OTC drugs (O-Med)

• ®antibacterial
• ®anti-inflammatory
• ®pain relief
• ®cleansing & deodorizing

Reduce number of bacteria & fungi

®Phenols, essential oils, halogens, biguinides, quaternary amonia

®Oxygenating agents against anaerobic bacteria

Cause local vasoconstriction and reduce tissue edema

®Alcohol, zinc chloride, zinc acetate, alum, tannic acid, acetic acid, citric acid

Alleviate pain and soreness

®Phenol derivatives, oil of wintergreen and eucalyptus oil

Degrade bacterial cell walls and also wash away microorganisms (Sodium laurel sulfate)   

Neutralize odor from decomposing oral debris (Chlorophyll)

Reduce the pH change resulting from bacterial metabolism

®Sodium perborate and sodium bicarbonate

• 1. anesthetic
• 2. lubrication
• 3. antiseptic
• 4. atringent

Topical oral agents aka "covering agents" for sores and irritations

®benzocaine, lidocaine, dyclonine

®sodium carboxymethyl cellulose, propylene glycol, hydroxypropyl cellulose, glycerin

®ethyl alcohol, salicylic acid, benzyl alcohol, phenol, K iodine, povidone iodine, benzalkonium chloride, benzethonium chloride, stearyl alcohol, cetyl pyridium chloride (CPC), benzoin tincture

®sugar gum, tannic acid, zinc chloride

• Benzocaine alcohol Free
• Benzocaine and Alcohol
• Benzocaine & Eugenol
• Benzocaine & Menthol
• Benzocaine & Phenol
• Dyclonine
• Lidocaine

- OTC topical covering agent

®an emollient paste of Na carboxymethyl cellulose in a plasticized hydrocarbon gel

available with benzocaine to provide relief; they may be compounded with other agents for better mucosal drug delivery

- OTC  topical covering agent

®a film-forming liquid composed of a hydroxypropyl cellulose and benzyl alcohol

available with benzocaine to provide relief; they may be compounded with other agents for better mucosal drug delivery

OTC  Topical Covering Agents

a mucoadherent compound with Na hyaluronate (healing), glycyrrhetinic acid (anti-inflammatory) and aloe vera (soothing)

OTC Topical Covering Agents

®sulfuric acid & phenol

- targeted to chemo or radiation-induced stomatitis as well as for other drug delivery

• Examples:
• - GelClair® oral gel
• - Carafate® (sucralfate)
• - Kepivance™ (keratinocyte growth factor, palifermin)

- mucoadhesive (targeted for chemo or radiation-induced stomatitis)

- contains PVP (polyvinylpyrrolidone) and sodium hyaluronate in a liquid gel – powder reconstituted w/ water to make oral suspension

- mucoadhesive (targeted for chemo or radiation-induced stomatitis)

- oral suspension (1 g/10 mL)

- mucoadhesive (targeted for chemo or radiation-induced stomatitis)

- powder reconstituted for IV injection

®Used for dry/cracked lips

®Have many ingredients: beeswax, petroleum jelly, menthol, camphor, scented oils, etc; may contain sunscreens (oxybenzone, dimethicone)

DRYNESS

• saliva substitutes
• saliva stimulants
• sialogogue agents
• salivary gland protective agents

• 1. Carboxy methyl cellulose & Hydroxymethyl cellulose
• 2. Mucopolysaccharide
• 3. Glycerate polymer
• 4. mucin
• 5. xylitol

• Examples:
• ®Moi-stir spray & liquid
• ®Salese liquid
• ®Saliment aerosol
• ®Saliv-aid liquid
• ®Salivart aerosol
• ®Oralube liquid
• ®Xerolube spary
• ®Optimoist spary and drops which also contains fluoride, calcium and phosphate
• ®Oasis spray and mouthwash

®Oral Balance gel also contains lactoperoxidase enzyme system

®Other Biotène products

- Orthana spary and lozenges

• - Xylomelt
• - Xerostom
• - Mighteaflow (also has catechins from tea plant)

- Chewing gums (Xylitol, Biotene)

- Oramoist discs

- Parasympathomimetic (cholinergic) herbal remedies (Pilocarpus jaborandi leaves, Narcissus pseudonarcissus (daffodil) bulbs)

- For patients w/ severe xerostomia require medical tx

• Examples:
• - Pilocarpine (Salagen) 5 mg
• - Cevimeline HCL (Evoxac) 30 mg
• [There are contraindications to the use of these agents]

• Bile secretion-stimulating drug (cholagogue)
• - Anethole trithione (Sialor) --> Serious side effects

Amifostine (Ethyol)

drug that protects against the damage of radiation and is the first drug to be approved by the FDA for the treatment of patients with head and neck cancers receiving radiation therapy

diminished taste seen in pts w/ dry mouth

diminished taste seen in pts w/ dry mouth

phantom tastes (metallic, sour, bitter, foul)

- Burning sensation in the tongue or other oral sites (like after biting into hot pepper)

• - Burning may be intermittent or continuous
• - absence of clinical and laboratory findings

- Pt presents w/ multiple oral complaints (Burning, dryness and taste alterations)

- More in women, especially after menopause

- Sometimes associated w/ type 2 DM, anxiety & depression, deficiencies in vitamins and nutrients

25%

- An unusually high number of taste buds = ability to taste phenylthiocarbamide “PTC” = bitter

- Women > men

®Supertasters are also super-perceivers of oral pain (alcohol & capsaicin)

®Supertasters are more sensitive in touch responses (fatty foods)

®Supertasters are more prone to dveloping BMS

Receptors found in taste buds throughout tongue, soft palate, pharynx, larynx, uvula, epiglottis       and the beginning of esophagus ®Tongue is innervated by V, chorda tympani of VII (ant 2/3), IX and XII (post 1/3) ®Soft palate, pharynx, larynx, uvula are innervated by the superficial petrosal of VII®Epiglottis & 1st third of esophagus is innervated by XTaste buds are surrounded by a         basket-like collection of pain neuronsCranial nerves transmit taste information from these sites to brain stem

®Many BMS patients have phantom tastes or loss of certain tastes  

®Because taste inhibits oral pain, taste dysfunction may contribute to altered sensations

®Loss of pain inhibition? Chorda tympani, trigeminal (V) & glossopharyngeal (IX) nerves all implicated

®Dysfunction in central dopaminergic system – protective effect of estrogen…

• ®Aging
• ®Menopause (Loss of estrogen effect)
• ®Dry mouth (Sjögren's syndrome, Chemotherapy or radiation therapy)
• ®Cranial nerve injury (Trauma, neoplasms, Bell’s palsy)
• ®Psychiatric conditions (Depression, anxiety,   eating disorders)
• ®Nutritional deficiencies (B1, zinc, copper)
• ®Medications (ACEI (timing?)
• ®Oral diseases (LP, Candida, viral infxns, periodontitis)
• ®Systemic conditions (Liver & renal disease)

• 1. benzodiazepines
• 2. SSRI antidepressants
• 3. Anticonvulsants
• 4. Alpha lipoic acid
• 5. Topical tx

®Clonazepam (Klonopin)- 0.25 to 2 mg/day

®Chlordiazepoxide (Librium)- 10 to 30 mg/day

®Paroxetine (Paxil)- 20 mg/day x 8 wks

®Sertraline (Zoloft)- 50 mg/day x 8 wks

®Gabapentin (Neurontin)- 300 to 1,600 mg/day

- 600 mg/ d x 2 mo

Clonazepam- Wafers 1 mg, 3 min tid

• Capsaicin
• - Hot pepper & water 1:2 dilution
• - Rinse w/ 1 teaspoon; increase strength to 1:1 dilution

®48% of US adults take a dietary supplement

®36% believe that supplements can help them live longer

®Dietary Supplements are regulated similarly to foods

®Exemption from premarket safety & efficacy research

• 10 Multivitamins & minerals 
• - Multivitamins, Vit E, C, B12, A, D
• - Ca, Mg, Zn, folic acid

• 10 Herbal supplements
• - Echinacea, ginseng, gingko biloba, garlic, St. John’s wort, peppermint, ginger, soy, chamomile, kavav kava

- 5 of these (ginkgo, garlic, St. John's wort, soy, and kava) have scientific evidence suggesting efficacy

- Concerns over safety and a consideration of other medical therapies

- Evidence suggests effectiveness against dementia

- Although has mild effect on PVD, no good evidence for claims of: Erectile dysfunction + Cerebrovascular ischemia

- Reports of anti-platelet activity causing spontaneous bleeding; also GI complaints, headaches, allergic rxns

- Interacts w/ MAOI, ASA, anti-PLT drugs & thiazide diuretics

®Mainly used for hyperlipidemia

®Evidence shows 4-6% reduction in cholesterol levels (17-32% w/ statins)

• ®No support for other claims:
• - Hypertension
• - Protective against gastric CA (antibacterial compound allicin)

®Reports of increased risk for bleeding; also GI symptoms, allergy (contact dermatitis, asthma, rhinitis, urticaria)

®Caution with anti-platelet drugs

- for mild to moderate depression

• No good support for:
• - Wound healing
• - Anti-inflammatory & analgesic effects

®Causes GI symptoms, dizziness, confusion, tiredness, sedation, photosensitivity, inhibition of sperm motility

®Many drug interactions due to interference w/ liver drug metabolism

-  for tx of menopausal symptoms and for lowering cholesterol

- Evidence shows a 4-5% reduction in LDL

- No good evidence for tx of hot flashes

- Concern for long-term estrogen effects

®Used as a sedative, relaxant or for its euphoric effects in the islands of South Pacific

®A small benefit for tx of anxiety

®Case reports of severe hepatotoxicity

®Combination w/ benzodiazepine may cause semicomatose state

- herbs

®Immune stimulant®Used for common cold, URI, lower UTI®Studies inconclusive®Rxn in people allergic to         sunflower seeds®Contraindicated in multiple sclerosis, HIV infection and tuberculosis®No known drug interaction

®Used for physical & cognitive performance

®Claims of anti-cancer and immunomodulatory effects

®Has androgenic effects

®Interacts w/ warfarin and other anti-coagulants, MAO inhibitors (Phenelzine)

®Not to be used w/ stimulants, antipsychotic drugs or hormones

®Reports of excessive arousal & hyperactivity

• ®Used for tx of IBS
• ®Trials suggest some benefit but no definitive conclusion
• ®Infrequent and mild side effects

®Used for nausea

• ®Questionnable effect on post-operative nausea
• ®May have some efficacy in motion sickness and chemotherapy-induced nausea

®No good evidence for:Thrombosis, Rheumatic & musculoskeletal diseases

®Reports of contact dermatitis but no other side effects®Caution w/ anti-platelet drugs

• ®Used for sleep disorders, (mild sedative), anxiety and GI problems
• ®No good evidence for any
• ®Believed to be generally safe
• ®Some reports of serious allergic rxns

inherent toxicity, overdose, drug-herb interactions & allergic responses

there are over 20,000 herbal products in this country. There is limited evidence to support the efficacy of even the top 10 herbs, and there is far less evidence for the rest