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Emergency Drugs & Drugs That Change Dental Care Chapter: Drugs Affecting Dental Care, Interactions and Emergencies
🖨 Print or save as PDF Updated 2026-10-20
Core emergency drugs Drug Use Adult dose and route Oxygen Almost every emergency (not hyperventilation) Nasal cannula or mask, e.g., 4–6 L/min cannula, 10–15 L/min non-rebreather mask Epinephrine 1 mg/mL Anaphylaxis; severe asthma not responding to albuterol 0.3–0.5 mg IM in the anterolateral thigh (child 0.01 mg/kg, auto-injector 0.15 mg); repeat every 5–15 min Nitroglycerin Angina 0.4 mg sublingual every 5 min up to 3 doses; not with a PDE5 inhibitor in the last 24–48 h or with low blood pressure Albuterol inhaler Bronchospasm (asthma) 2–4 puffs, repeat as needed Aspirin Suspected myocardial infarction 162–325 mg chewed (non-enteric-coated) Diphenhydramine Mild allergic reactions (hives, itching) 25–50 mg oral or IM Oral glucose Conscious hypoglycemia 15–20 g; recheck in 15 min Naloxone Opioid overdose 0.4 mg IM/IV or 4 mg intranasal; repeat as needed Midazolam (if trained) Prolonged seizures IM or intranasal per protocol
Syncope is the most common office emergency: supine, legs raised, oxygen; an AED should be available in every office. Drugs that change dental treatment Drug or class Dental concern Antiresorptives (bisphosphonates, denosumab) and antiangiogenic drugs Medication-related osteonecrosis of the jaw (MRONJ); highest risk with IV oncologic doses; do needed extractions before therapy when possible Phenytoin, cyclosporine, calcium channel blockers (nifedipine, amlodipine) Drug-influenced gingival enlargement; plaque control reduces it Anticholinergics, antidepressants, antihypertensives, antihistamines, opioids Xerostomia → caries, candidiasis, denture problems Long-term corticosteroids Delayed healing, infection risk, adrenal suppression (routine dental care rarely needs extra steroid; major surgery or infection may) Benzodiazepines with opioids Additive respiratory depression (FDA boxed warning) Lithium NSAIDs and metronidazole raise lithium levels Methotrexate NSAIDs and some antibiotics raise toxicity; oral ulceration is a toxicity sign
⚠️ Common traps Giving epinephrine IV or subcutaneously for anaphylaxis in the office: IM in the thigh is preferred. Giving nitroglycerin to a patient who took sildenafil today. Treating an unconscious hypoglycemic patient with oral glucose: risk of aspiration; use glucagon or IV dextrose. Overlooking antiresorptive drug history before extractions. Mini-quiz Pick an answer to see right away whether it is correct and why.
A patient develops hives, wheezing and low blood pressure after taking amoxicillin in the office. The first drug is:
A. Diphenhydramine 50 mg orally B. Nitroglycerin 0.4 mg SL C. Albuterol only D. Epinephrine 0.3 mg IM
Chest pain starts during treatment in a patient with known angina who took tadalafil yesterday. What should be avoided?
A. Oxygen B. Placing the patient upright C. Calling EMS D. Nitroglycerin
Which medication is most associated with gingival enlargement?
A. Nifedipine B. Lisinopril C. Metformin D. Atorvastatin
A conscious diabetic patient becomes shaky, sweaty and confused before lunch. The best first step is:
A. Give 15–20 g of oral glucose B. Give insulin C. Give aspirin 325 mg D. Give epinephrine IM
Which drug history most increases the risk of osteonecrosis after an extraction?
A. IV zoledronic acid for metastatic cancer B. Daily low-dose aspirin C. Amoxicillin last month D. Levothyroxine
0 of 5 answered
Answer key: 1 D · 2 D · 3 A · 4 A · 5 A
