Specialist Services | Drugs in dentistry

Medicines in dentistry specialist advisory service

The North West Medicines Information Centre (NWMIC) provides advice and support for enquiries relating to the use of medicines in dental patients. The centre is staffed by pharmacists experienced in providing medicines information.

The types of enquiry answered include:

• choice of antibiotic for dental infections
• use of prophylactic antibiotics for dental procedures
• management of the dental patient on anticoagulants, antiplatelets or steroids
• interactions and adverse effects associated with local anaesthetics
• availability of pharmaceutical agents used in dentistry
• medicines that can be prescribed on NHS dental prescriptions.

Guidance

The centre has prepared the following guidance documents:

• Saliva substitutes: choosing and prescribing the right product  
• Do patients with hydrocephalus shunts need antibiotic prophylaxis before undergoing dental procedures?  
• Is it safe to have amalgam fillings placed or removed if breastfeeding?
• Fluoride toothpaste - what are the dangers of chronic ingestion in adults?
• Do patients undergoing dental procedures need endocarditis prophylaxis?  
• When can dentists supply medicines?  
• Allergy to local anaesthetic agents used in dentistry – what are the signs, symptoms, alternative diagnosis and management options?
• How should dentists prescribe, store, order and dispose of controlled drugs?  
• What is the clinical significance of potential drug interactions with local anaesthetic preparations used in primary care dentistry?
• Can miconazole oral gel be used by patients taking a statin?  
• Patient Group Directions (PGDs) in dental practice
• What are the excipients in toothpastes?
• Which dental local anaesthetics are latex free?  
• What steroid supplementation is required for a patient with primary adrenal insufficiency undergoing a dental procedure?
• How should adults with cancer be managed by general dental practitioners if the need dental treatment?

All current UKMi Q&As are available on the Specialist Pharmacy Services website www.sps.nhs.uk.

Expired documents:

• Surgical management of the primary care dental patient on warfarin was last updated in 2007. NWMIC has no plans to update the document. This follows publication of guidance by the British Society for Haematology, the British Dental Association and the National Patient Safety Agency which is reflected in the BNF (see Prescribing in dental practice –Medical problems in dental practice – Thromboembolic disease). 

Who can use the service

The service is provided to all health care professionals but is primarily used by dentists working in primary care and the community dental service. Advice and support is also provided to dentists in secondary care and medicines information pharmacists.

Information on medicines not specifically related to dentistry is available from medicines information units based in hospital trusts. If your enquiry is not specifically related to dentistry please contact your local medicines information pharmacist (see UKMi Directory)

How to make enquiries

The medicines in dentistry specialist advisory service is available during the centre opening hours, 8.30am until 5.00pm Monday to Friday, excluding Bank Holidays. To contact the centre please call 0151 794 8206 or 0151 794 8113/4/5. There is an ansaphone on 0151 794 8117 outside office hours.

Information required when making an enquiry

For antibiotic prophylaxis (endocarditis, joint replacement) enquiries:

• the medical condition necessitating prophylaxis
• the dental procedure necessitating prophylaxis
• if the patient is allergic to any antibiotics
• is this a one off or will the patient need to come back for several visits to complete the treatment

For antibiotic choice enquiries:

• the dental condition for which the antibiotic is required
• if the patient is allergic to a specific antibiotic, details of the previous allergic reaction
• if the patient has received any antibiotics already for this condition
• if any physical interventions have been attempted e.g. lancing an abscess

 For drug interaction enquiries:

• is the enquiry prospective or retrospective
• details of all medication the patient is taking
• the underlying medical condition(s) the patient is being treated for
• the dental indication for the potentially interacting drug

Dental prescribing enquiries:

• is the patient an NHS or private patient?
• the age of the patient
• the indication for the prescription

Availability enquiries:

• name of the product
• dental use of the product
• sources of information already used

Medicines information pharmacists should have looked in standard medicines information reference resources before calling the service e.g. information on standard regimens for endocarditis prophylaxis can be found in section 5.1 of the BNF; most interaction enquiries can be answered using texts such as the current editions of Stockley or Hansten and Horn.

Sources of Information

The centre has access to a wide range of standard medicines information textbooks, journals and databases plus specific dental resources. However, information from the published literature is not used in isolation and practical experience is available from dentists working in the Liverpool University Dental Hospital. We also maintain a large database of previous enquires.

Dental textbooks:  Current editions of the following - 

• Medical problems in dentistry, Scully and Cawson
• Pharmacology and dental therapeutics, Seymour, Meechan and Yates
• American Dental Association guide to dental therapeutics
• Drug dictionary for dentistry, Meechan and Seymour
• Churchill’s pocketbook of clinical dentistry, Chestnutt and Gibson
• Oxford handbook of clinical dentistry, Mitchell and Mitchell
• Oral microbiology, Marsh and Martin
• Local anaesthesia in dentistry, Robinson, Ford and McDonald
• Adult antimicrobial prescribing in primary dental care for general dental practitioners, Faculty of General Dental Practitioners
• Dental care of the medically complex patient, Lockhart
• Tyldesley’s oral medicine, Field and Longman
• Oral and maxillofacial surgery, Scully
• dental suppliers catalogues

Dental Journals:

• British Dental Journal (1986 to date)
• Dental Update (1986 to date)
• Journal of the American Dental Association (1987 to date)

Liaison with clinical specialists in:

• Oral Medicine
• Restorative dentistry
• Oral microbiology
• Maxillofacial surgery