Pharmacology and therapeutics in dentistry

It is timely to devote an entire volume of Periodontology 2000 to the subject of pharmacology and therapeutics. There are two important reasons for this. First, we are all dealing with an increasing ageing population who are retaining their teeth well into old age. A large proportion of this population will be taking one or two medicines to enable them to continue with their normal daily activities. Second, certain drugs are the mainstay of dental practice. These include antibiotics, analgesics, local anesthetics, and agents to control anxiety. Many of our patients are medically compromised and this raises three important issues with respect to the delivery of routine dental care. • Can the patient s medication cause an adverse reaction in the mouth and associated structures? • Can the drugs that I wish to prescribe interact with their current medication? • What medical emergencies are likely to arise in this population and how should they be dealt with? There are many adverse drug reactions that affect the mouth and associated structures. These are reviewed by Seymour & Rudralingham (7). Such reactions can range from troublesome xerostomia to a life-threatening angioedema. Perhaps the most pertinent oral adverse drug reaction is drug-induced gingival overgrowth. This topic has been covered extensively in a previous volume of Periodontology 2000 (5). A thorough knowledge of possible drug interactions and the sequelae are an essential part of both medical and dental practice. The ever-increasing list of available medications is matched by a similar list of drug interactions. The paper by Hersh & Moore (2) provides an extensive and thorough review of drug interactions that can be encountered in dental practice. Obviously some drug interactions are more significant than others. The authors have quantified these so that there is a raised level of alertness. Medical emergencies in part relate to the above topics and such emergencies are more likely to occur in medically compromised patients than in healthy ones. It is essential that all dental professionals have a complete understanding of such emergencies. Within this remit is of course the diagnosis and management of such emergencies. The paper by Greenwood (1) covers all the medical emergencies that are likely to be encountered in the dental setting. In addition, specific dental emergencies are discussed together with their management. In comparison with our medical colleagues, dentists prescribe a very limited range of drugs, albeit on a more regular basis. Drugs of importance and concern in dental practice include local anesthetics, analgesics, antibiotics, and drugs used to reduce anxiety. Local anesthesia is the mainstay for providing relatively pain-free dentistry. Many patients still find injections through the oral mucosa unpleasant. It is against such a background that topical anesthetic agents were developed. The paper by Meechan (3) provides a comprehensive review of the efficacy, use, and unwanted effects of these agents with particular reference to their indications for periodontics. Topical anesthetics achieve anesthesia in exactly the same manner as the injectable preparations. The pharmacodynamics of local anesthetic agents is discussed in depth. A further challenge to periodontists is the provision of satisfactory analgesia after a variety of periodontal procedures. Most pain of periodontal origin has a significant inflammatory component and responds to appropriate anti-inflammatory drugs. The paper by Ong & Seymour (4) provides an overview of the efficacy of nonsteroidal anti-inflammatory agents – in particular, the possible use of pre-emptive dosing with the appropriate agent to reduce experience of