Table 6: Topical Medications for Orofacial Pain Anxiolytic Medications Formulations
Usual Daily Dosage
Anxiolytic Medications
Dexamethasone (Dexasone, generics)
0.5 mg/5 mL oral solution 1 mg/mL oral solution
Rinse and expectorate 1 mg q4-6h prn for pain.
Anti-inflammatory Antiemetic Multiple myeloma
Capsaicin (Zostrix, generics)
0.025%, 0.035%, 0.075%, 0.1% cream 0.025% transdermal patch
Apply tid-qid. Patch: Apply patch to affected area up to 3-4 times/day for 7 days. Patch may remain in place for up to 8 hours.
Topical analgesic
ER = extended-release.
ANALGESICS FOR SPECIAL POPULATIONS: THE DENTAL PATIENT WHO IS PREGNANT OR BREASTFEEDING
The pregnant dental patient presents two significant challenges to the dental professional. First, although most dental procedures are elective and can be postponed until after the pregnancy is over, dental treatment for a pregnant woman who has oral pain, advanced disease, or infection should not be delayed. Second, not all women of childbearing age know that they may be pregnant, and when selecting and prescribing a medication for any woman of childbearing age, the clinician should always consider the possibility of her conceiving while she is still receiving the medication. The aim when prescribing medication to a pregnant patient is to balance the risks of the drug’s potential adverse effects (usually on the fetus) with the benefit (usually to the mother) of treating the disease (Berlin,
Paul, & Vesell, 2009; Donaldson & Goodchild, 2012; U.S. Department of Health and Human Services, 2008). To reflect the dangers associated with the use of drugs in pregnancy, the FDA traditionally has classified drugs on the basis of the level of risk they pose to the fetus (Table 7; U.S. Department of Health and Human Services, 2008). Accordingly, drugs in pregnancy risk factor Categories A and B are considered safe for use in pregnancy, whereas drugs in pregnancy risk factor Category C may be used only if the benefits outweigh the risks. Use of drugs in pregnancy risk factor Category D should be avoided except in certain exceptional circumstances, and use of pregnancy risk factor Category X drugs in pregnant women is strictly prohibited.
Table 7: U.S. Food and Drug Administration Pregnancy Risk Factor Definitions Category Definition A
Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester (and there is no evidence of risk in later trimesters), and the possibility of fetal harm appears remote. B Either animal reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or animal reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no evidence of risk in later trimesters). C Either studies in animals have revealed adverse effects on the fetus (teratogenic, embryocidal, or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus. D There is positive evidence of human fetal risk, but the benefits of use in pregnant women may be acceptable despite the risk (for example, if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective). X Studies in animals or human beings have demonstrated fetal abnormalities or there is evidence of fetal risk based on human experience, or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant. Note . Adapted from “Content and Format Labeling for Human Prescription Drug and Biological Products; Requirements for Pregnancy and Lactation Labeling,” by the U.S. Food and Drug Administration, 2014. Retrieved from https://www.federalregister.gov/articles/2014/12/04/2014-28241/ content-and-format-of-labeling-forhuman-prescription-drug-and-biological-products-requirements-for; “Drug Safety and Availability,” by the U.S. Food and Drug Administration, 2015a. Retrieved from http://www.fda.gov/Drugs/DrugSafety/; “CFR – Code of Federal Regulations Title 21: 21CFR201.80: Labeling Requirements for Over-the-Counter Drugs,” by the U.S. Food and Drug Administration, 2015b. Retrieved from http://www. accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=201.80; “Pregnancy, Lactation, and Reproductive Potential: Labeling for Human Prescription Drug and Biological Products-Content and Format Draft Guidance for Industry,” by the U.S. Food and Drug Administration, 2020. Retrieved from https://www.fda.gov/regulatory-information/search-fda-guidance-documents/pregnancy-lactation-and-reproductive-potential- labeling-human-prescription-drug-and-biological. Many analgesics are available over the counter – that is, without
and contraction of the ductus arteriosis leading to maternal pulmonary hypertension (Thorpe et al., 2013). Gastroschisis is a congenital and often ibuprofen-related malformation in which fetal organs develop outside the abdominal wall (Torfs, Katz, Bateson, Lam, & Curry, 1996). Other drug-related cases of gastroschisis have been linked to maternal use of other NSAIDs, including aspirin and the decongestants pseudoephedrine and phenylpropanolamine (Torfs et al., 1996). The glucocorticoids, such as prednisone and dexamethasone, have been associated
a prescription – and can be purchased at retail outlets as well as pharmacies. As a result of this easy access, the wide- ranging effects of analgesics are often forgotten by patients and prescribers alike and not put into the context of being potentially dangerous during pregnancy or breastfeeding. A review of human studies focusing on the ingestion of ibuprofen during pregnancy found that this drug caused embryonic implantation disturbances, inhibition of parturition,
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