Rational

Prescribing
Practices and
Prescription Writing
In Dentistry

Prescribing privileges are controlled by the state licensing

boards
- Delegated powers by the state legislatures
Professions with prescribing privileges:
Physician
Dentist
Podiatrist
Veterinarian
Optometrist
Nurse Practitioner or Midwives
Physicians assistants
Pharmacists

How are we different from Quacks?

Does our training distinguish us?

Or is it because we use science in our clinical

practice?

How much are we influenced by the medical

representatives in our prescribing habits?

Ask these questions to yourself and search for

honest answers.

we commonly prescribe antibiotics and

analgesics.

How often are we aware why we prescribe a

particular
antibiotic or pain-killer?

How much are we contributing to the problem

of antibiotic resistance?

Have you ever asked

yourself whether your
children be able to fight their
infections in the future with
so many resistant bacteria
around?

Too many commercials(companies).

Too many drugs.
Many Dosage forms.
Too many generics for each drug

Rational use of drugs requires that patients

receive medications :
Appropriate to their clinical needs.
In doses that meet their own

requirement
For an adequate period of time,
And at lowest cost to them and their
community (WHO 1985).

 Appropriate indication.
The decision to prescribe drug(s) is entirely
based on medical rationale and that drug
therapy is an effective and safe treatment

 Appropriate drug.
The selection of drugs is based on
efficacy.

safety.
Suitability.
cost considerations.
Storage Condition.

 Appropriate patient.
No contra-indications exist

the adverse reactions is minimal,

the drug is acceptable to the patient.

 Appropriate information.
regarding his or her condition and the
medication(s) that are prescribed. Patients
should be provided with
relevant,
accurate,
important
clear information

 Appropriate monitoring.
The anticipated and unexpected effects of
medications should be appropriately
monitored.

The number of drugs per prescription is often

more than needed, with an average of 2.4 up
to 10 drugs, while generally one or two drugs
should be sufficient.
Wrong drug for a specific condition.
Drugs of doubtful efficacy.
Drugs of uncertain safety status.
Use of drugs in wrong dosage and duration.

In case of analgesics we need to know which

one will be appropriate for patients needs so
that he will get relief from his pain.

In case of antibiotics we should choose a

proper antibiotic which will take care of his
condition and assist his body in early
resolution of his ailment.

We should also know exactly in which

circumstances/ medical conditions preventive
prophylactic cover is needed.

we have a professional responsibility for

emergency dental care. When patients come
with trauma, acute spread of infection, or
hemorrhage, it is our duty to render
treatment so that he gets relief in a
reasonable time.
In many acute dental conditions,

extirpation of the pulp or extraction of the

tooth will be necessary.

Prescribing antibiotics is an adjunct in

many such situations. When it is clinically
indicated, it is definitely of therapeutic
benefit to the patient.

According to the American Dental

Association, the following guidelines should
be observed when prescribing antibacterial
drugs:

But systemic antibiotics should be used with

caution because of the possibility of toxicity,
side effects, the development of resistant
strains of microbes, and allergic reactions.

1- Make an accurate diagnosis;

2- Use appropriate antibiotics and dosing
schedules;
3- Consider using narrow-spectrum antibacterial
drugs (Clindamycin, Metronidazole, penicillin V
Potassium) in simple infections to minimize
disturbance of the normal micro flora, and
preserve the use of broad-spectrum drugs
(ampicillin, amoxicillin, erythromycin,
tetracycline, etc.,) for more complex infections

4- Avoid unnecessary use of antibacterial drugs in

treating viral infections;
5 - If treating empirically, revise treatment
regimen based on patient progress or test
results;
6 - Obtain thorough knowledge of the side effects
and drug interactions of an antibacterial drug
before prescribing it;
7 - Educate the patient regarding proper use of the
drug and stress the importance of completing
the full course of therapy (that is, taking all
doses for the prescribed treatment time).

American Academy of Pediatric Dentistry

(AAPD) has given recommendations for
clinical guideline on appropriate use of
antibiotic therapy.
Conservative use of antibiotics is indicated to
minimize the risk of developing resistance to
current antibiotic regimens.

Whenever an antibiotic is prescribed to a

female patient taking oral contraceptives to
prevent pregnancy, the patient must be
advised to use additional techniques of birth
control during antibiotic therapy and for at
least 1 week beyond the last dose as the
antibiotic may render the oral contraceptive
ineffective.

American Academy of Pediatric Dentistry

recommends the following general principles
when prescribing antibiotics for the pediatric
population.

When a child presents with a facial swelling

secondary to a dental infection, he should
receive immediate dental attention.

Depending on clinical findings, treatment

may consist of treating or extracting the
tooth/teeth in question with antibiotic
coverage.

Severity of the infection, the ability to obtain

adequate anesthesia, and the medical status
of the child should be taken into
consideration.

Bacteria can gain access to the pulpal tissue

through caries, exposed pulp or dentinal
tubules, cracks into the dentin, and defective
restorations.
While rendering treatments like pulpotomy,
pulpectomy, or extraction, antibiotic therapy
usually is not indicated

If the dental infection is contained within the

pulpal tissue or the immediately surrounding
tissue. In such a case, there will be no
systemic signs of an infection (i.e., no fever
and no facial swelling).

Viral conditions such as acute primary

herpetic gingivostomatitis should not be
treated with antibiotic therapy unless there is
strong evidence to indicate that a secondary
bacterial infection exists.

Analgesics are another group of drugs

commonly prescribed by dentists.
Our pain management goals should be:

Pain Management Goals

To maintain maximal patient comfort.

To minimize unwanted drug side effects.
To rapidly return injured tissue to function.

Pre-procedural analgesia can be employed for

delaying the onset of postoperative pain and
to reduce its magnitude.
But it has disadvantages like GI upset in
patient with empty stomach and GI upset in
anxious patient.
Ibuprofen 400mg hour before appointment
can be prescribed for this purpose.

 Step 1: Define the patients problem

Make specific & Accurate diagnosis.

Step 2:Consider the pathophysiological

implication of the diagnosis

Step 3: Specify the therapeutic objective .

 Step 4: Select the Drug of choice

Step 5: Determine the appropriate dosing
regimen.
Step 6: Devise a plan for monitoring the
drugs action and determine an end point for
therapy.
Step 5: Give information, instructions and
warnings (patient education).

Finally, your drug selecting criteria should be :

Efficacy.

Safety.

and

suitability.

cost of the medicine.

Y. M. Dailey1 and M. V. Martin :Are antibiotics being used appropriately

for emergency dental treatment? British Dental Journal OCTOBER 13
2001, VOLUME 191, NO. 7, PAGES 391-393
American Academy of Pediatric Dentistry (AAPD). Clinical guideline on
appropriate use of antibiotic therapy for pediatric dental patients.
Chicago (IL): American Academy of Pediatric Dentistry (AAPD); 2005. 3 p.
ADA Association report ; J Am Dent Assoc, Vol 135, No 4, 484-487.
2004 The American Dental Association
Marcos Luciano Pimenta Pinheiro, Filipe Polese Branco, Maria Cristina
Volpato, Eduardo Dias de Andrade: Analgesic choice in dentistryPart II :
The toxicity: Braz J Oral Sci. October-December 2005 - Vol. 4 - Number 15
Lane JE, Belson MG, Brown DK, Scheetz A. Chronic acetaminophen
toxicity: a care report review of the literature. J Emerg Med. 2002; 23:
253-6
Guidelines for dental treatment: dentistry and pregnancy. Aust Dent J.
1984; 29: 255-6.
Basic & Clinical Pharmacology, 12th Edition Bertram G. Katzung, Susan
B. Masters, Anthony J. Trevor