Pharmacology
PHAR 1303
Pharmacology is an essential course for a Dental Hygienist. It is important to be aware of the reasons behind taking certain medications, as well as their effects on individuals. Some medications may also contraindicate the use of particular anesthetics. At every clinical appointment, I apply skills I have learned in this course; however, I reference a Dental Drug book to clarify the use and effects of most medications. I have never had a client that has required local anesthetic; however, it is important to be able to recognize the injection sites for future clients, as this will allow the dental hygienist to prepare a complete tray for the dentist. What made this course challenging was the great amount of content. It was difficult to come up with a method to remember all major types of drugs and their effects on the oral cavity. Included is study material summarizing important content from this course in an organized way that may help with memory.
Local Anesthetic Sites
This diagram represents the local anesthetic sites within the oral cavity. It is important to note that dentists do not usually anesthetize the entire mouth, as this can complicate swallowing, thus increasing chances of choking. It also will inhibit the client's ability to speak or eat without difficulty.
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Local Anesthetic Contraindications
Hypertension
Epinephrine is contraindicated in clients with severely uncontrolled hypertension.
Epinephrine or levonordefrin should be minimized in clients with controlled hypertension. The initial dose for individuals taking non-selective B-blockers is a recommended ½ cartridge of lidocaine with epinephrine (1:100,00). The maximum dose for individuals taking non-selective B-blockers is 0.04 mg of epinephrine (two cartridges at 0.018 mg/cartridge 1:100,000) and 0.2 mg of levonordefrin (0.05 mg/cartridge 1:20,000). Monitor the client after administration.
Heart Failure, Angina, Stroke, Myocardial Infarction
Epinephrine is contraindicated in clients that have had bypass surgery or unstable angina within the past 3 months.
Vasoconstrictors should be minimized in clients with heart failure and angina pectoris. Monitor the client after administration.
Diabetes Mellitus
There are no contraindications in clients with controlled type I or type II diabetes mellitus.
Epinephrine should be minimized in clients with uncontrolled type I or type II diabetes mellitus, as it may counteract the effects of insulin, and increase blood glucose levels.
Adrenal Disease
Vasoconstrictors are contraindicated for clients with pheochromocytoma.
Thyroid Disease
There are no contraindications in clients taking thyroid hormone replacement with resulting controlled hyperthyroidism.
Vasoconstrictors are contraindicated in clients with uncontrolled hyperthyroidism.
Blood Dyscrasias
Prilocaine is contraindicated in patients with methemaglobinemia.
Asthma
Vasoconstrictors should be minimized in clients with asthma.
Cocaine User
Vasoconstrictors are contraindicated for clients having used cocaine within 24 hours.
Tricyclic Anti-Depressant and/or Monoamine Oxidase Inhibitor User
Vasoconstrictors are not recommended. If necessary, the maximum dose is lidocaine with 0.034 mg of epinephrine (two cartridges with 1:100,000 epinephrine). Monitor the client after administration.
Antipsychotic User
Epinephrine should be minimized in clients taking antipsychotic medication, as it may cause hypotension and tachycardia.
Pregnant Clients
Lidocaine is the preferred vasoconstrictor, due to its low concentration.
Common Medications and Their Oral Implications
Study Notes Review
This page provides a summary of oral local anesthetic sites and contraindications to vasoconstrictors, which are easy concepts to forget, but important to remember. In addition, it presents a table including a list of common medications and their associated oral side effects, as well as possible treatment for said side effects. These are concepts that are directly applicable in clinic, which is what made me want to take a second look at them in particular. This page can easily be printed and brought into clinic for reference when considering local anesthetic for clients, or when clients have an extensive pharmacy record with oral side effects. Readdressing courses from previous terms is an excellent way to take a fresh look at concepts that may have been forgotten or put aside in one's memory, but that will always be relevant in practice.
