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Doctors' Answers to "Frequently Asked Questions" - Dental Procedures

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Analgesic Selection for dental pain [posted 1/7/99]
Question: I am a dentist in North Carolina, and I do not have a DEA license. Would you please tell me what possible non-scheduled analgesic I could prescribe to patients that have severe dental pain from abscess or dental extractions or root canals or similar procedures. I understand that Duract has been taken off the market. I have also been advised that Ultram may be a possible choice. Would you give me your advice on other possibilities?

Answer: Ultram or Excedrin plus Benadryl.

Can Certain Drugs Cause Cavities [posted 11/3/98]
Question: I am a dentist treating a young man, 19. He has Spina Bifida. Has taken many drugs over the years. Macrodantan, Macrobid, Gentamiacin, Methenam Man, Amoxicilian; Current regiment: Ditropan, and Septra. Can these drugs or the Spina Bifida cause rampant caries? This man gets caries at a rate of someone with zerostomia or radiation therapy.

Answer: Not to my knowledge, but I have had another person on this column ask a similar question about Bactrim which is nearly identical to Septra. Worth trying a switch to another antibiotic class.

Prophylactic Antibiotic [posted 10/28/98]
Question: I have an artificial knee and different dentists have prescribed different antibiotics prior to and after dental surgery. Most recently the dentist said to start augmentin six hours before surgery and twice a day for seven days. Is there a standard routine for this kind of preventive therapy. Apparently there is potential problem with the bone ends when the mechanical knee is inserted into the bone.

Answer: There is a standard regimen which is put out by the American Heart Association. It varies every few years;but, is usually 2 gms (sometimes 3 gm) of a penicillin like drug 1 hours before and 1.5 gm 6 hours later. Higher and longer doses can be prescribed if there is continued risk of bacteria. Most physicians would use amoxicillin or equivalent and not augmentin.

Prophylactic Antibiotic
Question: Could you please update me on the standard regimen for high risk patients with regard to prophylactic antibiotic, both for children and adults before dental procedures are performed?

Answer: Do you mean all procedures or a specific problem? Each procedure uses different antibiotics depending on what the potential type of bacteria would be causing the post-surgical infection. In general, it is a drug like Kefzol or some antibiotic against gram positive bacteria. But, sometimes gram negative organisms need to be prevented as well. It depends entirely on the procedure and somewhat on the physician.

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