Hygiene Atlas

Atlas · Plate VIII · Pharmacology and Local Anesthesia · 07

CNS and other drugs

Benzodiazepines relieve anxiety and sedate, and flumazenil reverses them. Antidepressants dry the mouth, and tricyclics call for a limited vasoconstrictor dose. Phenytoin enlarges the gingiva, inhaled corticosteroids raise candidiasis risk, and cocaine or methamphetamine use within about 24 hours rules out epinephrine. Bisphosphonates and denosumab are linked to MRONJ, with much higher risk at IV cancer doses than oral osteoporosis doses.

High-yield facts · 10

  1. Benzodiazepines (diazepam, midazolam, triazolam) are used for anxiety and sedation; flumazenil reverses them.S51
  2. SSRIs (fluoxetine, sertraline) and tricyclics cause xerostomia; tricyclics plus epinephrine can raise BP, so limit vasoconstrictor.S14S51
  3. MAO inhibitors historically warned with vasoconstrictors; the interaction with dental epinephrine is considered minimal but still screened.S14
  4. Phenytoin causes gingival enlargement and is used for seizures.S51
  5. Cocaine or methamphetamine use within about 24 hours: do not use epinephrine (risk of arrhythmia, hypertensive crisis).S14
  6. Inhaled corticosteroids raise candidiasis risk; advise rinsing after use.S51
  7. Bisphosphonates (end in "-dronate") and denosumab are antiresorptives linked to MRONJ.S67
  8. MRONJ definition: exposed or probeable bone in the jaw for more than 8 weeks in a patient on antiresorptive/antiangiogenic drugs, with no history of jaw radiation or metastasis.S67
  9. MRONJ risk is much higher with IV cancer doses than with oral osteoporosis doses (oral risk is under about 0.05% in the 2022 AAOMS paper).S67
  10. Metformin is first-line oral therapy for type 2 diabetes; it rarely causes hypoglycemia alone. Insulin and sulfonylureas can.S51

Facts are written in our own words; each tag links to its source. Values marked "sources vary" differ between references, so check the one your program uses.