitivity.
Side effects
 Hypersensitivity.
 Gastrointestinal upset

35. Mechanism of action
 Inhibition of ergo sterol synthesis
Indications
 Used to treat oral fungal infections
Contraindications
 Previous hypersensitivity
 Best avoided during pregnancy and when
breastfeeding.
Precautions
 Use with caution in patients with renal and hepatic
disease.
Side effects
 Hypersensitivity reactions.
 Gastrointestinal problems

36. Mechanism
 Inhibit synthesis of ergo sterol
Used for the treatment of
a. systemic infections
b. mucocutaneous Candida infections
c. cryptococcal meningitis
 Avoid use in patients with kidney problems

37.  An agent that kills a virus or that suppress its
ability to replicate and hence inhibits its
capability to multiply and reproduce.
 Many antiviral drugs are Purine or Pyrimidine
analogs.
 Many antiviral drugs are Pro drugs. They must
be phosphorylated by viral or cellular enzymes in
order to become active.
 Anti-viral agents inhibits active replication so the
viral growth resumes after drug removal.

38.  Antiviral drugs
 Used to treat infections caused by viruses other
than HIV
 Antiretroviral drugs
 Used to treat infections caused by HIV, the virus
that causes AIDS
 Herpes-Simplex Viruses
 HSV-1 (oral herpes)
 HSV-2 (genital herpes)
 Varicella Zoster Virus
 Chickenpox
 Shingles

39. 1.Acyclovir (Zovirax)
Indication
 Used in topical , IV, oral formulations
 Herpes simplex virus 1,2 (HSV)
 Varicella zoster virus
 And used in treatment of herpes simplex
Herpes Simplex
 Herpes viruses are associated with “cold
 sores”
Adverse reactions
 Oral administration: headache (13%) is one of the
 most common; other central nervous system
 (CNS) and GI effects
 Parenteral administration: local reactions at the
 injection site are the most common

40. Side effect of acyclovir
 -Stinging sensation at site of application,
altered taste,
 gastrointestinal
 upset, renal failure, bone marrow depression,
tremors and
 convulsions,
 lichenoid reactions, rash and urticaria

41. 2. Famciclovir
Indications
 Used in the treatment of herpes zoster and genital herpetic
infections
Contraindications
 Hypersensitivity, children.
Precautions
 Renal and liver disease, pregnancy and
 breastfeeding.
Side effect
 Maintenance of adequate fluid intake is required
 with high doses.
 Fever, gastrointestinal upset, dizziness,
 confusion, and hallucinations,
 headache and sinusitis, rash

42. 3.Valaciclovir (Valtrex)
 An antiviral drug. It is a pro-drug for acyclovir.
Indications
 Used to treat herpes simplex and varicella-zoster
infections..
Contraindications
 Hypersensitivity, children.
Precautions
 Renal disease, pregnancy and breastfeeding.
Side effects
 Glossitis, altered taste, gastrointestinal upset, renal failure,
bone
 marrow depression, tremors and convulsions, rash, and
urticaria

43.  Frequently used to suppress inflammation.
The use of corticosteroids for the treatment of
oral mucosal lesions is justifiable if topical
therapy has failed

44.  Immunomodulating drugs
 Systemic therapy with non specific immuno
modulating drug are increasingly being used
for severe ulcerative and erosive oral
conditions
 Immunomodulatory drugs modify the
response of the immune system by increasing
(immunostimulators) or decreasing
(immunosuppressive) the production of serum
antibodies

45. Immunostimulator
 prescribed to enhance the immune response
against infectious diseases, tumours, primary or
secondary immunodeficiency, and alterations in
antibody transfer, among others
e.g. Thymosin ,Interleukins ,Specific antibodies
Immunosuppressor
 used to reduce the immune response against
transplanted organs and to treat autoimmune
diseases such as pemphigus, lupus, or allergies
 E.g. Prednisone ,dexamethasone ,Azathioprine

47. 1.Prednisolone
 Is used as an anti inflammatory and
immunosuppressive medication. Prednisolone
predominantly has glucocorticoids activity and is
the corticosteroids most commonly taken orally
for long term disease suppression
 50% of pts on long term corticosteroids develops
osteoporosis and bone loss
 Pts on prednisolone 25mg/day for more than 3-6
months should b given prophylactic
bisphosphonate

48.  Steroid sparing drugs it is used to minimize the
long term effect of systemic steroids
 It is cytotoxic immunosuppressant with
potentially serious side effect
 Not prescribed unless adequate monitoring is
available
 Pts are at risk of developing bone marrow
suppression particularly if thy have a deficiency
of thiopurine methyletransprase (tpmt), a
cytoplasmic enzyme involves in the metabolism
of azathioprine

49.  Dapsone
 Cyclosporine
 Colchicines
 Thalidomide
 mycophenolate

50.  Recurrent aphthous stomatitis
 bechets diseases
 Ulcerative vesiculoerosive diseases
 Major aphthae or erosive lichen planus
 Pamphigus vulgaris
 Erythema multiform
 Lichen planus
 Cicatrical pemphigoid
 Bullous pemphigoid
 Lupus erythamatosis

51.  Suppression of adrenal function
 Hypertension
 Diabetes
 Peptic ulceration
 Cushing syndrome
 Susceptibility to infection ( candidacies,
bacterial and viral infections)