296 Theories and techniques of oral implantology

Pain relievers

The dentist must know how to cope with all types of patients. Some may have a much lower threshold of pain than others, and the ability to prescribe the proper drugs and their dosages will be advantageous both to the patient and to the practitioner.

Very mild pain. Very mild pain relievers may usually be administered with no fear of undesirable side effects. Their pain-repression action is believed to result from a depressant effect in the region of the optic thalamus.

Acetylsalicylic acid tablets (300 mg.)

Sig: Take two tablets every 4 hours.

or

Aspirin or Empirin compound

Sig: Take one or two tablets every 4 hours.

Moderate pain accompanied by apprehension, anxiety, and nervousness. The addition of a barbiturate with acetylsalicylic acid has a depressant action on the central nervous system, which reduces the apprehension and nervousness. The barbiturate also potentiates the analgesic action of the aspirin. Because overdosage has led to serious accidents, the statement "Do Not Repeat" should be placed on the prescription.

Acetylsalicylic acid (600 mg.)

Pentobarbital sodium (300 mg.)

Sig: Take one ever 4 hours for dental pain. Do not repeat.

Severe pain. Some of the stronger pain relievers include the following drugs, which should be ad-ministered with appropriate precautions.

Codeine prevents the perception of pain in the higher centers of the central nervous system by de-pressing the pathways by which the response to pain is transmitted. Addiction to codeine is much less readily produced than addiction to morphine, but the patient should be cautioned against dependency.

Codeine phosphate tablets (30 mg.)

Sig: Take one every 4 hours. Do not repeat.

Sometimes the addition of aspirin is used to give an additive effect to the codeine.

Codeine phosphate (30 mg.)

Acetylsalicylic acid (300 mg.)

Mix and place in a capsule.

Sig: Take every 4 hours for severe pain only. Do not repeat.

Some other commonly used pain relievers are:

Darvon Compound-65 Capsules: Dispense twelve.

Sig: Take one every 4 hours for dental pain.

Dilone

Tablets: Dispense twelve.

Sig: Take one every 4 hours for dental pain.

Percordan

Tablets: Dispense twelve.

Sig: Take one every 4 hours for dental pain.

Very severe pain. Again, the dentist should be extra cautious when prescribing strong medications.

Meperidine hydrochloride (50 mg.)

Tablets: Dispense six.

Sig: Take every 4 hours for severe pain only.

Meperidine, also known as Demerol, Dolantin, or Isonipecaine, is a synthetic substance prepared as a result of the widespread search for morphine substitutes. Meperidine addiction is not as readily developed nor as vicious as morphine addiction.

Clotting agents

Thrombin, gelatin foam, fibrin foam, oxidized gauze, and thromboplastic brain extracts may be applied directly to bleeding surfaces to combat oozing from minute vessels. However, these agents should not be expected to control a strong flow of blood from an artery or vein. Other agents may be ad-ministered systemically for this purpose unless the patient is receiving anticoagulant therapy. Systemic anticoagulants include carbazochrome salicylate, menadiol sodium diphosphate, menadione, and menadione sodium bisulfite.

Carbazochrome salicylate (Adrenosem Salicylate, Adrestat) is an oxidation product of epinephrine said to be effective for controlling capillary bleeding characterized by increased capillary permeability. Despite clinical reports of this drug's effectiveness in specific cases, there is no adequate scientific evidence from strictly controlled studies to support the clinical claims.

Carbazochrome salicylate

Sig: Oral—adults, 1 to 5 mg. four times daily. Intramuscularly—adults, 5 mg. every 2 to 4 hours. (For children, the dosage is reduced proportionately.)

Menadiol sodium diphosphate (Synkayvite, sodium phosphate) is an analogue of vitamin K useful in the prevention or the treatment of hemorrhagic disorders associated with a vitamin K deficiency; overdosages of systemic anticoagulants, such as bishydroxycoumarin; or prolonged use of large doses of salicylates, quinine, sulfonamides, arsenicals, or barbiturates.