Recommendations only; alternative therapies may be advised
INFECTIONS
Periapical abscess
1. MINOR
Penicillin V 250mg qds 5 days
2. MODERATE
Amoxycillin 250mg tds 5 days (Well absorbed)
Or
Amoxil 2 x 3g sachets (Sugar free) 8 hours apart
Penicillin allergy Substitute Erythromycin for Pen V/Amoxycillin dose 250mg qds
Periodontal abscess
- Metronidazole 200mg tds for 3-5 days
Pericoronitis
- Metronidazole 200-400mg tds for 3-5 days
± Corsodyl mw as required | HSMW
Chronic periodontitis
- Tetracycline 250mg qds 14 days
AUG
- Metronidazole 200mg tds 5 days
- ± Sodium perborate mw 70%
Acute sinusitis
- Amoxycillin 250mg tds 5 days
Dry socket(Acute alveolitis)
- Local treatment as required
ANTI FUNGAL THERAPY
Denture stomatitis
- Nystatin pastilles 100 000 units qds14 days OR
- Miconazole Oral gel 25mg/ml 5-10ml after food qds 7-14 days
Angular cheilitis
- Resolve intra oral condition -Miconazole as above
ANTIVIRALS
1º oral Herpes Simplex Virus
-Acyclovir suspension (Zovirax)
-(Children)5ml suspension 5 x daily
-Fluids
Cold sores
-Acyclovir cream 5 x daily 5 days at prodromal stage (Zovirax)
ANTIBIOTIC PROPHYLAXIS(For LA
-3g IO Amoxil 1 hour pre-op Or 600mg Clindamycin 1 hour pre-op
Penicillin Allergy or Penicillin in last 4/52- 1.5g Erythromycin Stearate 1 hour pre-op followed by 0.5g 6 hours later
Special Endocarditis risk
-1g Amoxil IM1 hour
or
-120mg Gentamicin IMpre-op
or
-0.5g Amoxil 6 hours later
Seek advice from GMP or Cardiologist
|
.Previous clindamycin |
High b risk |
LA c GA |
Allergic to penicillin |
Previous d penicillin |
Antimicrobial regime for adults |
Region |
|
|
No |
No |
LA |
No |
No |
Amoxycillin 3g orally 1hr before procedure |
1 |
|
|
Yes |
Yes |
Clindamycin 600mg orally 1hr before procedure |
2 |
||||
|
GA |
No |
No |
Amoxycillin 1g IM in 2.5ml of 1% lignocaine hydrochloride then 500mg orally 6hr later. OR Amoxycillin 3g orally 4hr before procedure then 3g orally post op. OR Amoxycillin 3g orally plus Probenecid 1g orally before procedure |
3 |
|||
|
Yes |
Teicoplanin 400mg IV plus Gentamicin 120mg IV at induction, or 15 min before procedure |
4 |
|||||
|
Yes |
OR Clindamycin 300mg IV in 50ml diluent over 10 min given at induction or 15 min before procedure, then 150mg orally or IV in 25ml of diluent over 10 min, 6hr later |
5 |
|||||
|
Yes |
LA |
No |
No |
Amoxycillin 3g orally 1hr before procedure, then Gentamicin 120mg IM 30min before procedure |
6 |
||
|
Yes |
Yes |
4 to 5 |
|
||||
|
GA |
No |
No |
Amoxycillin 1g IM in 2.5ml of 1% lignocaine hydrochloride plus Gentamicin 120mg IV before induction, then Amoxycillin 500mg orally 6hr later |
7 |
|||
|
Yes |
Yes |
4 or 5 |
|
||||
|
|
a) within 14 previous days b) previous endocarditis c) LA = local analgesia GA = general anaesthesia d) within 14 previous days e) or use IV Antimicrobial regime for children under 10 years Route Drug ANY AMOXYCILLIN Under 5yrs: quarter PROBENECID adult dose ORAL CLINDAMYCIN 6mg/kg IV CLINDAMYCIN First dose: 3mg/kg) Second dose: 1.5mg/kg) IV TEICOPLANIN 6mg/kg IV or IM GENTAMYCIN 2mg/kg |
||||||
|
Yes |
No |
LA |
No |
No |
1 |
||
|
Yes |
Yes |
4 |
|||||
|
|
|
GA |
No |
No |
3 or 4 |
||
|
Yes |
Yes |
4 |
|||||
|
Yes |
LA |
No |
No |
6 |
|||
|
Yes |
Yes |
4 |
|||||
|
GA |
No |
No |
7 or 4 |
||||
|
Yes |
Yes |
4 |
|||||
Antibiotic prophylaxis of endocarditis for patients undergoing dental procedures. Follow the latest BSAC recommendations (British Society for Antimicrobial Chemotherapy).
(By courtesy of Professor C. Scully. Reproduced from the Dental Practice by M. Osman with the permission of A.E. Morgan Publications Ltd.)
ORAL ULCERATION
R A S
-Chlorhexidine gluconate 0.2% MW 10ml. Use as required
If more severe see BNF for steroid preparations.
E.g. Hydrocortisone Hemisuccinate 2.5mg qds
PAIN
1.Mild to moderate pain
-Ibuprofen 1.2g – 1.8g daily in divided doses Max 2.4g daily
-Or Paracetamol 500mg – 1g 6 hourly as necessary. Max 4g daily.
2.Moderate pain
-Dihydrocodeine 30mg qds (stops sleepless nights)
NO ASPIRINS