What are common dental medications prescribed in Canada, including dosing and indications?

Common Dental Drugs Prescribed in Canada: Dosing and Indications

The most commonly prescribed dental medications in Canada include antibiotics (primarily amoxicillin and clindamycin), analgesics, and antimicrobials, with specific indications for dental infections, prophylaxis, and pain management based on current guidelines. 1

Antibiotics for Dental Infections

First-Line Antibiotics

• Amoxicillin: 500 mg three times daily for 5-7 days; first-line treatment for dental infections in non-allergic patients 2, 3
• Phenoxymethylpenicillin: Alternative first-line option for specific patients with dental infections, particularly for those with apical abscesses requiring antibiotics 4, 5

For Penicillin-Allergic Patients

• Clindamycin: 300-400 mg three times daily for 5-7 days; primary alternative for penicillin-allergic patients 2, 5
• Azithromycin: May be considered for specific cases where clindamycin is contraindicated 5

Antibiotic Prophylaxis

Endocarditis Prophylaxis

• Amoxicillin: 2 g orally 1 hour before dental procedure for patients at high risk of infective endocarditis 5
• Clindamycin: 600 mg orally 1 hour before dental procedure for penicillin-allergic patients 5

Important Considerations for Antibiotic Use

Indications for Antibiotic Therapy

• Antibiotics should only be prescribed as an adjunct to surgical treatment (root canal therapy, extraction, or incision and drainage) in specific situations 4, 5:
  • Presence of systemic symptoms (fever, lymphadenopathy)
  • Evidence of spreading infection or cellulitis
  • Medically compromised or immunosuppressed patients 4, 5

Non-Indications for Antibiotics

• Antibiotics are not recommended for:
  • Acute apical periodontitis without systemic involvement 5, 4
  • Irreversible pulpitis 5
  • Chronic periodontitis (except sub-antimicrobial dose doxycycline) 5
  • Routine post-extraction prophylaxis in healthy patients 4

Pain Management

Non-Opioid Analgesics

• Acetaminophen: 325-1000 mg every 4-6 hours (maximum 4000 mg daily); first-line for mild to moderate dental pain 6
• Ibuprofen: 400-600 mg every 6-8 hours; first-line for inflammatory dental pain 6
• Naproxen: 500 mg initially, then 250 mg every 6-8 hours; alternative NSAID for dental pain 6

Combination Therapy

• Acetaminophen + Ibuprofen: Combined therapy (400-600 mg ibuprofen plus 500-1000 mg acetaminophen) provides superior analgesia compared to either medication alone for acute dental pain 6

Opioid Analgesics (Limited Use)

• Acetaminophen + Codeine: Reserved for moderate to severe pain when non-opioid analgesics are insufficient 6
• Acetaminophen + Hydrocodone: Alternative for severe dental pain; should be limited to short-term use 6

Topical Medications

Antimicrobial Mouthwashes

• Chlorhexidine gluconate 0.12-0.2%: Rinse for 30 seconds twice daily; indicated for gingivitis, periodontitis, and pre/post-surgical oral antisepsis 5

Topical Anesthetics

• Benzocaine gel/spray (20%): Apply to affected area for temporary relief of oral pain 5
• Lidocaine viscous (2%): Apply to affected area for temporary relief of oral pain 5

Special Considerations

Renal Impairment

• Dose adjustment required for many antibiotics in patients with renal impairment 5
• For patients on hemodialysis, amoxicillin 2 g should be administered 1 hour before dental treatment 5

Antimicrobial Stewardship

• Dental antibiotic prescribing has increased significantly in Canada, with dentists accounting for approximately 10% of all antibiotic prescriptions 1, 7
• Up to 80% of antibiotics prescribed by dentists may be unnecessary 7
• Emphasis should be placed on appropriate surgical management rather than antibiotic therapy for most dental infections 4, 5

Prescribing Trends in Canada

• Amoxicillin is the most frequently prescribed antibiotic by dentists in Canada 1
• Clindamycin is the second most commonly prescribed antibiotic by dentists in British Columbia, Canada 1
• During the COVID-19 pandemic, there was a 66% increase in dental prescriptions, with antibiotics accounting for 62% of all prescriptions 6