Dental Pharmacology-2

Dental Pharmacology Summary

Dental Pharmacology. Mobile Phone 01797522136, 01987073965. The study of pharmacology in Dental Science is called Dental Pharmacology. Dental Pharmacology discusses Astringents, examples of Astringents, Uses of Astringents, Therapeutic use of Astringents, Rational use of Astringents, Tannic acids, Uses of Tannic acids, Retraction Cords, Gingival Retraction Cords, The purpose of using Retraction Cords, Indications of Retraction Cords, Contraindications of Retraction Cords, Hemorrhage, Types of Hemorrhage, Hemostasis, Steps of Hemostasis, Classifications of the Hemostatic Agents, control of bleeding after the extraction of teeth, Adrenaline, Indication of Adrenaline, Side Effects of Adrenaline, Contraindications of Adrenaline.

Oral manifestations of patients with vit A deficiency, Oral manifestations of patients with vitamin B Complex deficiency, Oral Manifestations of patients with vitamin C and vitamin D deficiency, Ptyalism, Causes of Ptyalism, Xerostomia, Causes of Xerostomia, The Sjogrens syndrome, Causes of The Sjogrens syndrome, Anti sialagogue, Classification of sialagogue, Root canal medications, Intracranial medicaments, Obturating materials, Gutta-percha, Mummifying agents, Uses of formaldehyde, Uses of CMCP, Causes of sensitivity of tooth, Desensitizing agents, Uses of Obtundents, Uses of clove oil/ eugenol, Types of mouthwash,

Astringents

1. What is astringents?

Astringents are chemical compounds that are used to shrink or constrict body tissues thus reducing the secretion of exudates

2. Write down the example of astringents?

Zncl2. AgNO3, Tannic acid. Kino, Myrobalam,

3. Write down the uses of astringents?

• Used to stop bleeding from small cuts
• Reduce exudates from wounds and skin eruptions
• As antiperspirants in deodorants
• May stimulate the growth of new tissues when applied topically to wounds
• Higher concentrations can be used to remove undesirable tissue such as warts.

4 Write down the therapeutic use of astringents?

• Cleaning the face and preventing breakouts, like acne
• Stop bleeding from small cuts
• Hemorrhoids

5. Rational use of astringents in dentistry?

• Before taking impression in crown and bridge work
• Placing class V or root surface restoration
• They can be used alone or in combination with retraction cord
• Astringents are also used as mouthwash, paints, lotions and dentifrices in
  • Apthous ulcer
  • Stomatitis
  • Gingivitis
  • As local hemostatic

Tannic acids

6. What is tannic acid?

Tannic acids are obtained from nut galls, it is mainly obtained from oak tree. It is a yellowish white or light brown color powder It is soluble in water and in 95% alcohol.

7. Write down the dental use of tannic acid?

0.5% used as

• To prevent mucosal invasion of bacteria
• To prevent the absorption of toxins
• To reduce the secretion of mucosal glands
• To check exudation
• The tannic acid powder is used to reduce bleeding, particularly from dental sockets
• used to check bleeding from the nose, rectum, urethra
• 5 to 10 grains in one fluid ounce is harmless mouthwash for swollen, tender, and bleeding gums
• 1 parts tannic acid in 10 parts water is used as a mouthwash for stomatitis, tonsillitis, pharyngitis, etc.
• Tannic acid in combination with cresol is used as an obtundent to desensitize exposed dentine
• Sometimes it is used as mummifying agents in case of uninfected pulp
• It can also be used as antidote in case of acute poisoning.

GINGIVAL RETRACTION CORD

8. Write down the indications of gingival retraction?

• Presence of sub gingival caries
• Cervical abrasion or erosion
• To control hemorrhage
• Aesthetic consideration for sub gingival finish line
• Sub gingival tooth fracture
• When it’s necessary to retract gingival sulcus prior to impression taking

9.What is the purpose of using retraction cord?

the purpose of using retraction cord is to displace the gingival tissue traumatically so that the impression material can flow into the sub gingival space and record the finish lines perfectly

10.What instrument is used for placing the cord?

Periodontal probe or a plastic instrument can be used

11. Write down the contraindications of the Retraction cord.

• Patients with cardiovascular disease
• Hypertension
• Diabetes
• Hyperthyroidism
• Hypersensitivity to epinephrine

Hemostasis

12. What is hemorrhage?

Hemorrhage is escape of blood from blood vessels

13. What are the types of hemorrhage?

Depending on the types of blood vessels involved

a) Arterial hemorrhage

• Bleeding from ruptured artery, blood is brisk and bright red color

b) Venous hemorrhage

• Loss of blood from vein, dark color blood, flows in an even stream

c) Capillary hemorrhage

• Oozing from capillary is called capillary bleeding. In capillary bleeding no bleeding point can be made Bleeding is not severe and can be controlled by simple pressure with gauze pads

14.What are the types of bleeding?

a. Primary bleeding

• Occurs at the time of injury

b. Secondary bleeding

• If primary bleeding has stopped once, then again bleeding occurs after 24 hours
  • Cause
    • Dislodgement of clot
    • Trauma
    • Infection
    • Elevation of patients’ blood pressure

c. Intermediate bleeding

• Bleeding occurs within 8 hours after stoppage of primary bleeding Cause Loose foreign body in the wound like calculus, fragmented bones, pre existing granulation tissue

15.What is hemostasis?

Hemostasis is the cessation of bleeding from the damaged blood vessels.

16.Write down the steps of hemostasis

A. At first damaged blood vessels undergoes constrictions due to spasm in vessels wall to reduce blood flow.

B. In the second steps there is activation of platelet and formation of platelet plug. This leads to primary hemostasis.

C. In third step there is formation clot leading to completion of secondary hemostasis.

D. In the last step there is fibrous organization of the clot

17. Define hemostatic agents

Hemostatic agents are drug that are used to arrest blood flow by coagulation near the closed proximity to the lacerated vessel.

18. Write down the classification of the hemostatic agent.

A. local:

• Absorbable agents-
  • Oxidized cellulose
  • Oxidized regenerated cellulose
  • Absorbable gelatin sponge (gel form)

• Agents that modify blood coagulation-
  • Thrombin
  • Fibrin foam
  • Human fibrinogen

• Astringents-
  • Tannic acid
  • Kino
  • Karameria
  • ZnCl2, ZnSO4, KCI

• Socket plug-
  • Bone wax
  • White head varnish

• Physical agents-
  • Cold
  • Pressure

• Vasoconstrictor-
  • Adrenaline
  • Nor adrenaline

b. systemic:

• exogenous-
  • Vit-k
  • Aminocarproic acid
  • Cycloamine

• Endogenous-
  • Blood transfusion
  • Fresh frozen plasma
  • Anti hemophilic globulin

19. How can you control bleeding after the extraction of teeth?

• Pressure pack for 5-10 min
• Use of local hemostatic agents
• Cold pack for 5-10 mins
• Suture and ligation
• Hospitalize the patient incase of massive bleeding

20. Write down the side effects and contraindications of adrenaline?

Side effects

• Hypertension and increase cardiac workload
• Tachycardia
• Tremor
• Restlessness
• Insomnia
• Anxiety
• Throbbing headache
• Retention of urine
• Constipation

Contraindication:

• Hypertension
• Cardiac arrhythmia
• Ischemic heart disease
• Diabetes
• Cerebral hemorrhage

Dental consideration about vitamins

21. Write down oral manifestations with vit A deficiency

• White hyperkeratotic patches on oral mucosa
• Xerostomia

21. Oral manifestation of the patient with vitamin B complex deficiency

• B1 deficiency- burning mouth
• B2 deficiency angular cheilitis, glossitis, oral ulceration, anemia
• B6 deficiency sore mouth and tongue, glossitis, stomatitis, atrophy of papilla on the dorsum of the tongue
• Nicotinic acid deficiency mucosal ulceration, atrophy of papilla

22. Oral manifestation of patients with vitamin C deficiency.

• Swollen and bleeding gums
• Loose teeth
• Periodontal bone loss
• Anemia

23. Oral manifestation of the patient with vitamin D deficiency.

• Delayed eruption of tooth
• Abnormal dentine calcification

Sialagogues

24. Define sialagogue

The drugs or agents that are used to increase the flow of saliva. This drug is used in the treatment of Xerostomia.

25. Write down the classification of sialagogue

• Drugs that act within the mouth by exciting the taste buds Bitter, alcohol, ether, chloroform
• Drugs that act within the stomach Carbacol, methacoline
• Autonomic ganglionic stimulator-Nicotine
• Indirectly acting drugs-Neostigmine

26.Write down the uses of sialagogue

• Moisturing the mouth for deglutition and speech
• Prevention of dry mouth or xerostomia

27. Define anti sialagogue.

Drugs that decrease the production of saliva is called anti sialagogue

28. Give the examples of some anti sialagogue

• Astringents
• Opium
• Atropine
• Morphine
• Tropic amide

29. Write down the uses of anti sialagogue

• In pre-anesthetic medication
• During taking impression
• During the oral surgical procedure
• During tooth extraction

30. What is ptyalism?

Ptyalism is a clinical condition characterized by excessive secretion of saliva.

31. What are the causes of ptyalism?

• Local reflexes
  • Oral infection
  • Any type of oral wound
  • Dental procedure
  • New denture
• Pregnancy
• Stomatitis
• Epilepsy
• Nervous condition
• Nausea
• Some gastrointestinal disorder
• Administration of some drugs like pilocarline general anesthetic
• Bells palsy
• Stroke
• ANUG

32.What is xerostomia? Write down the causes

Xerostomia is a clinical condition when there is very little or no salivary secretion in the mouth leading to dry mouth

Cause

• Jorgen’s syndrome
• Irradiation
• Mumps
• HIV infection
• Iron deposition
• Dehydration
• Fluid loss
• Hemorrhage
• Persistent diarrhea or vomiting
• Psychogenic
• Drugs-
  • Diuretics, atropine, antihistamines, antiemetics, antidepressants
• Other cause-
  • Acute anxiety, emotional disturbance, excess sweating, Mouth breathing, open bite, excess smoking

33. What is sjogrens syndrome?

It is characterized by dryness of the mouth, dryness of the eye and is associated with rheumatoid arthritis. Middle-aged and elderly women are mainly affected.

34. Write down the oral and ocular effects of sjogrens syndrome.

Oral effects-

• Discomfort
• Difficulty with eating and swallowing
• Loss of taste sensation
• Disturbed quality of speech
• Predisposition to infection

Ocular effects-

• Loss of tear secretion
• Gritty sensation in the eye
• Risk of vision loss

Root Canal Medication

35. Write down the names of some intracranial medicaments?

• Eugenol
• Phenol, formocresol, paraformaldehyde
• Ca(OH)2
• Na hypochloride, I2
• Chlorhexidine gluconate
• Antibiotics

36.Uses of intracanal medicaments?

• To control infection
• To control pain
• To induce hard tissue formation
• Control exudate or bleeding
• Control inflammatory root resorption

37. Write down about Ca(OH)2

It is available in paste and powder form Ph 11-12

Indication-

• In root resorption
• In apexification and apexigenesis process
• Direct and indirect pulp capping
• As a sealer for obturation
• In infected canal

38. Write about MTA

Mineral trioxide aggregate is one of the most effective intracranial medicaments

• Its ph 12.5
• Setting time is more than 2 hours
• It is also known as Portland cement
• Available in 2 color, grey and white

Advantage

• Excellent biocompatibility
• Normal healing response
• Least toxic
• Bacteriostatic in nature

Disadvantage

• Costly
• Long setting time
• Difficult to manipulate

Indication

• As pulp capping material
• In apexification cases
• Repair of perforation
• In root resorption cases
• As root end filling material

39. Write down about CMCP

Camphorated para chlorophenol is another intracanal medicament used in endodontics.

Indication

As a dressing for infected teeth

40. EDTA

It is one of the ideal irrigation solution. It is relatively non toxic.

Functions

• Lubricating the canal
• Removing smear layer
• Emulsification
• Helps in enlarging narrow canals

41. Form cresol

Used in pulpotomy to fix the retained pulpal tissue

Canal Obturation

42. Write down some obturating materials

Gutta-percha, Resin, Silver points, Gold. Titanium, MTA, Calcium phosphate

43. Write down about gutta-percha

It is the most commonly used filling material in endodontic

Advantage

• Dimensionally stable
• Non-reactive material
• Becomes plastic when heated
• Radio opaque

44. Resilon

It is new material used for obturation

Mummifying agents

45. Mummifying agents name

• Formaldehyde
• Phenol
• Cresol
• Eugenol
• Iodines
• Formocresol

46.What is mummification?

It is the process of drying and hardening of vital tissue or fixation of cellular organs.

47. Uses of formaldehyde

• 0.5% formaldehyde solution kills bacteria and their spores
• 2-8% formaldehyde solution is used to disinfect inanimate objects
• formaldehyde vaper is used to disinfect air and surface of OT room
• 40% formaldehyde is used as preservatives

48. Adverse effects of formaldehyde

• formaldehyde has powerful irritating property, so it should not be applied to oral tissues
• It alters the tissue protein, so it may cause toxicity and allergic reaction
• If formaldehyde is ingested, mouth, throat, GIT are in severe pain and vomiting may occur
• After absorption formaldehyde depresses CNS and following symptoms may arise
  • Confusion
  • Tremor
  • Diplopia
  • Peripheral neuropathy
  • Ataxia

49. Uses of CMCP

• CMCP is used as antiseptic in root canal and periapical infection.
• It is also used for fixation of tissue in histopathology

Dental Desensitizing agents

50. What are the causes of sensitivity of tooth?

• Enamel
• Abrasion
• attrition
• Erosion
• Dental caries
• Cracked tooth syndrome
• Leakage or fracture of restoration
• Fracture of tooth
• Periodontal disease
• Unlined deep filling
• Gingival recession

51. Name of some desensitizing agents

• Clove oil
• Eugenol
• In generalized hypersensitivity- Use dentifrice containing
  • Fluoride
  • Strontium

52.Ideal properties of desensitizing agents

• Non irritating to the pulp
• Non toxic
• Relatively painless on application
• Have rapid onset of action
• Easy to use
• Permanently effective
• Non staining to the tooth

Obtundents

53.What is Obtundents?

Obtundents are the drugs that are used to desensitize the sensitivity of dentine by penetrating to the tubules.

54.Uses of Obtundents

• To relief pain during cavity preparation (clove oil, eugenol)
• To desensitize exposed dentine due to abrasion, erosion, attrition.
• Obtundents may be used as antiseptics in RCT

55. Name of some Obtundents

• Clove oil
• Silver nitrate
• Zinc chloride
• Phenols
• Camphor
• Thymol

56. Uses of clove oil/ eugenol

• Used as Obtundents to desensitize expose dentine
• used to relief pain in pulpitis and toothache
• Used in endodontic treatment as bacteriostatic or bactericidal material.
• It is used with ZnO powder for cavity liner, base or temporary filling

57. Side effects of eugenol

• It cause burning sensation to oral mucosa
• It may cause severe tissue damage when used to seal pulp cavity

Mouth wash

58. Write down basic composition of mouth wash

• An active agents- these ingredients are usually chlorhexidine, gluconate, hydrogen peroxide, fluoride, methyl salicylate etc. They have anti carious activity, anti microbial activity, reduction of plaque formation.
• A diluting agents- diluting agents are used to dissolve active ingredients, they act as preservatives and enhance the flavor.
• Surfactants -they are added in mouthwash for removal of debris
• Flavoring and sweetening agents- they are used to improve the property

59. Composition of antiseptic mouthwash

• Chlorhexidine
• Pyridinium chloride
• Water
• Liquefied phenol
• Tetracycline

60. Types of mouthwash

• Antiseptic mouthwash
• Fluoride containing mouthwash
• Obtundent mouthwash
• Astringent mouthwash
• Detergent mouthwash
• Anesthetic mouthwash

61. Uses of mouthwash

• to treat gingivitis
• to reduce plaque formation
• to remove bad breath
• for prevention and treatment of disease on oral cavity and upper respiratory tract
• for cleaning the mouth
• to control mouthwash

62. Ideal properties of mouthwash

• they should be effective against pathogenic microorganism
• they should not be harmful to oral mucosa
• they should not be effective against normal flora of mouth
• they should not interfere with saliva secretion of mouth
• they should not stain the tooth
• they should not cause gastric irritation
• they should have pleasant odor, color and taste

63.Write down the adverse effect of chlorhexidine mouthwash

• Most common side effect is formation of stain
• Higher concentration has irritating effect
• Regular use may reduce saliva secretion
• It may produce systemic toxicity if ingested

64.Direction of use of chlorhexidine mouthwash

Dose –

• 10 ml of 0.2% chlorhexidine in 1:1 dilution

For gingivitis

• Use 15 ml mouthwash for 30 seconds 2 times a day

For children

• Should not be used without doctor’s recommendation

65.Some brand name of mouthwash

• Chlorhexidine gluconate – oralon, oral C
• Benzamine Hydrochloride – Benostar (sore throat, mouth ulcer, sore tongue)
• Povidone iodine 1%- Arodin)