Pharmacology of drugs used in Endodontic and Restorative treatment

Iyad Abou Rabii

DDS. OMFS.MRes.PhD

What Drugs can be applied restorative and endodontic treatment ?

• Pulp Capping• Pulp necrosis generating• Endodontic retorative materials contains

aiding drugs• Haemostatic agent• Antiseptics• Topical local aneasthesic agents

• Pulp dent: Premixed Calcium Hydroxide Paste For Vital Pulp Therapy and Root Canal Therapy Bactericidal – Bacteriostatic (High pH destroyes baterial cell wall) - Radiopaque Calcium Hydroxide

Pulp Capping

• stimulates consistent dentin bridge formation.

• The new dentin bridge re-encloses the pulp in its own natural protective chamber and is visible clinically after approximately 2-3 months.

Pulp Capping

• Endodontic retorative materials contains aiding drugs • Active Points Chlorhexidine ® from

Roeko) that contains Chlohexidine in order to desinfect route canal.

Endodontic retorative materials contains aiding drugs

• Tempacanal ®• Antimicrobial intracanal dressing

between visits in order to desinfect canal .

• Used for • large periapical lesions and cysts• Transverse root fracture• Avulsed teeth

Endodontic retorative materials contains aiding drugs

Different Calcium Hydroxide Preperations

• (Caustinerf Arsenical ® from Septodont) that contains Arscenica Hydrochloride in addition to Lidocaine and Ephedrine Hydrochloride used to generate pulb necrosis.

Pulp necrosis

•  Haemostatic agent used to stop hemorrage from the inflammated pulp, and injured gengiva they are four types:• Hemostaic dressings• Absorbable Gelatin • Astringents and styptics• Vasoconstrictors

Haemostatic agents

• The simpliste way of bleeding control is to apply sterile gauze with moderate pressure.

• Collagen dressing may be applied• In more severe casses (bony bleeding)

Absorbable Gelatin Sponge may be used  

Haemostatic dressings

• Applied on the operated tissues, controls oozing and seal up the bleeding tissues immediately. This prevents blood loss from the deeper wounds

Example : Surgispon ®• absorbed biologically within 4-6 weeks• Not used in Restorative and

Endodontics practice

Absorbable Gelatin Sponge

• Can be apply locally, especially with patent having oral anti-coagulant drugs

• thrombin can regulate the growth, cell cycle progression, and functional reorganization of the pulp tissue during pulp healing and inflammatory processes (Mei-Chi Chang,1999)

Thrombin

• An astringent (also spelled adstringent) substance is a chemical compound that tends to shrink or constrict body tissues

• Styptics (also spelled stiptics) are a specific type of antihemorrhagic agent that work by contracting tissue to seal injured blood vessels

• Zinc, iron, and aluminum salts are the best Astringents and styptics substances used in dentistry

Astringents and styptics

• Applied locally and for a very short time.

• Can be injected, but it is better to avoid to do this

• adrenalin dipped gauze are available in the market

Vasoconstrictors

Examples

• Astrigedent X ® from Ultradent• Dental TD Zett ® from J.Morita• Quick Stat FS ® from Vista

Astrigedent X ® from Ultradent

• Astrigedent X is an aqueous 12.7% iron solution containing equivalent ferric sulfate and ferric subsulfate for difficult-to-stop, problem bleeding

• Less acidic than competitive iron subsulfate solutions

Dental TD Zett ® from J.Morita

• It is a fast-acting intraoral topical hemostatic agent.

• It combines aluminum chloride, which has an astringent action, with Cetylpyridinium chloride and also lidocaine.

• Indications - For hemostasis in the following cases:1) Subgingival abutment tooth or cavity preparation2) Gingival retraction during Gingivoplasty

Quick Stat FS from Vista

• 15.5% Ferric Sulfate Haemostatic Gel • Provides effective tissue management

when completing impressions, restorations, crown & amp; bridge, and Pedodontic pulp treatment

• Doesn`t flow onto surrounding tissue

Oral Rinses

Rinses are generally classified by the U.S. Food and Drug Administration (FDA) as either :

• cosmetic  • therapeutic • a combination of the two. 

Cosmetic rinses

• Cosmetic rinses are commercial over-the-counter (OTC) products that help remove oral debris before or after brushing, temporarily suppress bad breath, diminish bacteria in the mouth and refresh the mouth with a pleasant taste. 

Therapeutic rinses

•  Antiplaque/antigingivitis rinses containing an active bacteria- fighting ingredient such as quaternary ammonium compounds, boric and benzoic acid phenolic compounds.

• Anticavity fluoride rinses. • Topical antibiotic rinses • Enzyme rinses• Artificial saliva rinses• Rinses that control calculus formation

Natural/Herbal Oral Rinses

• Natural oral rinses do not contain alcohol, harsh chemicals, dyes or preservatives. They often contain herbs with beneficial properties and alternative ingredients

• For instance, Xylitol, a natural sweetener derived from the fibrous parts of plants, helps reduce the risk of tooth decay and promotes oral health. Recently several chewing gums have entered the marketplace that contain Xylitol and are promoted as reducing decay.

Examples :

• Phenol products: Listerine ®• Chlorhexidine products: Peridex ®• Herbal Sanguinaria products: Viadent ® • Therapeutic Anticavity Fluoride Rinses :

Oral-B ® Anticavity Rinse• Cosmetic Breath Freshening Mouth

Rinses: Signal ®

Side effects

• ulcers • sodium retention • stains • soreness • numbness • changes in taste • painful mucosal erosions. 

Symptoms of an oral rinse overdose include:

When swallowing especially by children

1. Breathing problems, such as deep breathing, rapid shallow breathing, slowed breathing or breathing stoppage

2. Gastrointestinal problems, such as abdominal pain, diarrhea, nausea and vomiting

3. Nervous system problems, such as coma, dizziness or drowsiness

Symptoms of an oral rinse overdose include:

4. Bluish skin, particularly lips and fingernails

5. Collapse

6. Convulsions

7. Decreased blood pressure (hypotension)

8. Less-frequent urination

9. Excessive sweating and thirstiness

10.Trouble walking normally

11. Slurred speech

topical anesthetic for oral mucosal application.

Examples

• Comfort caine ® (Harry Basworth)• Cainetips ® (J. Morita)• Pharmaethyl ® (Septodent)• Anaestho Gel ® (Voco)

Comfort Caine ®

• Comfort Caine is a topical anesthetic for oral mucosal application.

• Comfort Caine contains the active ingredient ethyl 4-amino benzoate 20% Benzocaine, in a flavored polyethylene glycol base sweetened with saccharin.

• Comfort Caine combines fast onset (15-20 seconds) and short duration (12-15 minutes) with virtually no systemic absorption.

Cainetips

• Individually wrapped, disposable swabs pre-filled with a 20% Benzocaine solution, CaineTips oral pain relievers are designed for intraoral applications

Cainetips ®

• The single dose packaging allows for direct and precise application with no mess or drips and delivers quick pain relief onset. 

• Recommended for pre-injection, periodontal curettage, deep scaling, and post-care treatment, they also help prevent cross-contamination. Available in a cherry flavored solution

Pharmaethyl ®

• Topical freezing agent with natural mint flavor.

• Pharmaethyl is used for local applications on the mucous membrane of the oral cavity and its adnexa: lancing of abscesses, extractions of deciduous teeth, extraction of pyorrheal teeth, vitality tests.

• Do not spray close to an open flame or any incandescent sources.

Anaestho Gel ®

• Contains the active ingredient of Lidocaine.

• Useful in case of aphtous ulcerations• Gag reflex inhibition

Thank You

Iyad Abou RabiiDDS.OMFS.MRes.PhD