12: Dental Drugs, Materials, Instruments and Equipment

CHAPTER 12 Dental Drugs, Materials, Instruments and Equipment

Dental drugs and products

Toothpastes, fluorides, anti-plaque and other mouthwashes, etc. are discussed in Chapter 8. Whitening agents, antiseptics and disinfectants (decontaminating agents), the other products used in oral healthcare, are discussed here. The most common drugs used in dentistry are anaesthetics, sedatives, analgesics and anti-microbial drugs.

Whitening Agents

Tooth-whitening products include strips, gels and varnishes containing hydrogen peroxide (H2O2) and are used for bleaching. H2O2 has been used for more than 70 years for oxygenating mouthwashes and to bleach teeth. The most common source of H2O2 used for whitening is carbamide peroxide which typically contains between 10% and 30% peroxide (15% is recommended), roughly equivalent to 3–10% hydrogen peroxide.

There are two methods of bleaching or whitening teeth:

External bleaching

External bleaching can be done in two ways:

Bleaching is not recommended in:

Internal bleaching

Internal bleaching is performed on teeth that are discoloured due to internal staining. This usually happens in teeth that have become non-vital from trauma or caries (see Chapter 5). Internal bleaching involves drilling a hole to the pulp chamber, cleaning and filling the root canal, and sealing a hydrogen peroxide gel into the pulp chamber for some days, and replacing this as needed (so called ‘walking-bleach’ technique).

Inhalational Sedation Agents

For inhalational sedation, sometimes termed relative analgesia or RA, two medical gases, nitrous oxide (N2O) and oxygen, are used. These gases are stored in specifically coloured cylinders (Tables 12.1 and 12.2). At least 20% and more usually 30% oxygen is given.

TABLE 12.2 Gases Used in Anaesthesia/Sedation Machines

Size of Cylinder Capacity (litres)
Oxygen Nitrous Oxide
E 680 1800
J 6800 18 000

Gases used in sedation/anaesthesia are usually supplied under high pressure either in cylinders or as a piped gas supply. The cylinders are made from molybdenum steel, in which gases and vapours are stored under pressure. The shape and colour of the plastic disc around the neck indicates when the cylinder was last examined. The most commonly used types/sizes are:

Nitrous oxide (N2O) is contraindicated for patients with:

It is also contraindicated:

Analgesics (Pain Killers)

Pain is probably the most important symptom suggestive of disease. However, the absence of pain does not mean a patient may not have disease. Different people respond differently to pain. The threshold for tolerance is lowered by tiredness, psychological factors, etc.

Anti-Microbials

Anti-microbials is a term that includes anti-bacterial (antibiotics), anti-fungal and anti-viral drugs. Indications for the use of antibiotics include:

Haemostatic Agents

Topical Haemostatic Agents

Haemostatic agents are often of animal source (Table 12.3) and, unless they are of synthetic origin, may thus be contraindicated in some patients on cultural/religious grounds.

TABLE 12.3 Some Topical Haemostatic Agents

Agent Main Constituent Origin
Avitene Collagen Bovine
Colla-Cote Collagen Bovine
Floseal Thrombin Bovine
Gelfoam Gelatin Bovine
Helistat Collagen Bovine
Instat Collagen Bovine
Thrombinar Thrombin Bovine
Thrombogen Thrombin Bovine
Thrombostat Thrombin Bovine
Beriplast Fibrin Various
Cyclokapron Tranexamic acid Synthetic
Surgicel Cellulose Synthetic

Floseal, Avitene and fibrin sealants are expensive. Gelfoam, Surgicel and collagen sponges are relatively inexpensive.

Drug safety

Using Controlled Drugs

Find Out More

Visit the website of the Medicines and Healthcare products Regulatory Agency (MHRA; www.mhra.gov.uk), the medicines safety watchdog, to read more about Yellow cards.

The webpage ‘Controlled drugs guidance for GP practices’ (www.gp-training.net/protocol/therapeutics/cd.htm) gives useful information about what should be included in a controlled drugs register and how they should be stored.

Jan 8, 2015 | Posted by in Dental Nursing and Assisting | Comments Off on 12: Dental Drugs, Materials, Instruments and Equipment
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