Your Pocket Size Dental Drug Reference Series

Your Pocket-Size Dental Drug Reference
2012 Edition
A Handbook of Commonly Used Dental Medications Useful in the

Management of Oral Diseases and Conditions
by
Michael A. Kahn, D.D.S.
© 2012
People’s Medical Publishing House-USA
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11 12 13 14/PMPH/9 8 7 6 5 4 3 2 1
ISBN-13: 978-1-60795-161-2
ISBN-10: 1-60795-161-4
Printed in China by People’s Medical Publishing House

Copyeditor/Typesetter: Spearhead Global, Inc.
Cover Designer: Mary McKeon
Library of Congress Cataloging-in-Publication Data
Kahn, Michael A.
Your pocket-size dental drug reference : a handbook of commonly used
dental medications useful in the management of oral diseases and conditions /
by Michael A. Kahn. — 2012 ed.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-60795-161-2
ISBN-10: 1-60795-161-4
I. Title.
[DNLM: 1. Pharmaceutical Preparations—Handbooks. 2. Dentistry—
Handbooks. QV 39]
617.6⬘061—dc23 2012005636
Notice: The authors and publisher have made every effort to ensure that
the patient care recommended herein, including choice of drugs and drug
dosages, is in accord with the accepted standard and practice at the
time of publication. However, since research and regulation constantly
change clinical standards, the reader is urged to check the product
information sheet included in the package of each drug, which includes
recommended doses, warnings, and contraindications. This is particularly
important with new or infrequently used drugs. Any treatment regimen,
particularly one involving medication, involves inherent risk that must
be weighed on a case-by-case basis against the benefits anticipated.
The reader is cautioned that the purpose of this book is to inform and
enlighten; the information contained herein is not intended as, and should
not be employed as, a substitute for individual diagnosis and treatment.
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Metric System
Weight
kilogram = kg = 1000 gram
gram = g = 1 gram
milligram = mg = 0.001 gram
microgram = μg = 0.001 milligram
Volume
liter = L = 1000 milliliters
milliliter = ml = 0.001 liter
Metric and Apothecary Equivalents

Weight Equivalents—Approximate
Metric Apothecary
1 mg 1/65 grain
65 mg 1 grain
1
32 mg /2 grain
324 mg 5 grains
1g 15.432 grains
31.103 g 1 ounce (oz)
Volume Equivalents—Approximate
Metric Apothecary
>1.0 ml 16.23 minims
4.0 ml 1 fluid dram
30 ml 1 fluid ounce (oz)
480 ml 1 pint
960 ml 1 quart
Household Equivalents—Approximate
Utensil Volume
1 teaspoonful (tsp) 5 ml
1 tablespoonful (tbsp) 15 ml
1 teacupful 120 ml
1 tumbler glassful 240 ml
Clark’s Rule
child’s weight (lb) × adult dose = child’s dose
150
v
Weight lb/kg Chart
1 kg = 2.2 lb
Kilograms (kg) Pounds (lb)
>10 22
20 44
25 55
30 66
35 77
40 88
45 99
50 110
55 121
60 132
vi
FOREWORD
This pocket-size booklet is a compilation of prescribed drugs
and therapeutic regimens useful in the treatment of common
oral diseases and conditions. Its content is not intended
to be all-inclusive but is provided to give an overview of
the pharmaceuticals available and the protocols that have
been developed. The number of medications within each
category has intentionally been limited so that the booklet
may be conveniently placed in a clothing apparel pocket. Oral
pathologists and other clinicians who have an interest in oral
medicine have successfully used the specialized protocols listed;
some regimens are off-label use. The author acknowledges that
the same treatment objectives may be accomplished by many
pharmacological and therapeutic approaches. Brand names are
included for the convenience of identification. No advertisement
or promotional support is accepted from any company or
interest.
The drugs are grouped according to their class of action
or use for a specific condition. Every effort has been made to
ensure that drug selection and dosage are in accordance with
current recommendations and practice; however, in view of
ongoing research, changes in governmental regulations, and
new drug reactions, the clinician is urged to check the package
insert or back label of each drug for any change in indication
or dosage and for warnings and precautions. For any given
patient, the drug, dosage, and administration may vary from the
accepted norm, depending on the clinical situation.
As with any therapeutic procedure, the clinician has
the responsibility to determine whether there are any
contraindications to the proposed therapy, be aware of the
potential complications and side effects, and inform the patient
of such possibilities. The following must always be considered
for possible contraindications: medical history, pregnancy,
nursing mothers, children, known hypersensitivities, the elderly
or medically compromised, patients with impaired renal or
hepatic function, concurrent medications, and full-disclosure
labeling.
vii
PREFACE TO THE FIFTEENTH EDITION
As in past editions, there is a limited increase in the number
of medications listed within certain categories and several
medications’ regimens have been updated, revised, or deleted
from the previous edition. Unless specifically noted, the
medication regimens included in this booklet are intended for
the adult population. A list of prescription requirements and safe
writing practices is included. A chart of weight and equivalents
is on the inside front cover; the newly revised indications for
American Heart Association’s guidelines of antibiotic prophylaxis
for bacterial endocarditis prevention during dental procedures is
located on the inside back cover.
Every effort has been made to ensure the accuracy of the
contents of this booklet; however, the author is not responsible
for any typographical errors and the clinician should always
verify the accuracy of the information provided. A special thanks
to my colleagues Drs. J. Michael Hall and Lynn Solomon for their
helpful manuscript suggestions.
Michael A. Kahn, D.D.S.

Professor and Chairman
Department of Oral and Maxillofacial Pathology—Suite DHS-646
Tufts University School of Dental Medicine
1 Kneeland Street
Boston, MA 02111 December, 2011
viii
TABLE OF CONTENTS
I. Antibiotics and Antimicrobials ......................................1
II. Antihistamines and Palliative Coating
Agents (Magic Mouthwashes) ....................................12
III. Topical Anesthetics, Chemical Cauterizers,
and Keratolytic Agents ...............................................14
IV. Antifungals ................................................................17
V. Immunosuppressives, Occlusive Dressings,
and Compounds ........................................................24
VI. Antiviral Agents/Viral-Blocking Agents/
Germicidals ...............................................................46
VII. Muscle Relaxants.......................................................51
VIII. Antianxiety Agents (Anxiolytics) for
Stress Management...................................................53
IX. Antidepressants .........................................................55
X. Analgesics .................................................................55
XI. Local Anesthetics.......................................................64
XII. Vasoactive Drugs .......................................................66
XIII. Antixerostomics and Fluoride Gels/Rinses ..................67
XIV. Tooth Desensitizers....................................................75
XV. Hemostatic Agents (Topical and IV) ............................76
XVI. Burning Mouth Syndrome, Neuralgia,
and Myofascial Pain ...................................................78
XVII. Nutrient Deficient and Supplement Therapy ...............84
XVIII. Taste and Smell Disorder Therapies ...........................85
XIX. Miscellaneous Over-the-Counter Oral Rinses
and Products to Relieve Mouth Pain ...........................86
XX. Herbal and Nonherbal Remedies ................................90
XXI. Management of Patients Receiving
Radiation or Chemotherapy........................................93
XXII. HIV Infection and AIDS ...............................................97
XXIII. Halitosis ....................................................................99
XXIV. Prescription Requirements and
Safe Writing Practices ..............................................100
Compounding Centers of America Phone Contact ................101

Dangerous Prescription Abbreviations .................................101
Relative Potencies of Selected Topical Corticosteroids .........102
References .........................................................................103
Index ..................................................................................109
ix
I. ANTIBIOTICS AND ANTIMICROBIALS
Amoxicillin 50 mg/ml (Amoxil®, Trimox®, Wymox®) [Child]
Dsp: 200 ml
Sig: Take 1 hour before dental procedure.
Use: For penicillinase-resistant infection.
Note: 50 mg/kg; total children’s dose should not exceed
adult dose.
Amoxicillin 500 mg (Amoxil®)

Dsp: #40
Sig: Take 1 tablet every 6 hours for 10 days.
Use: For penicillinase-resistant infection.
Caution: Decrease the dosage by 25–50% in the renal
compromised patients. Affects the potency of oral
contraceptives.
Amoxicillin 500 mg/clavulanate 125 mg (Augmentin®)

Dsp: #30
Use: For penicllinase-resistant infection (inhibits beta-
lactamases).
Note: Take with food/milk to decrease GI effects.
Caution: Decrease the dosage and/or frequency of
administration in renal-compromised patients.
Azithromycin 250 mg, 500 mg, 600 mg (Zithromax®;

Zmax®)
Dsp: #6
Sig: Take 2 capsules on day 1 at bedtime, then 1 capsule
every day for the next 4 days.
Use: For mild to moderate infections of the upper
respiratory tract, lower respiratory tract, uncomplicated
skin, and skin structure infections caused by
M. catarrhalis, S. pneumonia, S. pyogenes, S. aureus,
H. influenzae, Clostridium, and L. pneumophila. Alternate
drug for penicillin-allergic patients.
Note: Extended spectrum of activity. Antacids decrease
the absorption. Safe to use during pregnancy and end-
stage renal disease. Generic formulations are available.
Zmax is a single-dose enhancement (extended release)
of Z-pak (six 250-mg tablets taken over 5 days).
Caution: Decreases action of clindamycin, penicillins,
lincomycin, oral contraceptives. Contraindicated in liver
disease. May potentiate the effects of oral anticoagulants.
1
Cefaclor 500 mg (Ceclor®)
Dsp: #40
Sig: Take 1 capsule every 8 hours.
Use: Bactericidal; soft tissue infection of susceptible
microorganism.
Caution: May cause a false-positive clinitest; renal or
hepatic dysfunction; GI disease, especially colitis.
Cefaclor 125 mg/5 ml suspension (Ceclor®) [Child]

Dsp: 150 ml
Sig: For greater than 1 month: 20–40 mg/kg/day divided
every 8–12 hours; maximum dose is 2 g/day.
Use: Bactericidal; soft tissue infection of susceptible
microorganism.
Note: Twice-daily option is for treatment of otitis media
and pharyngitis.
Caution: May cause a false-positive clinitest; renal or
hepatic dysfunction; GI disease, especially colitis.
Cefditoren pivoxil 200 g (Spectracef®)

Dsp: #20
Sig: Take 1 tablet twice daily for 10 days.
Use: Bactericidal; mild to moderate pharyngitis/tonsillitis
in adults and adolescents caused by S. pyogenes.
Note: Not recommended when long antibiotic treatment
is necessary.
Caution: Contraindicated in patients with carnitine
deficiency. Dosage adjustments are necessary for
patients with moderate to severe renal insufficiency.
The pharmokinetics have not been studied in patients
with severe hepatic impairment nor for the prevention
of rheumatic fever following S. pyogenes pharyngitis/
tonsillitis.
Warning: If given to penicillin-sensitive patients, caution
should be exercised because cross-hypersensitivity among
beta-lactam antibiotics has been clearly documented.
Cephalexin monohydrate 250 or 500 mg (Keflex®)

Dsp: #40
Sig: Take 1 capsule every 6 hours for 7 days.
Use: Bactericidal; possible drug of choice when penicillin
is ineffective in 48 hours for g (+) infections; often
ineffective for penicillinase-secreting organisms; seems
2
to have less cross-allergenicity than other cephalosporins
(e.g., cephalothin sodium, cephadrine, cefoxitin).
Caution: Do not give more than 4 g/day. Decrease the
dosage in renal-compromised patients.
Cephalexin monohydrate 125 mg/5 ml suspension

(Keflex®) [Child]
Dsp: 200 ml
Sig: 25–50 mg/kg/day every 6 hours; severe infections:
50–100 mg/kg/day in divided doses every 6 hours;
maximum: 3 g/24 hours.
is ineffective in 48 hours for g (+) infections; often
ineffective for penicillinase-secreting organisms; seems
to have less cross-allergenicity than other cephalosporins
(e.g., cephalothin sodium, cephadrine, cefoxitin).
0.12% chlorhexidine gluconate (Peridex®; PerioGard®,

generics)
Dsp: 480 ml
Sig: Swish 1 tsp for 1 minute then expectorate; perform
twice daily morning and evening after tooth brushing.
Avoid eating or drinking for 30 minutes.
Use: reduces the pathogenic microbial flora associated
with inflammatory signs of oral disease.
Caution: May stain teeth yellow to brown; alter taste
temporarily; increase the deposition of calculus. Contains
11.6% alcohol.
0.12% chlorhexidine gluconate oral rinse without

alcohol (CHX®)
Dsp: 480 ml
Sig: Swish 15 ml for 1 minute then expectorate; twice
daily morning and evening after tooth brushing and
meals. Avoid eating or drinking for 30 minutes.
Use: Reduces the pathogenic microbial flora associated
temporarily; increase the deposition of calculus.
0.2% aqueous chlorhexidine gluconate (compounded

by pharmacist; only ask for peppermint, raspberry, or
spearmint flavoring agents).
3
Dsp: 480 ml
Sig: Swish 1 tsp for 1 minute then expectorate; perform
twice daily morning and evening after tooth brushing.
Avoid eating or drinking for 30 minutes.
Note: For alcoholics and patients with xerostomia (e.g.,
post-irradiation) because a non-alcohol formulation.
Available only through a specialty-compounding
pharmacist. To find your nearest pharmacist who
participates in the Compounding Centers of America, call
1-800-331-2498. 6-month shelf life.
Caution: may stain teeth yellow to brown; alter taste
Ciprofloxacin 250–750 mg (Cipro®)

Dsp: #14.
Sig: Take 1 tablet 2 times a day for 7 days.
Use: Complex periodontal infections (very effective
against staph infections).
Note: It can be used in combination with metronidazole
(i.e., 500 mg of ciprofloxacin twice daily. for 7 days with
250 mg of metronidazole 250 4 times daily for 7 days.
Antacids decrease absorption; cimetidine increases
levels.
Caution: Can cause CNS stimulation. Causes cyclosporine
and theophylline toxicity. Do not administer with dairy
foods.
Contraindicated in patients receiving tizanidine (Zanaflex®).
Clarithromycin 250 or 500 mg (Biaxin®)

Dsp: #14
Sig: Take 2 tablets per day for 7 days.
Use: For mild to moderate infections of the upper
respiratory tract and maxillary sinusitis. Active against
gram-negative anaerobes in addition to bacteria that
erythromycin is effective against.
Note: Can be taken with food and dairy products.
Caution: Decreases effect of anticholinergic drugs
and increases effects of cyclosporine and warfarin.
Decreases action of clindamycin, penicillins, lincomycin,
oral contraceptives, rifabutin, rifampin, and zidovudine.
Contraindicated with terfenadine, astemizole, and
4
cisapride. Avoid in pregnancy and hepatic or renal
disease.
Clindamycin 150 mg or 300 mg (Cleosin HCl®)

Dsp: #60
Sig: Take 1 capsule every 6 hours for 7 days.
Use: Bacteriostatic, may be bactericidal; most effective
against Bacteroides infections, most other anaerobes,
staphylococci; not effective against enterococci.
Note: Dosage does not need to be altered in mild or
moderate renal or hepatic disease, but 50% reduction is
necessary in end-stage renal disease or cirrhosis.
Caution: May cause clostridia pseudomembranous
ulcerative colitis 2–9 days after the start of therapy;
discontinue immediately.
Clindamycin 75 mg/5 ml (Cleosin Pediatric®) [Child]

Dsp: 100 ml
Sig: Take in 3–4 equally divided doses.
Use: Bacteriostatic, may be bactericidal; most effective
against Bacteroides infections, most other anaerobes,
staphylococci; not effective against enterococci.
Note: 8–25 mg/kg
Caution: May cause clostridia pseudomembranous
ulcerative colitis.
Dicloxacillin 250 mg (also 500 mg) (Dynapen®, Dycill®)

Dsp: #40
Sig: Take 1 tablet every 4 hours for 5–7 days.
is ineffective in 48 hours; effective for staphylococci
resistant to penicillin G or penicillinase-secreting
organisms; much higher blood level than methicillin
(beta-lactamase–resistant penicillin).
Note: Should be taken on an empty stomach.
Caution: Use with caution in renal-compromised patients
(decrease the dose); increases the effectiveness of
anticoagulants.
Doxycycline 200 mg (Vibramycin®)

Dsp: #15
Sig: Take 1 tablet at bedtime on first day, then 100 mg/
day at bedtime for 7–10 days (usually 10 days).
5
Use: Periodontal disease, same as tetracycline HCl.
Note: Can be used safely in patients with renal disease
without dose alterations. Increases the effect of
coumadin and causes digoxin toxicity. Can be given
with food.
Caution: Avoid in children under the age of 8, in pregnant
patients, and those with severe liver disease. Decrease
the dose by 50% if the patient has severe liver disease
but can be used in mild to moderate liver disease without
dose alteration. Do not give in patient with both liver and
kidney disease.
Doxycycline hyclate 10.0% (Atridox®); in the ATRIGEL®

delivery system
Dsp: 1 pouch
Sig: 1 pouch containing a doxycycline hyclate syringe
(50 mg), an ATRIGEL Delivery System syringe (450 mg),
and a blunt cannula. The final blended product is 500 mg
of formulation containing 50.0 mg of doxycycline hyclate.
Use: Chronic adult periodontitis for a gain in clinical
attachment, reduction in probing depth, and reduction in
bleeding upon probing.
Doxycycline hyclate 20 mg (Periostat®)

Dsp: #60
Sig: Take 1 capsule twice daily, at least 1 hour prior to
meals, as an adjunct following scaling and root planing for
up to 9 months. Intake of adequate amount of fluids along
with the capsules is recommended.
Use: Adjunct to scaling and root planing to promote
attachment level gain and to reduce pocket depth in
patients with adult periodontitis.
Caution: Safety beyond 12 months and efficacy beyond
9 months have not been established.
Erythromycin ethylsuccinate 400 mg (EES®, ERYC®,

Ery-Tab®)
Dsp: #56
Sig: Take 1 tablet 3 times a day. Continue for 7 days.
Use: Bactericidal; upper and lower respiratory tract acute
infections, soft tissue infections.
Note: Inhibits cytochrome P-450 enzyme in the liver, thus
decreasing the clearance of theophylline, cyclosporine,
and carbamazepine.
6
Caution: Avoid in patients with liver disease. Causes
digoxin and theophylline toxicity.
Erythromycin ethylsuccinate oral suspension

200 mg/5 ml (E.E.S.®, EryPed®) [Child]
Dsp: 200 ml
Sig: Prescribe 30–50 mg/kg/day divided every 6–8 hours;
do not exceed 2 g/day.
Use: Bactericidal; upper and lower respiratory tract acute
infections, soft tissue infections.
Erythromycin stearate 500 mg (Erythromycin®) or

E-mycin 250 mg
Dsp: #40
Use: Bacteriostatic; odontogenic infections in patients
allergic to penicillin (second choice for oral abscesses),
active against gram (+) cocci, may be useful against
Haemophilus spp. and Mycoplasma spp.; Legionnaire’s
disease; also available IM, IV.
Metronidazole 500 mg (Flagyl®)

Dsp #30
Sig: Take 2 tablets immediately, then 1 tablet every
6 hours for 7 days.
Use: Anaerobic soft tissue infections caused by anaerobic
cocci, bacteroides, and clostridium; for febrile patient
with acute necrotizing ulcerative gingivitis involving
anaerobic bacteria.
Note: Useful as a single agent or in combination
with amoxicllin, Augmentin®, or ciprofloxacin
in the treatment of periodontitis associated with
the presence of Actinobacillus actinomycetem-
comitans.
Caution: Avoid alcohol and do not use in patients with
liver or kidney disease.
Minocycline 4 mg bioresorbable powder in a
disposable cartridge (Arestin®)
Dsp: 1 unit-dose cartridge
Sig: Insert 1 unit-dose cartridge in supplied handle and
then place in each periodontal diseased pocket (variable
dose depending on size, shape, and number of pockets
being treated).
7
Use: An adjunct to scaling and root planing procedures
for the reduction of pocket depth in patients with adult
periodontitis.
Note: Administered after periodontal scaling and root
planing. Specifically, the cartridge is placed at the base
of the pocket and then the thumb ring in the handle
mechanism is pressed to expel the powder while
gradually withdrawing the tip from the base of the
pocket. The handle should be sterilized between usages.
Caution: Warn patients to avoid eating hard, crunchy,
or sticky foods for 1 week and postpone brushing for a
12-hour period, as well as avoid touching treated areas.
Patients should also postpone the use of interproximal
cleaning devices for 10 days after administration.
Not recommended for use in an acutely abscessed
periodontal pocket.
Warning: The use of drugs of the tetracycline class during
tooth development may cause permanent discoloration of
the teeth. Photosensitivity manifested by an exaggerated
sunburn reaction has been observed in some individuals.
Penicillin G 500 mg
Dsp: #40
Sig: Take 1 tablet every 6 hours.
Use: Bactericidal; active against g (+) cocci aerobic and
anaerobic, not beta-lactamase–producing staphylococci;
most anaerobes except Bacteroides fragilis are
susceptible; also available IV.
Penicillin V potassium 250 or 500 mg (Veetids®)

Dsp: #28
Sig: Take 1 tablet 4 times a day for 5–7 days.
Use: Oral bacterial and viral infections.
Note: The most effective antibiotic for the majority of the
oral infections. Effective against Strep. viridans, group A
strep, anaerobic strep, bacteroides, gram-negative rods,
and many, but not all staphylococci.
Caution: Avoid in renal compromised patients; no longer
recommended for dental procedure prophylaxis.
Penicillin V potassium liquid 125 mg/5 ml (Pen-Vee K®

liquid) [Child]
Dsp: 200 ml
Sig: Take 1 tsp every 6 hours.
8
Use: Bactericidal; odontogenic infections (e.g., abscess,
cellulitis), ANUG with fever, oral gonorrhea. Same as
penicillin G although less active against anaerobes than
penicillin G.
Phenoxymethyl penicillin V 500 mg

Dsp: #40
Sig: Take 2 tablets immediately and then 1 tablet every
6 hours before meals.
Use: Bactericidal; odontogenic infections (e.g., abscess,
cellulitis), ANUG with fever, oral gonorrhea. Same as
penicillin G although less active against anaerobes than
penicillin G.
Tetracycline HCl 500 mg (Achromycin V®)

Dsp: #40
Sig: Take 1 tablet or capsule every 6 hours. Continue for
7 days.
Use: Bacteriostatic; active against many anaerobes and
enteric gram negative rods. Fair activity against Strep.
viridans.
Tetracycline HCl oral suspension 250 mg/tsp

(Achromycin®)
Dsp: 4 oz
Sig: Take 1 teaspoon 4 times a day, rinse orally 5 minutes
and swallow.
Use: Minor, major, and herpetiform aphthous stomatitis;
active against certain g (+) cocci; Bacteroides fragilis
commonly resistant but not Actinobacillus spp. or
Capnocytophaga; also can be dispensed IM or IV.
Caution: Use Doxycycline hydrate (Vibramycin) if renal
impairment or tooth staining a factor (pregnancy and
younger than 8 years old); dairy and antacid products can
inactivate.
Tetracycline HCl 250 mg (Tetracyn®)

Dsp: #40
Sig: Dissolve 1 tablet in 1 tsp of warm water, then swish
solution for 3–5 minutes and swallow. Repeat 4 times
daily.
9
Tetracycline HCl 12.7 mg (Actisite®)
Dsp: 1 box of 10 fibers
Sig: Insert fiber into periodontal pocket up to gingival
margin while maintaining contact with pocket base.
Secure with cyanoacrylate adhesive.
Use: Adjunct to scaling and root planing in patients with
active periodontitis.
Note: Fibers lost during first 7 days must be replaced.
Caution: May reduce the effectiveness of oral
contraceptives; may permanently stain teeth; not for
use with acute abscesses; remove after 10 days or
immediately if erythema occurs.
Trimethoprim 80 mg and sulfamethoxazole 400 mg
(Bactrim®)
Dsp: #40
Sig: Take 1 tablet every 12 hours.
Use: For infections involving Escherichia coli, Hemophilus
influenzae, Klebsiella, and Enterobacter spp.
Note: Usually not used for dental infections.
Vancomycin 125 mg (Vancocin®, Lyphocin®)
Dsp: #12
Sig: Take 1 tablet 4 times a day for 1 week.
Use: Pseudomembranous colitis produced by C. difficile;
infections for suspected or documented methicillin-
resistant Staph. aureus or beta-lactam–resistant
coagulase-negative Staphylococcus.
Note: Can be given during hemodialysis, at the dialysis
site, for SBE prophylaxis. Stays effective for 7 days, post-
dialysis.
Caution: Contraindicated in patients with kidney disease.
OVER-THE-COUNTER ANTIMICROBIALS:
PerioShield oral heath rinse
Dsp: 300 ml
Sig: Rinse with 1/2 oz. twice daily for 30 seconds and
expectorate. Avoid rinsing or eating for 30 minutes
following treatment.
Use: Antiplaque and gingivitis agent; relapse prevention
tool for post-chlorhexidine treatment and at-home
maintenance therapy after scaling and root planing.
Note: Proprietary 0.2% delmopinol hydrochloride; not
10
bactericidal but, rather, disrupts the development and
maturation of biofilm
10% povidone-iodine solution (Betadine®)
Dsp: 8 oz.
Sig: Rinse 1 tsp in the mouth for 1 minute and spit out,
twice daily.
Use: For acute necrotizing ulcerative gingivitis.
Note: Should be used for a maximum of only 2 days.
Caution: Not to be used in patients allergic to iodine.
Solution should be completely spit out.
Listerine® liquid
Dsp: 1 bottle
Sig: Rinse 1 tbsp in mouth for 30 seconds, twice daily.
Use: Antiplaque and gingivitis agent.
Note: ADA seal of approval.
Colgate Total® toothpaste
Dsp: 1 tube
Sig: Brush teeth with toothpaste 2–3 times a day.
Use: Antiplaque and gingivitis agent.
Note: ADA seal of approval.
OVER-THE-COUNTER REMOVABLE PROSTHESES

DISINFECTANTS/CLEANERS
1. Removal of debris and concretions by dishwashing
liquid detergent or white vinegar. Ultrasonic cleaners
may be used, but there are anecdotal reports of tooth
and clasp dislodgment.
2. Soak in full-strength household chlorine bleach (0.525%
sodium hypochlorite) for 10 minutes (set timer), then
rinse thoroughly in cool water. Repeat weekly.
Note: May adversely affect dental alloys, acrylics, and
tissue-conditioning material. If the metal does not darken
or dull the surface, then it is okay to use.
Tufts University School of Dental Medicine:
1. Remove dentures from mouth and clean with a brush
at least two times a day. This should be done over a
sink filled with water.
2. Once per week, soak denture overnight in a cleansing
solution to remove stains and other accumulations.
Recommended solution is:
11
Calgon: 2 tsp
Clorox: 1 tsp
1
/2 glass of water
3. Rinse well with water before inserting denture back
into mouth
Warning: Do not place denture with metal into this
solution. Use vinegar and water instead OR
If metal affected, then try:
Soak for 6 hours (or overnight) in Oral Safe (sodium
benzoate, citric acid, disodium phosphate, glycerin,
water, FD and C blue, and C yellow #5, sodium saccharin,
and flavoring) to eliminate recoverable surface fungi (i.e.,
C. albicans).
Note: The solution is good for 1 week. The pH is 3.4 and
it is not corrosive, toxic, or carcinogenic; safe if ingested.
Manufactured by Great Lakes Orthodontics, Tonawanda,
NY; 1-800-828-7627. Cost is $6.50 for starter kit;
6-month refill kit is $21.00 with $4.00 shipping and
handling fee.
II. ANTIHISTAMINES AND PALLIATIVE COATING AGENTS

(MAGIC MOUTHWASHES)
Diphenhydramine HCl 50 mg (Benadryl®) or
promethazine 12.5 mg (Phenergan®; generic available)
[Child]
Dsp: #20
Sig: Take 1 tablet 3 times daily for 2–3 days.
Use: Mild to moderate allergic stomatitis of the
immediate type, erythema multiforme.
Note: Diphenhydramine causes xerostomia.
Caution: Do not administer more than 50 mg of
diphenhydramine per visit. Do not use during acute
asthma attacks; avoid in patients with history of
hyperthyroidism or angle-closure glaucoma; should not
be used along with alcohol, barbiturates, opioids, and
MAO-Is or any other centrally acting drug.
Diphenhydramine elixir 12.5 mg/5 ml (Benadryl®) or

promethazine syrup 6.25 mg/5 ml (Phenergan®) with
Kaopectate (attapulgite) or Milk of Magnesia 4 oz.
[Child and Adult]
Dsp: 8 oz.; compound the ingredients
12
Sig: Rinse with 1 tsp every 2 hours and expectorate.
Use: Allergic stomatitis of the immediate type, erythema
multiforme; palliation of painful vesiculoulcerative lesions
such as primary herpetic gingivostomatitis; sedation and
antiemetic effects.
Note: Dyclonine HCl 0.5%, 1 oz may be added for greater
anesthetic efficacy. Sucralfate (Carafate®) 1 g/10 ml or
Maalox (aluminum hydroxide, magnesium hydroxide)
may be substituted for Kaopectate or Milk of Magnesia.
Palliative rinse; no therapeutic effect. Allergic reactions
are extremely rare.
Caution: When topical anesthetics are used, patients
should be cautioned concerning a reduced gag reflex
and the need for caution while eating and drinking to
avoid possible airway compromise. Also, the preparation
can cause constipation and drowsiness; Maalox® may
be substituted for Kaopectate or Milk of Magnesia if
constipation is a problem.
Benacort-tetrastat elixir (Mary’s magic potion®)

Dsp: 1.5 g tetracycline, 60 mg hydrocortisone, 6 million
international units nystatin, 240 ml q.s. elixir of Benadryl
Sig: Rinse with 1 tsp 4 times daily for 2 minutes and
expectorate
Use: Severe mucositis; sedation effects.
Caution: In xerostomic patients, it increases likelihood of
caries.
Weisman’s Philadelphia mouthwash

Dsp: 80 ml oral 2% viscous lidocaine, 80 ml Maalox
(aluminum hydroxide, magnesium hydroxide), 80 mg
hydrocortisone, 160 ml distilled water
Sig: Rinse with 1 tsp 4 times daily for 2 minutes and
expectorate.
Use: Severe mucositis.
1-2-3 mouth rinse

Dsp: 40 ml Dimetapp elixir, 80 ml Kaopectate
(attapulgite), 120 ml distilled water
Sig: Shake well and rinse with 1 tsp as needed for 2
minutes and expectorate.
Use: Severe mucositis.
13
III. TOPICAL ANESTHETICS, CHEMICAL CAUTERIZERS, AND
KERATOLYTIC AGENTS
TOPICAL ANESTHETICS
20% benzocaine gel or liquid or spray (Hurricaine®)
Dsp: 1 oz.
Sig: Apply small amount to ulcer as needed for pain.
Use: Palliation of painful vesiculoulcerative lesions.
Caution: The FDA announced in 2011 that over-the-
counter benzocaine gels and liquids applied to the
gingiva (or other areas of the mouth) have caused a rare
but potentially fatal adverse effect, methemoglobinemia.
Benzocaine products should not be used on children
younger than 2 years of age (e.g., teething), except under
the advice and supervision of a healthcare professional.
14% benzocaine with 2% butamben 2% tetracaine
gel or liquid or ointment (Cetacaine®)
Dsp: 56 g (liquid) or 29 g (gel) or 37 g (ointment)
younger than 2years of age (e.g., teething), except under
0.5% or 1% dyclonine HCl (Dyclone®)
Dsp: 4 oz bottle
Sig: Rinse with 1 tsp for 2 minutes before each meal and
expectorate.
Note: If you cannot find Dyclone®, have the pharmacist
compound it and place it in a mechanical spray pump.
To find the nearest pharmacist who participates in the
Compounding Centers of America, call 1-800-331-2498.
2% lidocaine HCl viscous (Xylocaine®)
Dsp: 100 ml
Sig: Apply 3 drops with clean fingertip or cotton-tipped
applicator to oral sores as needed for pain, then
expectorate; alternatively, 2 tsp may be rinsed in the
14
mouth and then expectorate. For infant or toddler, apply 3
drops to pacifier (see Caution).
Note: This preparation can be used for infants who are
unable to rinse.
Caution: Do not swallow to avoid anesthetizing gag
reflex; parents should be instructed to observe the child
closely while he or she is taking food or liquids following
administration of the anesthetic. Reports of cutaneous
overuse leading to life-threatening events such as
arrhythmias and seizures.
5% lidocaine HCl liquid (Xylocaine®)
Dsp: 450 ml
Sig: Swish with 1 tbsp before each meal and expectorate.
5% lidocaine ointment (Xylocaine®)

Dsp: 35 g
10% lidocaine spray (Xylocaine®)
Dsp: 4 oz
Sig: Spray for 2 seconds on ulcer as needed for pain.
Orabase with benzocaine
Dsp: 5 g (or 15 g)
Sig: Apply to affected area before meals and as needed
for pain.
Use: Palliation of painful vesiculoulcerative lesions (e.g.,
aphthous ulcer).
CHEMICAL CAUTERIZERS
Debacterol® single-use applicator package (30%
sulfuric acid and 22% sulfonated phenolics); 1 box (24
15
individually wrapped applicator sets consisting of a prefilled
[0.2 ml] cotton swab applicator and drying cotton swab)
Dsp: 1 applicator package
Sig: Dry the affected area using the drying swab. Hold the
applicator with the colored ring pointing up. To start the
flow of Debacterol, gently bend the colored ring to one
side until it snaps. Debacterol will flow to the opposite
end (e.g., applicator swab). Apply directly to affected area
for no more than 5 seconds. Rinse thoroughly with water
and expectorate. Dispose of used applicator.
Use: Immediate palliation of painful minor aphthous ulcer.
Note: If excess irritation occurs during use, a rinse with
sodium bicarbonate (baking soda) will neutralize the
reaction (use 0.5 tsp in 120 ml of water).
Polyphenolsufonic acid complex, 100 ml, formaldehyde
solution, 18 ml, distilled water, 42 ml [Negatan®]
Dsp: Compound the ingredients
Sig: Dry ulcer and then apply 1 drop for 15 seconds and
then rinse with water.
Use: Palliation of painful vesiculoulcerative lesions (e.g.,
aphthous ulcer).
Note: Negatan® is no longer available in the United
States. Have the pharmacist compound it. Call
1-800-331-2498 to find the nearest pharmacist who
participates in the Compounding Centers of America.
Silver nitrate
Dsp: 1 oz.
Sig: Dry ulcer thoroughly, then apply topical anesthetic;
lightly apply the silver nitrate on an applicator to the ulcer
base for 5 seconds, then rinse with water.
Use: Palliation of painful minor aphthous ulcer.
Caution: The clinician must use extreme care not to
burn adjacent uninvolved mucosa by drying the area
thoroughly before applying the cauterizing agent.
KERATOLYTIC AGENT
10% podophyllum resin (Podofin®) and benzoin
tincture compound solution
Dsp: 10 ml
Sig: Dry the mucosal surface and apply 1 drop at a
time allowing drying between drops. Apply until area is
16
covered but do not apply more than a volume of 0.5 ml at
each treatment session.
Use: Viral conditions such as condyloma acuminatum.
Off-label use for excess keratinization of mucosal
surfaces such as hairy tongue.
Caution: A 25% solution may be used on skin but limit to
10% solution on or near mucosal surfaces.
IV. ANTIFUNGALS
Amphotericin B oral suspension 100 mg/ml
Dsp: 48 ml
Sig: Swish 1 ml 4 times a day in the mouth (after meals
and at bedtime) for 3–4 minutes and swallow. Do not eat
or drink for 30 minutes after use.
Use: Mucocutaneous and oropharyngeal candidiasis
when topical therapy is ineffective.
Note: Fungizone® product is no longer available.
Amphotericin B oral suspension 100 mg/ml

Dsp: 24 ml
Sig: Swab 1 ml 4 times a day in the mouth (after meals
and at bedtime) for 3-4 minutes and swallow. Do not eat
or drink for 30 minutes after use.
Use: Mucocutaneous and oropharyngeal candidiasis
when topical therapy is ineffective and the patient is
debilitated and cannot rinse.
Note: Fungizone trade name product is no longer
available. Can dilute to 100 mg/4 ml for easy swish and
expectorate.
Amphotericin B 3% cream
Dsp: 20 g tube
Sig: Apply to affected areas 2–4 times/day for 1–4 weeks
of therapy depending on the nature and severity of the
infection.
Use: Mucocutaneous and cutaneous Candida infections.
Anidulafungin 50 mg (Eraxis®)
Dsp: Injection, powder for reconstitution
Sig: IV adults, for candidemia, intra-abdominal, or
peritoneal: 200-mg loading dose on day 1, followed
by 100 mg daily for at least 14 days after last positive
culture; for esophageal, 100-mg loading dose on day 1,
17
followed by 50 mg daily for at least 7 days after symptom
resolution.
Use: Esophageal candidiasis, candidemia, abdominal
abscesses and peritonitis with Candida (echinocandin)
Caspofungin acetate 50 mg and 70 mg (Cancidas®)
Dsp: Injection, powder for reconstitution, as acetate
Sig: IV infusion slowly, over 1 hour: esophageal, 50 mg/
day; invasive aspergillus, initial dose of 70 mg on day 1,
subsequently 50 mg/day.
Use: Invasive aspergillus infections in patients who are
refractory or intolerant of other therapy; candidemia and
other Candida infections (intra-abdominal abscesses,
esophageal, peritonitis, pleural space).
Warning: Concurrent use of cyclosporine should be
limited to patients for whom benefit outweighs risk owing
to a high frequency of hepatic transaminase elevations
Clotrimazole troches 10 mg (Mycelex®)
Dsp: #70
Sig: Dissolve, in mouth, 1 troche as a lozenge 5 times
daily for 14 consecutive days.
Use: Fungicidal; oral candidiasis.
Note: Remove denture(s) if applicable. Do not eat or drink
for 30 minutes following use. Troche contains sucrose,
risk of caries with prolonged use (>3 months); care must
be exercised in diabetic patients.
Clotrimazole 1% cream (Lotrimin-Rx®, generic)
Dsp: 15 g
Sig: Apply thin film to inner surface of denture and/or
angles of mouth 4r times a day (after each meal and at
bedtime).
Use: Denture sore mouth; angular cheilitis.
Note: Do not eat or drink for 30 minutes following use.
Continue for at least 3 days after apparent clinical
resolution. An inexpensive over-the-counter athlete’s
foot cream (Lotrimin AF) is also available and may be
substituted and used identically.
Clotrimazole 1% and betamethasone cream
(Lotrisone®)
Dsp: 15 g tube
Sig: Apply a thin amount to the affected area twice daily.
Use: Angular cheilitis.
18
Clotrimazole 10 mg/ml suspension [Infant or Child]
Dsp: 90 ml; the pharmacist should blend 900 mg of
clotrimazole powder into to 2 tubes of Oral Balance
moisturizing oral gel.
Sig: Swab 1–2 ml on affected area 4 times a day (after
meals and at bedtime).
Use: Fungicidal; oral candidiasis in debilitated patients
who cannot rinse and for very young children when a
rinse is ineffective.
Note: Shake before using; do not eat or drink for 30
minutes following use. To find your nearest pharmacist
who participates in the Compounding Centers of America,
call 1-800-331-2498.
Fluconazole 100 mg tablets (Diflucan®); also available

in 50 mg, 150 mg and 200 mg tablets
Dsp: #15
Sig: Take 2 tablets on first day, then take 1 tablet daily
thereafter for 14 days to treat oral candidiasis; for 21 days
to treat esophageal candidiasis. Take 4 tablets on first day,
then take 2 tablets for 28 days to treat systemic candidiasis.
Use: Systemic fungal infection—oropharyngeal,
esophageal, mucocutaneous and systemic candidiasis
(HIV-seropositive patients).
Caution: Avoid in patients with severe liver and kidney
disease.
Fluconazole 100 mg tablets (Diflucan®)/hydrocortisone

10 mg and iodoquinol 10 mg (Alcortin A gel®)
Dsp: 11 tablets/30 g tube
Sig: Apply a thin film of cream to the affected area
3–4 times daily for 10 days in conjunction with 200 mg
of fluconazole immediately on day 1 and 100 mg each
day on days 2–10.
Use: Severe exfoliative cheilitis (chapped lips).
Note: Patient must stop lip licking habit for complete
resolution.
Flucytosine 250 mg or 500 mg (Ancobon®)

Dsp: #30
Sig: Take 50–150 mg/kg/day in divided doses every
6 hours.
Use: Adjunctive treatment of susceptible fungal infection;
used in combination with amphotericin B, fluconazole, or
19
itraconazole. Synergistic with amphotericin B for fungal
infections (Aspergillus spp.).
Hydrocortisone 10 mg and iodoquinol 10 mg (Alcortin

A gel®)
Dsp: 30 g tube
Sig: Apply small dab to corner of mouth, 4 times a day.
Use: Angular cheilitis; candidiasis.
Note: Advise patient to avoid contact with oral cavity
because it has a very bitter taste.
Hydrocortisone 2% and iodoquinol 1% (Alcortin

A gel®)
Dsp: 24-pack box (48 g)
Sig: Apply as a thin film 3–4 times daily to the affected
area.
Note: Do not use with an occlusive dressing.
Itraconazole 100 mg (Sporanox®)

Dsp: #28
Sig: Take 1 capsule twice daily or 2 tablets with a meal or
orange juice.
Use: Fungistatic; oral candidiasis when topical
therapy is not practical or is ineffective. Also may
be used for blastomycosis and histoplasmosis,
Aspergillus, Coccdioides, Cryptococcus, Sporothrix, and
chromomycosis.
Note: Dose may be increased 100 mg/day to 400 mg/day.
Doses greater than 200 mg/day should be given in
2 divided doses.
Caution: May cause irreversible liver damage; avoid in
congestive heart failure.
Itraconazole 10 mg/ml oral solution (Sporonox®)

Dsp: 150 ml
Sig: Swish in mouth and swallow 200 mg daily for 1–2
weeks.
Use: Fungistatic; oral candidiasis when other topical
therapy is ineffective. Also may be used for blastomycosis
and histoplasmosis, Aspergillus, Coccdioides,
Cryptococcus, Sporothrix and chromomycosis.
Note: Dose may be increased 100 mg/day to 400 mg/day.
20
Doses greater than 200 mg/day should be given in
2 divided doses.
Caution: May cause irreversible liver damage.
Ketoconazole cream 2% (Nizoral®, generic)

Dsp: 15 g, 30 g, or 60 g tube
Sig: Rub gently to affected area 1–2 times per day.
Use: Fungistatic; oral candidiasis, angular cheilitis.
Note: If denture wearer, apply thin film to inner surface of
denture. Do not eat or drink for 30 minutes following use.
Caution: May cause irreversible liver damage.
Ketoconazole cream 2% (Nizoral®, generic) mixed with

equal parts of triamcinolone acetonide 0.1% or 0.5%
ointment (Kenalog) or fluocinonide 0.05% ointment
(Lidex®) or clobetasol 0.05% ointment (Temovate®).
Dsp: 30 g
Sig: Apply thin film to inner surface of dentures or
medication trays twice daily. May also gently rub into the
affected area once or twice daily.
Use: Candidiasis.
Ketoconazole 200 mg (Nizoral®, generic)

Dsp: #14
Sig: Take 1 tablet daily, with a meal, for 2 weeks.
Use: Fungistatic; oral and mucocutaneous candidiasis
when patient cannot tolerate topical therapy or respond
to topical (e.g., nystatin).
Note: Do not take antacids within 1 hour of this medication.
Caution: May cause irreversible liver damage; liver
function should be monitored with long-term use
(>3 weeks). Multiple severe drug interactions possible,
especially with some antihistamines.
Micafungin sodium 50 mg (Mycamine®)

Dsp: IV adults: powder for reconstitution as sodium;
contains lactose.
Sig: For esophageal candidiasis, 150 mg daily with
median trial of 14 days; for prophylaxis of Candida
infection in hematopoietic stem cell transplantation
50 mg daily with median trial of 18 days.
Use: Inhibits cell wall synthesis (new echinocandins
class); esophageal candidiasis; prophylaxis in patients
21
undergoing hematopoietic stem cell transplant. Unlabeled
use for aspergillus infections and prophylaxis for HIV-
related esophageal candidiasis.
Note: Side effects include isolated serious cases of
serious hypersensitivity and anemia as well as changes
in liver and kidney function.
Miconazole buccal 50 mg tablets (Oravig®)
Dsp: 14 tablets
Sig: Apply 1 mucosa-adhering tablet to the gingiva daily
for 2 weeks.
Use: Oropharyngeal candidiasis (especially immune-
depressed patients); also may be preferred in patients
suffering from salivary gland hypofunction compared with
other azoles.
Note: Cost can be prohibitive for some patients; however,
single dose per day enhances patient compliance.
Caution: Monitor in patients with a history of
hypersensitivity to azoles.
Nystatin oral suspension 100,000 IU/ml (Mycostatin®,

Nilstat®)
Dsp: 240 ml
Sig: Take 1 tsp (2–5 ml) every 6 hours (after each meal
and before bedtime), rinse orally for 2 minutes then
swallow (if pharyngeal involvement) or expectorate, for
1 week. Do not eat or drink for 30 minutes following
application.
Use: Oral candidiasis.
Note: Remove denture(s) if applicable; a few drops can be
added to the water used for soaking acrylic prostheses. If
dentate, good oral hygiene should be reinforced because
nystatin suspension has a high sugar content (50%).
Advise the patient to regularly brush his or her palate if
he or she has a removable maxillary prosthesis.
Nystatin pastilles or troches 200,000 IU (Mycostatin®)

Dsp: #80
Sig: Dissolve 1 pastille in mouth 4 times daily as a
lozenge for 14 consecutive days.
Use: Oral candidiasis.
Note: Remove denture(s) if applicable. If dentate, good
oral hygiene should be reinforced because nystatin
suspension has high sugar content. Advise the patient
22
to regularly brush her or his palate if she or he has a
removable maxillary prosthesis. Do not chew the pastille.
More effective than the oral suspension.
Nystatin topical powder 100,000 IU (Mycostatin®

topical powder)
Dsp: 15 g squeeze bottle
Sig: Apply liberally to tissue side of clean denture after
meals and after rinsing the denture. Soak the denture
in a suspension of 1 tsp of powder and 8 oz. of water
overnight.
Use: Denture-related candidiasis.
Note: If dentate, good oral hygiene should be reinforced
because nystatin suspension has high sugar content.
Advise the patient to regularly brush his or her palate if
they he or she has a removable maxillary prosthesis.
Nystatin ointment 100,000 IU (Mycostatin®, Nilstat®,

generic)
Dsp: 15 g (or 30 g) tube
Sig: Apply thin film to affected area and to inner surface
of denture, after each meal and at bedtime, until healing
occurs. Do not eat or drink for 30 minutes after use.
Use: Denture-related candidiasis; angular cheilitis.
Note: Inexpensive; a polyethylene and mineral oil gel base.
Can be mixed with a topical steroid ointment (see p. 37).
Also available as an aqueous vanishing cream base.
Nystatin 100,000 units/g—triamcinolone acetonide

0.1% ointment (Mycolog II®, Mytrex®)
Dsp: 15 g (30 g, 60 g) tube
Sig: Apply to the corner of the mouth after each meal and
at bedtime until healing occurs.
Use: Angular cheilitis.
Note: Concomitant intraoral antifungal treatment may be
indicated. As with nystatin ointment, in denture wearers,
this may be applied as a thin film to the inner surface of
the denture.
Nystatin 100,000 units/g—triamcinolone acetonide

0.1% ointment (Mycolog II®, Mytrex®) and erythromycin
gel 2%
Dsp: Compound 30 mg of Mycolog II and 30 mg of
erythromycin gel in a 1:1 ratio
23
Sig: Apply to corner of the mouth after each meal and
1
/2 hour before bedtime until healing occurs.
Use: Especially useful for recalcitrant angular cheilitis that
has been secondarily infected with Staph. aureus.
Caution: Ensure patient is not allergic to erythromycin.
OVER-THE-COUNTER PREPARATIONS
1% clotrimazole vaginal cream (Gyne-Lotrimin®)
Dsp: 1 tube (15 g, 30 g, 60 g, or 90 g)
Sig: Apply small dab to corner of mouth, 4 times a day OR
apply small dab to tissue side of denture or to infected
oral mucosa 4 times a day.
Clotrimazole 200 mg (Gyne-Lotrimin®)
Dsp: 1 box
Sig: Dissolve 1/2 vaginal tablet, in mouth, as a lozenge
twice daily for 14 consecutive days.
Use: Fungicidal; oral candidiasis.
Note: Remove denture(s), if applicable. Do not eat or
drink for 30 minutes following use. Inexpensive substitute
for Clotrimazole prescription cream if the patient is not
reluctant to use; however, for some patients, a very bitter
taste will be detected. Bitter taste can be counteracted by
a sip of milk.
2% miconazole nitrate vaginal cream (Monistat 7®)
Dsp: 45 g tube
Sig: Apply to affected area and tissue side of denture
4 times a day.
Use: Oral candidiasis (denture sore mouth); angular cheilitis.
V. IMMUNOSUPPRESSIVES, OCCLUSIVE DRESSINGS,

AND COMPOUNDS (FOR CHRONIC VESICULAR/BULLA
AND EROSIVE/ULCERATIVE DISEASES)
PRESCRIPTION OCCLUSIVE DRESSINGS

0.5% hydrocortisone acetate ointment (Orabase HCA®)
Dsp: 5 g tube
Sig: Dry area and then apply thin film to oral sores after
meals and at bedtime. Do not rub in.
Use: Oral erosive lichen planus, bullous pemphigoid,
oral pemphigus, contact (delayed) allergic stomatitis,
recurrent aphthous stomatitis, chapped (cracked) lips.
24
Delmopinol HCl mouth rinse 2 mg/ml (Decapinol®)
Dsp: 1 bottle
Sig: Use twice daily after brushing and flossing.
Use: Reduce gingivitis
Note: Classified by the FDA as a bioadhesive device
rather than a drug. A physical barrier is created to
prevent aggregation and colonization of bacteria at
the tooth and gum interface. It is not antimicrobial or
antiseptic.
OVER-THE-COUNTER OCCLUSIVE DRESSINGS

Alvogyl® (eugenol, butamben, iodoform)
Dsp: 11 g jar
Use: Dry socket (alveolar osteitis)
Avamin Melts® (500 μg methylcobalamin)

Dsp: 1 box (60 discs)
Sig: Apply 2 dry mucoadhesive discs over the aphthous
ulcer on the first day; and then 1 disc each succeeding
day.
Use: Recurrent aphthous stomatitis
Benzoin tincture saturated swabsticks (Aplicare, Inc.,

Meriden, CT)
Dsp: 1 case—10 boxes of 50 single sterile swabstick
pouches
Use: Topical skin adhesive that prepares the skin for
maximum adhesion of dressing or bandages.
Note: Can be removed with acetone alcohol or alcohol;
order number is S-1106.
BetaCell oral rinse (micellized retinyl palmitate,

micellized D-alpha-tocopheral, micellized beta carotene,
glycerin)
Dsp: 16 oz. bottle
Sig: Swish 10 ml in the mouth for 60 seconds in the
morning and in the evening and expectorate.
Note: No alcohol or sugar; natural spearmint flavor;
unpublished findings purport reversal of hyperkeratosis
and dysplasia.
Use: Gingival irritations, denture sores, aphthous ulcers,
burns, orthodontic appliance sores, and oral leukoplakia
(see note).
25
Canker Cover® mint flavor (oral canker sore patch)
(menthol, beta-carotene, citrus oil, magnesium chloride,
carbomer)
Dsp: 1 box (6 patches)
Sig: Apply 1 mucoadhesive patch, white side up, with
clean, dry finger for 20 seconds.
Use: Recurrent minor aphthous stomatitis.
Note: Do not remove patch before it dissolves. If needed,
apply a second patch 24 hours after the first application.
Cankermelts®—GX (1.4 mg glycyrrhizin [licorice root

extract])
Sig: Apply 1 dry mucoadhesive disc for 1–2 minutes over
the aphthous ulcer as soon as detected for at least 16
hours per day until 8 hours after you last feel the sore;
reapply when patch totally dissolves after 4–6 hours.
Use: Recurrent aphthous stomatitis; orthodontic-induced
ulcers.
Note: To last longer, 2 discs may be used at once, 1
on top of the other. Contains no products of nuts, corn,
wheat, rice, grain, soy, egg, fish, shellfish, milk, or yeast.
Caution: Do not use more than 90 discs in a 3-day period
(30/day) or more than 18 discs every day for 5 days or
more. Keep out of reach of children younger than age 6
owing to risk of choking.
Gelclair® bioadherent oral gel (no alcohol; key ingredients:

polyvinyl pyrrolodone, hyaluronic acid, glycyrrhetinic acid)
Dsp: 15 ml per single-dose packet; 1 box contains 21
single-dose packets
Sig: 3 times a day or as often as needed, pour entire
contents of single-dose packet into glass and add 1 tbsp
of water (undiluted or more dilution may be performed to
achieve desired viscosity). Stir mixture and immediately
rinse for at least 1 minute and expectorate. Avoid eating
or drinking for at least 1 hour after use.
Use: For recurrent aphthous ulcers and nonspecific small
ulcers.
Note: Contraindicated in any patient with a known history
of hyerpesensitivity to any ingredients. Gel may become a
little darker and thicker over time, but this does not affect
efficacy or safety.
Caution: Keep out of direct sunlight; do not refrigerate.
26
Orabase® Sooth-N-Seal (formulated 2-octyl
cyanoacrylate)
Dsp: 1 ml (10 uses with 10 applicators)
Sig: Apply 2 drops of liquid into a plastic well. Dip pointed
end of provided sponge swab into the well; dry affected
area with rounded sponge swab end and then dab
pointed end of swab on mouth sore for no more than a
second. Dab a second time if needed. Do not release lip
or cheek for at least 5 seconds.
Use: For recurrent aphthous ulcers and nonspecific small
ulcers.
Note: Do not refrigerate.
Caution: Product is a fast-setting adhesive; take care to
avoid bonding of product to unintended areas. Avoid all
contact with eyes. Not for ingestion (call poison control if
accidental ingestion).
Orajel® Protective MouthSore Discs (benzocaine 15

mg, carbomer, pregelatinized zea mays [corn] starch)
Dsp: 1 box (8 discs)
Sig: Apply 1 mucoadhesive disc to sore.
Use: Recurrent minor aphthous stomatitis.
younger than 2 years of age (e.g., teething), except
under the advice and supervision of a healthcare
professional.
OraMoist® mucoadhesive patch

Dsp: 1 box
Sig: Apply to affected oral mucosa.
Use: Recurrent aphthous stomatitis.
Note: If the patch does not attach owing to extremely dry
mucosa, then first moisten with water. A nondrug formula
composed of time-released lipids, citrus oil, sea salt,
enzymes, and xylitol.
OraPatch® (acemannan hydrogel—a freeze-dried gel of

aloe vera; also known as Carrington patch or Manapol
patch)
27
Sig: Clean and dry hands and carefully apply 1 patch to
the affected oral mucosa; avoid squeezing patch. Hold
against mucosa until adherence and keep the area as dry
as possible. Use for pain as needed.
Use: Originally developed for aphthous ulcers, but has
FDA approval for any type of oral traumatic ulcer; most
recently approved for dry socket management.
Rincinol P.R.N.® (aloe vera; alcohol-free, no benzocaine

or hydrogen peroxide)
Dsp: One 4 oz. bottle or 3 on-the-go soft packs per
package
Sig: After drying area, pour contents of packet into mouth
and rinse for 1 minute and expectorate.
Use: Nonspecific oral ulcers, aphthous ulcers, minor oral
irritations and burns, denture irritation.
Zilactin-L® gel (80.8% SD benzyl alcohol 37, 7% tannic

acid, 2.5% salicylic acid)
Dsp: 5.2 oz. tube
Sig: After drying area, apply a thin coat with clean
fingertip or cotton-tip applicator over affected tissue
every 1–2 hours.
Use: Recurrent aphthous ulcers, abrasions, and herpes
simplex lesions.
ANTI-INFLAMMATORIES
STEROIDS
Caution: Systemic steroids are contraindicated or must be
used with caution in a number of systemic conditions (e.g.,
steroids raise blood sugar in diabetics). Consultation with
a patient’s physician is recommended before prescribing.
Most oral pathologists feel that tapering of prednisone is
not necessary with 5- to 7-day burst therapy nor is tapering
necessary with alternate-day therapy if the dosage does
not exceed 20 mg. Steroids are contraindicated if an
active infection exists (the microbial proliferation is usually
enhanced and systemic dissemination is possible). Baseline
hematology laboratory studies to include platelets are
necessary to monitor possible bone marrow suppression.
Hepatotoxicity has been reported.
Special Advice: In order to reduce the possibility
of adrenocortical suppression, it is important that
28
prednisone be taken in harmony with diurnal
adrenocortical steroid levels. In order to accomplish this,
prednisone should be taken 90 minutes after normal
arising time. Alternate-day AM dosage also reduces the
possibility of adrenocortical suppression.
Note: When gingival lesions are prominent, a soft acrylic
splint that extends over the attached gingiva can be
useful to help occlude the topical steroid gel to the
mucosal tissues. On page 102, the relative potencies of
selected topical corticosteroids are listed.
Compounded Solutions
Betamethasone sodium phosphate 4.6 g
Lidocaine 4.23 g
Diphenadryl cherry 45 ml
Methycellulose 1% solution 148 ml
Ethyl alcohol 190 1 ml
Stevia 1.0 g
Tangerine oil 6 ml
Sig: Rinse, swish, and expectorate solution 4-5 times

daily.
Note: Flavoring agents are optional. Rather expensive.
(Courtesy of Dr. J. M. Hall)
Miles’ Mixture
84,000 IU nystatin, 84 mg tetracycline, 1.04 mg
hydrocortisone/5 ml liquid
Use: Alternate rinse with 2% viscous lidocaine for
2 minutes and expectorate 4 times daily.
Use: Major aphthous ulcer in the immunosuppressed
[Source: Glick M, Muzyka BC. JADA 1992;123:61–65.]
Beclomethasone dipropionate aerosol spray, 40 μg

(Qvar® 40, Beclovent®)
Dsp: 1 inhaler 7.3 g (40 μg/inh)
Sig: Take graduated doses according to the
manufacturer’s instruction. Apply spray to back of the
oral cavity.
Use: Hard-to-reach oral cavity areas such as the tonsillar
pillars.
Note: Improper use can cause a number of oropharyngeal
adverse events including candidiasis and dysphonia.
29
Betamethasone 0.6 mg/5 ml syrup (Celestone®)
Dsp: 118 ml
Sig: Take 1 tsp 4 times a day. Gargle for as long as
possible and expectorate.
recurrent aphthous stomatitis.
Note: Taking with food may minimize gastrointestinal
distress.
Caution: Not recommended for supplementary use in
corticosteroid-treated patients undergoing stress; also
increased susceptibility to infection.
0.05% betamethasone dipropionate ointment

(Diprolene®)
Dsp: 15 g (45 g) tube
Sig: Apply to oral sores 4 times daily (after meals and at
bedtime).
distress.
Caution: Warning label states only for external use;
tell patient to ignore the label (i.e., off-label use). If
candidiasis occurs, then add 100,000 units of nystatin
into each gram of the ointment.
0.1% betamethasone valerate ointment (Valisone®)

Dsp: 15 g (45 g, 110 g, 430 g) tube
Sig: Apply thin amount to oral sores 4 times daily (after
meals and at bedtime).
distress.
Caution: Prolonged use can result in tissue thinning.
0.05% clobetasol propionate gel or ointment

(Temovate® or generic)
Dsp: 30 g tube
30
Sig: Dry area and apply to oral lesions 4–6 times daily
(after meals and at bedtime). Do not rub in.
Note: The gel formulation has a slightly lower potency
than the ointment. If a denture wearer, apply a thin film
to the inner surface of the denture base wherever it
contacts the oral lesions.
0.05% clobetasol propionate ointment (Temovate or

generic) with Orabase or Orabase with benzocaine
Dsp: 30 g tube (15 g each, compounded 1:1)
(after meals and at bedtime). Do not rub in. Do not eat or
drink anything for 1/2 hour after use.
Note: Mixing with equal parts of Orabase promotes
adhesion and may improve efficacy.
0.05% clobetasol propionate and nystatin

100,000 IU/ml aqueous solution
Dsp: 100 ml
Sig: Swish 10 ml of the solution 3 times daily for
5 minutes.
Use: Oral erosive lichen planus.
Dexamethasone elixir 0.5 mg/5 ml (Decadron®)
Dsp: 100 ml
Sig: Take 1–2 tsp as an oral rinse for 2 minutes 3 times a
day, then expectorate. Discontinue when lesions become
asymptomatic.
Use: Minor aphthous ulcerations, other oral erosive
stomatitides.
31
Dexamethasone elixir 0.5 mg/5 ml (Decadron®)
Dsp: 237 ml
Sig: For 3 days, rinse with 1 tbsp 4 times a day and
swallow; then for 3 days, rinse with 1 tsp 4 times a day
and swallow; then for 3 days, rinse with 1 tsp 4 times a
day and swallow every other time; then rinse with 1 tsp
four times a day and expectorate.
Use: Severe oral erosive lichen planus, severe recurrent
aphthous stomatitis, severe benign mucous membrane
pemphigoid, erythema multiforme.
Note: Discontinue when mouth becomes comfortable;
rinse after meals and 1/2 hour before bedtime; if
discomfort recurs begin regimen at step 3.
Note: Roxane Laboratories offers a sugar-free, dye-free,
trace of alcohol oral solution (240 ml; 500 ml)
Dexamethasone sodium phosphate injectable

4 mg/ml with lidocaine HCl
Sig: Following local anesthesia, inject 0.5–1.0 ml
(0.1–0.2 mg per injection site) around margins of ulcer
with a 25-gauge needle twice a week until ulcer heals.
Use: Very severe cases of oral erosive lichen planus,
major aphthous stomatitis, benign mucous membrane
pemphigoid, and erythema multiforme.
0.05% fluocinolone gel (Synalar®) [Child or Adult]

Dsp: 15 g (30 g, 60 g) tube
Sig: Dry area and apply thin amount to oral lesions 4–6
times daily (after meals and at bedtime). Do not rub in.
Note: A synthetic corticosteroid that differs structurally
from triamcinolone acetonide. May be compounded with
benadryl.
0.05% fluocinonide gel or ointment (Lidex® or generic)

[Child or Adult]
Dsp: 15 g (30 g, 60 g) tube
Sig: Dry area and apply thin amount to oral lesions 4–6
times daily (after meals and at bedtime). Do not rub in.
32
Note: The gel formulation has a slightly lower potency
than the ointment but generally has better patient
acceptance. If a denture wearer, apply a thin film to the
inner surface of the denture base wherever it contact the
oral lesions.
Caution: Has a bitter taste; patient may prefer
betamethasone valerate.
0.05% fuocinonide (Lidex® or generic) ointment

compounded 1:1 with Orabase or Orabase with
benzocaine
Dsp: 30 g total (15 g each)
Note: Mixing with equal parts of Orabase promotes
adhesion and may improve efficacy.
gingiva (or other areas of the mouth) have caused
a rare but potentially fatal adverse effect, methemo-
globinemia. Benzocaine products should not be used
on children younger than 2 years of age (e.g., teething),
except under the advice and supervision of a healthcare
professional.
0.05% halobetasol propionate gel (Ultravate®)

Dsp: 30 g tube
1% hydrocortisone with polymyxin B, bacitracin,

neomycin cream compounded 1:1 with 5% lidocaine
ointment
Dsp: 5 g tube
Sig: Apply to lip sores 3 times a day.
Use: Recurrent herpes labialis.
Caution: Do not apply during early active (intact vesicle)
stages.
33
Methylprednisolone 4 mg (Medrol® Dosepak 21s)
Dsp: 1 Dosepak [contains twenty-one 4 mg tablets]
Sig: Take graduated daily doses according to the
manufacturer’s directions listed on the Dosepak
(according to many oral pathologists, the manufacturer’s
graduated daily doses [tapering] of this product is not
necessary owing to its low dosage).
Caution: Do not prescribe if patient has existing infectious
disease or diabetes mellitus (hyperglycemia danger).
1% pimecrolimus cream (Elidel®) (60 g and 100 g are

also available)
Dsp: One 30 g tube
Sig: Apply twice daily for 2 weeks.
Use: Oral erosive lichen planus.
Note: Off-label use for oral involvement.
Caution: FDA advisory in January 2006 advises may
increase the risk of developing cancer and should be
used only as a second-line therapy (i.e., a black box
warning)
Prednisone 10 mg (5 mg and 20 mg are also available)

or dexamethasone 0.75 mg
Dsp: #40
Sig: Take 1 tablet every 6x hours for 7 days, followed by
1 tablet every 12 hours for 4 days, followed by 1/2 tablet
every 12 hours for 3 days.
pemphigoid, and erythema multiforme; varicella zoster
(shingles).
Note: A high-dose, short course can also be prescribed;
40–80 mg daily for 2 weeks or less (i.e., burst therapy);
no tapering needed. When daily dose is 30 mg or
greater, patients may experience insomnia, headache, or
irritability.
Prednisone 10 mg tablets (5 mg and 20 mg are also

available) (Deltasone®)
34
Dsp: #50
Sig: Take 5 tablets in the morning (90 minutes after
normal arising time) until lesions recede, then decrease
by 1 tablet on each successive day OR switch to every-
other-day therapy for 4 doses, then stop systemic
therapy. The patient may then continue with topical
steroid therapy.
Use: very severe cases of oral erosive lichen planus,
Note: When daily dose is 30 mg or greater, patients
may experience insomnia, headache, or irritability.
Concomitantly administer azathioprine.
Prednisone 20 mg tablets (5 mg and 10 mg are also

available) (Deltasone®)
Dsp: #20
Sig: Take 2 tablets each day for 10 days.
Note: When daily dose is 30 mg or greater, patients may
experience insomnia, headache, or irritability.
Prednisone 20 mg tablets (Deltasone) and 0.12%

chlorhexidine gluconate mouthwash
Dsp: #10
Sig: Take 1 tablet each day for 10 days and rinse with
chlorhexidine twice daily.
Use: Herpetiform aphthous stomatitis.
Prednisolone syrup 15 mg/5 ml (Prelone®)

Dsp: 8 oz
Sig: Take 1 tsp 4 times a day. Gargle or swish for as long
as possible and expectorate.
35
Prednisolone syrup 15 mg/5 ml (Prelone)
Dsp: 16 oz
Sig: Take 4 tsp on awakening for 3 days, 3 tsp for 3 days,
and 1.5 tsp on awakening for 3 days for long as possible
and expectorate.
Use: Burst therapy for very severe cases of oral erosive
lichen planus, major aphthous stomatitis, benign mucous
membrane pemphigoid, and erythema multiforme.
0.1% (or 0.5%) triamcinolone acetonide ointment

(Kenalog®)
Sig: Dry area and apply a thin film to oral sores 4 times
daily (after meals and at bedtime). Do not rub in. Do not
eat or drink for 1/2 hour after use.
Note: If denture wearer, apply a thin film to inner surface
of denture wherever the denture base contacts an oral
lesion.
0.1% triamcinolone acetonide ointment (Kenalog) in

Orabase or Orabase with benzocaine
Dsp: 30 g total (15 g each)
Sig: Dry area and apply a thin film to oral sores 4 times
daily (after meals and at bedtime). Do not rub in. Do not
eat or drink for 1/2 hour after use.
0.1% triamcinolone acetonide aqueous suspension

Dsp: 200 ml This suspension may be compounded
by a pharmacist: Add 5 ml of 95% ethanol to a vial of
triamcinolone acetonide 40 mg/ml injectable and q.s. to
200 ml with sterile water OR use 40 mg triamcinolone
acetonide micronized powder and dissolved in 95%
ethanol and q.s. to 200 ml with sterile water.
Sig: Pour 1 tsp into a clean container and then swish in
mouth for 1 minute, 4 times a day (i.e., after meals and at
bedtime), and expectorate. Do not pour any solution back
into bottle.
36
Note: Do not drink or eat for 1/2 hour after using.
Shake bottle well before using. Shelf life is 6 months.
A 0.2 % suspension may also be used by doubling
the triamcinolone content without increasing the
ethanol content. The micronization enhances topical
efficacy while minimizing absorption, thus reducing
concomitant systemic steroid side effects. The
micronized powder choice is less expensive than
Kenalog 40 mg/ml (no generic available in U.S.) and
provides a much larger surface area, which results in
better tissue effects.
Caution: Do not allow the pharmacist to compound
with sweetener and/or flavoring agents because that
will reduce the contact time and probably interfere with
tissue binding.
0.1% triamcinolone acetonide suspension with

nystatin suspension
Dsp: 200 ml
Sig: Swish 1 tsp for 1 minute 4 times a day (after meals
and at bedtime) and expectorate.
Use: For patients predisposed to candidiasis with
oral erosive lichen planus, bullous pemphigoid, oral
pemphigus, contact (delayed) allergic stomatitis,
Note: Do not drink or eat for 1/2 hour after using. Shake
well before using. Shelf life is 6 months.
0.1% triamcinolone acetonide suspension in

2% viscous lidocaine
Dsp: 100 ml
Sig: Swish 1 tsp for 1 minute 4 times a day (after meals
and at bedtime) and expectorate.
Use: For patients who need immediate pain relief
with oral erosive lichen planus, bullous pemphigoid,
Note: Do not drink or eat for 1/2 hour after using. Shake
well before using. Shelf life is 6 months.
37
Triamcinolone acetonide injectable 25- and 40-mg/ml
suspension (Kenalog® 40 or Aristocort® 25 or 40)
Sig: Following local anesthesia (to provide
vasoconstriction), aspirate into an empty local anesthetic
Carpule or a tuberculin syringe and multiple injections
of 0.05–0.1 ml are made into the submucosa or into the
bulk tissue or granuloma (i.e., inject 10–40 mg).
Use: Very severe cases of oral erosive lichen
planus, major aphthous stomatitis, benign mucous
membrane pemphigoid, and erythema multiforme; also
granulomatous swellings (e.g., cheilitis granulomatosa).
Especially beneficial to manage solitary lesions
recalcitrant to topical or systemic steroids.
Note: Some oral pathologists advise diluting to 10 mg/ml.
USED IN CONJUNCTION WITH A LOWERED DOSE OF STEROIDS

Azathioprine 50 mg (Imuran®)
Dsp: #30
Sig: Take 1 tablet daily in conjunction with prednisone.
Use: Prescribed concomitantly with prednisone for
managing severe conditions of oral erosive lichen planus,
pemphigoid, erythema multiforme in which the patient
does not respond well to steroid alone. This combination
gives the clinical effects of a higher dosage of topical or
systemic steroids without their side effects.
Caution: Chronic use increases the risk of nausea/vomiting,
neoplasia as well as serious hematological consequences.
Monitor the patient weekly and taper medications as
indicated by clinical response. Discontinue if severe
nausea occurs. Treatment should be in collaboration
with the patient’s physician. Azathioprine should not be
taken during pregnancy. A baseline CBC and liver enzyme
panel should be ordered prior to starting patients on
azathioprine.
ALTERNATIVES TO STEROIDS
5% amlexanox oral paste (Aphthasol®)
Dsp: 5 g tube
Sig: Apply a small amount of paste (~1/4 inch) to the
fingertip as soon as possible after noticing the symptoms
of an aphthous ulcer and with gentle pressure dab onto
38
each mouth ulcer 4 times a day (after breakfast, lunch,
and dinner and at bedtime following oral hygiene). Use
should continue until the ulcer heals.
Note: Advise patient not to eat or drink for 1/2 hour after
application and to wash hands following use.
Caution: Safety and effectiveness in pediatric patients
has not been established.
Clofazimine soft gelatin 50 mg capsules (Lamprene®)

Dsp: #20
Sig: Take 1 tablet twice daily with meals for 10 days.
Use: Off-label use for autoimmune diseases.
Note: May cause discoloration of the skin.
Caution: Should be used with caution in patients who
have GI problems such as abdominal pain and diarrhea.
Dosages greater than 100 mg daily should be given
for as short a period as possible and only under close
medical supervision.
Colchicine 0.6 mg (VitiGam®)

Dsp: #42
Use: FDA orphan drug (unlabeled/investigational)
status for Behçet’s disease; selected cases of recurrent
aphthous stomatitis that have not been controlled with
topical or systemic steroids.
Note: Can be used in combination with topical or
systemic steroids. Side effects include diarrhea,
neutropenia.
Caution: Decreased male fertility; avoid in renal, GI, heart,
or hematological disorders.
Dapsone 25 mg (Avlosulfon®)
Dsp: #30
Sig: Take 1 tablet daily for 3 days, then 2 tablets daily
for 3 days, then 3 tablets daily for 3 days, followed by
2 tablets twice daily for 3 days.
Use: Oral benign mucous membrane pemphigoid;
maintenance dose after accelerated schedule is between
100 and 150 mg daily. Can be used in combination with
topical and systemic steroids.
Note: Patient can be worked up to 150 mg daily as
needed and 100 mg tablets are available.
39
Caution: Used in consultation with patient’s primary
physician. May cause hemolysis; red cell counts,
hemoglobin, and hematocrit should be closely monitored
(i.e., blood counts weekly for first month, monthly for
6 months and semiannually thereafter). Controversy
about mucous membrane use exists. Can also cause
photosensitivity.
Doxycycline 100 mg (generic)

Dsp: #30
Sig: Take 1 tablet daily with food and 8 oz. of water.
Use: Oral benign mucous membrane pemphigoid;
herpetiform aphthous stomatitis (use for 10–14 days)
with chlorhexidine mouthwash twice daily.
Note: An anticollagenase agent.
Immune globulin, intravenous (Carimune NF®,

Gammagard® liquid, Gammar P-IV®, Gamunex®,
Iveegam EN®, Octagam®, Panglolubin NF®, Polygam S/D®)
Dsp: Injection, powder for reconstitution
Sig: Approved doses and regimens may vary between
brands.
Use: Off-label use for autoimmune diseases.
Warning: Acute renal dysfunction can rarely occur;
usually within 7 days of use; use with caution in
the elderly, patients with renal disease, diabetes
mellitus, volume depletion, sepsis, paraproteinemia,
and nephrotoxic medications owing to risk of renal
dysfunction.
2% Lidocaine (viscous) 100 ml, tetracycline oral

suspension (125 mg/5ml) 18 ml, dexamethasone
(0.5 mg/5 ml) 9 ml, nystatin oral suspension
(100,000 IU) 73 ml
Dsp: 200 ml
Sig: Rinse or gargle with 2 tsp for 2 minutes 4–5 times
daily.
Methotrexate 2.5 mg
Dsp: #10
Sig: Take 1 tablet weekly
40
Note: Dosage may be increased as needed. Expensive;
however, an injectable form is inexpensive and may be
swallowed (25 mg/ml available in 10 ml vial).
Caution: Used in consultation with patient’s primary
physician. May cause hemolysis; red cell counts,
hemoglobin, and hematocrit should be closely
monitored (i.e., blood counts weekly for first month,
monthly for 6 months and semiannually thereafter).
Immunosuppression side effect has been reported.
Misoprostol (Cytotec®)
Dsp: Dosed in various microgram increments
[compounded by a pharmacist]
Note: This medication is a prostaglandin and expensive;
excellent for pain relief and increases healing rate via
enhanced epithelial proliferation. Can be formulated
into an insufflator (“powder puffer”),troche or occlusive
ointment (e.g., clobetasol, fluocinonide). Amitriptyline may
be added as a topical anesthetic. To find your nearest
pharmacist who participates in the Compounding Centers
of America, call 1-800-331-2498.
Caution: An abortifacent and should NOT be given to
women of childbearing age.
Mycophenolate mofetil 250 mg and injection

(CellCept®; Myfortic®)
Dsp: 1 carton (4 vials); each sterile vial has 20 ml equal
to 500 mg as a HCL salt
Sig: Should be administered under the supervision of a
physician experienced in immunosuppressive therapy.
Use: Oral pemphigus vulgaris (immunosuppressant
orphan drug status).
Caution: Use with active peptic ulcer disease; do not
administer with antacids.
Warning: Risk for infection and development of
lymphoproliferative disorders (particularly of the skin)
are increased. Patients should limit exposure to sunlight/
41
UV light; severe neutropenia may occur. Also, has been
linked to an increased risk for first trimester pregnancy
loss and increased risk for congenital malformation
including particularly cleft lip/palate as well as anomalies
of the distal limbs, heart, esophagus, and kidneys.
Caution: Has been reported to cause progressive
multifocal leukoencephalopathy in the
immunocompromised patient.
Pentoxifylline 400 mg (Trental®)

Dsp: #90
Sig: Take 1 tablet 3 times a day with food.
Use: Very severe major aphthous stomatitis especially for
patients diagnosed with Behçet’s disease.
Note: Therapeutic trial is 30 days. Off-label use for
this blood viscosity-reducing agent. This is a second-
tier option when the patient has failed to respond to
sodium lauryl–free dentifrice, chlorhexidine mouth rinse,
avoidance of known triggers, diazepam for stress-related
recurrences, and topical and/or systemic corticosteroids.
Significant side effects such as insomnia and GI upset
have been reported.
Sucralfate (Carafate) 6 g, tetracaine 2% (Pontocain®),

15 ml, distilled water 15 ml
Dsp: 30 ml
Sig: Apply to affected area as needed.
0.03% tacrolimus ointment (Protopic®)

Note: An immunosuppressant that may be used when
first-line medications fail to resolve the condition.
Caution: Use only as second-line agent for short-term
and intermittent treatment in patients unresponsive to, or
intolerant of, other treatments.
42
Warning: The FDA issued a public health advisory about
a potential cancer risk based on animal studies and case
reports in a small number of patients [2006 Black Box
warning]. In 2011, the American Academy of Dermatology
Advisory Task Force found no causal proof that topical
immunomodulators cause lymphoma or nonmelanoma
skin cancer, and systemic immunosuppression after
short-term or intermittent long-term topical application
seems an unlikely mechanism; however, there are still
some strong debates and controversies regarding the
exact indication of immunomodulators and their duration
of use in the absence of active controlled trials.
Tacrolimus 1.0 mg capsule (Prograf®) mixed with

1000 ml purified water—aqueous oral rinse
Dsp: 1000 ml
Sig: Rinse with 10 ml solution for 2 minutes, 4 times a
day, expectorate.
Note: Shelf-life 1 month, refrigerated an
immunosuppressant that may be used when first-line
medications fail to resolve the condition.
Caution: Use only as second-line agent for short-term
and intermittent treatment in patients unresponsive to, or
intolerant of, other treatments.
Warning: The FDA issued a public health advisory about
a potential cancer risk based on animal studies and case
reports in a small number of patients [2006 Black Box
warning]. In 2011, the American Academy of Dermatology
Advisory Task Force found no causal proof that topical
immunomodulators cause lymphoma or nonmelanoma
skin cancer, and systemic immunosuppression after
short-term or intermittent long-term topical application
seems an unlikely mechanism; however, there are still
some strong debates and controversies regarding the
exact indication of immunomodulators and their duration
of use in the absence of active controlled trials.
Tetracycline oral suspension (125 mg/5 ml)

Dsp: 100 ml
Sig: Swish 5 ml for 2 minutes 4 times a day.
Use: Oral nonviral soft tissue ulcerations or erosions.
43
Tetracycline oral suspension (125 mg/5 ml) 18 ml,
dexamethasone elixir (0.5 mg/5 ml) 9 ml,
diphenhydramine elixir (12.5 mg/5 ml) 173 ml
Dsp: 200 ml
Sig: Rinse mouth with 1–2 tsp for 2 minutes 4 times
daily, and then expectorate.
Tetracycline 500 mg and nicotinamide 500 mg

(niacinamide)
Dsp: 120 tablets of each
Sig: Take 1 tablet of each 4 times a day.
Use: For control of recurrent aphthous stomatitis that
has failed with other therapeutic approaches or long-
term steroid therapy is the only effective control; diffuse
oral benign mucous membrane pemphigoid; recurrent
erythema multiforme minor, and severe oral erosive
lichenoid drug eruptions (the patient must stay on the
eruption-causing drug).
Note: Improvement usually occurs in 2–6 weeks; after 6
months, if the disease is well controlled, the dose can be
tapered. Secondary candidiasis may arise.
Caution: Some patients experience flushing of the skin
from 2 g of nicotinamide per day. Lowering the dose
to 1.5 g/day usually solves the cutaneous flushing;
alternatively, 81 mg of acetylsalicylic acid taken 30
minutes prior to this preparation is reported to prevent
cutaneous flushing.
Special note: This is a second-tier option when the
patient has failed to respond to sodium lauryl–free
dentifrice, chlorhexidine mouth rinse, avoidance of known
triggers, diazepam for stress-related recurrences, and
topical and/or corticosteroids. Do not use time-released
type of niacinamide owing to possible drug-induced
hepatotoxicity.
0.1% tretinoin ointment (Retin-A®)

Dsp: 20 g tube
Sig: Apply lightly once daily, before bed, to the entire
affected area.
Use: Oral lichen planus, acne.
44
Note: Also available in 0.05%, 20 g, and 45 g tubes.
Caution: Controversial use on mucous membranes.
OVER-THE-COUNTER ALTERNATIVES TO STEROIDS

Cimetidine 200 mg (Tagamet® HB 200)
Dsp: 1 bottle
Sig: Take 1 tablet 3 times daily.
Use: For recurrent aphthous stomatitis that does not
respond to routine management.
Caution: Decreased absorption of fluconazole,
ketaconazole, tetracycline; increased blood levels of
metronidazole, alcohol, lidocaine, narcotic analgesics.
Lactinex tablets
Dsp: 1 bottle (55 tablets)
Sig: Chew up and swallow with milk. Take 4 tablets 4
times a day for 4 days; then 3 tablets 4 times a day for 4
days; 2 tablets 4 times a day for 4 days; 1 tablet 4 times
a day for 4 days; 1 tablet once a day for 10 days.
Use: For chronic vesicular and ulcerative oral diseases.
TOPICAL WOUND REPAIR

Becaplermin 0.01% gel (Regranex®)
Dsp: 7.5 g tube (2 g, 15 g)
Sig: Apply the gel once daily in a 1/16-inch-thick layer
spread evenly on the ulcerated area of the skin.
Use: Adjunct to good ulcer care practices in lower
extremity diabetic, neuropathic ulcers that extend into
the subcutaneous tissues or beyond and have adequate
blood supply. Anecdotal use in deep, slow healing ulcer of
the oral cavity (i.e., traumatic granuloma).
Note: Calculate the amount of gel to apply by the area
(L × W) of the ulcer; as the ulcer heals, recalculate the
dose at weekly or biweekly intervals. In diabetic patients
likely to be bedridden or limited in activities.
Caution: Nonsterile; for use in ulcers that do not heal by
primary intention. Do not apply with fingers. Black box
warning of increased cancer risk if use 3 or more tubes.
Medihoney (80% Leptospermum honey)

Dsp: 1 oz. tube
Use: Wound and burn dressing.
45
VI. ANTIVIRAL AGENTS/VIRAL-BLOCKING AGENTS/
GERMICIDALS
Antiviral use in children can be problematic for herpes
simplex because no definitive study exists; however,
prior publication of the use of acyclovir liquid in a cohort
of 800 children for varicella reported no problems.
Acylovir liquid (200 mg/5 ml) may be used in children
for treatment of primary herpes gingivostomatitis, when
administered 5 times daily for 5 days using the child’s
weight in kilograms (Kg = 2.2 lb) thusly:
1
5–10 kg / tsp
4
3
11–15 kg / tsp
8
1
16–20 kg / tsp
2
5
21–25 kg / tsp
8
3
26–30 kg / tsp
4
5
31–35 kg / tsp
8
>35 kg 1 tsp (adult dose)
Acyclovir 5% ointment (Zovirax®)

Dsp: 3 g or 15 g tube
Sig: Apply to skin of lip with a cotton-tipped applicator
or gloved finger every 2 hours during waking hours,
beginning when symptoms first occur (i.e., prodromal
stage).
Use: Recurrent herpes labialis (some decrease viral
shedding, not pain). In primary herpes labialis, reports of
decreased viral shedding and pain.
Note: Apply during early (prodromal) recurrence if
possible; otherwise directly over vesicles. Do not apply
with exposed finger to avoid autoinoculation to other
body sites (e.g., eyes) or transmission to other persons.
Has an irregular performance against oral lesions; better
on genital lesions, immunocompromised patients and
herpes zoster patients (does not prevent postherpetic
neuralgias). No generic available at this time.
Acyclovir 5% ointment (Zovirax) with dyclonine HCl

1% or lidocaine 1% compound
Sig: Apply to oral lesions with a cotton-tipped applicator
or gloved finger every 2 hours during waking hours,
beginning when symptoms first occur (i.e., prodromal
stage).
46
Acyclovir 5% cream (Zovirax)
Dsp: 2 g tube
Sig: Apply to skin of lip with a cotton-tipped applicator or
gloved finger 5 times per day for 4 days, beginning when
symptoms first occur (i.e., prodromal stage).
Use: Recurrent herpes labialis (some decrease viral
shedding, not pain). In primary herpes labialis, there
are reports of decreased viral shedding and pain.
Note: Apply during early (prodromal) recurrence if
possible; otherwise directly over vesicles. Do not apply
with exposed finger to avoid autoinoculation to other
body sites (e.g., eyes) or transmission to other persons.
Has an irregular performance against oral lesions; better
on genital lesions, immunocompromised patients, and
herpes zoster patients (does not prevent postherpetic
neuralgias). No generic available at this time.
Caution: Approved for patients 12 years of age and
older.
Acyclovir 200 mg (Zovirax or generic) [Child or Adult]

Dsp: #50 or #60
Sig: Adults: Take 1 capsule 5 times daily for 10 days
(primary HSV) or 5 days (recurrent HSV) OR 2 capsules
3 times a day for 10 days (primary HSV) or 5 days
(recurrent HSV). Children: 20 mg/kg 5 times per day.
Use: Prevention of recurrent herpes simplex infection
and herpes-related erythema multiforme; varicella zoster
(shingles).
Note: Treatment should begin during the early stage of
the recurrence in the immunosuppressed patient. The
current FDA recommendation is that systemic acyclovir
is used to treat oral herpes only for immunocompromised
patients (until lesions are crusted over). May be used in
children 2 years and older as a liquid suspension. Frontal
headaches are common if patient is not adequately
hydrated.
Caution: Use with caution in renal function impairment,
dehydration.
Acyclovir 400 mg (Zovirax or generic)

Dsp: #60
Sig: Take 1 capsule every 12 hours.
flare-ups.
47
Note: May be indicated for patients experiencing 6 or
more episodes per year. An alternate regimen is 200 mg
acyclovir by mouth 3–5 times daily (see p. 47).

Dsp: #9
Sig: Take 1 capsule twice daily 1 day before dental
appointment, then 1 capsule each day for 7 days.
flare-ups.
Note: Child: 20 mg/kg 5 times a day is an accepted
dosage.

Dsp: #50
Sig: Take 1 capsule 5 times a day for 10 days.
Use: Active oral herpes simplex, cytomegalovirus, hairy
leukoplakia, and herpes zoster.
Note: Therapy is most effective if started within 48 hours
after the onset of symptoms. It is probably not indicated
if the patient has been symptomatic for 7 days or longer.
Patient must maintain good hydration (64 fluid oz/day).
Acyclovir 5% and hydrocortisone 1% cream (Xerese®,

Xerclear®)
Dsp: 1 tube
Sig: Apply to sore 5 times daily for 5 days.
Use: Recurrent herpes labialis
Note: Therapy is most effective if started within 48 hours
after the onset of symptoms. It is probably not indicated
if the patient has been symptomatic for 7 days or longer.
Patient must maintain good hydration (64 fluid oz/day)
Famciclovir 500 mg (Famvir®; generic available); also

available in 125 mg and 250 mg
Dsp: #21
Use: Acute herpes zoster (shingles) infection; recurrent
herpes labialis (off-label use).
Note: This is the prodrug of pencyclovir with
approximately the same efficacy and safety as acyclovir.
Equivalent to acyclovir in the duration of acute pain, but
more effective for duration of postherpetic neuralgia.
48
Start soon after symptoms appear (within 48 hours), and
efficacy after 72 hours is questionable.
Caution: Reduce doses in renal impairment. Drug
interactions with cimetidine, digoxin, and theophylline
products. This medication has not been studied in
children younger than 18 years old, and there are no
randomized controlled studies with proof of efficacy for
chronic recurrent herpes labialis.
Famciclovir 500 mg (Famvir; generic available)

Dsp #3
Sig: Take 3 tablets for 1 day OR 11/2 tablets twice for
1 day.
Use: Recurrent herpes labialis (off-label use).
Note: This is the prodrug of pencyclovir with
approximately the same efficacy and safety as acyclovir.
Equivalent to acyclovir in the duration of acute pain, but
more effective for duration of postherpetic neuralgia.
Start soon after symptoms appear (within 48 hours), and
efficacy after 72 hours is questionable.
Caution: Reduce doses in renal impairment. Drug
interactions with cimetidine, digoxin, and theophylline
products. This medication has not been studied in
children younger than 18 years old.
Penciclovir 1% cream (Denavir®)

Dsp: 2 g tube
Sig: Apply thin amount to herpetic lesion every 2 hours
during waking hours for a period of 4 days. Treatment
should be started as early as possible (i.e., during the
prodrome or when lesions appear).
Use: Recurrent herpes simplex infection (studies indicate
decreased pain and mean duration of lip lesions by 1/2
day).
Note: Do not apply with fingertip. No studies of primary
HSV labialis or immunocompromised patients.
Valacyclovir HCl 500 mg (Valtrex®; generic available)

Dsp: #42 OR #14
Sig: Take 2 caplets 3 times a day for 7 days without
regard to meals OR take 1 tablet twice daily for 7 days.
Use: Herpes zoster (shingles) in immunocompetent
individuals.
49
Note: Not for use in immunocompromised patients. A
prodrug of acyclovir that is 3–5 times more bioavailable
than acyclovir. More effective than acyclovir for acute
pain cessation and duration of postherpetic neuralgia.
Start soon after symptoms appear (48 hours), and
efficacy after 72 hours is questionable. Lowest cost
among prescription antivirals listed.
Caution: Reduce doses in renal impairment. This
medication has not been studied in children younger than
18 years old. Avoid in patients with HIV or bone marrow
or renal transplants owing to risk of hemolytic-uremic
syndrome.
OVER-THE-COUNTER
Aluminum acetate (Domeboro® astringent solution),
10% docosanol cream (Abreva)
Dsp: 2 g tube
Sig: Apply to herpetic lesion 5 times a day as soon as
possible after detection.
Use: Recurrent orofacial herpes simplex infections (i.e.,
cold sores, fever blisters).
Caution: Local application must be done with a cotton-
tipped applicator to prevent viral transmission and
autoinoculation.
Benzylalkonium chloride (Viroxyn®)

Dsp: 1 kit (3 single-dose application vials)
Sig: Remove cap from the vial and replace it on the other
end. Hold the vial between thumb and index finger while
applicator end is up. Pinch the vial in the center at the top
of the cap to break inner ampule. Hold with white applicator
down and allow the medication to saturate the swab. Place
the applicator against the area of the lip to be treated and
massage the medication into the sore by rubbing for about
10 seconds. Continue rubbing until all medication has been
used. Keep the applicator saturated at all times. When
finished, recap vial, and dispose immediately.
Note: Some patients may require a second treatment with
a new vial if they experience a secondary new viral load
at the same site 12–72 hours later. Prior to treatment,
the lip should be clear of all other preparations; do not
use soap or other cleansers (dry wipe, water, or alcohol
50
may be used). Following application, no cleaners should
be used on the lip for a minimum of 1 hour. Anionic
cleansers will react with and neutralize the active
ingredient. Likewise, citric acid consumed within 1 hour
of application could neutralize the active ingredient if it
contacts the area of treatment.
Caution: Do not rub the skin so vigorously that it results
in damage to the skin. Some studies indicate this
sterilization compound is mutagenic.
Citrus bioflavonoids and ascorbic acid tablets

400 mg (Peridin-C®)
Ds: #20
Sig: Take 2 tablets immediately, then 1 tablet every
4 hours for 3–4 days.
2% tetracaine gel (Viractin®)

Dsp: 0.25 oz. tube
Sig: Apply to herpetic lesion of the lip not more than 3–4
times a day as soon as possible after detection.
Use: Recurrent orofacial herpes simplex infections (i.e.,
cold sores, fever blisters).
Caution: Local application must be done with a cotton-
tipped applicator to prevent viral transmission and
autoinoculation. A physician should be consulted for
use in children younger than 2 years of age.
L-Lysine 500 mg (Enisyl®)

Dsp: #100
Sig: Take 4 tablets every 4 hours until symptoms subside.
Use: Label: Improves utilization of vegetable proteins.
Off-label use: Prevention of recurrent herpes simplex
infection.
Note: Treatment should begin during the early stage
of the recurrence. May be used for up to 3 months for
maintenance.
VII. MUSCLE RELAXANTS

Baclofen 10 mg (Lioresal®)
Dsp: #60
Sig: Take 1/2 tablet 3 times daily for 3 days, then 1 tablet 3
times daily for 3 days, then 11/2 tablets 3 times daily.
Use: Myogenic facial pain, tension headache.
51
Chlorzoxazone 250 mg (Paraflex®)
Dsp: #100
Sig: Take 2 tablets every 4 hours.
Chlorzoxazone with acetaminophen 500 mg tablet

(Parafon® forte, generic)
Dsp: #15
Sig: Take 1 tablet at bedtime.
Note: Short-term use is recommended. This regimen can
be prescribed along with NSAIDs. May take with food
or milk. May cause morning hangover; dosage can be
reduced in sensitive individuals.
Cyclobenzaprine HCl 10 mg (Amrix®, Cycoflex®,

Flexeril®; generics)
Dsp: #15
Sig: Take 1 tablet at bedtime; do not crush or chew.
Use: Useful for acute myogenic facial pain but
questionable for chronic condition; treatment of muscle
spasm associated with acute TMJ pain.
Note: Short-term use is recommended (i.e., no longer
than 2–3 weeks. This regimen can be prescribed along
with NSAIDs. May take with food or milk. May cause
morning hangover; dosage can be reduced in sensitive
individuals.
Cyclobenzaprine HCl extended release 15 mg

capsules (Amrix; also available in 30 mg)
Dsp: #15
Sig: Take 1 tablet at bedtime; do not crush or chew.
Use: Useful for acute myogenic facial pain associated
with but questionable for chronic condition; treatment of
muscle spasm associated with acute TMJ pain.
Note: Short-term use is recommended (i.e., no longer
than 2-3 weeks. This regimen can be prescribed along
with NSAIDs. May take with food or milk. May cause
morning hangover; dosage can be reduced in sensitive
individuals.
Caution: Not recommended for use in the elderly.
Guaifenesin 10% in speed gel

Dsp:10 g
52
Sig: Rub 1–2 drops into affected area at first sign of
spasm. Massage in well.
Note: Has PLO gel with an additional surfactant to
increase onset. Works well for locks, spasms, and
cramping.
VIII. ANTIANXIETY AGENTS (ANXIOLYTICS) FOR STRESS

MANAGEMENT
Caution for this drug class: Patients should not drive
themselves to or from the dental appointment. Do not
prescribe to pregnant women.
Alprazolam 0.25 mg (Xanax®)

Dsp: #20
Sig: Take 1 tablet 3 times daily or 1 tablet 1 hour prior to
dental appointment.
Use: Tension reduction prior to appointments, myogenic
facial pain.
Alprazolam 0.5 mg extended-release (Xanax XR®;

generic available)
Dsp: #20
Sig: Take 1/2 tablet 3 times daily or 1/2 tablet 1 hour prior to
dental appointment.
facial pain.
Buspirone 5 mg (Buspar®)
Dsp: #20
Sig: Take 1 tablet twice daily.
facial pain.
Chlordiazepoxide 10 mg (Librium®)
Dsp: #20
facial pain.
Clorazepate dipotassium 7.5 mg (Traxene®)

Dsp: #20
Use: Short-term management of anxiety symptoms.
53
Diazepam 5 mg (Valium®)
Dsp: #20
Sig: Take 1 tablet before bedtime a day prior to surgery,
then 1 tablet 1 hour prior to surgery.
facial pain.
Caution: Contraindications similar to codeine. Do not use
in the presence of cimetidine or any other H2-blocker.
Hydroxyzine 25 mg (Atarax®)
Dsp: #10
Sig: Take 2 tablets 1 hour before dental procedure.
Use: Anxiety and anxiety-related skin eruptions; sedation
and antiemetic action.
Hydroxyzine 25 mg (Atarax) [Child]

Dsp: #10
Sig: Take 1–2 tablets 1 hour before dental procedure or
0.6 mg/kg/dose every 6 hours.
Use: Anxiety and anxiety-related skin eruptions; sedation
and antiemetic action.
Note: Children younger than 6 years should be prescribed
12.5–25 mg 1 hour before procedure.
Hydroxyzine pamoate 25 mg (Vistaril®)

Dsp: #20
Sig: Take 1 tablet 15–30 minutes before dental
appointment.
Use: Short-term relief of anxiety; sedative when used as
premedication.
Hydroxyzine pamoate 25 mg (Vistaril) [Child]

Dsp: #20
Sig: Take 1 tablet 15–30 minutes before dental
appointment or 0.6 mg/kg/dose every 6 hours.
Use: Short-term relief of anxiety; sedative when used as
premedication.
Lorazepam 1 mg (Ativan®)
Dsp: #20
Sig: Take 1 tablet daily or 1 tablet 1 hour prior to dental
appointment.
facial pain.
54
Prochlorperazine maleate 5 mg (Compazine®)
Dsp: #20
Use: Short-term relief of anxiety; severe nausea and
vomiting.
IX. ANTIDEPRESSANTS
Doxepin HCl 25 mg (Sinequan®)
Dsp: #45
Sig: Take 1 tablet each evening for 5 days, then 2 tablets
each evening for 5 days, then 4 tablets each evening for
7 days.
Use: Atypical facial pain of psychogenic origin and
burning mouth syndrome; most effective in depressed
patients with anxiety.
Caution: Dexamethasone suppression test advisable
initially. Maintenance dose varies from 100 to 200 mg
daily.
Fluoxetine HCl 20 mg (Prozac®)

Dsp: #30
Sig: Take 1 tablet daily in the morning.
patients.
Trazodone HCl 50 mg (Desyrel®)

Dsp: #70
Sig: Take 2 tablets each evening for 5 days, then 3 tablets
each evening for 5 days, then 3 tablets 3 times daily for
7 days.
patients.
daily in divided doses. Increased risk of suicidal thinking
and behavior (suicidality) associated with use in children
and adolescents.
X. ANALGESICS
Note: NSAIDs should be taken with 8 oz of water and
the patient should remain upright for at least 20 minutes
55
to help avoid gastritis side effect. NSAIDS should never
be taken together, nor should they be combined with
aspirin. NSAIDs have anti-inflammatory effects as well
as producing analgesia. Do not use codeine in patients
with history of allergy to morphine; use with extreme
caution in patients with respiratory disease and hepatic
disease; do not administer to patients on antidepressants,
phenothiazines, or those consuming alcohol, barbiturates,
and opioids. All pain medications should be prescribed for
a course of no more than 3 days to avoid addiction and to
re-evaluate persistent pain.
Beginning in January 2011, the FDA has established a
3-year time period for drug manufacturers to limit the
amount of acetaminophen to 325 mg in tablets and
capsules to reduce overdoses and severe subsequent
liver injury.
PRESCRIPTION FOR MILD TO MODERATE PAIN

Aspirin 325 mg, butalbital 50 mg, caffeine 40 mg
(Fiorinal®)
Dsp: #40
Sig: Take 1–2 tablets every 4 hours as needed for pain.
Use: Mild to moderate pain (NSAID).
Diflunisal 250 or 500 mg (Dolobid®)

Dsp: #16
Sig: Take 2 tablets initially, then 1 tablet every 8–12
hours for pain.
Use: Mild pain.
Note: maximum dose is 1.5 g/day.
Caution: Precipitates the toxicity of digoxin,
anticoagulants, methotrexate, dilantin, sulphonylureas,
lithium, indocin, hydrochlorothiazide, and acetaminophen,
so avoid administering in their presence.
Etodolac 200 mg (Lodine®)

Dsp: #30
Sig: Take 1–2 tablets every 6–8 hours as needed for pain.
Caution: Do not exceed 1200 mg/day. For patients
weighing less than 60 kg, the 24-hour dose should not
exceed 20 mg/kg.
56
Ibuprofen 800 mg (Motrin®)
Dsp: #28
Sig: Take 1 tablet 3 times per day.
Note: For severe pain, Motrin (800 mg) can be given up to
4 times per day.
Ketoprofen 12.5 mg (Orudis®)

Dsp: #30
Sig: Take 2 caplets to start, then 1 caplet every 4–6
hours, up to 6 caplets per day.
Naproxen sodium 275 mg (Anaprox®)

Dsp: #30
Sig: Take 2 tablets immediately then 1 tablet every 6–8
hours, not to exceed 5 tablets per 24 hours.
Note: This is the prescription form of Aleve.
Caution: Potential increase risk of heart attack, stroke,
GI bleeding, .and allergic reactions
OVER-THE-COUNTER
MILD TO MODERATE PAIN
Acetylsalicylic acid 325 mg (Anacin®, A.S.A.,
Bayer® Aspirin®, Bufferin®, Ecotrin®, Empirin®) or
acetaminophen 325 mg (Tylenol®, regular strength)
Dsp: 1 bottle
Sig: Take 2 tablets every 6 hours as needed for pain.
Use: Mild pain.
Caution: Avoid aspirin in individuala with viral disease
such as chicken pox (Reye’s syndrome), the elderly
patient, the pregnant patient, history of platelet
dysfunction, bleeding disorders, compromised renal
and/or hepatic status, esophagitis, gastritis, peptic ulcer
disease, and aspirin-induced asthma. Inhibits platelet
aggregation and is a gastric irritant. Stop aspirin intake
7 days prior to surgery after consultation with the
physician.
Avoid acetaminophen in G6PD patients; toxicity will occur
if patient takes 5-8g/day over several weeks. Chronic
alcohol abuse can precipitate acetaminophen toxicity, and
57
avoid taking acetaminophen with alcohol. Avoid taking
regular-strength acetaminophen for more than 2–3 days
along with increased fluid intake in patients on coumadin.
Ibuprofen 200 mg (Motrin®, Advil®, Nuprin®)
Dsp: 1 bottle
Sig: Take 2–4 tablets every 4 hours, up to 16 tablets
per day.
Caution: GI bleeding and bone marrow depression
possible side effects.
Ibuprofen (Motrin) [Child]

Dsp: # 20
Sig: Take 4–10 mg/kg/dose every 6–8 hours.
Ketoprofen 12.5 mg (Orudis KT®)

Dsp: 1 bottle
Sig: Take 2 caplets to start, then 1 caplet every 4–6
hours, up to 6 caplets per day.
Naproxen sodium 275 mg (Aleve®)

Dsp: 1 bottle
Sig: Take 2 tablets to start, then take 1 tablet every 6–12
hours; up to 3 tablets per day.
Use: Mild pain to moderate pain (NSAID).
Note: Aleve is the over-the-counter form of Anaprox;
same drug, same tablet size but the over-the-counter
dosage is lower, duration longer, as per FDA rule.
Caution: Avoid in patients with history of peptic
ulcer, hepatic or renal disease, and in patients on
anticoagulants. Recent questions concerning tendency to
increase risk of heart attack and stroke.
PRESCRIPTION FOR MODERATE PAIN

Butalbital 50 mg/aspirin or acetaminophen 325 mg/
caffeine 40 mg (Fiorinal®, Fioricet®)
Dsp: #40
Sig: Take 1 or 2 tablets every 4 hours as needed for pain.
58
Use: Moderate pain.
Note: This regimen is useful for promoting sleep.
Hydrocodone 5 mg and acetaminophen 500 mg

(Lortab® 5 mg)
Dsp: #20
Sig: Take 1 or 2 tablets every 4 hours for pain; do not
exceed 8 tablets in 24 hours.
Use: Moderate pain.
Ketorolac tromethamine 10 mg (Toradol®)
Dsp: #40
Use: Moderate pain (NSAID).
Oxycodone HCl 5 mg—acetaminophen 325 mg
(Percocet®; generic available) or oxycodone HCl 4.5
mg—oxycodone terephthalate 0.38 mg-aspirin
325 mg (Percodan)
Dsp: #20
Sig: Take 1 tablet every 4 hours as needed for pain.
Use: Moderate pain.
Note: Percocet is preferred for dental use.
Caution: Addiction and high abuse; avoid in elderly, G6PD
anemia, severe liver disease, and pulmonary disease.
PRESCRIPTION FOR MODERATE TO SEVERE PAIN

Acetylsalicylic acid 325 mg (Bayer Aspirin®) or
acetaminophen 325 mg (Tylenol®) with
#1 (Codeine 7.5 mg)
#2 (Codeine 15 mg)
#3 (Codeine 30 mg)
#4 (Codeine 60 mg)
Dsp: #20
Sig: Take 1 tablet every 4–6 hours as needed for pain.
Use: Mild to moderate pain.
Note: Codeine causes nausea, constipation, and sedation.
Acetylsalicylic acid is not an ideal postoperative drug
because it will cause excessive bleeding.
Caution: Addiction side effect; do not prescribe for more
than 2–3 days. Avoid #3 in G6PD patients or those taking
tricyclic antidepressants, MAO-Is, and phenothiazines.
Use only #1 or #2 in the elderly.
59
Celecoxib 100 mg, 200 mg, 400 mg tablets (Celebrex®)
Dsp: #10
Sig: Take 400 mg followed by an additional 200 mg if
needed on day 1; maintenance dose: 200 mg twice daily
as needed.
Use: Acute dental pain.
Warning: Increased risk of cardiovascular effects,
including MI, stroke, and new-onset or worsening of
preexisting hypertension as for all NSAIDs. Also, do not
give if recent coronary bypass graft procedure.
Dihydrocodeine bitartrate 16 mg, aspirin 356.4 mg,

caffeine 30 mg (Synalgos-DC®)
Dsp: #10
Use: Moderate to severe pain; sedation.
Hydrocodone bitartrate 7.5 mg and acetaminophen

750 mg (Vicodin®)
Dsp: #30
Sig: Take 2 tablets immediately and 1 tablet every
6 hours as needed for pain.
Caution: Do not use with MAO-Is, tricyclics,
antipsychotics, antianxiety agents, other narcotics,
alcohol or barbiturates; contraindicated in patients with
G6PD anemia.
Hydrocodone bitartrate 10 mg and acetaminophen

650 mg (Lorcet®)
Dsp: #30
Sig: Take 1 tablet every 4–6 hours as needed for pain.
Hydrocodone bitartrate 7.5 mg and ibuprofen 200 mg

(Vicoprofen®; Reprexain®—hydrocodone bitartrate 5.0 mg)
Dsp: #45
Sig: 1–2 tablets every 4–6 hours as needed for pain.
Note: Maximum of 5 tablets per day.
Use: Short term (<10 days) moderate to severe pain
when an anti-inflammatory effect is desired.
60
preexisting hypertension as for all NSAIDs. Also, the
simultaneous use of aspirin and ibuprofen should be
avoided because the latter may interfere with the benefits
of the former.
Ketorolac nasal spray 15.75 mg/spray (Sprix®)

Dsp: 1.7 g [8 metered spray]
Sig: 1 spray in each nostril (total dose: 31.5 mg) every
6–8 hours; maximum dose: 4 doses (126 mg/day).
Use: Short-term management of moderate to moderately
severe acute pain requiring analgesia at the opioid level.
Caution: Known to reversibly decrease platelet
aggregation.
Oxycodone HCl 5 mg and ibuprofen 400 mg

(Combunox®)
Dsp: #20
Sig: Take 1 tablet every 6 hours as needed.
Use: Short-term (<3–5 days) treatment for acute
moderate to severe pain when the concomitant anti-
inflammatory action of ibuprofen is desired.
Note: Maximum of 4 tablets/24 hours.
Caution: Contraindicated in patients with paralytic ileus;
persons allergic to aspirin.
preexisting hypertension as for all NSAIDs.
Oxymorphone HCl 5, 10 mg, 20 mg, and 40 mg tablets

(Opana®, Opana ER)
Dsp: #12
Sig: Immediate: 10–20 mg every 4–6 hours as needed;
extended release 5 mg every 12 hours with supplemental
doses of immediate release as a “rescue” medication as
dosage is titrated.
Use: Regular release for moderate to severe pain
and preoperatively as a sedative and/or supplement
to anesthesia; extended release for management of
moderate to severe pain in patients requiring around-the-
clock opioid treatment for an extended period of time.
Note: Can cause a reduction of saliva production or
secretion contributing to discomfort and dental disease
(i.e., caries, oral candidiasis, and periodontal disease).
61
Caution: Tablets should be swallowed whole.
Warning: Healthcare provider should be alert to problems
of abuse, misuse, and diversion.
Tapentadol HCl 50 mg (Nucynta®; 75 and 100 mg also)
Dsp: #32
Sig: Take 1–2 tablets every 4–6 hours as needed; may
administer a second dose 1 hour or more after the
initial dose (max. dose on day 1 is 700 mg; day 2 and
thereafter 600 mg)
Use: Moderate to severe acute pain.
Note: Dose and dosage intervals should be individualized
according to pain severity.
Contraindications: Use of MAO-I within 14 days.
Tramadol HCl 50 mg (Ultram®, Ultram ER 100 mg)
Dsp: #32
Sig: Take 1–2 tablets every 4–6 hours; limit 400 mg/day.
Extended release: one 100 mg tablet once daily.
Use: Moderate to severe pain; especially helpful in TMD.
Contraindication: Hypersensitivity to tramadol, codeine, or
other opioids. Risk of seizures in patients taking MAO-Is,
tricyclic antidepressants, or serotonin reuptake inhibitors.
Caution: Potential for abuse, seizures, and anaphylactoid
reactions. FDA recommends gradual tapering of dose to
avoid withdrawal symptoms.
Ibuprofen 400 mg and acetaminophen 1000 mg
Dsp: #1 of each
Sig: Take a single dose following dental surgery
procedure.
Use: Moderate to severe pain.
PRESCRIPTION FOR SEVERE PAIN
Fentanyl buccal effervescent lozenge 100, 200, 400,
600, 800 μg (Fentora®)
Dsp: #28 (7 blister cards with 4 tablets in each card)
Sig: The initial dose should be 100 μg. Dosing may be
repeated once during a single episode of breakthrough
pain if pain is not adequately relieved by 1 dose; redosing
may occur 30 minutes after the start of administration.
62
Patient should be titrated to a dose that provides
adequate analgesia with tolerable side effects. Each
tablet is retained within the buccal cavity for a period
sufficient to allow disintegration of the tablet and
absorption of fentanyl across the oral mucosa.
Use: Management of breakthrough pain in patients with
cancer who are already receiving and now are tolerant to
opioid therapy for their underlying persistent cancer pain.
Note: Fentora is 1 of 5 delivery forms of fentanyl sulfate.
The others are fentanyl solution (no brand name) for
IV delivery, a film for buccal application (Onsolis),
transdermal patch (Duragesic), and a solid lollipop form
(Actiq). The latter contains 2 g of sugar in a raspberry-
flavored additive and, thus, creates a high risk for
caries and other dental problems if abused or used in
xerostomic patients.
Caution: As with all opioids, respiratory depression,
circulatory depression, hypotension, and shock.
Hydromorphone HCl 2 mg (Dilaudid®)

Dsp: #16
Use: Severe pain.
Note: Triplicate prescription required.
Meperidine HCl 50 mg (Demerol®)

Dsp: #16
Use: Severe pain in patients allergic to codeine.
Note: Triplicate prescription required. Can cause nausea,
constipation, and sedation like codeine.
Caution: Avoid in elderly patients, severe liver disease,
and severe kidney disease.
Meperidine HCl 50 mg, promethazine HCl 25 mg

(Mepergan® fortis)
Dsp: #12
Use: Severe pain.
Caution: Respiratory depression and addiction side
effects.
63
NONANALGESIC FOR SPECIAL CASE HEAD AND NECK PAIN
Carbamazepine 100 mg (Tegretol®)
Dsp: #40
Sig: Take 1 tablet 2 times daily for 2 days, then 1 tablet
3 times a day thereafter.
Use: Trigeminal and glossopharyngeal neuralgias. Most
patients can be maintained on 400–800 mg/day.
Note: Dose may be increased up to 800 mg/day.
Caution: While escalating, CBCs should be monitored
regularly because carbamazepine induces a dose-related
marrow suppression.
Prednisone 10 mg (Deltasone®)
Dsp: #30
Sig: Take 1 tablet each day.
Use: Giant cell arteritis of the temporal or facial artery.
XI. LOCAL ANESTHETICS

AMIDES
4% articaine HCl with 1:100,000 or 1:200,000 epi-
nephrine (Articadent) (Septocaine®, Zorcaine® [1:1000,000])
Effects last for 45–75 minutes. Maximum number of
cartridges for healthy 140 lb. adult is 6.0; medically
compromised is 2.0.
Note: The 1:200,000 epinephrine formulation serves as a
useful alternative in certain patient populations when less
epinephrine is desired.
0.5% bupivicaine with 1:200,000 epinephrine
(Marcaine®, Vivacaine®)
Effects last for 90 minutes or longer. Maximum number
of cartridges for healthy 140 lb. adult is 9.0; medically
compromised is 2.0.
2% lidocaine with 1:100,000 epinephrine (Xylocaine®,
Octocaine®, Xylocaine)
Effects last for 60 minutes. Maximum number of
compromised is 2.0.
2.5% lidocaine with 2.5% prilocaine periodontal gel
(Oraqix®)
Use: Indicated for adults who require localized anesthesia
in periodontal pockets during scaling and/or root planing.
64
Sig: Apply on the gingival margin around the selected
teeth using the blunt-tipped applicator; wait 30 seconds,
then fill the periodontal pockets using the blunt-tipped
applicator until the gel becomes visible at the gingival
margin; wait another 30 seconds before starting
treatment.
Note: Use only with the Oraqix dispenser (not injected).
Typically 1 cartridge (1.7 g) or less will be sufficient for
one quadrant of the dentition. When administered, it
should be a liquid, not a gel.
Caution: Contraindicated in patients with a known
hypersensitivity to local anesthetics of the amide type.
3% mepivicaine HCl plain (Carbocaine®, Isocaine 3%®,
Polocaine®, Scandonest 3% Plain®, Mepivacaine 3%®)
Effects last for minutes. Maximum number of cartridges
for health 140 lb. adult is 7.0; medically compromised
is 1.5.
2% mepivicaine HCl with Levonordefrin 1:20,000

(Carbocaine with Neo-Cobefrin, Isocaine 2%, Scandonest
2%).
compromised is 2.0.
4% prilocaine HCl (Citanest Plain)

cartridges for 140 lb. adult is 5.0; medically compromised
is 2.0.
4% prilocaine with 1:200,000 epinephrine (Citanest
Forte)
Effects last for 2 hours. Maximum number of cartridges
for healthy 140 lb. adult is 5.0; medically compromised
is 2.0.
ESTERS
Propoxycaine and procaine (Ravocaine)
Effects last for 30–40 minutes. Maximum number of
cartridges for healthy 140 lb adult is 9.0; medically
compromised is 2.0.
Caution: Avoid use of local anesthetics with epinephrine
in conjunction with MAO-Is and tricyclic antidepressants,
65
thiouracil, digoxin, and theophylline, and in patients with
severe cardiac and pulmonary disease.
LOCAL ANESTHETIC OVERDOSE MANAGEMENT

Reassure patient; ask the patient to hyperventilate.
If seizure occurs, give 10 mg diazepam IV slowly;
administer oxygen in severe cases; do CPR if cardiac
arrest occurs.
LOCAL ANESTHETIC REVERSAL AGENT

Phentolamine mesylate (OraVerse®)
Adults—dose is based upon the number of cartridges of
local anesthetic administered; infiltration/block, 0.2 mg if
1
/2 cartridge administered, 0.4 mg if 1 cartridge, 0.8 mg if
2 cartridges.
Children—maximum dose of 0.2 mg if weight is 15–30
kg; maximum dose of 0.4 mg if weight is greater than
30 kg and younger than 12 years old:
XII. VASOACTIVE DRUGS

Diltiazem 60 mg (Cardizem®)
Dsp: #55
Sig: Take 1 tablet twice daily for 5 days; 1 tablet 3 times
a day thereafter.
Use: Short-term therapy for cluster headache and the
prevention of midface vascular pain.
Ergotamine tartrate with caffeine suppositories

(Cafergot®)
Dsp: #10
Sig: Place 1 tablet rectally at onset of pain attack.
Use: Migraine headache, midface cluster headache.
Caution: Do not use more than 5 doses per week;
contraindicated in gravid women; use cautiously in
hypertensive patients. Ergot causes intestinal side effects.
Nifedipine 10 mg (Procardia®)
Dsp: #60
Use: Short-term therapy for cluster headache
(sphenopalatine neuralgia) and the prevention of
midface vascular pain.
66
XIII. ANTIXEROSTOMICS AND FLUORIDE GELS/RINSES
SOME DRUGS REPORTED TO FREQUENTLY CAUSE
XEROSTOMIA
Anticholinergics and antiparkinsonian agents—
benztropine mesylate, dicyclomine, flavoxate,
methantheline bromide, oxybutynin
Antidepressants—amitriptyline, desipramine, imipramine,
MAO-Is, all TCAs, trazodone
Antipsychotics—chlorpromazine, haloperidol,
prochlorperazine, thioridazine, thiothixene, trifluoperzine
Antihypertensives—beta blockers, captopril, clonidine,
guanethidine, methyldopa, reserpine
CNS stimulants—amphetamines, dethylproprion,
phentermine, phenylpropranolamine, pseudoephedrine
Diuretics—calcium-sparing diuretics, carbonic anhydrase
inhibitors, chlorthalidone, loop diuretics, thiazides
Miscellaneous—atropinics, hypotensive agents,
narcotics, muscle relaxants, systemic bronchodilators
PRESCRIPTION SALIVA SUBSTITUTES

Aquoral artificial saliva (oxidized glycerol triesters,
silicon dioxide, aspartame, and artificial flavoring)
Dsp: 1 bottle
Sig: 2 sprays (0.1 ml/spray), 3–4 times daily.
Use: Relieves symptoms of dry mouth that may be
the result of Sjögren’s syndrome, oral inflammation,
medication, chemo- or radiotherapy, and stress or aging.
Caphosol—see page 94.
Maxisal liquid
Dsp: 1 bottle
Sig: Use as needed.
Use: Enhance salivary function; can also be used for
patient with burning mouth syndrome.
Numoisen liquid and lozenge
Liquid—water, sorbitol, linseed extract, chondrus
crispus, methylparaben, sodium benzoate, potassium
sorbate, dipotassium phosphate, propylparaben (300 ml).
Lozenge—sorbitol 0.3 g/lozenge, polyethylene glycol,
malic acid, sodium citrate, calcium phosphate dibasic,
hydrogenated cottonseed oil, citric acid, magnesium
stearate, silicon dioxide (100s)
67
Oasis® mouthwash and mouth spray
Mouthwash—water, glycerin, sorbitol, poloxamer 338,
PEG-60, hydrogenated castor oil, copovidone, sodium
benzoate, carboymethylcellulose (473 ml) (alcohol-free,
sugar-free; mild mint flavor).
Spray—glycerin, cetylpryridinium, copovidone (30 ml)
(alcohol-free, sugar-free; contains sodium benzoate;
delivers ~150 sprays, mild mint flavor).
OVER-THE-COUNTER SALIVA SUBSTITUTE

0.5% sodium carboxymethyl cellulose aqueous
solution
Dsp: 8 fl oz
Sig: Rinse as frequently as needed.
Use: Relieve symptoms of dry mouth.
OVER-THE-COUNTER SALIVA SUBSTITUTES (SHORT-TERM

EFFECT)
Entertainer’s Secret® (50 ml pump spray), Sal-eze®,
Xero-Lube® (6 oz pump spray), Salivart® (25 or 75 g
spray bottle with nitrogen propellant), Moi-Stir® (4 oz
plastic squeeze bottle), Omnii® Plaque fighter spray,
Orex®, Saliva Substitute® (4 oz plastic squeeze bottle),
MouthKote® (8 oz pump spray), Glandosane®, Sage Moist
Plus®, Salix®, Roxane® (120 ml bottle), Oral Swabsticks®
(75 ct rayon swabs), Orazyme® (16 oz), Nighttime Spray®
(35 ml spray bottle), Tom’s of Maine® Natural Oral
Moisturizing mouthwash, Koolerz®, Spry®.
Sig: Rinse frequently as needed.
Use: Dry mouth.
Note: Consider topical treatment in custom trays for those
patients with severe xerostomia. Short-term effect that
some people find useful but most can have poor patient
acceptance. Beware of sorbitol (noncariogenic sugar
alcohol) found in some of these products because it may
cause increase Strep. mutans and diarrhea.
OVER-THE-COUNTER DENTAL CHEWING GUMS

Biotene® Dry Mouth Gum
Dsp: 1 package (17 pieces)
Sig: Chew gum as needed.
Caution: Use caution if patient has removable dentures.
68
Spry Dry Mouth Gum—various flavors with xylitol
Dsp: 1 package (20 pieces and 600 pieces)
Sig: Chew gum as needed.
OVER-THE-COUNTER DENTIFRICES (TOOTHPASTES)

Biotene® Dry Mouth Toothpaste
Dsp: 1 tube
Spry Regular and Fluoride Toothpaste

Dsp: 1 tube
Tom’s of Maine® Natural Anticavity Fluoride Toothpaste

for a Dry Mouth
Dsp: 1 tube
OVER-THE-COUNTER ORAL MOISTURIZING GELS

Laclede ORALBalance® Mouth Moisturizing gel or Sage
Mouth Moisturizer or Glandosane Mouth Moisturizer
Dsp: 1.5 oz tube
Sig: Apply directly to the area (including denture
underside if applicable) with clean fingertip or cotton-
tipped applicator as often as needed for relief, especially
at night.
Use: Dry mouth.
Note: High patient acceptance; slightly sweet flavor.
OVER-THE-COUNTER MUCOADHESIVE BIODEGRADABLE

DISCS
Oral Health’s XyliMelts® (500 mg Xylitol), mint or mint-
free
Dsp: 1 box of 40 discs
Sig: Place disc on upper or lower posterior attached
gingiva with the tan adhesive side against the gingiva
(aided by the tongue) and then do not touch it with
the tongue for 30 seconds. At bedtime, use 2 discs
(bilaterally); during the day use as needed (at least
3–4).
Use: Dry mouth.
Note: For maximum benefit, do not consume fructose
until 1 hour following use.
Caution: Xylitol raises blood glucose half as much per
unit weight as typical carbohydrates.
69
OraMoist® mucoadhesive patch
Dsp: 1 box
Sig: Apply to affected oral mucosa.
Note: Nondrug formula of time-released lipids, citrus oil,
sea salt, xylitol.
PRESCRIPTION SALIVA STIMULANTS (FOR CHRONIC

SALIVARY HYPOFUNCTION):
Bethanechol 25 mg (Urecholine®)
Dsp: #35
Sig: Take 1 tablet 5 times a day.
Use: Dry mouth.
Caution: Adverse side effects possible (heart irregularities
and diarrhea); close collaboration with patient’s
physician.
Cevimeline HCl 30 mg (Evoxac®)

Dsp: #90
Sig: Take 1 tablet 3times a day.
Use: Dry mouth for patients with Sjögren’s syndrome.
Note: Cevimeline has a longer half-life and duration of
action than pilocarpine. Some patients cannot tolerate
cevimeline, so a prescription of pilocarpine may also be
prescribed; ask the patient to give each one a trial. It may
take up to 90 days of usage to achieve a therapeutic effect.
Contraindications: Patients for whom miosis is
undesirable (e.g., narrow-angle glaucoma, acute iritis)
and patients with uncontrolled asthma.
Caution: May cause decreased visual acuity (particularly
at night and in patients with central lens changes) and
impaired depth perception; patients should be cautioned
about driving at night or performing hazardous activities
in reduced lighting. Excessive sweating may lead to
dehydration in some patients. Use with caution in
patients with a history of biliary stones, nephrolithiasis,
or pulmonary disease. Potentially can alter cardiac
conduction and heart rate and produce transient change
in hemodynamics.
Pilocarpine HCl 5 mg and 7.5 mg tablets (Salagen®;

generics available)
Dsp: #120
70
Sig: 1 tablet 3–4 times per day; may increase up to 6
tablets per day after 1 week.
Use: Dry mouth; developed for side effect of radiation
therapy in head and neck cancer and for patients with
Sjögren’s syndrome.
Note: Pilocarpine is best taken 30 minutes prior to meals
and at bedtime. Patients should be titrated for a minimum
of 90 days to achieve clinical effects however, tablet is
unscored and so you cannot titrate effect.
Caution: Adverse side affects possible (heart irregularities
and diarrhea); close collaboration with patient’s physician
needed. Do not prescribe or prescribe with caution for
patients with hypertension, arrhythmia, biliary disease,
urolithiasis, or psychosis.
Pilocarpine 4% ophthalmic solution (generic)

Dsp: 15 ml bottle
Sig: Place 2 drops in 1–2 tbsp of water, swish, and
swallow up to 4 times a day.
Use: Dry mouth.
Note: The dose can be placed on sugarless gum;
bioavailability is the same as pilocarpine solution.
OVER-THE-COUNTER SALIVA STIMULANTS (FOR CHRONIC

SALIVARY HYPOFUNCTION)
Salistat®-Tabs (Shaffer Laboratories)
Dsp: 1 box
Sig: Let tablet dissolve on tongue periodically as needed
throughout the day.
Use: Dry mouth.
Saliva Stimulant Tablets (Salix® SST)

Dsp: NDC Code # 20186-213-00 [30 ct trial size box;
120 ct box]
Sig: Let tablets dissolve under tongue.
Use: Dry mouth.
Note: A buffered citric acid tablet that is not a shelf item
in a drug store. Have the pharmacist order by the case
according to the NDC Code # listed at phone number
215-453-2505. No drug interactions or adverse effects.
Well accepted by patients (pleasant flavor and easy to
carry).
71
SALIVA INHIBITOR FOR SALIVARY HYPERFUNCTION
(SIALOSCHESIS)
Atropine 0.4 mg (Sal-Tropine®)
Dsp: #1 per dental appointment
Sig: Take 1 tablet 1 hour before dental appointment on an
empty stomach.
Use: To induce xerostomia due to excessive salivation
(ptyalism).
Note: Child: 7–16 lb—0.1 mg; 17–24 lb—0.15 mg; 25–
40 lb—0.2 mg; 41–65 lb—0.3 mg; 65–90 lb—0.4 mg.
Caution: Potential to cause mouth dryness may be
increased if it is given with other drugs that have
anticholinergic action.
Propantheline bromide 7.5 mg or 15 mg (Pro-Banthine®)
Dsp: #10
Sig: Take 15–30 mg 1 hour prior to dental appointment.
Use: To induce xerostomia due to excessive salivation
(ptyalism).
Caution: Contraindicated in glaucoma and can cause dry
eyes, so contact lens wearers should remove contacts.
DRUGS REPORTED TO CAUSE PTYALISM (EXCESSIVE SALIVA)

Alprazolam, clonidine, clozapine, levodopa, lithium,
lorazepam, petoxifylline, pilocarpine, reserpine, valproic
acid.
FLUORIDE GELS, VARNISH, CREAM, AND RINSES

(ANTICARIES AGENTS)
PRESCRIPTION, HOME USE
0.05% acidulated phosphate sodium fluoride (Phos-
Flur® Rinse) (bubble gum, cherry, cinnamon, cool mint,
and grape flavors)
Dsp: 200 ml or 500 ml bottles
Sig: At bedtime, once daily. Rinse and swish vigorously
with 5–10 ml (1–2 tsp) for 1 minute. Do not eat or drink
for 30 minutes after application.
Use: Prevention of decalcification and dental caries; ideal
for orthodontic patients.
Note: 0.02% rinse—Act, Fluorigard.
0.4% stannous fluoride gel (Flo Gel®, True Gel®, Nova-
Gel®, IDP Gel-oh®, Gel-Kam®, Omni-Gel®, Stan-Gard®,
72
Gel-Pro®, Control®, Easy Gel®, Perfect Choice®, Basic
Gel®, Gel-Tin®, Thera-Flur®, Stop®)
Dsp: 4.3 fl oz tubes in assorted flavors (e.g., mint,
cinnamon)
Sig: Use once daily, after regular brushing. Gently brush
onto teeth for 1 minute, then vigorously swish, then
expectorate. Do not eat or drink for 30 minutes after
application.
Use: Caries prevention.
Note: 0.1% gels—over-the-counter generics
Caution: When the taste of acidulated SnF2 gel is
poorly tolerated or where there is etching of ceramic
restorations, neutral pH sodium fluoride gel (PreviDent )
should be considered. Acidic pH may be irritating to dry,
atrophic tissues.
0.2% neutral sodium fluoride (Prevident® rinse)

Dsp: 16 oz
1.1% neutral sodium fluoride gel (Prevident Gel) or

1.0% (Thera-Flur-N)
Dsp: 0.8 oz or 2.0 oz plastic tube in assorted flavors
(mint, sherbet, berry, cherry, and lime)
Sig: Use once daily, after regular brushing. Gently brush
onto teeth for 1 minute then vigorously swish, then expel.
Do not eat, drink, or rinse mouth for 30 minutes after
application.
Note: Karigel-N® (neutral sodium fluoride)—5 drops with
11/2 tsp of baking soda creates a fluoride toothpaste that
is mildly abrasive; no artificial flavors, colors; especially
helpful for post-irradiation caries prevention when
applied in trays. Also, generic neutral sodium fluoride
generic is available, but its bioavailability does not equal
PreviDent Gel.
1.1% neutral sodium fluoride dental cream (PreviDent

5000 Plus, Prevident 5000 Booster and Prevident 5000
Dry Mouth [SLS free])
Dsp: 2 oz tube
Sig: After normal brushing, flossing, and rinsing, apply
this toothpaste twice daily.
73
Use: Caries prevention in the xerostomic population.
Note: Avoid drinking, rinsing, or eating for 30 minutes
following treatment. This is a combination mild dentifrice
and high-potency fluoride treatment in a single product.
1.1% neutral sodium fluoride 5000 ppm with

potassium nitrate toothpaste with sensitivity relief
(Fluoridex®)
Dsp: 4 oz tube
Sig: Apply this toothpaste twice daily.
Use: Caries prevention and tooth desensitizer.
1.1% neutral sodium fluoride dental paste with

tricalcium phosphate (Clinpro® 5000)
Dsp: 4 oz tube
Sig: Apply once daily in place of conventional toothpaste.
Sodium fluoride 0.5 mg fluoride ion/1.0 ml (Luride®

Drops) [Child]
Dsp: 30 ml (60 ml) bottle with dropper
Sig: Apply 2 drops per day in the mouth of the child (birth
to 2 years). Apply 4 drops per day in the mouth of the
child (2–3 years). Apply 8 drops per day in the mouth of
the child (3–12 years).
Use: To provide fluoride for children living in areas where
fluoride level is 0.6 ppm or less; dental caries prevention
during tooth development.
PRESCRIPTION, DENTAL OFFICE USE

2.0% neutral sodium fluoride (Fluorocare Neutral®)
Dsp: 16 oz. bottle in assorted flavors
Sig: Place a continuous ribbon of gel in a fluoride
applicator tray. Allow fluoride gel to remain in contact
with teeth for 4 minutes. Expectorate. Do not eat or drink
for 30 minutes after application.
Use: Prevention of decalcification and dental caries.
Caution: Do not swallow.
1.2% acidulated phosphate fluoride (Fluorocare Time

Saver; Minute-Gel®)
Dsp: 16 oz bottle in assorted flavors
74
Sig: Place a continuous ribbon of gel in a fluoride
applicator tray. Allow fluoride gel to remain in contact
with teeth for 2–4 minutes. Expectorate. Do not eat or
drink for 30 minutes after application.
Use: Prevention of decalcification and dental caries.
Caution: Do not swallow.
1.23% acidulated phosphate fluoride foam (Fluoridex

Maximum Uptake®)
Dsp: 4.4 oz bottle in assorted flavors
Sig: Place in a fluoride applicator tray. Allow fluoride
foam to remain in contact with teeth for 2–4 minutes.
Expectorate. Do not eat or drink for 30 minutes.
HOME, OVER-THE-COUNTER USE

0.05% sodium fluoride (Fluorigard®, ACT®)
Dsp: 16 oz bottle
Sig: Use once daily, after regular brushing. Vigorously
swish, then expel.
Use: For patients whom have low-to-moderate caries
risk.
Listermint with fluoride

Dsp: 16 oz bottle
Sig: Use once daily, after regular brushing. Vigorously
swish, then expectorate.
Use: For patients who have low-to-moderate caries risk.
XIV. TOOTH DENSENSITIZERS

5% benzalkonium chloride, 35% hydroxyethyl
methacrylate [HEMA], 0.5% sodium fluoride (Health-
Dent® desensitizer with fluoride)
Dsp: 10 ml bottle
Sig: Apply for 30 seconds with a sterile cotton pellet then
air dry.
Use: Hypersensitive teeth (desensitizer).
Colgate Sensitive Pro-Relief Desensitizing paste

Dsp: 85 g tube (60-unit dose cups, 1.5 g each)
Sig: Apply paste to prophy polishing cup and polish
sensitive areas for approximately 3 seconds each.
Use: Hypersensitive teeth.
75
Glutaraldehyde/hydroxyethyl methacrylate [HEMA]
(Gluma)
Dsp: 5 ml bottle
Sig: Apply Gluma primer to the dentin of the tooth to be
restored or that has sensitivity using a gentle rubbing
motion with a sterile cotton pellet; wait 30 seconds and dry.
Note: A dry tooth surface prior to application is not
necessary. A moist surface is acceptable.
5% sodium fluoride varnish (Duraphat®)
Dsp: 10 ml tube
Sig: Remove excess moisture; apply with disposable
cotton-tipped applicator.
5% sodium fluoride varnish (PreviDent®)
Dsp: 20 ml tube
Sig: Remove excess moisture; apply with disposable
brush applicator.
Use: Dentinal and postoperative sensitivity.
Note: Patient should eat only soft foods for 2 hours after
treatment. Other fluoride preparations such as fluoride
gels should not be administered during the same day.
Contraindications: Ulcerative gingivitis and stomatitis.
OVER-THE-COUNTER
TheraDent oral rinse (potassium nitrate, potassium
phosphate, calcium acetate, sodium fluoride)
Dsp: 240 ml bottle
Sig: 1 tsp swish twice daily, after morning and nighttime
brushing
Note: May be used with antisensitivity toothpaste.
XV. HEMOSTATIC AGENTS (TOPICAL AND IV)

TOPICAL
HemCon® dental dressing
Dsp: 1 pack
Sig: Using cotton pliers, place the dressing into the
extraction wound, making sure it conforms properly to
the socket; the top of the dressing should be flush with
the crestal gingiva; place sterile gauze over the dressing
76
and have the patient apply gentle biting pressure of 1–2
minutes.
Use: Physical barrier for temporary protection of oral
mucosa tissue and to provide pain relief; extractions and
other oral procedures.
Note: Becomes adhesive when in contact with blood;
dissolves in 48 hours but may take up to 7 days.
Caution: Contains chitosan (positive charge with red
blood cells to seal over the wound) derived from shrimp
shells. There have been no known allergic reactions
since marketed in 2003; however, individuals with known
shellfish allergies should exercise caution in the use of
products containing chitosan.
Hemostatsyl hemostatic agent
Viscous syringe delivery
Thrombin (Thrombogen®, bovine origin)
Dsp: One 1000 unit vial
Sig: Mix solution of 100 units/ml (10 ml of diluent added
to the 1000 unit package) and immediately apply to the
surface of bleeding tissue as a solution. The recipient
surface should be sponged before product is applied.
OR-Apply in dry powder form to oozing surface.
Use: Aid in hemostasis wherever oozing blood from
capillaries and small venules is accessible.
Caution: Must not be injected! Apply on the surface
of the bleeding tissue as a solution or powder. Use
has sometimes been associated with abnormalities in
coagulation status; if this occurs, then consult an expert
in coagulation disorders.
INTRAVENOUS
Tranexamic acid (Cyklokapron®)
Dsp: Injection, solution: 100 mg/ml; tablet 500 mg (not
available in U.S. but available from manufacturer in
select cases)
Sig: IV: 10 mg/kg immediately before surgery, then 25
mg/kg/dose orally 3–4 times/day for 2–8 days. Oral: 25
mg/kg 3–4 times/day beginning 1 day prior to surgery
Use: Short-term use (2–8 days) in hemophilia patients
during and following tooth extraction to reduce or
prevent hemorrhage; off-label use for angina bullosa
hemorrhagica.
77
Caution: Dosage modification required in patients
with renal impairment; ophthalmic examination before
and during therapy required if patient is treated
beyond several days. Caution in patients with history of
cardiovascular, renal, cerebrovascular or thromboemoblic
disease.
OVER-THE-COUNTER
Purified salt of basic ferric sub sulfate (Cut-Trol®)
Dsp: 1 bottle
Sig: Use full strength on cotton applicator. For best
results, excess blood should be absorbed and the liquid
applied immediately. Dry with compressed air.
Use: Variety of dental and oral surgery procedures where
bleeding is a major impediment.
Note: Do not freeze or refrigerate. Avoid exposure to
bright sunlight.
Caution: Contains no epinephrine or aluminum chloride
and should not be used in combination with either.
XVI. BURNING MOUTH SYNDROME, NEURALGIA, AND

MYOFASCIAL PAIN
Consider a TCA or benzodiazepines in low dose
when a suspected psychogenic or idiopathic case.
The dosage should be adjusted according to the
individual response of the patient and maintenance
doses may have to be continued for many months.
Alprazolam 0.25 mg (Xanax®)

Ds: #50
Sig: Take 1 tablet 3 times a day.
Use: Burning mouth syndrome.
Caution: Side effects expected include dry mouth and
morning drowsiness; adjust dosage according to patient
reaction and clinical symptomatology.
Alprazolam 0.5 mg extended release (Xanax XR;

generic available)
Dsp: #20
Sig: Take 1/2 tablet 3 times daily or 1/2 tablet 1 hour prior to
dental appointment.
78
Amitriptyline 25 mg (Elavil®)
Dsp: #50
Sig: Take 1 tablet at bedtime for 1 week, then 2 tablets at
bedtime; increase to 3 tablets after 2 weeks and maintain
at that dosage.
Use: Burning mouth syndrome, neuralgia, myofascial
pain, and headache.
reaction and clinical symptomatology. Contraindicated in
patients with a history of ischemic cardiovascular disease
and myocardial infarction.
Amitriptyline 2% spray
Dsp: 30 ml
Sig: Spray to affected area 3–-4 times daily as needed.
Use: Neuralgia and myofascial pain.
Note: Same precautions as for oral amitryptyline.
Capsaicin cream (Zostrix®) mixed with lidocaine

powder to make a 1% concentration of the anesthetic
Sig: Apply the mixture, in a tray, for 10 minutes to the
affected area 4 times a day for 1–2 months, then 3 times
a day for 2 weeks, then twice daily for 2 weeks, then
once daily for 2 weeks or, alternatively, 5 times a day for
1 week then 4 times a day for the next 3 weeks.
Use: Burning mouth syndrome and deafferentation pain
(neuralgia).
Carbamazepine 100 or 200 mg (Tegretol®)

Dsp: #30
Sig: Take 1 tablet at bedtime.
Note: Take with food or milk.
Caution: Has a narrow therapeutic index—requires
periodic blood levels. Watch for bone marrow depression,
elevated LFTs. Contraindicated in cardiac patients.
Carbamazepine ER 200 or 300 mg (Carbatrol®)

Dsp: #30
79
Sig: Take 1 caplet at bedtime.
Use: Neuralgia and myofascial pain
Note: Gives more even blood levels than immediate
release product.
Carbamazepine 5% in PLO gel

Dsp: 30 g
Sig: Rub small amount into the affected area 3–4 times
daily or as needed.
Note: Fast-onset pain relief; works well for patients
who cannot tolerate oral therapy. May be combined
with other agents as needed. Ibuprofen may enhance
effects.
Chlordiazepoxide 5 mg (Librium®)
Dsp: #50
Sig: Take 1 or 2 tablets 3 times a day.
Clonazepam 0.5 mg (Klonopin®)

Ds: #10
Sig: Dissolve 1/4 tablet on the tongue (without swallowing)
4 times daily.
Use: Burning mouth syndrome; bad taste in mouth.
Note: Rapid onset of relief that should last 3–5 hours.
If no response, then consider systemic prescription.
Caution: Physician consultation and oversight are strongly
recommended.
Clonazepam 0.25 mg (Klonopin)

Dsp: #21
Sig: Take 1 tablet at bedtime for 1 week. Increase the
daily dose by as much as 0.25 mg each week, up to a
total dosage of 3 mg.
Note: If the burning subsides at any point, that dose
can be maintained. Re-evaluate after 3 weeks of
medication.
recommended. May cause significant sedation.
80
Dsp: #25
Sig: Take 1/2 tablet twice daily for 3 days. Then increase
dose to 1/2 tablet 3 times a day for 3 days; then 1/2–1
tablet 4 times a day for 3 days; then 1 tablet 3 times a
day.
Note: If the burning subsides at any point, that dose
can be maintained. Re-evaluate after 3 weeks of
medication.

Dsp: #90
Sig: Week 1: take 1 tablet at bedtime; if no improvement,
then week 2: take 1 tablet every 12 hours; if no
improvement, then week 3: take 1 tablet every 8 hours.
Note: If the burning subsides at any point, that dose can
be maintained. Re-evaluate after 3 weeks of medication.
Clonazepam is now available in an oral disintegrating
tablet (i.e., wafer; 0.5 mg, 0.25 mg, 0.125 mg, and 1 mg
strengths). They may be dissolved on the tongue surface
and swallowed.
Diazepam 2 mg (Valium)
Dsp: #50
Sig: Take 1 or 2 tablets 3 times a day.
Diphenhydramine elixir 12.5 mg/tsp (Benadryl)

Dsp: 6 oz
Sig: Rinse with 1 tsp for 2 minutes before each meal and
swallow.
Doxepin HCl 25 mg (Sinequan®)

Dsp: #45
81
Sig: Take 1 tablet each evening for 5 days, then 2 tablets
each evening for 5 days, then 4 tablets each evening for
7 days.
burning mouth syndrome, most effective in depressed
patients with anxiety.
Caution: Dexamethasone suppression test advisable initially.
Maintenance dose varies from 100 to 200 mg daily.
Fluoxetine HCl 20 mg (Prozac®)

Dsp: #30
Sig: Take 1 tablet daily in the morning.
patients.
Gabapentin 100 mg (300 mg, 400 mg) (Neurontin®)

Dsp: #30
Sig: Take 1 capsule at bedtime.
Note: Has fewer side effects and less drowsiness than
carbamazepine. Safe for cardiac patients.
Lorazepam 0.5 mg (Ativan®)

Dsp: #90
Sig: Take 1 tablet 2 or 3 times daily.
Nortriptyline 10 or 25 mg (Pamelor®)
Dsp: #90
Sig: Take 1 tablet at bedtime for 1 week, then 2 tablets at
bedtime. Increase to 3 tablets at bedtime after 3 weeks
and maintain that dosage, if needed.
Use: Burning mouth syndrome, neuralgia, and myofascial
pain.
Note: Twice the potency of amitriptyline and less
drowsiness and xerostomia, so may be better tolerated in
the elderly.
Caution: Increased risk of suicidal thinking and behavior
(suicidality) associated with use in children and
adolescents.
Phenytoin 100 mg (Dilantin®)

Ds: #30
82
Sig: Take 1 capsule at bedtime, advancing as directed.
Note: Long-term efficacy is less than 20%; requires blood
levels; multiple drug interactions.
Salicylic acid 300 mg, vanilline 10 mg, alcohol 96%
in water 5 ml, solution sorbitol 20 ml, purified water,
q.s. ad 100 ml.
Dsp: Make solution
Sig: Use 1 tsp undiluted as a mouthwash twice daily for 1
minute, after meals. Do not swallow.
Trazodone HCl 50 mg (Desyrel®)
Dsp: #70
Sig: Take 2 tablets each evening for 5 days, then 3 tablets
each evening for 5 days, then 3 tablets 3 times daily for
7 days.
burning mouth syndrome, most effective in depressed
patients.
daily in divided doses. Increased risk of suicidal thinking
and behavior (suicidality) associated with use in children
and adolescents.
OVER-THE-COUNTER
Alpha lipoic acid 300 mg caplets
Dsp: #40
Sig: Take 2 tablets each day for 20 days and then
reassess.
Note: Some published studies recommend reducing
to 200 mg daily after the initial dose, however, some
patients continue to require 600 mg for efficacy.
Caution: Do not use if taking hypoglycemic agents.
Capsaicin 0.025% cream (Zostrix)

Dsp: 1 tube
Sig: Apply small dab to affected area 3–4 times a day and
rub well.
Use: Burning mouth syndrome and deafferentation pain
(neuralgia).
83
Note: Patient may rinse the mouth with cepacaine
mouthwash prior to application of the capsaicin. The
capsaicin should remain on the affected area for 3–4
minutes. Pain relief may take as long as 4–6 weeks.
Capsaicin topical [Tabasco® sauce]

Sig: Mix 1 part Tabasco sauce to 2 or 3 parts of water,
rinse, and expectorate every 2–3 hours or, alternatively,
apply full-strength Tabasco sauce directly to the affected
area.
Use: Burning mouth syndrome desenisitization.
Note: After 1 week, a daily application may be sufficient.
If the patient cannot tolerate the burning that initially
occurs after application, have her or him rinse her or his
mouth several times with cold milk.
Kamillosan
Dsp: 1 bottle
Sig: Place 10 drops in 1 oz of water and spray on the oral
mucosa.
Note: Manufactured by Asta Medica (Germany) but
available in the U.S. by contacting Merz Apotheke, 4716
North Lincoln Avenue, Chicago, IL 60625 or call 1-800-
252-0275.
XVII. NUTRIENT DEFICIENT AND SUPPLEMENT THERAPY

Ferrous sulfate 250 mg
Dsp: #100
Sig: Take 1 tablet 3 times a day for 1 month, and then
reassess patient’s hemoglobin.
Use: Iron deficiency anemia.
Folic acid 0.4 mg

Dsp: #30
Sig: Take 1 tablet daily for 1 month, and then reassess
patient’s folic acid level.
Use: Folic acid deficiency.
Water-soluble bioflavonoids 200 mg with ascorbic

acid 200 mg
Ds: #100
Sig: Take 1 tablet 3 times a day for 2 weeks.
Use: Vitamin deficiency.
84
OVER-THE-COUNTER PREPARATIONS:
Ensure Plus (P-V-M Food Supplement)
Dsp: 20 cans
Sig: 3–5 cans in divided doses throughout the day as
tolerated. Serve cold.
Use: Food supplement.
Meritene (Protein-Vitamin-Mineral Food Supplement)
Dsp 1 lb can (plain, chocolate, eggnog flavors)
Sig: Take 3 servings daily. Prepare as indicated on the
label. Serve cold.
Use: Food supplement.
XVIII. TASTE AND SMELL DISORDER THERAPIES

A deficiency of zinc has been associated with a loss
of taste (and smell) sensation so consider for zinc
replacement in patients with proven zinc deficiency:
PRESCRIPTION
Z-BEC®
Dsp: #60
Sig: Take 1 tablet daily with food or after meals.
Use: Taste disorders after neurological, olfactory, and
systemic influences have been ruled out.
OVER-THE-COUNTER PREPARATIONS
Orazinc 220 mg
Ds: #100
Sig: Take 1 capsule 3 times a day with milk for at least
1 month.
Use: Taste disorders after neurological, olfactory, and
systemic influences have been ruled out.
MISCELLANEOUS
Multivitamins with minerals/iron
REFERRAL CENTERS
Smell and taste research centers supported by the NIDCD
often need research patients to help their scientists study
the chemosenses. Prospective patients should have their
physicians write to or phone the following research centers:
85
Clinical Smell and Taste Research Center
Hospital of the University of Pennsylvania
3400 Spruce Street, G1
Philadelphia, PA 19104
Phone: 215-662-6580
Department of Oral Biology
Connecticut Chemosensory Clinical Research Center
University of Connecticut Health Center
Farmington, CT 06032
Phone: 203-679-2459
Monell Chemical Senses Center
3500 Market Street
Philadelphia, PA 19104
Phone: 215-898-6666
Rocky Mountain Taste and Smell Center
University of Colorado Medical Center
4200 East 9th Avenue
Denver, CO 80262
Phone: 303-270-7464
SUNY Upstate Clinical Smell Research Center
766 Irving Avenue
Syracuse, NY 13210
Phone: 315-473-5591
SOME DRUGS REPORTED TO AFFECT TASTE AND SMELL

Metronidazole, azathioprine, lithium salts,
chlorpheniramine maleate, amphotericin, ampicillin,
griseofulvin, idoxyuridine, tetracylines, chlorhexidine,
captopril, opiates, levodopa, baclofen, carbamazepine,
amphetamines, pentamidine, metformin, carbonic
anyhydrase inhibitors.
XIX. MISCELLANEOUS OVER-THE-COUNTER ORAL RINSES

AND PRODUCTS TO RELIEVE MOUTH PAIN
OVER-THE-COUNTER ORAL RINSES (WITH ACTIVE
INGREDIENT LISTED)
Biotene® gentle mouthwash

Lysozyme 6 mg, lactoferrin 6 mg, glucose oxidase 4000
units, zinc gluconate—alcohol-free
Cepacol® mouthwash/gargle
Alcohol 14%, cetylpyridinum chloride 0.05%
86
Crest Pro-Health rinse
Alcohol-free, cetylpyridinum chloride 0.7%
Dr. Tichenor’s® antiseptic liquid

SD alcohol 38B 70%
Lavoris® original mouthwash

SD alcohol 38B
Listerine® liquid* or citrus flavored or tartar protection

Alcohol 26.9%, eucalyptol 0.092%, thymol 0.064%,
methyl salicylate 0.06%, menthol 0.042%
Listerine® Total Care Zero Fresh mintflavored (anticavity)

Alcohol-free; fluoride-containing
Mentadent® mouthwash
Alcohol 10%
MuGard mucoadhesive oral wound rinse

Benzyl alcohol
Oxyfresh® Original Mint mouthrinse

Stabilized chlorine dioxide—alcohol-free
PerioPatch mucoadhesive patch (strawberry flavor)

Gum acacia-based adhesive; methyl hyrdoxypropyl
cellulose, ethylcellulose, polyacrylic acid
Plax® Advanced Formula (original)

Alcohol 8.7%, S.T. 37 solution, hexylresorcinol 0.1%
Rembrandt® Natural mouthwash
Scope® (original mint and cool peppermint)

SD alcohol 38F 14%, cetylpyridinum chloride, domiphen
bromide
Targon® Smoker’s mouthwash (original)

SDA alcohol 38B 16%
Tom’s of Maine® Natural mouthwash

Menthol—alcohol-free
87
Viadent® Advanced Care oral rinse
Cetylpyridinum chloride 0.05%
Note: SD = specially denatured alcohol.
* = ADA-certified.
OVER-THE-COUNTER PRODUCTS TO RELIEVE MOUTH PAIN

(WITH ANESTHETIC/ANALGESIC LISTED)
Caution: The FDA announced in 2011 that over-
the-counter benzocaine gels and liquids applied
to the gingiva (or other areas of the mouth) have
caused a rare but potentially fatal adverse effect,
methemoglobinemia. Benzocaine products should not
be used on children younger than 2 years of age (e.g.,
teething), except under the advice and supervision of
a healthcare professional.
Ameseal® (aloclair) oral lesion relief spray (aloe vera
extract)
Anbesol® baby gel (benzocaine 7.5%)
Anbesol® gel or liquid (benzocaine 6.3% gel, 6.4% liquid;
phenol 0.5%)
Anbesol® maximum strength gel or liquid (benzocaine
20%)
Baby Gumz® (benzocaine 10%)—alcohol-free
Banadyne-3® (benzocaine 5%)
Benzodent® denture analgesic ointment (benzocaine 20%)
BetaCell® liquid (vitamin A, vitamin E, beta carotene)
Blistex® lip medex ointment (camphor 1%, menthol 1%,
phenol 0.5%)
Blistex® medicated ointment (menthol 0.6%, camphor
0.5%, phenol 0.5%)
Campho-Phenique® cold sore gel (camphor 10.8%,
phenol 4.7%)—alcohol-free
Cankaid® liquid
Canker Cover® oral patch (citrus oil, magnesium with
HPC/carbopol polymers; menthol, beta-carotene)
Cankermelts® GX patches (licorice root extract)
Carmex® lip balm ointment (menthol, camphor, salicylic
acid, phenol)
Cepacol® Viractin® (Tetracaine 2%)
ChapStick® medicated lip balm stick or ointment
(camphor 11%, menthol 0.6%, phenol 0.5%)
88
Dental-Elite® oral mucosal analgesic liquid (benzocaine
5%, camphor)
Dentapaine® gel (benzocaine 20%)—alcohol-free
Dent’s® maxi-strength toothache treatment drops
(benzocaine 20%)
Dr. Hand’s® teeth gel/lotion (menthol)
ExtraRobusteen® (magnesium, bromide, iodine)
Gly-Oxide® liquid
Herpecin-L® cold sore lip balm stick
Hurricaine® Gel* (benzocaine 20%)—alcohol-free, dye-
free, gluten-free, sulfite-free
Kank-A® professional strength liquid (benzocaine 20%)
Lip-Ex® ointment (phenol, camphor, salicylic acid,
menthol)
Lip Clear® Lysine Plus ointment (L-lysine, lithium
carbonate 3X, propolis extract, calendula flower extract,
echinacea flower extract, zinc oxide, goldenseal extract,
Vitamin A, D,E, cajeput oil, tea tree oil, gum benzoin
tincture vitamins, herbs, and minerals)
Lipmagik® liquid (benzocaine 6.3%, phenol 0.5%)
Little Teether’s® oral pain relief gel (benzocaine 7.5%)—
alcohol-free
Medadyne® liquid (benzocaine 10%, menthol, camphor,
benzyl alcohol)
Mucotrol® chewable wafer
Novitra®
Numzident® adult strength gel (benzocaine 10%)
Ora5 liquid Band-Aid® (copper sulfate, iodine, potassium
iodine, alcohol)
Orabase® gel (benzocaine 15%)
Orabase® lip cream (benzocaine 5%, menthol 0.5%,
camphor, phenol)—alcohol-free
Orabase® plain paste—alcohol-free
Orabase-B® with Benzocaine paste (benzocaine 20%)—
alcohol-free
OraFilm® pain-relieving strips (benzocaine 6%)
Oragesic® solution (benzyl alcohol 2%, menthol)
Orajel® regular strength gel (benzocaine 10%)
Orajel® maximum strength gel (benzocaine 20%)
Orajel protective mouthsore discs (benzocaine 15 mg)
Peroxyl® hygienic dental rinse
Proxigel® (menthol)
89
Quercitin® cream
Red Cross® canker sore medication ointment (benzocaine
20%, phenol)
Rembrandt® canker relief gel (benzocaine)
Retre-Gel® (benzocaine 5%, menthol 1%)
Tanac® medicated gel (dyclonine HCl 1%)
Ulcerease® liquid and spray
Zilactin gel (benzyl alcohol 10%)
Zilactin®-L gel (benzyl alcohol)
Zilactin®-B gel (benzocaine 10%)—alcohol-free; avoid in
pediatric age
Note: SD = specially denatured alcohol.
* = ADA-certified.
OVER-THE-COUNTER SODIUM LAURYL SULFATE-FREE

TOOTHPASTES (HELP PREVENT RECURRENT APHTHOUS
ULCERS IN SOME PATIENTS)
Biotene Dry Mouth Toothpaste®, Laclede
CloSYS®, Rowpar Pharmaceuticals
Orajel Dry Mouth Moisturizing Toothpaste®, Del
Pharmaceuticals
Polar White Whitening Toothpaste®, Dentek Oral Care
Rembrandt Whitening Toothpaste For Canker Sore
Sufferers®, Oral-B
Sensodyne® (certain types)
Spry Toothpaste®
Squigle Enamel Saver Toothpaste®, multiple internet
sites
TheraBreath Toothpaste®, internet site
Tooth and Gum Paste®, Dental Herb Company
XX. HERBAL AND NONHERBAL REMEDIES

Black cohosh (black snakeroot, baneberry)
Administration: Extracts for oral administration.
Active chemicals: Triterpene glycodies; tanninsiso-
falvones, fatty acids, and a volatile oil.
Claimed action: Estrogen-like action, suppression of
luteinizing hormone release and interaction with estrogen
receptors.
Use: Symptoms of premenstrual and dysmenorrhea
disorders and menopausal-associated hot flashes,
vaginal dryness, water retention, and related complaints.
Note: Should be avoided in pregnancy and lactation.
90
Caution: Theoretical chance that patients taking oral
anticoagulants, aspirin, or NSAIDs could show increased
bleeding times.
Chamomile (common chamomile, German chamomile)

Administration: Available in teas, infusions, mouth rinse,
and oral dose forms.
Active chemicals: Volatile oil containing alpha-bisabolol,
flavinoids, umbelliferone.
Claimed action: Anti-inflammatory, antispasmodic,
antibacterial, carminative; promotes wound healing.
Use: Inflammation and spasm in the GI tract; topically
for inflammation, burns, wounds, and infection of the
skin and mucous membranes; topically for anogenital
inflammation; as a deodorant.
Caution: Theoretical chance that patients taking oral
anticoagulants could show increased bleeding times.
Chondroitin sulfate
Administration: Available in oral dose forms in
combination with glucosamine; professional ophthalmic
preparations are also available.
Active chemicals: Glycosaminoglycan found in
mammalian cartilaginous tissue.
Claimed action: Oral administered believed to concen-
trate in cartilage; may also inhibit leukocyte elastase
where high concentrations are associated with
rheumatoid arthritis and bring fluid into the joint; serum
lipid-lowering and antithrombogenic effects have also
been suggested.
Use: Treat dry eyes as an ophthalmic solution; in
combination with sodium hyaluronate it is used to
support ocular surgery; arthritis; but clinical studies
indicate it is somewhat less effective than NSAIDs.
Note: Ask patient about other antiarthritic drugs used
including OTC drugs.
Echinacea (American cone flower, Kansas snakeroot,

purple cone flower)
Administration: Available in a variety of preparations
for internal and external use. Parenteral dose forms are
available in Germany.
Active chemicals: Caffeic acid glycoside; alkylamides;
essential oils; flavinoids.
91
Claimed action: Improved wound healing, stimulation
of the immune system, antibacterial, antiviral, and anti-
inflammatory activity.
Use: Enhance wound healing; Candida infections;
supportive therapy for common colds and upper
respiratory infections, and lower urinary tract infections.
Also, dermatoid arthritis and supportive use in colon
cancer.
Caution: Should not be used in patients with autoimmune
diseases or progressive infectious diseases; use beyond
8 consecutive weeks could cause hepatic toxicity
and should not be used with other hepatotoxic drugs
(e.g., ketoconazole). May decrease effectiveness of
immunosuppressants.
Ginkgo (Maidenhair tree, ginkyo)
Administration: Capsules and leaf extracts; doses range
from 120 to 240 mg of dry extract for 8 weeks for
chronic diseases. Use for longer than 3 months requires
re-evaluation of benefits.
Active chemicals: Multiple flavonoids, flavone glycosides,
bioflavones, terpenoids, and bilobalide.
Claimed action: Improvement in blood flow in the
microcirculation; inhibition of development of
traumatically or toxic-induced cerebral edema; improved
hypoxic tolerance in cerebral tissues; reduction in rentinal
edema; increased memory performance; inhibition of
age-related reduction in muscarinic receptors; and
antagonism of platelet-activating factor.
Use: Cerebral insufficiency; Alzheimer’s dementia;
circulatory disorders associated with diabetes; memory
deficits; vertigo; tinnitus; and impotency associated with
the use of selective serotonin reuptake inhibitors.
Caution: Contraindicated during pregnancy and lactation.
Some evidence for anticoagulant activity; monitor or use
antiplatelet drugs such as aspirin or NSAIDs with caution.
Discontinue use 2 weeks before surgery and general
anesthesia. Concurrent use with MAO-Is and tricyclics.
Ginseng
Administration: The root is used for teas and various
other oral preparations.
Active chemicals: Steroid-like compounds (ginsenosides
or panaxosides); volatile oil and flavinoids.
92
Claimed action: Effects vary from CNS stimulation to
depression. Improves resistance to stress in laboratory
models, but there is a lack of evidence in humans. Also,
claims of decreased platelet aggregation and increased
memory and concentration.
Use: Improvement of stamina and to enhance performance.
Caution: May have MAO inhibition properties. Discontinue
use 2 weeks before general anesthesia.
Saw palmetto (sabal, cabbage palm, saw palmetto berry)

Administration: Available for oral administration as the
herb, in teas, or extracts from the ripe, dry fruit.
Active chemicals: Sinosterols (phytosterols), flavinoids,
polysaccharides, and free fatty acids.
Claimed action: Antiandrogenic, anti-inflammatory, and
low-level estrogenic activity.
Use: Symptoms of benign prostatic hypertrophy, in
particular, urinary difficulties.
Caution: Headaches and GI side effects may occur; avoid
use in pregnancy and in women of childbearing age.
St. John’s wort (hypericum, kaimath weed, John’s wort)

Administration: Variety of oral preparations and as an
infusion.
Active chemicals: Quinoids, flavinoids, bioflavonoids, and
a volatile oil.
Claimed action: Antidepressant, anti-inflammatory, and
antimicrobial.
Use: Depression; healing of burns; herpes simplex virus
and HIV; antibacterial; dyspepsia.
Caution: Used with caution in severely depressed
patients taking other antidepressive medications
including MAO-Is, tricyclic antidepressants, and selective
serotonin reuptake inhibitors; avoid use in patients with
a history of seizure disorders or migraine.
XXI. MANAGEMENT OF PATIENTS RECEIVING RADIATION OR

CHEMOTHERAPY
MOUTH RINSES
Alkaline saline mouth rinse (salt/bicarbonate)
Mix 1/2 tsp each of salt and baking soda in a glass of water.
Sig: Rinse with copious amounts 4 times a day.
93
Biotene mouth rinse (no alcohol)
Dsp: 1 bottle
Sig: Rinse as needed 3 or 4 times a day.
Gelclair bioadherent oral gel (no alcohol; key

ingredients: polyvinylpyrrolodone, hyaluronic acid,
glycyrrhetinic acid)
Dsp: 15 ml per single-dose packet; 1 box contains 21
single-dose packets
Sig: 3 times a day or as often as needed, pour entire
contents of single-dose packet into glass and add 1 tbsp
of water (undiluted or more dilution may be performed to
achieve desired viscosity). Stir mixture and immediately
rinse for at least 1 minute and expectorate. Avoid eating
or drinking for at least 1 hour after use.
Note: Contraindicated in any patient with a known history
of hypersensitivity to any ingredients. Gel may become a
little darker and thicker over time, but this does not affect
efficacy or safety.
Caution: Keep out of direct sunlight; do not refrigerate.
MuGard mucoadhesive oral wound rinse

Dsp: 1 bottle (8 fluid oz)
Sig: Rinse mouth with 5 ml 4–6 times daily for 30–60
seconds, or longer if possible.
Note: Do not wait for mucositis symptoms to appear, but
begin use on the first day of chemotherapy or radiation
therapy and continue for each day of treatment. Do not
eat or drink for 1 hour after use.
Neutral calcium2+/PO43– rinse (Caphosol®) Calcium2+

4.74 mM, PO43– 2.96 mM, Na+ 97.67 mM, Cl– 116.6 mM
and pH 7.1
Dsp: 30 ml per dose
Sig: 4 times a day rinse with 30 ml of solution following
topical application of neutral 2% NaFl gel administered
by tray.
Use: Reduce frequency, intensity, and duration of oral
mucositis in patients undergoing hematopoietic stem cell
transplantation.
Note: A neutral supersaturated solution used in
combination with topical fluoride treatments.
94
Sucralfate suspension 1 g/10 ml (Carafate®)
Dsp: 14 oz.
Sig: Rinse with 10 ml for 1 minute before meals and
at bedtime; then expectorate (or swallow if pharyngeal
ulcerations).
Note: Patients may also prepare slurry using oral tablets
by placing a 1-gram tablet in approximately 15–30 ml of
water. The tablet disintegrates rapidly in water. Patients
may also from a paste by mixing an individual tablet
daily with a topical anesthetic and applying directly to
individual ulcerations.
CHEWABLE WAFER
Mucotrol 2.2 g wafer
Dsp: 1 package
Sig: Chew wafer as needed for oral pain and allow to
slowly dissolve in mouth.
INTRAVENOUS
Palifermin (Kepivance®)
Sig: 60 μg/kg/day for 3 consecutive days before and after
myelotoxic therapy; total of 6 doses.
Use: Decrease the incidence and severity of severe oral
mucositis associated with hematological malignancies
in patients receiving myelotoxic therapy requiring
hematopoietic stem cell support.
Note: May cause taste alteration, mouth/tongue
discoloration or thickness.
GINGIVITIS CONTROL
0.12% Chlorhexidine gluconate mouthwash (Peridex®,
Periogard®)
Dsp: 32 oz
Sig: Rinse with 1/2 oz twice daily for 30 seconds and
expectorate. Avoid rinsing or eating for 30 minutes
Note: Should be used concurrently with substitute saliva
to provide the needed protein-binding agent for efficacy
and substantivity.
0.12% chlorhexidine gluconate oral rinse without

alcohol (CHX®)
95
Dsp: 480 ml
Sig: Swish 15 ml for 1 minute then expectorate; twice
daily morning and evening after tooth brushing and
meals. Avoid eating or drinking for 30 minutes.
2% lidocaine (viscous) 100 ml, tetracycline oral

suspension (125 mg/5 ml) 18 ml, dexamethasone
(0.5 mg/5 ml) 9 ml, nystatin oral suspension (100,000
IU) 73 ml
Dsp: 200 ml
Sig: Rinse or gargle with 2 tsp for 2 minutes 4–5 times
daily.
OVER-THE-COUNTER
BetaCell oral rinse (micellized retinyl palmitate, micellized
D-alpha-tocopheral, micellized beta carotene, glycerin)
Dsp: 16 oz bottle
Sig: Swish 10 ml in the mouth for 60 seconds in the
morning and in the evening and expectorate.
Note: No alcohol or sugar; natural spearmint flavor;
unpublished finding purports reversal of hyperkeratosis
and dysplasia.
Use, additional: Gingival irritations, denture sores,
aphthous ulcers, burns, orthodontic appliance sores, and
leukoplakia (see note).
Ulcerease
Dsp: 6 oz bottle
Sig: Rinse or gargle.
Note: No alcohol; no artificial flavor or color; also comes
in spray for pediatric use.
CARIES CONTROL
Neutral NaFl gel 1.0% (Thera-Flur-N®)
Dsp: 24 ml
Sig: Place 1 drop per tooth in a custom tray; apply for
5 minutes daily. Avoid rinsing or eating for 30 minutes
96
Stannous fluoride gel 0.4%
Dsp: 4.3 oz.
Sig: Place 1 drop per tooth in custom tray; apply for
5 minutes daily. Avoid rinsing or eating for 30 minutes
following treatment. Do not swallow the gel.
TOPICAL ANESTHETICS: see page 14.
ANTIFUNGALS: see page 17.
XXII. HIV INFECTION AND AIDS

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS
Abacavir (Ziagen®)—used in combination with other
antiretroviral drugs
Abacavir and lamivudine (Epzicom®)
Abacavir and lamivudine and zidovudine (Trizivir®)
Didanosine (Videx®, ddI)—used in patients unable to
use ZDV or have not responded to treatment; also Videx
EC—delayed release formula for increased patient
compliance.
Emtricitabine (Emtriva®)—used in combination with other
antiviral agents
Emtricitabine and tenofovir disoproxil fumarate (Truvada®)
Lamivudine (Epivir®, 3TC)—used in combination with ZDV
Stavudine (Zerit®, d4T)—used when intolerance to other
therapies
Tenofovir disoproxil fumarate (Viread®)
Valganciclovir (Valcyte®)—used in AIDS-related
cytomegalovirus retinitis
Zalcitabine (HIVID®, ddC)—used in combination with ZDV
Zidovudine (Retrovir®, AZT®, ZDV®)—used in symptomatic
HIV infections, confirmed P. jiroveci pneumonia, or
absolute CD4 lymphocyte counts < 200/m3
Zidovudine and lamivudine (Combivir®)—used in
combination with at least 1 other antiretroviral agent
PROTEASE INHIBITORS
Amprenavir (Agenerase®)—in combination with other
antiretroviral agents
Atazanavir sulfate (Reyataz®)—used in combination with
other antiretroviral agents
Darunavir (Prezista®)—used in combination with ritonavir
and other antiretroviral agents.
97
Fosamprinavir (Lexiva®)—used in combination with other
antiretrovirals
Indinavir (Crixivan®)—post exposure prophylaxis after
needle stick with ZDV and epivir
Nelfinavir (Viracept®)—when indicated by surrogate
marker changes
Ritonavir (Norvir®)—single-drug therapy or used in
combination with nucleoside analogs
Ritonavir and lopinavir (Kaletra®)
Saquinavir mesylate (Invirase®)—used in combination
with ritinovir
Tipranavir (Aptivus®)—used in combination with ritinovir
and at least 2 other anti-HIV medications
NONNUCLEOSIDE/NUCLEOTIDE REVERSE TRANSCRIPTASE

INHIBITORS
Delaviridine (Rescriptor®)—used in combination with ZDV
or videx or both
Efavirenz (Sustiva®)—used in combination with other
antiretroviral agents that the patient has not previously used
Nevirapine (Viramune®)—used in combination with
nucleoside analogs when clinical or immunologic
deterioration
FUSION INHIBITOR
Enfuvirtide (Fuzeon®)—in combination with other HIV
antiretroviral agents
ENTRY INHIBITOR (CCR5 CO-RECEPTOR ANTAGONIST)

Maraviroc (Selzentry®)
HIV INTEGRASE STRAND TRANSFER INHIBITOR

Raltegravir (Isentress®)
CELLULAR INHIBITOR
Hydroxyurea (Droxia®, Hydrea®)
IMMUNE-BASED THERAPY
Aldesleukin (Proleukin®)
Interleukin-2 (Proleukin®)
HIV immunogen (Remune®)
98
MULTICLASS COMBINATION PRODUCT
Efavirenz, emtricitabine, and tenofovir (Atripla®)
XXIII. HALITOSIS
TONGUE CLEANERS
Breath Ace Breathfreshener® (888-484-2587); Breath-So-
Fresh® (888-437-3749); Breath Taker® (800-826-5650);
Breathtique® (800-682-5840); Denteco® (508-755-0804);
Dr. Tung’s® (800-960-1744); Dr. Wieder’s® (212-529-
1598); Oolitt® (813-931-0390); Orafresh® (800-749-4553);
Oralgiene® (800-933-6725); Professional Tongue Cleaner®
(877-662-9500); Sakool® (800-433-6835); Tongue
Refresher® (800-222-1851); Vista® (414-636-9755)
CHEMICAL PRODUCTS
MALODOR REDUCTION (ZINC SALTS AND/OR CHLORINE DIOXIDE)
Breath RX® (800-422-9448); Breath Gel® (888-437-3749);
Fresh Breath Institute® (888-FBI-TEST); Oxyfresh® (800-
999-9951, ext. 534); Proxi Pure Rinse® (215-504-9388);
Closys-II® (480-948-6997); Therabreath® (800-992-2966);
Tri-Oral® (800-492-7040); Enfresh® (877-363-7374);
Nuconfidence®; Breath Remedy® (800-393-0789);
Rembrandt Dazzling Breathdrops®; Monge® (Bonge, Inc.);
The Natural Dentist® (Woodstock Natural Products); Tooth
and Gum Tonic® (Dental Herb); Colgate Professional Breath
Lozenges® and Rinse; Wow (Wow! Labs); Profresh Rinse®
(ProFresh); Retardex® (Rowpar Pharm.); SmartMouth®
(Triumph Pharmaceuticals)
OVER-THE-COUNTER SPECIFIC REGIMEN

4% chlorhexidine gluconate (Hibiclens®)
Dsp: 120 ml (also 480 ml, 960 ml)
Sig: Scrape the tongue, particularly the base of the
tongue, twice daily and then brush the base of the tongue
with 4% chlorhexidene gluconate.
Use: Halitosis.
Note: If halitosis persists, then consider other GI anatomic
sites as contributors including Zenker’s diverticulum.
Caution: Advise patient that the tongue will be raw for
a while because the bacteria layer is gone, exposing
inflamed papillae.
99
XXIV. PRESCRIPTION REQUIREMENTS AND SAFE WRITING
PRACTICES
Doctor’s Name
Address
Phone Number
Patient’s Name Date
Patient’s Address Age
Rx Drug Name Dosage/Size
Dsp Number of tablets, capsules, ounces to be dispensed.
Sig Direction on how drug is to be taken.
Doctor’s Signature
State License Number
DEA Number (if required)
Fill Generic: This note, if added to the prescription, allows
the pharmacist to fill with the least expensive generic
drug available.
Prescription Writing—always include:

1. Date
2. Full name and address of patient
3. Name and address of prescriber
4. Signature of prescriber
If Class II drug, then the Drug Enforcement Agency (DEA)
number is necessary. If Class II and Class III narcotic, then
a triplicate prescription form (in the state of California) is
necessary and it must be handwritten by the prescriber.
Safe Writing Practices
1. There should be a space between a number and its
units because it is easier to read. There should be no
periods after the abbreviation mg or ml.
2. Never place a decimal and a zero after a whole
number. If the decimal point is not seen because it
falls on a line or because individuals are working
from copies in which the decimal point is not seen,
this causes a 10-fold overdose.
3. Just the opposite is true for numbers less than 1.
Always place a zero before a naked decimal.
4. Never abbreviate the word unit. The handwritten U
or u looks like a 0 (zero) and may cause a 10-fold
overdose error to be made.
100
5. Q.D. is not a safe abbreviation for once daily,
because when the Q is followed a sloppy dot; it
looks like QID, which means 4 times daily.
6. O.D. is not a safe abbreviation for once daily, because
it properly interpreted as meaning “right eye” and has
caused liquid medications such as saturated solution
of potassium iodide and Lugol’s solution to be
administered incorrectly. There is no safe abbreviation
for once daily. It must be written out in full.
7. Do not use chemical names such as 6-
mercaptopurine, because 6-fold overdoses have
been given when these were not recognized as
chemical names. The proper name of this drug is
mercaptopurine.
8. Do not abbreviate drug names because they are
misinterpreted and cause error.
9. Do not use the apothecary system or symbols.
10. When writing an outpatient prescription, write a
complete prescription. A complete prescription can
prevent the prescriber, the pharmacist, and/or the
patient from making a mistake and can eliminate the
need for further clarification.
The legible prescription should contain:
a. Patient’s full name
b. For pediatric or geriatric patients, their age
(or weight where applicable)
c. Drug name, dosage form and strength; if a drug is
new or rarely prescribed, print this information
d. Number or amount to be dispensed
e. Complete instructions for the patient, including
the purpose of the medication
f. When there are recognized contraindications for
a prescribed drug, indicate to the pharmacist that
you are aware of this fact.
Call 1-800-331-2498 to find the nearest pharmacist
who participates in the Compounding Centers of
America.
DANGEROUS PRESCRIPTION ABBREVIATIONS

ABBREVIATION INTENDED MEANING COMMON ERROR
U = units; mistaken for a zero (0) or a 4, resulting in
overdose. Also mistaken for “cc” (cubic centimeters
[cm3]) when poorly written.
101
μg = micrograms; mistaken for “mg” (milligrams),
resulting in an overdose.
Q.D. Latin abbreviation; the period after the “Q” for “every
day” has sometimes been mistaken for an “I” and the drug
has been given “QID” (4 times daily) rather than daily.
Q.O.D. Latin abbreviation; misinterpreted as “QD” for
“every other day” or “QID” (“4 times daily”). If the “O”
is poorly written, it looks like a period or an “I.”
SC or SQ = subcutaneous; mistaken for “SL”
(“sublingual”) when poorly written.
T I W = 3 times a week; misinterpreted as “3 times a
day” or “twice a week.”
D/C = discharge; mistaken for “discontinue.” Patient’s
medication has been prematurely discontinued when D/C
(intended to mean “discharge”) was misinterpreted as
“discontinue.”
HS = half strength; misinterpreted as the Latin
abbreviation “HS” (“hour of sleep”).
cc = cubic centimeters; mistaken for “U” (“units”) when
poorly written.
IU = International Unit; mistaken for “IV” (“intravenous”)
or 10 (ten)
MS, MSO4 Confused for (1); can mean morphine, MgSO4,
another sulfate, or magnesium sulfate
RELATIVE POTENCIES OF SELECTED TOPICAL

CORTICOSTEROIDS [MODIFIED FROM ONLINE
THE MERCK MANUALS]
Class
I Betamethasone dipropionate 0.05% ointment
Clobetasol propionate 0.05% cream or ointment
Halobetasol propionate 0.05% cream or ointment
II Betamethasone dipropionate 0.05% cream
Fluocinonide 0.05% cream, gel, ointment, or solution
III Betamethasone valerate 0.1% ointment
Fluocinonide 0.05% cream
Triamcinolone acetonide 0.1% ointment
102
IV Fluocinonide acetonide 0.025% ointment
Triamcinolone acetonide 0.1% cream
V Betamethasone valerate 0.1% cream
Fluocinonide acetonide 0.025% cream
Hydrocortisone valerate 0.2% cream or ointment
VI Triamcinolone acetonide 0.025% cream
VII Hydrocortisone 1% cream or 2.5% ointment
Class I is the most potent and Class VII is the least potent.
REFERENCES
Baker KA, course presenter. American Academy of Oral and
Maxillofacial Pathology annual meeting, CERP—approved
continuing dental education course, Chicago, IL, April 29,
2001.
Bulletin Board of Oral Pathology <BBOPLIST@LISTSERV.
BUFFALO.EDU>
Ciancio SG, editor. ADA Guide to Dental Therapeutics, 1st edition,
ADA Publishing Company, Inc., Chicago, IL, 1998.
Daniels TE, Wu AJ. Conley, editor. Xerostemia: Clinical evaluation
and treatment in general practice. Journal of the California
Dental Association 2000:28(12):933-941.
Eversole LR. Appendix V. In Clinical Outline of Oral Pathology:
Diagnosis and Treatment Planning, 3rd edition. Lea & Febiger,
Philadelphia, 1992.
Eversole LR. Oral Medicine: A Pocket Guide. WB Saunders,
Philadelphia, 1996.
Femiano F, Scully C. Burning mouth syndrome: double blind
controlled study of alpha-lipoic acid therapy. Journal of Oral
Pathology and Medicine 2002;31:267–269.
Gage TW, Pickett FA. Mosby’s Dental Drug Reference, 5th edition.
Mosby, St. Louis, 2001.
Ganda K, course director. Management of the Medically
Compromised Dental Patient: Do’s, Don’ts and Drug-Drug
Interaction. Tufts University School of Dental Medicine, Department
of General Dentistry, Medicine IIB course manual, 2006.
Gonzalez-Moles MA, et al. Treatment of severe chronic oral
erosive lesions with clobetasol propionate in aqueous solution.
103
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and
Endodontics 2002;93:264–270.
Jancso N, Jancso-Gabor A, Szolcsanyi J. Direct evidence for
neurogenic inflammation and its prevention by denervation and
by pretreatment with capsaicin. British Journal of Pharmacology
and Chemotherapy 1967;31:138–151.
Langlais RP, Miller CS. Appendix II. In Color Atlas of Common Oral
Diseases. Lippincott Williams & Wilkins, Philadelphia, 2003.
Murphy JL, editor. Nursing Practitioner’s Prescribing Reference.
Prescribing Reference, Inc., New York, NY, 2004.
Nagamatsu M, Nickander KK, Schmelzer JD, et al. Lipoic acid
improves nerve blood flow, reduces oxidative stress, and
improves distal nerve conduction in experimental diabetic
neuropathy. Diabetes Care 1995;18:1160–1167.
Newland JR, Meiller TF, Wynn RL, Crossley HL. Oral Soft Tissue
Diseases: A Reference Manual for Diagnosis and Management.
Lexi-Comp, Hudson, OH, 2005.
Passeron T, et al. Treatment of oral erosive lichen planus
with 1% pimecrolimus cream: a double-blinded, randomized,
prospective trial with measurement of pimecrolimus levels in the
blood. Archives of Dermatology 2007;143:472-476; 511–515;
519–523.
Physician Desk Reference, 61st edition. PDR Network, Inc.,
Montvale, NJ, 2007.
Rosenberg SW, Arm RN, editors. Clinician’s Guide to Treatment of
Common Oral Conditions, monograph of the American Academy
of Oral Medicine, 4th ed. New York City, NY, 1997.
Shingler DC, editor-in-chief. Dental Prescription Handbook: The
Blue Book. American Academy of Oral Pharmacology, Cleveland,
OH, 1996.
Wynn RL, Meiller TF, Crossley HL. Drug Information Handbook for
Dentistry, 13th edition. Lexi-Comp, Cleveland, OH, 2087.
Internet:www.ada.org/public
104
Notes:
105
Prophylactic Regimens for Dental/Oral/Respiratory
Tract or Esophageal Procedures to Prevent Bacterial
Infective Endocarditis (IE). Total children’s dose
should not exceed adult dose.
I. Standard general prophylaxis for patients at risk

Amoxicillin: Adults, 2.0 g (children, 50 mg/kg) given
orally 30–60 minutes before procedure.
II. Unable to take oral medications

Ampicillin: Adults, 2.0 g (Children, 50 mg/kg) given IM
or IV 30–60 minutes before procedure
OR
Cefazolin or ceftriaxone 1 g (children, 50 mg/kg) IM or
IV 30–60 minutes before procedure.
III. Amoxicillin/ampicillin/penicillin-allergic patients

Clindamycin: Adults, 600 mg (Children, 20 mg/kg)
given orally 30–60 minutes before procedure
OR
Cephalexin* or cefadroxil*: Adults, 2.0 g (Children, 50
mg/kg) orally 30–60 minutes before procedure
OR
Azithromycin or clarithromycin: Adults, 500 mg
(Children, 15 mg/kg) orally 30–60 minutes before
procedure.
IV. Amoxicillin/ampicillin/penicillin-allergic patients

unable to take oral medications
Clindamycin: Adults, 600 mg (Children, 20 mg/kg) IM
or IV 30–60 minutes before procedure.
OR
Cefazolin or ceftriaxone*: Adults, 1.0 g (Children,
25 mg/kg) IM or IV within 30–60 minutes before
procedure.
________________________________
*
Cephalosporins should not be used in patients with a
history of anaphylaxis, angioedema, or urticaria with
penicillins or ampicillin
________________________________
106
Endocarditis Prophylaxis Recommended
Cardiac conditions with the highest risk of adverse
outcome from endocarditis:
• Prosthetic cardiac valve
• Previous infective endocarditis
• Congenital heart disease (CHD)*
• Unrepaired cyanotic CHD including palliative shunts
and conduits
• completely repaired congenital heart defect with
prosthetic material or device, whether placed by
surgery or by catheter intervention, during the first
6 months after the procedure*
• Repaired CHD with residual defects at the site
or adjacent to the site of a prosthetic patch or
prosthetic device (which inhibits endothelialization)
• Cardiac transplantation recipients who develop cardiac
valvulopathy
________________________________
*
Except for the conditions listed earlier, antibiotic
prophylaxis is no longer recommended for any other type
of CHD.
All dental procedures that involve manipulation
of gingival tissue or the periapical region of teeth or
perforation of the oral mucosa only for patients with
underlying cardiac conditions associated with the highest
risk of adverse outcome from IE (i.e., listed earlier).
________________________________
Endocarditis Prophylaxis Not Recommended

Routine anesthetic injections through noninfected tissue
Taking dental radiographs
Placement of removable prosthodontic or orthodontic
appliances
Adjustment of orthodontic appliances
Placement of orthodontic brackets
Shedding of deciduous teeth
Bleeding from trauma to the lips or oral mucosa
107
INDEX
Abacavir, 97 Adrenocortical suppression,
Abreva, 50 28–29
Abscesses Adrenocortical steroids, diurnal,
abdominal, 18 29
acute, 10 Advil, 58
oral, 7, 9 Aerobic bacteria, 8
Acetaminophen Agenerase, 97
dosage limitations, 56 AIDS
500 mg with hydrocodone 5 cellular inhibitor, 98
mg, 59 entry inhibitor, 98
500 tablet with chlorzoxazone, fusion inhibitor, 98
52 HIV integrase strand transfer
750 mg, with hydrocodone inhibitor, 98
bitartrate, 60 immune-based therapy, 98
650 mg, with hydrocodone mononucleoside/nucleotide
bitartrate, 60 reverse transcriptase
325 mg, 57–59 inhibitors, 98
325 mg with codeine, 59 multiclass combination
325 mg with oxycodone HCl 5 product, 99
mg, 59 nucleoside reverse
toxicity, 56–57 transcriptase inhibitors, 97
Acetylsalicyclic acid protease inhibitors, 97–98
325 mg, 57 Alcohol, generally
325 mg with codeine, 59 abuse, 57–58
Achromycin V, 9 consumption, cautionary
Acidulated phosphate notes, 56
fluoride as ingredient, 12, 45
0.05%, sodium, 72 Alcoholics, medications to avoid, 4
1.2%, 74–75 Alcortin A gel, 19–20
1.23%, foam, 75 Aldesleukin, 98
Acne, as side effect, 44 Aleve, 58
ACT, 75 Allergies
Actinobacillus spp., 9 to aspirin, 61
Actiq, 63 to codeine, 63
Actisite, 10 to morphine, 56
Acyclovir penicillin, alternatives
800 mg, 48 medications for, 1, 7
400 mg, 47–48 risk for, 57
5%, cream, 47 shellfish, 77
5%, with hydrocortisone 1% Alpha lipoic acid 300 mg caplets,
cream, 48 83
5%, ointment, 46 Alprazolam
5%, ointment with dyclonine 0.5 mg extended release, 53,
HCl 1% or lidocaine 1% 78–79
compound, 46 0.25 mg, 53, 78
200 mg, 47 side effects of, 72
Aluminum, generally Antianxiety agents, 53–55, 60.
acetate, 50 See also Anxiety
chloride, 78 Antiarthritic drugs, 91
Alvogyl, 25 Antibiotics
Amitriptyline beta-lactam, 2
contraindications for, 41, 67 overview of, 1–10
2% spray, 79 Anticaries agents
25 mg, 79 home, over-the-counter, 75
Amlexanox, 5%, oral paste, 38–39 prescription, dental office use,
Amoxicillin 74–75
50 mg/ml, 1 prescription, home use, 72–74
500 mg/ml, 1 Anticholinergic agents, 4, 67
500 mg/clavulanate 125 mg, 1 Anticoagulants
2.0 g, 107 influential factors, 1, 91–92
Amphetamines, 67, 86 toxicity, 56
Amphotericin B Antidepressants
influential factors on, 19–20 characterized, 55–56, 93
oral suspension, 100 mg/ tricyclic (TCAs), 59–60, 62, 65,
ml, 17 67, 78, 92
side effects of, 86 Antifungals, 17–24
3% cream, 17 Antihistamines, 12, 21
Ampicillin Antihypertensives, 67
side effects of, 86 Anti-inflammatories
2.0 g, 107 alternatives to steroids, 38–45
Amprenavir, 97 steroids, 28–38
Amrix, 52 topical wound repair, 45
Anacin, 57 used in conjunction with
Anaerobic bacteria, 7–8 lowered dose of steroids, 38
Analgesics Antimicrobials
characterized, 55–56 over-the-counter, 10–11
for mild to moderate pain, overview of, 1–2
56–58 Antiparkisonian agents, 67
for moderate pain, 58–59 Antiplatelet drugs, 92
for moderate to severe pain, Antipsychotic agents, 60, 67
59–62 Antiviral agents, 46–51, 97
narcotic, 45 Antixerostomics, 67–75
for severe pain, 62–63 ANUG with fever, 9
Anaprox, 57 Anxiety, 53–55
Ancobon, 19–20 Anxiolytics, 53–55
Anemia, as side effect, 22, 59–60, Aphthasol, 38–39
84 Aphthous ulcers, prevention
Anesthesia methods, 90
general, 93 Aptivus, 98
supplemental, 61 Arestin, 7–8
topical, 14–15, 41 Aristocort, 38
Anesthetics, local. See Local Arteritis, giant cell, 64
anesthetics Arthritis, 91–92
Anidulafungin 50 mg, 17–18 Articadent, 64
110
Articaine HCl, 4%, with 1:100,000 aerosol spray, 40 :g, 29
or 1:200,000 epinephrine, Beclovent, 29
64 Behçet’s disease, 39
A.S.A., 57 Benacort-tetrastat elixir, 13
Aspergillus spp., 20 Benadryl, 12–13, 81
Aspirin Benzalkonium chloride, 5%, 35%
characterized, 57, 61 hydroxyethyl methacrylate
influential factors on, 91 (HEMA), 0.5% sodium
325 mg, butalbital 50 mg, fluoride, 75
caffeine 40 mg, 56 Benzocaine
Astemizole, contraindications, 4 characterized, 14
Asthma 14%, with 2% butamben 2%
aspirin-induced, 57 tetracaine gel or liquid or
contraindicated medications ointment, 14
for, 12 gel or liquid or spray, 20%, 14
uncontrolled, 70 Orabase with, 15, 31
Atarax, 54 Benzocaine gels, for mouth pain
Atazanavir sulfate, 97 relief, 14, 88–90
Ativan, 54, 82 Benzodiazepines, 78
Atridox, 6 Benzoin tincture saturated
ATRIGEL®, 6 swabsticks, 25
Atripia, 99 Benztropine mesylate, 67
Atropine 0.4 mg, 72 Benzylalkonium chloride, 50–51
Atropinics, 67 Beta blockers, 67
Attapulgite, 12 BetaCell oral rinse, 25
Augmentin, 1 Betadine, 10
Autoimmune diseases, 39, 92 Betamethasone dipropionate
Avamin Melts®, 25 0.05% cream or ointment,
Avlosulfon, 39–40 102
Azathioprine Betamethasone
characterized, 35, 86 0.05% cream, 102
50 mg, 38 0.05%, dipropionate ointment,
Azithromycin (AZT) 30, 102
characterized, 97 0.1% valerate cream, 103
500 mg, 107 0.1%, valerate ointment, 30
250 mg, 500 mg, 600 mg, 1 0.6 mg/5 ml syrup, 30
Azoles, sensitivity to, 22 Bethanechol 25 mg, 7
Biaxin, 4–5
Baclofen, 51, 86 Biliary stones, 70
Bacteroides fragilis, 9 Biliary disease, 71
Bactrim, 10 Bioflavenoids and ascorbic acid
Barbiturates, 12, 56, 60 tablets
Basic Gel, 73 citrus, 400 mg, 51
Bayer Aspirin water-soluble, 200 mg, 84
characterized, 57 Biotene®, 68, 86
with codeine, 59 Black cohosh, 90–91
Becaplermin 0.01% gel, 45 Blastomycosis, 20
Beclomethasone dipropionate Bleeding disorders, 57
111
Bone marrow Capnocytophaga spp., 9
depression, 58, 62, 79 Capsaicin
suppression, 28, 64 cream, 79
Bronchodilators, systemic, 67 0.025% cream, 83–84
Bufferin, 57 topical, 84
Bulla diseases, 24–28 Captopril, 67, 86
Bupivicaine, 0.5%, with 1:200,000 Carafate, 42, 95
epinephrine, 64 Carbamazepine
Burning mouth syndrome ER 200 or 300 mg, 79–80
characterized, 55, 67 5% in PLO gel, 80
over-the-counter medications, influential factors on, 6, 86
83–84 100 mg, 64, 79
overview of medications, 200 mg, 79
78–83 Carbocaine, 65
Burns, 25 Carbonic anhydrase inhibitors,
Buspar, 53 67, 86
Buspirone 5 mg, 53 Cardiovascular system
Butalbital 50 mg/aspirin or angina bullosa hemorrhagica,
acetaminophen 325 mg/ 77
caffeine 40 mg, 58–59 arrhythmia, 71
Butamben, 25 cardiac arrest, as side effect,
66
Cafergot, 66 congestive heart failure,
Cancer medications to avoid, 20
colon, 92 coronary bypass graft patients,
head and neck, 71 60
nonmelanoma skin, 4 diseases of, generally, 7, 39,
pain, 63 66, 79
risk factors for developing, 34, endocarditis prophylaxis, 108
43, 45 heart attack risk, 57
see also Chemotherapy patient infective endocarditis (IE),
management; Radiation bacterial, preventive
patient management prophylactic regimens, 107
Cancidas, 18 influential factors, 60–61
Candida, 17 myocardial infarction, 60–61,
Candidemia, 18 79
Candidiasis Cardizem, 66
characterized, 29 Caries, see also Anticaries agents
denture-related, 23 control, 96–97
esophageal, 18, 21 influential factors, 13, 61
mucocutaneous, 17 prevention of, 73–74
oral, 20–21, 24, 61 risk for, 18, 75
oropharyngeal, 17, 22 Carimune NF, 40
predisposition to, 37 Carnitine deficiency, 2
secondary, 44 Carrington patch, 27
Canker Cover mint flavor, 26 Caspofungin acetate 50 mg and
Cankermelts®-GX, 26 70 mg, 18
Caphosol, 6, 94 Cauterizers, chemical, 15–16
112
CCR5 co-receptor antagonist, 98 125 mg/5 ml suspension
Ceclor, 2 (Keflex), 3
Cefaclor clarithromycin, 15 mg/kg, 107
125 mg/5 ml suspension, 2 clindamycin 75 mg/5 ml, 5
500 mg, 2 clindamycin, 20 mg/kg, 107
Cefadroxil, 1.0 g and 2.0 g, 107 clotrimazole 10 mg/ml
Cefazolin, 107 suspension, 19
Cefditoren pivoxil 200 g, 2 erythromycin ethylsuccinate
Ceftriaxone, 107 oral suspension (EES,
Celebrex, 60 EryPed), 7
Celecoxib 100 mg, 200 mg, 400 fluocinolone, 0.05%, gel or
mg tablets, 60 ointment, 32–33
Celestone, 30 hydroxyzine 25 mg (Atarax), 54
CellCept, 41–42 hydroxyzine pamoate 25 mg
Cellulitis, 9 (Vistaril), 54
Cephalexin ibuprofen (Motrin), 58
1.0 g, 107 infective endocarditis (IE)
2.0 g, 107 preventive prophylactic
Cephalexin monohydrate regimens for, 107
125 mg/5 ml suspension, 3 local anesthetic reverse agent
250 or 500 mg, 2–3 (OraVerse), 66
Cephalosporins, 3 older than 2, 47
Cerebrovascular disease, 78. See penicillin V potassium liquid
also Stroke 125 mg/5 ml (Pen-Vee K
Cetacaine, 14 liquid), 8–9
Cevimeline HCl 30 mg, 70 promethazine 6.25 mg/5 ml,
Chamomile, 91 12–13
Cheilitis promethazine 12.5 mg
angular, 18, 20–21, 23–24 (Phenergan), 12
exfoliative, 19 sodium fluoride 0.5 mg fluoride
Chemotherapy patient ion/1.0 ml (Luride Drops),
management, 67, 93–97 74
Chicken pox, 57. See also under age 2, 14, 31–32, 50
Varicella zoster under age 6, 26
Children, medication guidelines under age 8, 6
acyclovir, 46–47 Chitosan, 77
age 12 and older, 47 Chlordiazepoxide
amoxicillin 20 mg/kg, 107 5 mg, 80
amoxicillin 50 mg/ml, 1, 107 10 mg, 53
atropine (Sal-Tropine), 72 Chlorhexadine, 86
azithromycin, 15 mg/kg, 107 Chlorhexidine gluconate
cefaclor 125 mg/5 ml 4%, 99
suspension (Ceclor), 2 0.12%, 3
cefazolin, 25 mg/kg and 50 0.12% oral rinse without
mg/kg, 107 alcohol, 3
ceftriaxone, 25 mg/kg and 50 0.2% aqueous, 3–4
mg/kg, 107 Chlorpheniramine maleate, 86
cephalexin monohydrate Chlorpromazine, 67
113
Chlorthalidone, 67 Clostridium, 1, 7
Chlorzoxazone Clotrimazole
250 mg, 52 1% and betamethasone cream,
with acetaminophen 500 mg 18
tablet, 52 1% cream, 18
Chondroitin sulfate, 91 10 mg/ml suspension, 19
Chromomycosis, 20 troches 10 mg, 18
Chronic vestibular/bulla diseases, 200 mg, 24
24–28 vaginal cream, 1%, 24
CHX, 3 Clozapine, 72
Cimetidine CNS stimulants, 4, 67
drug interactions, 49 Coagulation disorders, 77
200 mg, 45 Coating agents, palliative, 12
Cipro, 4 Coccdioides, 20
Ciprofloxacin 250–750 mg, 4 Codeine
Circulatory depression, 63 allergy to, 63
Cisapride, contraindications, 5 contraindications for, 54, 56
Citanest Forte/Citanest Plain, 65 overview of, 59
Clarithromycin sensitivity to, 62
250 mg, 4–5 Colchicine 0.6 mg, 39
500 mg, 4–5, 107 Colgate
Cleosin Sensitive Pro-Relief
HCl, 5 Desensitizing paste, 75
Pediatric, 5 Total® toothpaste, 10
Clindamycin Colitis
influential medications, 4 pseudomembranous, 10
150 mg or 300 mg, 5 as side effect, 2
600 mg, 107 Combivir, 97
75 mg/5 ml, 5 Combunox, 61
Clinitest, influential factors, 2 Compazine, 55
Clinpro 5000, 74 Condyloma acuminatum, 17
Clobetasol, 41 Constipation, as side effect, 13
Clobetasol, 0.05%, propionate Corticosteroids, topical, relative
cream or ointment, 102 potencies of, 102–103
gel or ointment, 30–31 Coumadin, 6, 58
and nystatin 100,000 IU/ml Crixivan, 98
aqueous solution, 31 Cryptococcus, 20
ointment with Orabase or Cut-Trol, 78
Orabase with benzocaine, Cyclobenzaprine HCl
31 extended release 15 mg
Clofazimine soft gelatin 50 mg capsules, 52
capsules, 39 10 mg, 52
Clonazepam Cyclosporine
0.25 mg, 80 concurrent use of, 18
0.5 mg, 80–81 influential factors, 6
Clonidine toxicity, 4
characterized, 67, 72 Cycoflex, 52
dipotassium 7.5 mg, 53 Cyklokapron, 77–78
114
Cytochrome P450 inhibition, 6 Diflunisal 250 or 500 mg, 56
Cytotec, 41 Digoxin
contraindications for, 66
Dapsone 25 mg, 39–40 drug interactions, 49
Darunavir, 97 toxicity, 6–7, 56
Deafferentation pain, 79, 83 Dihydrocodeine bitartrate 16 mg,
Debacterol®, 15–16 aspirin 356.4 mg, caffeine
Decadron, 31 30 mg, 60
Decapinol, 25 Dilantin
Delaviridine, 98 characterized, 82–83
Delmopinol HCl mouth rinse, 2 toxicity, 56
mg/ml, 25 Dilaudid, 63
Deltasone, 35, 64 Diltiazem 60 mg, 66
Demerol, 63 Diphenhydramine
Denavir, 49 elixir 12.5 mg/5 ml, 12
Dental chewing gums, over-the- elixir 12.5 mg/tsp, 81
counter, 68–69 (12.5 mg/5 ml) 173 ml, with
Dentures. See Removable tetracycline, 44
prostheses disinfectants/ HCl 50 mg, 12
cleaners Diprolene, 30
Depression, 55, 83, 93 Diuretics, 67
Dermatoid arthritis, 92 Docosanol, 10%, cream, 50
Desipramine, 67 Dolobid, 56
Desyrel, 55, 83 Domeboro astringent, 50
Dethylproprion, 67 Doxepin HCl 25 mg, 55, 81–82
Dexamethasone Doxycycline
elixir 0.5 mg/5 ml, 31–32 hyclate 10.0%, 6
(0.5 mg/5 ml) 9 ml, with 100 mg, 40
lidocaine, 40 20 mg, 6
(0.5 mg/5 ml) 9 ml, with 200 mg, 5–6
tetracycline, 44 Dressings
0.75 mg, 34 burn, 45
sodium phosphate injectable occlusive, 24–28
4 mg/ml with lidocaine wound, 45
HCl, 32 Droxia, 98
suppression test, 83 Dry mouth, symptom relief, 67–71
Diabetic patients, medication Duraphat, 76
guidelines for, 18, 28, 35, Dycill, 5
40, 45 Dyclone®, 14
Diazepam Dyclonine HCl
characterized, 44, 66 with acyclovir ointment, 46
5 mg, 54 0.5% or 1%, 14
2 mg, 81 Dynapen, 5
Dicloxacillin 250 mg and 500 Dysphonia, 29
mg, 5
Dicyclomine, 67 Easy Gel, 73
Didanosine, 97 Echinacea, 91–92
Diflucan, 19 Ecotrin, 57
115
EES, 6–7 myogenic, 51–54
Efavirenz, 98–99 psychogenic, 55, 82–83
Elavil, 79 Famciclovir, 500 mg, 48–49
Elderly patients, cautionary notes Famvir, 48–49
for, 40, 52, 57, 59, 63 Fentanyl buccal effervescent
Elidel, 34 lozenge 100, 200, 400, 600,
E-mycin 250 mg, 7 800 :g, 62–63
Empirin, 57 Fentora, 62–63
Emtricitabine, 97, 99 Ferrous sulfate 250 mg, 84
Emtriva, 97 Fioricet, 58–59
Enfuvirtide, 98 Fiorinal, 56, 58–59
Enisyl, 51 Flagyl, 7
Ensure-Plus, 85 Flavoxate, 67
Enterobacter spp., 10 Flexeril, 52
Enterococci, effective medications Flo Gel, 72–73
against, 5 Fluconazole
Epinephrine, 64–65, 78 characterized, 19
Epivir, 97 contraindications for, 45
Epzicom, 97 100 mg tablets, 19
Eraxis, 17–18 100 mg tablets/hydrocortisone
Ergot, 66 10 mg and iodoquinol 10
Ergotamine tartrate with caffeine mg, 19
suppositories, 66 Flucytosine 250 mg or 500 mg,
Erosive/ulcerative diseases, 19–20
24–28 Fluocinolone, 0.05%
Ery-Tab, 6–7 gel, 32
ERYC, 6–7 gel or ointment, 32–33
EryPed, 7 ointment compounded with
Erythema 1:1 with Orabase with
influential factors, 10 benzocaine, 33
multiforme, 13, 32, 34–36, 38, Fluocinonide
44, 47 acetonide 0.25% ointment or
Erythromycin, characterized, 4, 7 cream, 103
Erythromycin ethylsuccinate contraindications for, 41
400 mg, 6–7 0.05% cream, gel, ointment, or
oral suspension 200 mg/5 solution, 102
ml, 7 Fluoride gels/rinse, 67–75
Erythromycin stearate 500 mg, 7 Fluoridex, 74
Escherichia coli, 10 Fluoridex Maximum Uptake,
Esophagitis, 57 75
Etodolac 200 mg, 56 Fluorigard, 75
Eugenol, 25 Fluorocare
Evoxac, 70 Neutral, 74
Time Saver, 74–75
Facial arteries, 64 Fluoxetine HCl 20 mg, 55, 82
Facial pain Folic acid
midface vascular, 66 deficiency, 84
myofascial, see Myofascial pain 0.4 mg, 84
116
Food and Drug Administration over-the-counter regimens, 99
(FDA) guidelines, 14, 25, tongue cleaners, 99
27, 30, 32, 34, 43, 56, 58, Halobetasol
62, 88 0.05%, propionate gel, 33
Food supplements, 85 propionate 0.05% cream or
Fosamprinavir, 98 ointment, 102
Fungizone®, 17 Haloperidol, 67
Fuzeon, 98 Headache
characterized, 79
Gabapentin 100 mg (300 mg, 400 cluster, 66
mg), 82 medication guidelines for,
Gammagard liquid, 40 51–52
Gammar P-IV, 40 midface cluster, 66
Gamunex, 40 migraine, 66, 93
Gastritis, 57 Head and neck pain,
Gastrointestinal bleeding, risk for, nonanalgesics for, 64
57–58, 62 Health-Dent desensitizer with
Gastrointestinal diseases and fluoride, 75
disorders, 2, 39 Hematology
Gelclair bioadherent gel, 26, 94 hematological disorders, 39
Gel-Kam, 72–73 hemodynamics, influential
Gel-Pro Control, 72–73 factors, 70
Gel-Tin, 73 platelet aggregation, influential
Germicidals, 46–517 factors, 61
Gingivitis platelet dysfunction, 57
control, 95–96 steroid therapy and 28–29
necrotized ulcerative, 11 see also Anemia
ulcerative, 7, 76 Hematopoietic stem cell
Ginkgo, 92 transplant patients, 22
Ginseng, 92–93 HemCon dental dressing, 76–77
Glaucoma, 12, 70 Hemolysis, 40–41
Gluma, 76 Hemostatic agents
Glutaraldehyde/hydroxyethyl intravenous, 77–78
methacrylate (HEMA), 76 topical, 76–77
Gonorrhea, oral, 9 Hemostatsyl hemostatic agent, 77
Gram-negative anaerobes, 4 Hepatoxicity, 28, 44
Griseofulvin, 86 Herbal remedies, 90–93
Guanethidine, 67 Herpes
Guanifenesin 10% in speed gel, gingivostomatitis, primary, 46
52–53 labialis, primary and recurrent,
Gyne-Lotrimin, 24 46–50
oral, 47
Haemophilus spp., simplex, orofacial, 50
characterized, 7 simplex virus (HSV), 47
influenzae, 1, 10 zoster, 46
Hairy tongue, 17 Herpetic gingivostomatitis, 13
Halitosis Histoplasmosis, 20
chemical products, 99 HIV immunogen, 98
117
HIVID, 97 valerate 0.2% cream or
HIV infection ointment, 102
cellular inhibitor, 98 Hydromorphone HCl 2 mg, 63
entry inhibitor, 98 Hydroxyurea, 98
fusion inhibitor, 98 Hydroxyzine
HIV integrase strand transfer pamoate 25 mg, 54
inhibitor, 98 25 mg, 54
immune-based therapy, 98 Hypertension, 60–61, 66, 71
mononucleoside/nucleotide Hypertensive agents, 67
reverse transcriptase Hypoglycemia, 83
inhibitors, 98 Hypotension, 63
multiclass combination
product, 99 Ibuprofen
nucleoside reverse characterized, 61
transcriptase inhibitors, 400 mg, with acetaminophen
97 1000 mg, 62
protease inhibitors, 97–98 400 mg, with oxycodone HCl
Hormone suppression, 90 5 mg, 61
H2-blockers, 54 200 mg, 58
Human immunodeficiency virus. 200 mg, with hydrocodone
See HIV immunogen; HIV bitartrate, 60
infection 800 mg, 57
Hurricaine, 14 Idoxyuridine, 86
Hydra, 98 IDP Gel-oh, 72–73
Hydrochlorothiazide toxicity, 56 Ileus, paralytic, 61
Hydrocodone bitartrate Imipramine, 67
7.5 mg and acetaminophen Immune-depressed patients, 22
750 mg, 60 Immune globulin, intravenous,
7.5 mg and ibuprofen 200 mg, 40
60–61 Immunocompromised patients,
10 mg and acetaminophen 650 42, 49
mg, 60 Immunomodulators, topical, 43
Hydrocodone 5 mg and Immunosuppresant therapy,
acetaminophen 500 mg, 41, 43
59 Immunosuppressed patients, 29,
Hydrocortisone 46–47
actetate ointment, 0.5%, 24 Immunosuppressives, 24–28
1%, with polymyxin B, Imuran, 38
bacitracin, neomycin cream Indinavir, 98
compounded 1:1 with 5% Indocin toxicity, 56
lidocaine ointment, 33 Infants
1% cream or 2.5% ointment, clotrimazole 10 mg/ml
103 suspension, 19
10 mg, with fluconazole and congenital malformations, 42
iodoquinol 10 mg, 19 lidocaine HCl viscous, 2%,
10 mg and iodoquinol 10 15
mg, 20 Infection, medication guidelines
2% and iodoquinol 1%, 20 for
118
acute, 6–7 Ketoconazole
aspergillus, 18, 20, 22 cream 2% or mixed with equal
bacterial, oral, 8 parts of triamcinolone
Bacteroides, 5 acetonide 0.1% or 0.5%
C. difficile, 10 ointment, or fluocinonide
Candida, 17, 21 0.05% ointment, or
fungal, 19 clobetasol 0.05% ointment,
herpes simplex, 47, 51 21
HIV management, 97–99 200 mg, 21
lower respiratory, 1, 6–7 Ketorolac
ontogenic, 9 nasal spray, 61
penicillin-resistant, 1 tromethamine 10 mg, 59
penicillinase-resistant, 1 Kidney diseases and disorders
periodontal, 4 compromised renal status, 57
skin, 1 contraindicated medications,
soft tissue, 2, 6–7 6–7, 10
staph, 4 end-stage renal disease, 5
steroid treatment, 28 renal-compromised patients,
upper respiratory, 1, 4, 6–7, 92 medication cautions for, 1,
urinary tract, 92 3, 5, 8–9
Infectious disease, medication renal dysfunction, as side
guidelines for, 35, 92 effect, 2
Interleukin-2, 98 renal impairment, 47, 78
Invirase, 98 medications to avoid, 5, 39–40,
Iodine, allergies to, 11 63, 78
Iodoform, 25 nephrotoxic medications, 40
Iodoquinol Klebsiella spp., 10
with hydrocortisone 10 mg, 20 Klonopin, 80–81
10 mg, with fluconazole and
hydrocortisone 10 mg, 19 Laclede ORALBalance®, 69
with 2% hydrocortisone, 20 Lactinex tablets, 45
Iritis, acute, 70 Lamivudine (3TC), with abacavir
Isentress, 98 or zidovudine, 97
Isocaine 3%, 65 Lamprene, 39
Itraconazole L. pneumophila, 1
characterized, 20 Legionnaire’s disease, 7
100 mg, 20 Lesions
10 mg/ml oral solution, 20–21 herpes simplex, 28, 49
Iveegam EN, 40 genital, 46
gingival, 29
Kaletra, 98 vesiculoulcerative, 13–16
Kamillosan, 84 Leukoencephalopathy, 42
Kaopectate, 12Keflex, 2–3 Leukoplakia, 96
Kenalog, 21, 36, 38 Levodopa, 72, 86
Kepivance, 95 Levornordefrin, 65
Keratolytic agents, 16–17 Lexiva, 98
Ketaconazole, 45 Librium, 53, 80
Ketaprofen 12.5 mg, 57–58 Lidex, 21, 32–33
119
Lidocaine overdose management, 66
characterized, 45 reversal agent, 66
mixed with capsaicin cream, Lodine, 56
79 Loop diuretics, 67
ointment, 5%, 15 Lopinavir, 98
1%, with acyclovir ointment, Lorazepam
46 characterized, 72
with triamcinolone acetonide 0.5 mg, 82
suspension, 37 1 mg, 54
2%, with 1:100,000 Lorcet, 60
epinephrine, 64 Lortab 5 mg, 59
2.5%, with 2.5% prilocaine Lotrimin AF/Lotrimin-Rx, 18
periodontal gel, 64–65 Lymphoma, 43
viscous, 2%, 100 ml, Lymphoproliferative disorders, 41
tetracycline oral suspension Lyphocin, 10
(125 mg/5 ml) 18 ml,
dexamethasone (0.5 mg/5 Manapol patch, 27
ml) 9 ml, nystatin oral MAO-Is, 12, 59–60, 62, 65, 67,
suspension (100,000 IU) 73 92–93
ml, 40 Maraviroc, 98
Lidocaine HCl Marcaine, 64
liquid, 5%, 15 Mary’s magic potion, 13
viscous, 2%, 14–15 Maxisal liquid, 67
Lincomycin, 4 Medically compromised patients,
Lioresal, 51 65
Listerine®, 10 Medihoney, 45
Listermint with fluoride, 75 Men’s health guidelines
Lithium benign prostatic hypertrophy, 93
characterized, 72 male fertility, 39
salts, 86 Mepergan fortis, 63
toxicity, 56 Meperidine HCl 50 mg
Liver diseases and disorders characteristics of, 63
cirrhosis, 5 promethazine HCl 25 mg, 63
compromised hepatic status, Mepivicaine 3%, 65
57 Mepivicaine HCl
hepatic dysfunction, as side 2%, with Levonordefrin
effect, 2 1:20,000, 65
hepatic impairment, 2 3%, plain, 65
hepatic toxicity, 92 Meritene, 85
liver damage, as side effect, Metformin, 86
20–21 Methantheline bromide, 67
medications to avoid, 1, 5–7, Methemoglobinemia, sources of,
59, 63 14–15, 31, 88
L-Lysine 500 mg, 51 Methicillin, 5
Local anesthetics Methotrexate
amides, 64–65 toxicity, 56
characterized, 38 2.5 mg, 40–41
esters, 65–66 Methyldopa, 67
120
Methylprednisone 4 mg, 34 Mucositis, 13
Metronidazole Mucotrol 2.2 g wafer, 95
characterized, 45, 86 MuGard mucoadhesive oral
500 mg, 7 wound rinse, 94
Micafungin sodium 50 mg, 21–22 Muscle relaxants, 51–53, 67
Miconazole Mycamine, 21–22
buccal 50 mg tablets, 22 Mycelex, 18
nitrate vaginal cream, 2%, 24 Myclog II, 23
Miles’ Mixture, 29 Mycophenolate mofetil 250 mg
Milk of Magnesia, 12 and injection, 41–42
Minocycline 4 mg bioresorbable Mycoplasma spp., 7
powder in a disposable Mycostatin, 22–23
cartridge, 7–8 Myfortic, 41–42
Minute-Gel, 74–75 Myofascial pain
Misoprostol, 41 characterized, 79
Monistat 7, 24 over-the-counter medications,
Monoamine oxidase-inhibitors. 83–84
See MAO-Is overview of medications,
M. catarrhalis, 1 78–83
Motrin, 57–58 Mytrex, 23
Mouth pain relief, over-the-
counter oral rinses, 86–90 Naproxen sodium 275 mg, 57–58
Mouth rinses, see Oral rinses; Narcotics, 67
Mouthwash Negatan®, 16
alkaline saline, 93 Nelfinavir, 98
Biotene®, 94 Neo-Cobefrin, 65
chlorhexadine, 42, 44 Nephrolithiasis, 70
neutral calcium2+/PO, 94 Neuralgia
radiation or chemotherapy glossopharyngeal, 64
patient management, 93–97 over-the-counter medications,
sucralfate suspension 1 g/10 83–84
ml, 95 overview of medications,
Mouthwash 78–83
chlorhexidine, 40 postherpetic, 47–49
chlorhexadine gluconate, sphenopalatine, 66
0.12%, 95 trigeminal, 64
chlorhexadine gluconate, 0.12%, Neurontin, 82
without alcohol, 95–96 Neutral sodium fluoride
magic, 12 0.2%, 73
Oasis®, 68 1.1% dental cream, 73–74
prednisone, 20 mg tablets 1.1% dental paste with
and 0.12% chlorhexidine tricalcium phosphate, 74
gluconate, 35 1.1% 5000 ppm with
Weisman’s Philadelphia potassium nitrate
mouthwash, 13 toothpaste with sensitivity
Mucoadhesive biodegradable relief, 74
discs, over-the-counter, 1.1% or 1.0%, gel, 73
69–70 2.0%, 74
121
Neutropenia, as side effect, 39, Octocaine, 64
42 Omni-Gel, 72–73
Nevirapine, 98 Onsolis, 63
Niacinamide, 44 Opana/Opana ER, 61–62
Nicotinamide, 500 mg, with Opiates, 86
tetracycline, 44 Opioids, 12, 56, 62–63
Nifedipine 10 mg, 66 Orabase
Nilstat, 22–23 with benzocaine, 15, 33, 36
Nizoral, 21 characterized, 31, 36
Nonherbal remedies, 90–93 HCA, 24
Non-steroidal anti-inflammatory Sooth-N-Seal, 27
drugs (NSAIDs), 52, 55–56 Orajel Protective MouthSore
Nortriptyline 10 or 25 mg, 82 Discs, 27
Norvir, 98 Oral canker sore patch, 26
Nov-Gel, 72–73 Oral contraceptives, influential
Nucynta, 62 medications, 4, 10
Numoisen liquid and lozenge, Oral erosive lichen planus, 24,
67–68 30–38, 40–44
Nuprin, 58 Oral Health’s XyliMelts®, 69
Nutrient deficient and supplement Oral leukoplakia, 25
therapy, 84–85 Oral moisturizing gels, over-the-
Nystatin counter, 69
contraindications for, 21, 31 Oral rinses
ointment 100,000 IU, 23 BetaCell, 25, 96
100,000 units/g-triamcinolone delmopinol HCl mouth rinse, 2
acetonide 0.1% ointment, mg/ml, 25
23 Listerine®, 11
100,000 units/g-triamcinolone for mouth pain relief, 86–88
acetonide 0.1% ointment 1-2-3 mouth rinse, 13
with erythromycin gel 2%, PerioShield, 10
23–24 oral suspension 10% povidone-iodine solution,
(100,000 IU) 73 ml, with 10
lidocaine, 40 0.12% chlorhexidine gluconate
oral suspension 100,000 IU/ without alcohol, 3
ml, 22 Oral wound rinse, MuGard
pastilles or troches 200,000 mucoadhesive, 94
IU, 22–23 OraMoist® mucoadhesive patch,
topical powder 100, 000 IU, 27, 70
23 OraPatch, 27–28
with triamcinolone Oraqix, 64–65
acetinomide suspension, 37 OraVerse, 66
Oravig, 22
Occlusive dressings Orazinc 220 mg, 85
medications to avoid using Orthodontic appliance sores, 25
with, 20 Orudis, 57
over-the-counter, 25–28 Orudis KT, 58
prescription, 24–25 Otitis media, 2
Octagam, 40 Oxybutynin, 67
122
Oxycodone HCl Peridex, 3
4.5 mg-oxycodone Peridin-C, 51
terephthalate 0.38 mg- Periodontal disease, 6, 61
aspirin 325 mg, 59 Periodontitis, 6, 8, 10
5 mg-acetaminophen 325 PerioGard, 3
mg, 59 Periostat, 6
5 mg and ibuprofen 400 mg, Peritonitis, with Candida, 18
61 Petoxifylline, 72
Oxymorphone HCl 5, 10 mg, 20 Pharyngitis, 2
mg, and 40 mg tablets, Phenergan, 12–13
61–62 Phenothiazines, 56, 59
Phenoxymethyl penicillin V 500
Pain management. See mg, 9
Analgesics Phentermine, 67
Palifermin, 95 Phentolamine mesylate, 66
Pamelor, 82 Phenylpropanolamine, 67
Panglobulin NF, 40 Phenytoin 100 mg, 82–83
Paraflex, 52 Phos-Flur Rinse, 72
Parafon forte, 52 Photosensitivity, as side effect, 8
Paraproteinemia, 40 Pilocarpine
Patches characterized,70, 72
oral canker sore, 26 HCl 5 mg and 7.5 tablets,
OraMoist® mucoadhesive, 70–71
27, 70 4% ophthalmic solution, 71
OraPatch, 27–28 Pimecrolimus, 1%, cream, 34
Pediatric medications. See Podofin, 16–17
Children; Infants Podophyllum resin, 10%, and
Pemphigoid benzoin tincture compound
bullous, 24, 30–31, 33, 36–37, solution, 16–17
40–44 Polocaine, 65
benign mucous membrane, 32, Polygam S/D, 40
34–36, 38–40, 44 Polyphenolsufonic acid complex,
Pemphigus, oral, 24, 30–33, 100 ml, formaldehyde
36–37, 40–44 solution, 18 ml, distilled
Pen-Vee K liquid, 8–9 water, 42 ml, 16
Penciclovir, 1%, cream, 49 Pontocain, 42
Pencillin Povidone-iodine solution, 10%
alternatives for, 5 (Betadine), 10
G 500 mg, 8 Prednisolone syrup 15 mg/5 ml,
influential medications, 4 35–36
V potassium 250 or 500 mg, 8 Prednisone
V potassium liquid 125 mg/5 cautionary notes, 28–29
ml, 8–9 10 mg, 34–35, 64
Pentamidine, 86 20 mg tablets, 35
Pentoxifylline 400 mg, 42 20 mg tablets and 0.12%
Percocet, 59 chlorhexidine gluconate
Percodan, 59 mouthwash, 35
Perfect Choice, 73 Prelone, 35–36
123
Prescription guidelines Qvar 40, 29
abbreviations, dangerous,
101–102 Radiation patient management,
requirements, 100 67, 93–97
safe writing practices, Raltegravir, 98
100–101 Ravocaine, 65–66
topical corticosteroids, relative Regranex, 45
potencies of, 102–103 Remune, 98
PreviDent Renal diseases and disorders.
characterized, 73, 76 See Kidney diseases and
5000 Booster, 73–74 disorders
5000 Dry Mouth (SLS free), Reprexain-hydrocodone bitartrate
73–74 5.0 mg, 60–61
5000 Plus, 73–74 Rescriptor, 98
gel, 73 Reserpine, 67, 72
rinse, 73 Respiratory depression, 63
Prezista, 97 Retin-A, 44–45
Prilocaine Retrovir, 97
4%, with 1:200,000 Reyataz, 97
epinephrine, 65 Reye’s syndrome, 57
HCl, 4%, 65 Rheumatoid arthritis, 91
Pro-Banthine, 72 Rifampin, 4
Procardial, 66 Rincinol P.R.N., 28
Prochlorperazine Ritabutin, 4
contraindications to, 67 Ritonavir, 98
maleate 5 mg, 55
Prograf, 43 Safe writing practices,
Proleukin, 98 prescription guidelines
Promethazine abbreviation intended meaning
HCl 25 mg, with meperidine common error, 101–102
HCl 50 mg, 63 overview of, 100–101
syrup 6.25 mg/5 ml, 12 Sal-Tropine, 72
12.5 mg, 12 Salistat-Tabs, 71
Propantheline bromide 7.5 mg or Saliva, generally
15 mg, 72 aquoral artificial, 67
Propoxycaine and procaine, excessive, causes of, 72
65–66 inhibitors, for salivary
Prostheses, removable, over- hyperfunction, 72
the-counter disinfectants/ Saliva stimulants, for chronic
cleaners, 11–12 saliva hypofunction
Protopic, 42–43 over-the-counter, 71
Prozac, 55, 82 prescription, 70–71
Pseudoepinephrine, 67 Saliva Stimulant Tablets, 71
Psychosis, 71 Saliva substitutes
Ptyalism, 72 over-the-counter, short-term
Pulmonary disease, 59, 66, 70 effect, 68
Purified salt of basic ferric sub prescription, 67–68
sulfate, 78 Salix SST, 71
124
Salogen, 70–71 allergic, 13
Saquinavir mesylate, 98 contact (delayed) allergic, 24,
Saw palmetto, 93 30–33, 36–37, 40–44
Scandonest 3% Plain, 65 herpetiform aphthous, 9, 35,
Second-line therapies, 34 40
Seizure, as side effect, 62, 66 major aphthous, 32, 34–36, 38
Seizure disorders, 93 recurrent aphthous, 24–27,
Selective serotonin reuptake 30–33, 36–37, 39–45, 70
inhibitors, 62, 93 as side effect, 76
Selzentry, 98 Stop, 73
Sepsis, 40 Streptococcus
Septocaine, 64 mutans, 68
Shingles. See Varicella zoster pneumonia, 1
Shock, as side effect, 63 pyogenes, 1–2
Silver nitrate, 16 viridans, effective medications
Sinequan, 55, 81–82 against, 8–9
Sinusitis, maxillary, 4 Stroke, risk for, 57, 60–61
Sjögren’s syndrome, 67 Sucralfate 6g, tetracaine 2%,
Sodium fluoride distilled water 15 ml, 42
0.05%, 75 Sulphonylurea toxicity, 56
5%, varnish, 76 Sustiva, 98
Spectracef, 2 Swabsticks, 25
Splints, 29 Synalar, 32
Sporanox, 20–21 Synalgos-DC, 60
Sporothrix, 20
Sprix, 61 Tabasco® sauce, 84
Spry Tacrolimus
Dry Mouth Gum, 69 0.03%, ointment, 42–43
Regular/Fluoride toothpaste, 69 1.0 mg capsule mixed with
St. John’s wort, 93 purified water and oral
Stan-Gard, 72–73 rinse, 43
Stannous fluoride gel, 0.4%, Tagamet HB 200, 45
72–73, 97 Tapentadol HCl 50 mg, 62
Staphylocci Taste and smell disorder therapies
effective medications against, drugs that affect taste and
5, 8 smell, 86
Staphylococcus aureus, 1, 10 over-the-counter medications,
Stavudine, 97 85
Steroids prescription medications, 85
alternatives to, 38–45 referral centers, 85–86
cautionary notes, 28–29 vitamins and supplements, 85
compounded solutions, 29 zinc deficiency and, 85
over-the-counter alternatives Tegretol, 64, 79
to, 45 Temovate, 21, 31
overview of, 29–38 Tenofovir
topical wound repair, 45 characterized, 99
Stomatitides, oral erosive, 31 disoproxil fumarate, 97
Stomatitis Terfenadine, contraindications, 4
125
Tetracaine, 2%, gel, 51 Toothpastes
Tetracycline Colgate Total, 10
characterized, 45 over-the-counter, 69
oral suspension (125 mg/5 ml) over-the-counter sodium-lauryl
18 ml, with lidocaine, 40 sulfate-free, 90
side effects of, 86 Toradol, 59
Tetracycline HCl Tramadol, 62
characterized, 6 Tramadol HCl 50 mg, 62
500 mg, 9 Tranexamic acid, 77–78
500 mg and nicotinamide 500 Traxene, 53
mg, 44 Trazodone
oral suspension (125 mg/5ml), characterized, 67
43 HCl 50 mg, 55, 83
oral suspension (125 mg/5 Trental, 42
ml) 18 ml, dexamethasone Tretinoin, 0.1%, ointment, 44–45
elixir (0.5 mg/5 ml) 9 ml, Triamcinolone acetinomide
diphenhydramine elixir injectable 25- and 40-mg/ml
(12.5 mg/5 ml) 173 ml, 44 suspension, 38
oral suspension 250 mg/tsp, 0.1% aqueous suspension,
9 36–37
2.7 mg, 10 0.1% cream, 103
250 mg, 9–10 0.1% ointment, 23–24, 102
Tetracyn, 9–10 0.1% ointment in Orabase or
Theophylline Orabase with benzocaine,
contraindications for, 66 36
drug interactions with, 6, 49 0.1% or 0.5%, ointment, 36
toxicity, 4, 7 0.1% suspension in 2%
Thera-Flur, 73 viscous lidocaine, 37
Thera-Flur-N, 73 0.1% suspension with nystatin
TheraDent oral rinse, 76 suspension, 37
Thiazides, 67 0.025% cream, 103
Thioridazine, 67 Trifluoperzine, 67
Thiothixene, 67 Trimethoprim 80 mg and
Thiouracil, contraindications sulfamethoxazole 400
for, 66 mg, 10
Thrombin, 77 Trimox, 1
Thromboembolic disease, 78 Trizivir, 97
Thrombogen, 77 True Gel, 72–73
Tipranavir, 98 Tylenol, regular strength, 57. See
TMD, 62 also Acetaminophen
TMJ pain, 52
Tom’s of Maine® toothpaste, 69 Ulcer(s)
Tonsilitis, 2 aphthous, 25, 28, 38, 96
Tooth/teeth major aphthous, 29
desensitizers, 75–76 minor aphthous, 16
hypersensitive, 75–76 neuropathic, 45
staining, as side effect, 3–4, oral, 28
9–10, 96 peptic, 57
126
Ulceration, soft tissue, 43 Warfarin, 4
Ulcerative colitis, as side effect, 5 Weisman’s Philadelphia
Ulcerative diseases, 24–28, 45 mouthwash, 13
Ulcerease, 96 Women’s health guidelines
Ultram/Ultram ER, 62 hormone suppression, 90
Ultravate, 33 lactation, 90
Urecholine, 70 menopause, 90
Urolithiasis, 71 pregnancy, 5–6, 38, 42, 53, 57,
90, 92–93
Vaginal creams, 24 vaginal creams, 24
Valacyclovir HCl 500 mg, 49–50 women of child-bearing age,
Valcyte, 97 41, 93
Valganciclovir, 97 Wound repair, topical, 45
Valisone, 30 Wymox, 1
Valium, 54, 81
Valproic acid, 72 Xanax
Valtrex, 49–50 characterized, 53, 78
Vancocin, 10 XR, 53, 78–79
Vancomycin 125 mg, 10 Xerclear, 48
Varicella Xerese, 48
characterized, generally, 46 Xerostomia, drugs reported to
zoster, 34, 47–49 cause, 12, 67–75, 82
Vasoactive drugs, 66 Xerostomic patients, 63
Vesicular disease, chronic oral, Xylitol, 69
45 Xylocaine, 14–15, 64
Vestibular diseases, 24–28
Vibramycin, 5–6, 9 Zalcitabine, 97
Vicodin, 60 Z-Bec, 85
Vicoprofen, 60–61 Zerit, 97
Videx, 97 Ziagen, 97
Viracept, 98 Zidovudine
Viractin, 51 with abacavir and lamivudine,
Viral-blocking agents, 46–51 97
Viramune, 98 influential medications, 4, 97
Viread, 97 Zilactin-L gel, 28
Viroxyn, 50–51 Zinc deficiency, 85
Vistaril, 54 Zithromax, 1
Vitamin deficiency, 84 Zmax, 1
VitiGam, 39 Zorcaine, 64
Vivacaine, 64 Zostrix, 79, 83–84
Volume depletion, 40 Zovirax, 46–48
127

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Your Pocket-Size Dental Drug Reference

A Handbook of Commonly Used Dental Medications Useful in the

© 2012 PMPH-USA, Ltd.

Printed in China by People’s Medical Publishing House

Library of Congress Cataloging-in-Publication Data

Metric and Apothecary Equivalents

Michael A. Kahn, D.D.S.

Compounding Centers of America Phone Contact ................101

Amoxicillin 500 mg (Amoxil®)

Amoxicillin 500 mg/clavulanate 125 mg (Augmentin®)

Azithromycin 250 mg, 500 mg, 600 mg (Zithromax®;

Cefaclor 125 mg/5 ml suspension (Ceclor®) [Child]

Cefditoren pivoxil 200 g (Spectracef®)

Cephalexin monohydrate 250 or 500 mg (Keflex®)

Cephalexin monohydrate 125 mg/5 ml suspension

0.12% chlorhexidine gluconate (Peridex®; PerioGard®,

0.12% chlorhexidine gluconate oral rinse without

0.2% aqueous chlorhexidine gluconate (compounded

Ciprofloxacin 250–750 mg (Cipro®)

Clarithromycin 250 or 500 mg (Biaxin®)

Clindamycin 150 mg or 300 mg (Cleosin HCl®)

Clindamycin 75 mg/5 ml (Cleosin Pediatric®) [Child]

Dicloxacillin 250 mg (also 500 mg) (Dynapen®, Dycill®)

Doxycycline 200 mg (Vibramycin®)

Doxycycline hyclate 10.0% (Atridox®); in the ATRIGEL®

Doxycycline hyclate 20 mg (Periostat®)

Erythromycin ethylsuccinate 400 mg (EES®, ERYC®,

Erythromycin ethylsuccinate oral suspension

Erythromycin stearate 500 mg (Erythromycin®) or

Metronidazole 500 mg (Flagyl®)

Penicillin V potassium 250 or 500 mg (Veetids®)

Penicillin V potassium liquid 125 mg/5 ml (Pen-Vee K®

Phenoxymethyl penicillin V 500 mg

Tetracycline HCl 500 mg (Achromycin V®)

Tetracycline HCl oral suspension 250 mg/tsp

Tetracycline HCl 250 mg (Tetracyn®)

OVER-THE-COUNTER REMOVABLE PROSTHESES

II. ANTIHISTAMINES AND PALLIATIVE COATING AGENTS

Diphenhydramine elixir 12.5 mg/5 ml (Benadryl®) or

Benacort-tetrastat elixir (Mary’s magic potion®)

Weisman’s Philadelphia mouthwash

1-2-3 mouth rinse

5% lidocaine ointment (Xylocaine®)

Amphotericin B oral suspension 100 mg/ml

Fluconazole 100 mg tablets (Diflucan®); also available

Fluconazole 100 mg tablets (Diflucan®)/hydrocortisone

Flucytosine 250 mg or 500 mg (Ancobon®)

Hydrocortisone 10 mg and iodoquinol 10 mg (Alcortin

Hydrocortisone 2% and iodoquinol 1% (Alcortin

Itraconazole 100 mg (Sporanox®)

Itraconazole 10 mg/ml oral solution (Sporonox®)

Ketoconazole cream 2% (Nizoral®, generic)

Ketoconazole cream 2% (Nizoral®, generic) mixed with

Ketoconazole 200 mg (Nizoral®, generic)

Micafungin sodium 50 mg (Mycamine®)

Nystatin oral suspension 100,000 IU/ml (Mycostatin®,

Nystatin pastilles or troches 200,000 IU (Mycostatin®)

Nystatin topical powder 100,000 IU (Mycostatin®

Nystatin ointment 100,000 IU (Mycostatin®, Nilstat®,

Nystatin 100,000 units/g—triamcinolone acetonide

Nystatin 100,000 units/g—triamcinolone acetonide

V. IMMUNOSUPPRESSIVES, OCCLUSIVE DRESSINGS,

PRESCRIPTION OCCLUSIVE DRESSINGS

OVER-THE-COUNTER OCCLUSIVE DRESSINGS