Pharmacology


______________ are chemical substances that interact with mineralized tissue, including teeth and bones


fluoride ions


What are the two effects of the fluoride ion that result in the prevention of decay?


direct effect on the hydroxyapatite crystal of enamelaction on the indivivual micro-organisms in biofilm


What type of fluoride effect is being described?
systemic fluorides consumed during tooth development interact with hydroxyapatite crystals of enamel, forming the stable compound calcium fluoride. This chemical structure results in mineralized tissues that are less soluble in acids secreted by acidogenic micro-organisms in the mouth. The same action occurs with topical fluoride


direct effect on hydroxyapatite


What type of fluoride effect is being described?
when sodium fluoride is topically applied at appropriate concentrations, bacterial enzyme systems are inhibited, thereby altering the pattern of acid production that woul result in demineralization of tooth structure. Topically applied fluorides change hydroxyapatite to fluorapatite and also promote remineralization of decalcified enamel, which provides effective protections from progressive cavitation. Topical fluoride absorbed by dental biofilm alters the usual pattern of microbial acid production.


action of fluoride ion on the individual micro-organisms in biofilm


Is complete plaque removal prior to the application of fluoride essential for the benefits of the fluoride to occur?


no


true or false. Fluoride has both beneficial and detrimental effects. The beneficial effects outweigh the other.


both are true


Which type of fluoride toxicity is from a fluoride overdose and is a serious medical emergency that must be managed immediately to prevent death?


acute toxicity


Which type of fluoride toxicity occurs slowly over time, and management is by medical intervention?


chronic toxicity


___________ toxicity occurs due to a single overdose of fluoride.


acute


How many reported incidents of fluoride toxicity fatalities have been recorded? With how many of those in the dental office?


31


The following symptoms are from which type of fluoride toxicity?
nausea, vomiting, diarrhea, intestinal cramping, profuse salivation, black stools, progressive hypotenstion, and cardiac irregularities; death is due to respiratory failure and cardiovascular collapse


acute toxicity


What are 3 steps in the management of acute fluoride toxicity?


start with inducing emesis and vomiting to get fluoride out of the stomachhave pt drink several glasses of milk to bind fluoride and prevent absorptionmonitor vital signs and prepare for CPR until EMT arives


During the age of tooth mineralization, drinking water with fluoride >2 ppm can lead to fluorosis of tooth enamel. What type of toxicity is this?


chronic


What is the most common sign of chronic fluoride toxicity during tooth development?


fluorosis of enamel (mottled enamel)


true or false. Children drinking water with 1 ppm fluoride in it, and also ingesting additional fluoride supplements can develop dental fluorosis
True False


true


What are the 2 accepted agents of fluoride for professional application?


Sodium fluorideacidulated phosphate


What type of fluoride is recommended when restorations are present, and why?


sodium fluoriderestorations could be damaged by the acid in acidulated phosphate


What type of fluoride application is recommended for the pt with rampant decay, or who is at increased risk for caries, such as a client who is undergoing head and neck radiation therapy?


home applied agent with 5,000 ppm


Describe which type of professionally applied fluoride supplies the highest concentration and has the most efficacious caries reduction, and then which ones follow next after that.


5% fluoride varnish (38% reduction)2% NaF (29% reduction)1.23% APF (22% reduction)


What is the decision of wether or not to polish teeth based on?


based on the presence of extrinsic stains and for supragingival biofilm removal


Which type of fluoride is the agent of choice when porcelain or composite restorations or sealants are present?


2% topical Sodium fluoride neutral formulation


What type of fluoride is an alternate selection when porcelain restorations or sealants are present and a 3-month maintenance schedule is followed?


Sodium fluoride


Which type of fluoride is indicated for the pt who may be taking medications on a chronic basis that contain sugar (i.e. some antiepileptic drugs are supplied as syrups for kids who cannot tolerate taking tablets), when the pt is taking a drug for more than a few days that contains sugar (i.e. nystatin to treat candidiasis, sugar is added) or when drugs are taken chronically that cause xerostomia


acidulated phosphate fluoride 1.23% topical agents


When is APF contraindicated?


when porcelain, composite, or glass ionomer restorations or sealants are present


Which type of fluoride solutions are no longer marketed for topical application due to their disagreeable taste and staining of decalcified areas and margins of restorations?


stannous fluoride topical agents (SnF 10%)


What is the active ingredient in fluoride varnish?


5% sodium fluoride


Which type of fluoride is FDA approved in the US as a dentin desensitizing agent and as a cavity liner under the medical device category of approval?


5% NaF formulation varnish


true or false. a practitioner who uses fluoride varnish as an anticaries agent is using the product 'off label' on the basis of professional judgement.
True False


true


Which type of fluoride application is advocated for moderate- and high-risk caries-susceptible children, particularly children under 5 years of age, as well as for children recieving orthodontic treatment?


fluoride varnish


Why is the application of fluoride varnish suitable for special-needs populations such as very young children with autism and those with management problems such as mental or physical disabilities?


because of the simplicity of the application


Which type of fluoride offer the safest topical fluoride treatment available for young children at risk for dental caries?


fluoride varnish


true or false. patient-applied fluoride varnish should not be used in children under 6 years old, or pts who can not spit.
True False


true


Which type of dentifrice would be best recommended to the pt who has gingivitis?


dentifrices with triclosan (colgate total)


Which type of drugs would be the drugs of choice for the management of mild odontogenic pain?


Over the counter formulations of: ASA-aspirin (acetylsalicylic acid)APAP (acetominophen, tylenol)ibuprofennaproxen sodium


When is ASA (aspirin) effective against dull throbbing pain of odontogenic orign?


in doses of 650 or 1,000 mg


When should the clinician not recommend ASA (aspirin) for odontogenic pain relief?


when a client is taking a drug prescribed for a medical condition that interacts with ASA


What is the drug of choice to treat for long-term control of pain associated with osteoarthritis?


Acetominophen (tylenol)


Which type of drug is safe for treating dental pain in the pt with alcohol-related liver disease?


therapeutic APAP doses (4,000 mg/day)


What are two drugs used in the primary line of treatment for dental pain?


aspirinacetaminophen


What are 2 drugs that are both COX-1 inhibitors and can be used for either the first line of analgesic treatment or second line of treatment depending on the dosage?


ibuprofennaproxen sodium


What are the drugs of choice for the management of moderate-to-severe odontogenic pain?


COX-1 inhibitors alone, in combination with APAP, or with codeine or hydrocodone


Which type of drugs are the drug of choice for dental pain when substance abuse (other than alcohol) is suspected or when an individual has a history of substance abuse and is in recovery


COX-1 inhibitors


Which is the best drug if there are no other problems?


ibuprofen


Which drug combination might be an appropriate alternative for the management of acute odontogenic pain in those situations where COX-1 inhibitors or opioid analgesics are contraindicated such as peptic ulcer disease or substance abuse recovery?


tramadol in combination with APAP


What is the best drug to give pregnant pts?


acetominophen


What is the best drug to use for a healthy person?


ibuprofen


What is the best drug to use for a person with peptic ulcer disease?


tramadol w/ acetominophen


What is the best drug to use for a person who has a history of substance abuse?


COX-1 inhibitor (nonopeioid


What is a drug that is ok to use with alcoholics?


appropriate dose of acetominophen


Which type of cyclooxygenase inhibitor protects the gastric mucosa by enhancing gastric blood flow, and inhibits acid output?


COX-1 induced prostaglandis


Which type of cyclooxygenase romotes platelet aggregation and clot formation?


COX-1 induced thromboxane


which type of drugs increase the pain threshold to noxious stimuli by reducing prostaglandin synthesis, but they also interfere with thromboxane induced platelet afftregation and increase bleeding?


aspirinibuprofen (NSAIDs)


Which type of cyclooxygenase is expressed (synthesized) primarily in the brain, kidneys, female reproductive system, and bones? Synthesis is induced by inflammatory cytokines in other tissues including endothelial cells, it prevents platelet aggregation and promotes vasodilation


COX-2


Which type of drug is a COX-2 inhibitor? And when should it not be used?


celecoxib (celebrex)in pts with cardiovascular disease


name two COX-1 inhibitors


ASAibuprofen


Which type of cyclooxygenase isoforms are expressed (synthesized) primarily in the CNS?


COX-3 isoforms


What is a COX-3 inhibitor that is relatively weak of peripheral prostaglandi biosynthesis?


acetominophen


Which route of administration is the safest?


the oral route (enteral)


Which route of administration is used in emergency situations is the most predictable, and is less safe than the oral route?


IV


What is a problem with topical application routes of administration?


it is more likely to cause allergic reactions


What is the prototype for indirectly acting drugs that cause a rapid release of Nor from the mobile pool of the ANT?


amphetamine


What drug increases both systolic and diastolic blood pressure, increased heart rate and force of contraction can occur, although compensatory reflexes generally acto to slow the heart rate, and if doses of this drug is high, it can cause arrhythmia


amphetamine


true or false. contraction of the sphincter in the urinary bladdar caused by amphetamine leads to difficult urination and urinary retention
True False


true


What are amphetamines used therapeutically for?


narcolepsy


What are 6 results of amphetamines when used therapeutically? (results of which why they are abused)


stimulate the medullary respiratory center in brainreverse drug-induced CNS depressionincrease wakefulness and alertnessdecrease the appetitedecrease fatigueelevate the mood, leading to euphoria


true or false. the use of vasoconstrictors is contraindicated in individuals who have recently used cocaine.
True False


true


What dose of vasoconstrictors is indicated for pts with cardiac problems?


0.04 mg (cardiac dose)1 cartridge of epi 1:50,0002 cartridges of epi 1:100,0004 cartridges of epi 1:200,000


an antibacterial agent capable of suppressing the growth/multiplication of bacteria


baceriostatic


an antibacterial agent capable of killing bacteria


bactericidal