Antibiotik for Dental Uses

7/24/2019 Antibiotik for Dental Uses

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Dentists prescribe several categories of medications to manage a variety of diseases and

conditions associated with the oral cavity. Among these conditions are bacterial, fungal and

viral infections, pain, and caries prevention. The prescription of medications is more

complicated than in the past with clinicians dealing with an increasing number of issues

such as microbial resistance to prescribed antibiotics and drug interactions within the

increased number of medications used by both adult and pediatric patients. Theadministration of drugs to pediatric patients is further complicated by the necessity to

adjust the dosages of medications to accommodate their lower weight and body size. In

this course the reader will find descriptions of the most commonly used medications used in

dental care with emphasis on the pediatric patient. As you review the medications you will

see that the dose and instructions on how to take them will vary from patient to patient,

depending on the patients age, weight and other considerations. The categories of

medications covered by this course are antimicrobials, which include antibiotics, antifungals,

and antivirals, analgesics, and fluorides.

In general, pediatric patients cannot be given adult dosages of drug. The primary reasonfor this is the difference in body size. !hile the drugs discussed in this course provide the

drug dosage for pediatric patients, the clinician may be faced with the need to prescribe adrug not listed that does not provide that information. "everal rules e#ist to compute thedosage of a drug for a child, the most common $larks rule. $larks rule determines the

dose suitable for a child based on the typical adult weight of %&' lb (or )' kg*. $larks rule+

Childs weight lb (or kg)

X adult dose =

childs dose

150 lb (or 70 kg)

or e#ample, if the adult dose of -enicillin / is &''mg every 0 hours, the dose for a 1' lb(%2 kg* pediatric patient would be calculated as+

40 lb (18 kg)

X 500 mg = 133 mg

eer! " hours

150 lb (or 70 kg)

$larks rule may also be used to calculate dosages for underweight, ill or elderly patients.

In general, pediatric patients cannot be given adult dosages of drug. The primary reasonfor this is the difference in body size. !hile the drugs discussed in this course provide the

drug dosage for pediatric patients, the clinician may be faced with the need to prescribe adrug not listed that does not provide that information. "everal rules e#ist to compute the

dosage of a drug for a child, the most common $larks rule. $larks rule determines the

dose suitable for a child based on the typical adult weight of %&' lb (or )' kg*. $larks rule+


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Childs weight lb (or kg)

X adult dose =

childs dose150 lb (or 70 kg)

or e#ample, if the adult dose of -enicillin / is &''mg every 0 hours, the dose for a 1' lb(%2 kg* pediatric patient would be calculated as+

40 lb (18 kg)

X 500 mg = 133 mg

eer! " hours150 lb (or 70 kg)

$larks rule may also be used to calculate dosages for underweight, ill or elderly patients.

Infections of the teeth and oral cavity can increase in severity and develop into life

threatening situations if not properly managed. Infection management can consist of a

combination of dental or surgical procedures and the use of antimicrobials. Antimicrobials

are drugs that suppress or kill the growth of microbes 3 bacteria, viruses, fungi or

parasites. Antimicrobial activity is ma#imized when the specific microbe causing the

infection is identified by culture or serologic testing and the antimicrobial most active

against that microbe is administered in appropriate doses. The most common

antimicrobials used in dentistry are antibiotic agents, antifungal agents and antiviral agents.

Antibiotics are drugs that are produced by microbes or by chemical methods to produce an antibacterial action.Antibiotics are the second most prescribed group of drugs in dentistry, after local anesthetics. The widespread use

of antibiotics has resulted in common bacteria developing resistance to drugs that once controlled them. To reduce

the resistance rate, health care providers must prescribe antibiotics judiciously. Antibiotics should be prescribed as

soon as possible for optimal healing. If the infection does not respond to the initially prescribed drug, a culture from

the infected site is indicated. The duration of drug therapy should extend at least 5 days past the point of substantial

improvement or resolution of symptoms. The importance of completing a full course of antibiotic therapy must beemphasized to the patient. hould the antibiotic be discontinued prematurely, the surviving bacteria can restart an

infection that may be resistant to the original antibiotic.

ituations that may necessitate the prescription of antibiotics are!

#ral $ou%d &a%ageme%t

"ral wounds are associated with an increased ris# of bacterial contamination. $xamples of oral wounds are soft

tissue laceration, complicated tooth fracture %pulp exposure&, severe tooth displacement %including avulsion&,gingivectomy, and severe ulcerations. If the oral wound seems to have been contaminated by extraoral bacteria,

antibiotics therapy should be considered.

'e%tal %ectio%


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'acteria can gain access to pulpal tissue through caries, exposed dentin tubules and defective restorations resulting

in acute dental infection. Treatment of acute dental infection is accomplished by immediate dental treatment%pulpotomy, pulpectomy or extraction&. Antibiotic therapy is usually not indicated if the infection is contained

within the pulpal tissue or the immediately surrounding tissue and the patient does not exhibit systemic signs ofinfection %fever and facial swelling&.

(atients presenting with facial swelling secondary to a dental infection receive dental treatment accompanied byantibiotic therapy. If the clinician is able to achieve ade)uate local anesthesia, the dentist may render immediate

treatment followed by a regimen of antibiotics. If the infection is of such severity that achievement of ade)uate

local anesthesia is )uestionable, then prescription of antibiotics for a period of 5*+ days should be considered

before rendering treatment. -hile oral antibiotics may be the simplest route of administration, in cases of severe

infection hospitalization and intravenous administration may be necessary.

*ediatric *eriodo%tal 'iseases

(rolonged antibiotic therapy may be prescribed for the management of chronic periodontal disease, especially in

patients with an immunodeficiency disease. In pediatric periodontal diseases %neutropenias, (apillon*evere

syndrome, leu#ocyte adhesion deficiency& the immune system is unable to control the growth of periodontal

microbes. As this is a chronic rather than an acute condition, effective drug selection may be accomplished byculture and susceptibility testing.

+iral 'iseases

Antibiotics should not be prescribed for viral conditions %acute primary herpetic gingivostomatitis& unless there is

strong evidence to suggest that a secondary infection exists.

#ral Co%trace,tie -se

It is not uncommon for oral contraceptives to be prescribed for adolescent females to prevent pregnancy. -henantibiotics are prescribed in concurrence with oral contraceptives, the patient must be advised to use additional birth

control techni)ues as antibiotics may render the oral contraceptive ineffective for at least + wee# beyond the lastdose.

Antibiotics can be categorized by the bacteria they target. They are either narrow or wide spectrum. /arrowspectrum antibiotics are effective specifically against either gram*positive or gram*negative antibiotics. 'road

spectrum antibiotics are effective against a wider range of bacteria. The efficacy of an antibiotic against a particular

bacteria is determined by culturing the pathogen and testing its susceptibility to a particular antibiotic.

0nfortunately, culturing and susceptibility testing may ta#e 12 hours to several days resulting in a delay in initiation

of antimicrobial therapy. Thus, until culturing and susceptibility results are available a best guess is made for

determining the most effective antibiotic for a specific clinical situation.

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Causes and Treatment of Odontogenic Infections

3ost orofacial infections are of odontogenic origin. 4ental pulp infection, as a result of caries, is the leading cause

of odontogenic infection. The major pathogens identified in dental caries are members of the viridens %alpha*hemolytic& streptococci family including Streptococcus mutans, Streptococcus sobrinisand Streptococcus milleri.

"nce bacteria invade the dental pulp an inflammatory reaction results in necrosis and a lower tissue oxidation*reduction potential. At this stage, the bacterial flora changes from predominately aerobic to more anaerobic flora.

Anaerobic gram*positive cocci (Peptostreptococcus)and anaerobic gram negative rods %'acteroides, (revotella,(orphromonas and usobacterium& predominate. The infection progresses forming an abscess at the apex of the

root, resulting in bone destruction. 4epending on host resistance and bacteria virulence the infection may spread

into the marrow, perforate the cortical plate and spread to the surrounding tissues.

Additionally, the anaerobic bacteria inhabiting the periodontal tissues may provide an additional source of

odontogenic infection. The most common anaerobes are Actinobacillus actinomycetemcomitans, (revotellaintermediud, (orphyrommonas gingivalis, usobacterium nucleatum, and $i#enella corrodens.
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3ost odontogenic infections %6& contain mixed aerobic and anaerobic bacteria. (ure aerobic infections have less

than a 56 incidence. (ure anaerobic infections have a 156 incidence. The consensus by researchers is that in earlyodontogenic infections, bacteria are aerobic with gram*positive, alpha*hemolytic streptococci (S.

viridens)predominating. As the infection matures and increases in severity the microbial flora becomes a mix ofaerobes and anaerobes. The anaerobes found are determined by the site of origin7 pulpal or periodontal. As the host

defenses begin to control the infection process the flora becomes predominately anaerobic.

Thus, the choice of antibiotic is influenced by a number of factors! tage of infection development and the ability of

the patient to ta#e the antibiotic 8 medical conditions or allergy.

Antibiotics may also be categorized by their method of attac#. 'actericidal antibiotics actually #ill microorganisms,

while bacteriostatic antibiotics slow bacterial growth and depend on the host immune system to eliminate the

microorganism. An antibiotic may be bactericidal for one microorganism and bacteriostatic for another.

'actericidals are preferable over bacteristatics in most situations. 'acteriostatics should not be administered to

immunocompromised patients whose compromised immune system may be unable to assist in clearance of the

microorganism. 9ommon bactericidals used in dentistry are the penicillins and cephalosporins. 9ommon

bacteristatics are the macrolides, tetracyclines and sulfonamides.

The ideal antibiotic for treating dental infections would be bactericidal against gram positive cocci and the majorpathogens of mixed anaerobic infections. It would cause minimal adverse effects and allergic reactions and be

relatively low in cost.

.able 1/ m,iric %tibiotics o Choice or #do%toge%ic %ectio%s/

.!,e o %ectio% %tibiotic o Choice

$arly %first : days of

infection&

(enicillin ;


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.able 2/ m,iric %tibiotics o Choice or #do%toge%ic %ectio%s/

%tibiotic'osage

Childre% dults

(enicillin ;#g body

weight in e)ually divided

doses )=*Eh for at least days7

maximum dose! : g>day

+1 years! 5 mg )=h for at

least days

9lindamycinE*15 mg>#g in :*2 e)ually

divided doses

+5*25 mg )=h for at least

days7 maximum dose! +.E

g>day

9ephalexin %#g>day in divided

doses )=h

evere infection! 5*+

mg>#g>day in divided doses

)=h7 maximum dose : g>12h

15*+ mg )=h7 maximum

dose 2 g>day

Amoxicillin

F 2 #g! 1*2 mg>#g>day in

divided doses )Eh

2 #g! 15*5 mg )Eh or

E5 mg )+1h for at least

days7 maximum dose 1 g>day

2#g! 15*5 mg )Eh or


days! maximum dose! 1 g>day

Amoxicillin>clavulani

c acid %Augmentin?&

F 2 #g! 1*2 mg>#g>day individed doses )Eh

2 #g! 15*5 mg )Eh or


days! maximum dose 1 g>day

2 #g! 15*5 mg )Eh or


days7 maximum dose! 1g>day

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Page 5 of 25

Penicillin VK

-enicillin / is a beta4lactam antibiotic and is bactericidal against gram4positive cocci andthe major microbes of mi#ed anaerobic infections. Adverse drug reactions include mild

diarrhea, nausea and oral candidiasis. There is a '.) to %'5 allergy rate among patients.

About 2&5 of allergic reactions are delayed and take greater than 6 days to develop. The

usual allergic responses e#hibited are skin rashes that usually respond to antihistamine

therapy (diphenhydramine, 7enadryl8*. "evere reactions of angioedema have occurred,

characterized by severe swelling of the lips, tongue, face, and periorbital tissues. -atients

reporting a history of penicillin allergy should never be given -enicillin /. The alternative

antibiotic is clindamycin. If the allergy reaction is of the delayed type and not

anaphylactoid, a first generation cephalosporin may used as an alternative.

-enicillin / may be given with meals, however blood concentrations are slightly higher

when given on an empty stomach. The preferred dosing is one hour before meals or twohours after meals.


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Contraindications:9ypersensitivity to penicillin or any component of the formulation.

Warnings/Precautions::se with caution in patients with severe renal impairment

(modify dosage*, history of seizures, hypersensitivity to cephalosporins.

The usual daily dose of enicillin VK for treating odontogenic infections is:

$hildren ; %6 years of age+ 6&4&' mg


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gram positive cocci and similar in efficacy against anaerobes. Thus penicillin ;< is the drug of choice for treating

odontogenic infections.

Co%trai%dicatio%sCypersensitivity to amoxicillin, penicillin or any component of the formulation.

$ar%i%gs*recautio%s0se with caution in patients with severe renal impairment %modify dosage&7 low incidenceof cross*allergy with other beta*lactams and cephalosporins exists.

.he usual dail! oral dose or treati%g odo%toge%ic i%ectio%s i% childre% is

9hildren under +1 years! 1*2 mg>#g divided in 1*: doses daily for + days.

9hildren over +1 years and adults! 15 85mg : times>day, maximum 1*: gm>day for + days.Amoxicillin is supplied as a +15, 1, 15, 2 mg>5ml solution or chewable tablets7 15 or 5mg capsules.

am,le amo6icilli% ,rescri,tio% or a 3 !ear old ,atie%t weighi%g 12 kg (25 lb) with acial swelli%g

Rx:Amoxicillin +15mg>5ml

Disp:+5 mlSig:Ta#e + teaspoon every E hours for + days

In situations when amoxicillin is ineffective due to possible bacterial resistance to the drug and the patient cannottolerate the adverse gastrointestinal side effects of clindamycin, clavulanate potassium can be administered in

conjunction with amoxicillin %Augmentin?&. 9lavulonic acid binds and inhibits beta*lactamases that inactivate

amoxicillin. It is recommended that it be ta#en with food to increase absorption and decrease HI intolerance.

Co%trai%dicatio%sCypersensitivity to amoxicillin, clavulanic acid, penicillin or any component of the

formulation7 history of hepatic dysfunction.

$ar%i%gs*recautio%s(rolonged use may result in superinfection. 0se with caution in patients with severe renal

impairment %modify dosage&. Incidence of diarrhea is higher than with amoxicillin alone.

.he usual dail! oral dose o ugme%ti%?or treati%g odo%toge%ic i%ectio%s i% childre% is

9hildren : months and F 2 #g! 1*2 mg>#g>day in : divided doses.

9hildren 2 #g and adults! 15*5 mg every E hours or E5 mg every +1 hours.

Augmentin?is supplied as +15, 1, 15 2 mg >5ml solution, chewable tablets and tablets.

am,le amo6icilli%claula%ate (ugme%ti%?) ,rescri,tio% or a 3 !ear old ,atie%t weighi%g 12 kg (25 lb) with

acial swelli%g

Rx:Augmentin?+15 mg>5ml solution %or chewable tablets&

Disp:+5 ml %or : chewable tablets&

Sig:+ tsp %or tablet& every E hours for + days

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Page , of 25

-irst .eneration Cehalosorins

The first generation cephalosporins are alternatives to penicillin / for the treatment of

odontogenic infections. The oral dosage forms of this class are cefadro#il (Duracef8*,

cephale#in (/efle#8*, and cephradine (elosef8*. They are indicated as alternatives to

penicillin / in early infection because they are bacterially effective against aerobes but not

anaerobes. They are active against gram4positivestaphylococciand streptococci, but

ineffective against enterococci. The rate of cross reactivity between cephalosporins and
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penicillins is %5 when the allergic reaction to penicillin is delayed. It should be used with

caution in those patients e#hibiting anaphylactoid reactions.

Contraindications:9ypersensitivity to cephale#in, any component of the formulation, or

other cephalosporins.

Warnings/Precautions:>odify dosage in patients with severe renal impairment?

prolonged use may result in superinfection. :se with caution in patients with a history of

penicillin allergy. >ay cause antibiotic associated colitis.

$ephale#in (/efle#8* is the first generation cephalosporin most often used to treat

odontogenic infections.

The usual daily oral dose for treating odontogenic infections in children is:

$hildren under %6 years+ 6&4&' mg#g>day divided every E*+1 hours with a maximum dose of 1 g>day.

9hildren over +1 years and adults! 15*5 mg divided every E*+1 hours.9efaclor and cefuroxine are supplied as +15, +E, 15, :5 mg>5ml suspensions and 15 and 5 mg capsules.

am,le ceaclorceuro6i%e ,rescri,tio% or a 3 !ear old ,atie%t weighi%g 12 kg (25 lb) with acial swelli%g

Rx:9eflacor +15 mg>5ml

Disp:+5ccSig:+ teaspoon every E hours for + days

(revious


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*age 10 o 25

/ext

acrolides &0rythromycin1 Clarithromycin1 *ithromycin(

The macrolides are antibiotics with a spectrum of coverage similar to penicillin, with the

addition of some penicillanase4producing staphylococci, chlamydiae,

Legionella,mycoplasma and others. rythromycin is the most popular macrolide. In its

free base form it is unstable at gastric p9 so it is administered as a salt form (stearate or

estolate* or with an enteric coating. (Bote+ Due to differences in absorption the three forms

have different dosages*. Its most common side effect is gastrointestinal upset.

$larithromycin and azithromycin are structural derivates of erythromycin with a broader

spectrum of activity and increased bioavailability. 7oth agents e#hibit less gastrointestinal

upset than erythromycin. >acrolides are bacteriostatic rather than bacteriocidal and thus

are not recommended in immuno4compromised patients.

In the past, macrolides were considered highly effective antibiotics for treating dentalinfections and freCuently substituted in penicillin allergy. $urrently, however, the high

resistance rates of oral streptococciand oral anaerobesto the macrolides has reduced their

use in dental infections. or patients with a penicillin allergy clindamycin is the preferred

alternative antibiotic for treating dental infections.

Contraindications:9ypersensitivity to erythromycin or any component of the formulation.

Warnings/Precautions::se with caution in patients with hepatic impairment.

Administration may be accompanied by malaise, nausea, vomiting, abdominal colic and

fever. Discontinue use if these occur. Avoid using erythromycin lactobionate in neonates

since formulations may contain benzyl alcohol which is associated with to#icity in neonates.

:se in infants has been associated with infantile hypertrophic pyloric stenosis. Interactswith numerous other drugs increasing the serum levels of the drugs. $onfirm patients

medical history before prescribing.

The oral dosages and dosage forms of the macrolides are:

Erythromycin

Infants and children 3 $2 years

7ase+ @'4&' mg


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!amle erythromycin estolate rescrition for a " year old atient #eighing $2 %g

&25 l'( #ith facial s#elling:

Rx:rythromycin estolate %6& mg


11/16

'acterial endocarditis is much more li#ely to result from fre)uent exposure to random bacteremias

associated with daily activities than form bacteremia caused by dental, HI tract, or H0 tract

procedures.

(rophylaxis may prevent an exceedingly small number of cases bacterial endocarditis, in individuals

who undergo dental, HI tract or H0 tract procedures.

The ris# of antibiotic associated adverse events exceeds the benefit from prophylactic antibiotic

therapy.

3aintenance of optimal oral health and hygiene may reduce the incidence of bacteremia from daily

activities and is more effective than prophylactic antibiotics for a dental procedure for reducing the

ris# of bacterial endocarditis.

The revised guidelines clarified when antibiotic prophylaxis is>is not recommended, i.e.

+. "nly an extremely small number of cases might be prevented by antibiotic prophylaxis.

1. Antibiotic prophylaxis for dental procedures is recommended only for patients with underlying cardiacconditions associated with the highest ris# of adverse outcomes from bacterial endocarditis.

:. or patients with these underlying cardiac conditions, prophylaxis is recommended for all dental

procedures that involve manipulation of gingival tissues or the periapical region of teeth or perforation

of the oral mucosa.

2. (rophylaxis is not recommended based solely on an increased lifetime ris# of ac)uiring bacterial

endocarditis

pecific recommendations from the 1 ACA guidelines on prevention of bacterial endocarditis are included in the

following tables. 9onsultation with the patientJs physician is recommended to determine the patientJs susceptibility

to bacterial endocarditis.

.able 3/ Cardiac Co%ditio%s ssociated with the ighest isk o derse #utcomes rom %docarditis or

$hich *ro,h!la6is *rior to 'e%tal *rocedures is ecomme%ded/

(rosthetic cardiac valve

(revious bacterial endocarditis

9ongenital heart disease %9C4&

0nrepaired cyanotic 9C4, including palliative shunts and

conduits

9ompletely repaired congenital heart defects with prosthetic

material or devices, whether placed by surgery or catheter intervention

within the first = months after the procedure

Bepaired 9C4 with residual defects at the site or adjacent to

the site of a prosthetic patch or prosthetic device %which inhibit


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endothelialization&

9ardiac transplantation recipients who develop cardiac

valvuopathy

.able 4/ 'e%tal *rocedures or $hich %docarditis *ro,h!la6is isis %ot ecomme%ded or *atie%ts i% .able

3/

ecomme%ded

All dental procedures that involve manipulation of gingival

tissue or the periapical region of the teeth or perforation of the oralmucosa

9ot recomme%ded

Boutine anesthetic injections through no infected tissue

4ental radiographs

(lacement of removable prosthodontic or orthodontic

appliances

Adjustment of orthodontic appliances

(lacement of orthodontic brac#ets

hedding of deciduous teeth

'leeding from trauma to the lips and tongue

.able 5/ egime%s or 'e%tal *rocedures/

dmi%ister si%gle dose 30 to "0 mi%utes beore ,rocedure

ituatio% ge%t dults Childre%

"ral Amoxicillin 1 gm 5 mg>#g

0nable to ta#e oral

medication

Ampicillin

"B

1gm I3 or I; 5 mg>#g I3 or I;


13/16

9efazolin or

ceftriaxone+gm I3 or I; 5 mg>#g I3 or I;

Allergic to

penicillins or

ampicillin*oral

9ephalexin

"B9lindamycin

"B

Azithromycin or

clarithromycin

1 gm

=mg

5mg

5 mg>#g

1 mg>#g

+5 mg>#g

Allergic to

penicillin or

ampicillin and

unable to ta#e oral

medication

9efazolin or

ceftriaxone

"B

9lindamycin

+ gm I3 or I;

=mg I3 or

I;

5 mg>#g I3 or I;

1 mg>#g I3 or I;

(revious

*age 12 o 25

/ext

*ntifungals

"ral fungal infections occur from alterations in oral flora as a result of the extensive use of broad spectrum

antibiotics, steroids, chemotherapy immunosuppression, and inade)uate oral hygiene and nutrition. The mostcommon fungal infection found in children is candidiasis. The clinical variations of candidiasis most commonly

found in children are pseudomembranous candidiasis, angular cheilitis, erythematous candidiasis and

mucocutaneous candidiasis.

Treatment of candidiasis is accomplished through the topical application of nystatin, clotrimazole and amphotericin

and systemic administration of #etoconazole, fluconazole, itraconazole when topical treatment is ineffective. -hen

prescribing antifungals, the clinician must closely monitor and re*evaluate the patientJs response every two wee#s.

If the response is inade)uate, the diagnosis, choice of medication and dosage should be reevaluated. The chosen

form of administration is dependent on the childJs ability and maturity to follow directions. The drugs areadministered until 1 days after symptoms disappear.

ample perscriptions!

Topical Antifungals

Rx:/ystatin ointmentDisp:25 gm tube

Sig:Apply locally as directed with a thin coat to the affected area 2*5 times>day

Rx:/ystatin +, units>ml oral suspension

Disp:: mlSig:Binse with + teaspoon %5 ml& for 1 minutes 2*5 times>day and expectorate.

Rx: 9lotrimazole %3ycelex?& + mg trochesDisp: troches

Sig:4issolve + troche in mouth 5 times>day until gone
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Rx:day.

Systemic Antifungals The decision to use systemic antifungals are based on diagnostic culture results.

Rx:day until finished

Angular Cheilitis Treatment

Rx:Iodo)uinol and hydrocortisone creamDisp:25 gm tube

Sig:Apply locally as directed :*2 times>day for + days to 1 wee#s and re*evaluate

Rx:/ystatin and triamcinolone acetonide ointment

Disp:25 g tube

Sig:Apply locally as directed to affected area 2 times>day for + days to 1 wee#s and re*evaluate.

-revious

Page $" of 25

*nti6irals and 7lcerati6e 8esions

Be#t

Advances in the pharmacological treatment of viral infections lag behind the treatment ofbacterial or fungal infections. The reason is due to the difficulty in attaining adeCuate

degrees of selective to#icity. "ince virus replication uses the same metabolic mechanismsessential for the function of normal cells, it was difficult to find drugs that would inhibit viral

growth without killing the host. 9owever recent advances in the research of viral replicationhave lead to discovery of agents useful in antiviral activity in the oral cavity. The agents are

not highly effective and are best used as soon as symptoms first appear. "ystemicsupportive therapy should be administered in conjunction with antivirals which includes

forced fluids, high concentration protein, vitamin and mineral food supplements and rest.iral infections may become secondarily infected with bacteria reCuiring antibiotics.

Gral viral infections are most commonly caused by the herpes simple# virus. The herpeszoster or herpes varicella3zoster virus can cause similar viral eruptions involving the oral

mucosa.

Diagnosis of oral viral infections begins by evaluation of presenting signs and symptoms. A

distinction must be made between lesions associated with herpes and aphthous ulcerswhich do not have a viral etiology.

iral lesions (9erpetic gingivostomatitis* are characterized by an initial acute onset ofvesicular eruptions on the soft tissues that Cuickly rupture into small ulcerations that are

covered by a yellowish gray pseudomembrane surrounded by an erythematous halo. Theulcers may coalesce to form larger irregular ulcerations. The lesions are found on the

gingival, tongue, palate lips (labialis*, buccal mucosa, tonsils and posterior pharyn#. The

ulcers gradually heal over )4%' days without scarring. The disease is accompanied by highfever, malaise, irritability, headache and pain in the mouth during the first three days of
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onset. It usually appears in children between the ages of si# months and four years.

Treatment consists of administration of acyclovir and supportive therapy.

Contraindications:9ypersensitivity to acyclovir, valacyclovir, or any component of the

formulation.

Warnings/Precautions::se with caution in immunocompromised patients. "afety and

efficacy of oral formulations have not been established in pediatric patients H 6years ofage. The ointment is for e#ternal use only to the lips and face. Do not apply to the eye orinside the nose or mouth. Treatment should begin at the first sign of symptoms.

The oral systemic dose of acyclo6ir &only gi6en in se6ere cases of 9!V( is:

$hildren 6 years and ; 1' kg+ 6' mg


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Rx:Diphenhydramine liCuid (7enadryl8< /aopectate or >aalo#* < Jidocaine viscous (mi#

%

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Antibiotik for Dental Uses