Drugs and Dentistry: Everything You Need to Know

Dentists prescribe medication for use during and after procedures. There are lots of reasons prescriptions are necessary for patients, but the most common are:

• Pain: No one likes to be in pain – and dental pain is one of the worst kinds. Dental pains can include toothaches, tooth sensitivity, procedure pains (like drilling and scraping), post procedure pain and soreness. Dentists use drugs to prevent and reduce pain from any drilling, scraping or prodding.
• Anxiety: Anxiety about the dentist can range from nervousness in the waiting room to severe discomfort and physical symptoms in the dental chair. Whether you have an anxiety disorder or just nerves about the dentist, your dentist might prescribe medication to reduce anxiety during your procedure. If you have dental anxiety and want to learn more – check out our blog on Facing your Fears at the Dentist.
• Infection: Your mouth can develop infections that put your health at risk. Tooth decay, cavities, broken teeth, and other issues can lead to infection that your dentist will treat with antibiotics. Major dental work like extractions and oral surgery can also put you at risk for developing infection – so your dentist might prescribe antibiotics to prevent infections too.

Pain, anxiety, and infection are just a few reasons dentists prescribe medication. However, there are a lot of prescriptions used to treat those symptoms. Here are a few of the most commonly used drugs in dentistry:

• NSAID Pain Relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used drugs in dentistry. Your dentist will likely recommend them for any short-term pain relief needed after your dental work. Common NSAIDS are ibuprofen (Motrin or Advil), naproxen (Aleve), and aspirin (Bayer or Excedrin).
• Acetaminophen: Acetaminophen, or Tylenol, is an over-the-counter drug for short term pain relief. Unlike NSAID pain relievers, Tylenol is not an anti-inflammatory – so it won’t fight any swelling or inflammation brought on by your dental procedures. Dentists use it to treat pain and discomfort.
• Local Anesthetic: The dreaded needle. Local anesthetics include novocain, articaine, prilocaine, mepivacaine, bupivacaine, and most commonly lidocaine. These drugs are injected where your dentist will be working to prevent pain during procedures. They are often mixed with epinephrine so they will last longer.
• Antibiotics: If you have an infection in your mouth, or if dental work puts you at risk for one, your dentist might prescribe antibiotics to prevent or fight infection. The most common antibiotics used in dentistry are doxycycline, penicillin, amoxicillin, and Antibiotics are most commonly prescribed when you have a major procedure.
• General Anesthesia: For more intense procedures, such as oral surgery, your dentist/surgeon might recommend the use of general anesthesia. These drugs are injected intravenously (through an IV hookup) and put the patient to sleep so they won’t feel the procedure. They commonly include ketamine, propofol, fentanyl and midazolam.
• Nitrous Oxide: Dentists use Nitrous Oxide (N2O), or laughing gas, as a pain-relief and anti-anxiety treatment during medical procedures. The patient inhales a combination of nitrous oxide and oxygen to create euphoria, a dissociative effect to mask discomfort and reduce anxiety.
• Sedation Drugs: Anxiety prescriptions such as diazepam (valium) and lorazepam (ativan) are benzodiazepines – a family of drugs that create a calming affect for the patient. Dentists use these to relieve anxiety in patients before a procedure. They are normally administered with a pill, but they can also be delivered through injection or IV (ask your dentist about these methods).
• Topical Analgesics: These are applied directly to your gums to reduce pain and discomfort. They are rubbed onto your gums or teeth with a cotton swab before your Dentist applies a local anesthetic. You might also use them as a post-procedure pain reliever. They include Ambesol, Orajel, Chloraseptic, and

For more information on commonly used drugs in dentistry, check out Cleveland Clinic’s article on Medications Used in Dentistry.

If you’ve filled out paperwork in your dental office, you have seen forms asking you to list any medical conditions you have and what drugs you’re taking. These forms can be a drag – but they help your dentist know what might be affecting your oral health and what treatments will be effective. Make sure to take these forms seriously and inform your dentist of any changes at your next appointment.

If you’re curious about how common drugs can affect your oral health, here are a few common examples:

• Ibuprofen/Motrin/Aleve: Ibuprofen can cause dry mouth that can increase your risk for cavities. If you are going to be taking ibuprofen for awhile, be sure to brush!
• Benadryl: Benadryl (Diphenhydramine) and other common antihistamines can also cause dry mouth. Antihistamines can present a greater risk for plaque buildup and cavities because they are sometimes used as long-term or frequent treatment for allergies. If you use Benadryl to treat your allergies, ask your dentist if it is affecting your oral health.
• Blood thinners: Anticoagulants, or blood thinners, are used to treat blood clots and prevent heart attacks and strokes. But they can lead to dental issues like bleeding in your gums when you brush. Common blood thinners include warfarin and heparin. If you are on blood thinners, make sure to use a soft-bristled toothbrush and brush gently! Also make sure your dentist knows you are on these medications so they can take precautions to reduce bleeding during your appointment.
• Birth Control: One of the lesser known side effects of many birth control pills is the potential for soft-tissue reactions. Birth control can include swelling of the gums and mouth, sores, or If you are experiencing any of these side effects, talk to your dentist about creating a plan to help you minimize your symptoms.
• Chewable and Gummy Vitamins and Antacids: Chewable vitamins and antacids aren’t known for having many side effects. But they often contain sugar and vitamin C that can get stuck in your teeth and increase risk for cavities. If you take chewable vitamins and antacids, make sure to brush and floss your teeth vigilantly!

If you have pre-existing medical conditions, you might be asking yourself, “are any dental medications going to make my condition worse?” It’s especially important to ask your dentist or Primary Care Physician (PCP) this question. Here are a few common conditions with treatments that can negatively interact with dental prescriptions: 

Heart Conditions: Heart conditions, like heart blocks or sinoatrial blocks, that are not treated can put you at risk to adverse effects from lidocaine -- the most common local anesthetic used in dentistry. Consult with your dentist to make sure they pick the right anesthetic for you. If you think you might be at risk for a heart condition, talk to your doctor. And check out our blog on heart medication and your oral health!

High Blood Pressure: If you have acute or chronic high blood pressure, it is advised to avoid NSAID pain relievers such as ibuprofen and Aleve. These medications can increase your blood pressure – and even put you at risk for heart attack or stroke.

Allergies: If you have a corn allergy, local anesthetics such as lidocaine and Novocain can trigger an allergic reaction. These anesthetics often have corn-based dextrose (sugar) mixed into the solution. If you think you might have a corn allergy, check with your doctor and dentist before your next dental procedure.

Pregnancy: Dental care during pregnancy is safe and recommended. However, make sure to tell your dentist if you are pregnant - they might recommend you avoid certain prescriptions during this time. For example, many dentists recommend avoiding nitrous oxide during the first two trimesters of pregnancy due to the medicine’s potential to effect DNA production.

Oral Contraceptives: Certain oral contraceptives, or birth control pills, can reduce the effectiveness of certain medications. For example, many types of birth control pills can reduce how much diazepam/valium helps anxiety during your dental visit. If you are taking birth control, check with your dentist to make sure they are prescribing the medication that will be the most effective for you.

Gastrointestinal Diseases: Gastrointestinal problems such as Gastroesophageal Reflux Disease (GERD), Crohn’s disease, and ulcerative colitis can create problems with anti-inflammatory drugs – particularly NSAID pain relievers. NSAID’s like ibuprofen can worsen gastrointestinal symptoms including stomach pain, nausea, and diarrhea – and even increase risks for ulcers. If you have GI problems, consult with your dentist about which medications you should avoid in your dental treatment and potential alternatives.

Keep in mind these are only some issues that can interfere with your dental treatment. If you have concerns about any prescriptions or have any pre-existing medical conditions, make sure to speak up and let your dentist know. There are alternatives for almost every dental medication and treatment - so there is something out there that will work for you!

Now that you know what’s common in dental medicine, you might be wondering what is new. Like every medical field, dentistry makes and finds new innovations every year. Here are a few trends surrounding dental medications.

A reduction in Antibiotics: Infection is one of the greatest risks in dentistry, and precautionary antibiotics have been often gone hand-in-hand with dental procedures. But, recent studies are showing over 80.9% of antibiotic prescriptions prior to surgical procedures are unnecessary.  As a result of studies like this one, dentists have been pushing back on prescribing antibiotics and only prescribing them if a patient shows signs of infection or has a pre-existing condition that makes them a considerable risk for infection.

NSAIDs vs. Opioids: Opioid addiction continues to be a problem in the U.S. and a major point of discussion for Dentists, Physicians, and Lawmakers. Studies show that U.S Dentists prescribe more than 37 times more opioid-based painkillers than England. With studies like this, more and more dentists are promoting the use of NSAID pain relievers for pain treatment. NSAIDs have proven to be just as effective for treating dental pain as opioids– without the risk for addiction. NSAIDs also have fewer side effects and are generally considered to be safer than the opioid based pain relievers. You can read more about the argument for NSAIDs over opioids in study results here.

Whether you want to learn more about dental prescriptions or are concerned about how other medical conditions and treatments might affect your dental care, the best course of action is always talk to your dentist. Your dentist is the expert on your individualized treatment plan and is meant to be a resource for you. Keep in mind - medication is just one part of your treatment plan and overall oral health. If you’d like to learn more about improving your oral health, check out our  Dental Treatment Tip Sheet.