Table 2 Examples of enquiries received and answers given
Enquiry | Answer | Resources used |
|---|---|---|
Antibiotic interactions | Metronidazole does not interact with methotrexate and can be prescribed for this patient. | Manufacturer's summary of product characteristics. |
A patient taking methotrexate needs an antibiotic for a dental infection. Amoxicillin interacts with methotrexate. Is metronidazole safe to prescribe? | Stockley's Drug Interactions (online database). | |
Antiplatelet drugs | Aspirin and clopidogrel should not be stopped. However bleeding time is likely to be prolonged. Do the extraction early in the day to allow time to manage any problems, be prepared to pack and suture the socket and advise the patient on how to avoid dislodging the clot. | UKMi Medicines Q&A: Surgical management of the primary care dental patient on antiplatelet medication. |
A patient taking aspirin and clopidogrel needs a tooth extraction. Should the antiplatelet drugs be stopped? | ||
Availability of medicines | Aphthasol is a US product containing amlexanox. Two preparations (Aphtheal and Aftasol) containing amlexanox are licensed in the UK but have never been marketed. A Swedish company has rights to market Aphthasol in Europe but cannot say when they will market it in the UK. Currently Aphthasol can be imported from the US via a hospital or community pharmacy. | Internet search. |
A university dental hospital department wants information on the availability of Aphthasol 5% oral paste in the UK. | European and UK medicines regulator websites. | |
Manufacturer's website/medical information department. | ||
Drug import company. | ||
Bisphosphonates | Do not stop the bisphosphonate. Advise the patient about a small risk of BONJ, signs and symptoms to report and the need for good oral hygiene. Do not prescribe antibiotics. Extract the tooth and follow up the patient at 3-4 weeks to ensure the socket has healed and there is no evidence of ONJ; refer promptly to secondary care if problems occur. | Local dental hospital bisphosphonate guidelines. |
A patient taking alendronate needs a tooth extraction. What advice do we give about managing the risk of bisphosphonate-induced osteonecrosis of the jaw (BONJ)? | British Dental Association Factfile on bisphosphonates. | |
Corticosteroid cover | A tooth extraction under local anaesthesia is considered to be a minor surgical procedure. Local anaesthetics do not provoke the stress response. The patient does not need corticosteroid cover. | British National Formulary |
A patient needs a tooth extracted under local anaesthesia. He had a corticosteroid injection in his shoulder last week. Will he need corticosteroid cover? | In-house evidence-based review (prepared following a literature search for published papers and national guidance). | |
Legal issues | Since April 1st 2006, schedule 2 and 3 controlled drugs (including temazepam) must be prescribed on a FP10PCD form. There are two versions available – a personalised form containing the prescriber's details (FP10PCDNC) and a non-personalised form (FP10PCDSS). These should be ordered from your local primary care trust. | NHS Business Services Prescription Pricing Division website. |
A dentist wrote a private prescription for temazepam which a community pharmacist refused to dispense. How can he prescribe temazepam for his patients? | UKMi Medicines Q&A: How should dentists prescribe, store, order and dispose of controlled drugs? | |
British Dental Association. | ||
Local anaesthetic interactions | Adrenaline given as part of a dental local anaesthetic does not significantly interact with quetiapine, lithium or venlafaxine. However using an aspirating syringe and giving no more than two 2.2mL cartridges containing 1:80,000 adrenaline will minimise effects on blood pressure, should it be inadvertently injected intravenously. | Textbooks/Manufacturer's summary of product characteristics. |
A patient taking quetiapine, lithium and venlafaxine has been told he must not have adrenaline. He has previously had tachycardia after local anaesthesia using adrenaline. Does adrenaline interact with antipsychotics? | Stockley's Drug Interactions (online database). | |
UKMi Medicines Q&A: What is the clinical significance of potential drug interactions with local anaesthetic preparations used in primary care dentistry? |
