prophylactic (ward off disease) measure to prevent infective endocarditis (or IE) and in other medical conditions. Patients having history of infective endocarditis, rheumatic heart disease, artificial heart valves, and some heart murmurs are at high risk when involved in dental procedures that are likely to cause bleeding. They are prescribed a large dose of antibiotics before treatment and a smaller dose 6 hours after the initial dose. In all cases the dental officer will review the patient’s health history and will prescribe an antibiotic if needed. Many types of antibiotics are available; listed are a few groups that are used.

Penicillin

Penicillin is one of the most important of the antibiotics. It is derived from a number of Penicillium molds commonly found on breads and fruits. It is one of the most effective and least toxic of the antimicrobial agents used in dentistry.

Cephalosporins

Cephalosporins are a group of antibiotics that are structurally and pharmacologically related to the penicillin. Because the cephalosporins are structurally similar to pencillians, some patients who are allergic to penicillin may be allergic to a cephalosporin drug. So, special caution is necessary when taking cepha- losporins.

Tetracyclines

The tetracyclines, introduced in 1948, were the first truly broad-spectrum antibiotics. Administration to children and pregnant women is not indicated because it may produce discoloration of the teeth and slow bone marrow growth.

Erythromycin

Erythromycin has a bitter taste and is destroyed by gastric acids, and usually comes in the form of a coated tablet. Erythromycin is one of the drugs of choice when penicillin is contraindicated. Many patients cannot tolerate the nausea and stomach upset commonly associated with erythromycin, so the dentist may have to prescribe an alternate drug.

NON-NARCOTIC ANALGESICS AND ANTIPYRETICS

Analgesics are drugs that relieve pain without producing unconsciousness or impairing mental capacities. Many of these drugs also have an antipyretic and/or an anti-inflammatory effect. Antipyretics are drugs that lower increased body temperatures. Analgesics can be used to relieve pain from toothache, or can be prescribed for dental postoperative pain relief.

Aspirin

Aspirin is an economical analgesic, antipyretic, and anti-inflammatory agent used for mild to moderate pain. It is contraindicated in peptic ulcer disease. It acts as a gastric mucosal irritant and has an anticoagulant (inhibits blood clotting) effect.

Acetaminophen

This drug is similar to aspirin, but has no anti-inflammatory action. It is available as tablets, elixir, drops, or capsules and is useful for patients who are sensitive to aspirin.

OPIUM AND ALKALOIDS

Alkaloid-based compound names end inlne. Examples include atropine, caffeine, and nicotine. The most important alkaloids of opium are morphine and codeine. All of the opiate derivative drugs are very addictive and require strict control.

Ibuprofen

Ibuprofen is indicated for the relief of mild to moderate pain. It is used as an anti-inflammatory agent for dental pain associated from post surgical or operative procedures. It is not to be given to patients in the third trimester of pregnancy or anyone with a history of gastrointestinal bleeding.

Morphine Sulfate

Morphine sulfate is a drug indicated for the relief of severe pain and used preoperatively to sedate patients, treat myocardial infarctions, and is used in casualty care. It is contraindicated in patients with head injuries, acute alcoholism, or convulsive disorders.

Codeine Sulfate

Codeine sulfate is like morphine, but has one-sixth of the analgesic power and one-fourth of the respiratory depressant of morphine. It is used as a pain reliever in dentistry for moderate to severe dental pain. 7-4