Contraindications & cautions

Information provided in this section of the website is reproduced from the Drug Prescribing for Dentistry Analgesic and Antibiotic Contraindications and Cautions Supplement, published in May 2021

Analgesics and antibiotics

Some drugs prescribed in dental practice have important contraindications and cautions for patients with certain conditions, such as heart or circulatory conditions, renal or hepatic impairment or those at increased risk of gastrointestinal adverse effects. Where a drug is contraindicated for a particular condition, the drug should be avoided in patients with that condition. Where a drug has a caution listed for a particular condition, the drug may be prescribed for a patient with that condition if a safer alternative cannot be found. However, the patient should be monitored for adverse-effects or deterioration in their condition and a dose reduction might be advisable in some cases.

This section provides details of the contraindications and cautions which should be taken into account when prescribing analgesics or antibiotics in dental practice. Much of the content was originally developed as part of the response to the COVID-19 pandemic but is now provided as a supplement to the SDCEP Drug Prescribing For Dentistry guidance

General Advice

• Most odontogenic pain can be relieved effectively using paracetamol and/or ibuprofen to provide optimal analgesia.*
• The prescribing of antibiotics must be kept to a minimum and used only where there is a clear need. Treat dental abscesses in the first instance by using local measures to achieve drainage, with removal of the cause where possible. Antibiotics are not indicated in the absence of swelling or other signs of infection.
• Where analgesics and/or antibiotics are necessary, an up-to-date medical history should be obtained from the patient. This should include details of any medical conditions, current medications (including over-the-counter drugs, e.g. analgesics) and allergies that the patient might have.
• It is also important to establish the patient’s self-management to date to check for possible overdose of analgesics.
• Be aware that prescribing for some patient groups, such as the elderly, patients who are immunocompromised or with hepatic or renal problems, patients who are pregnant and nursing mothers might differ. Refer to the BNF (www.medicianescomplete.com) for further details.
• If the patient has a relevant underlying health condition, consider liaising with their general medical practitioner or specialist.
• Advise patients to contact the practice if their symptoms persist or worsen

*Optimal analgesia is defined as the lowest effective dose of painkillers taken for the shortest duration necessary to control symptoms without exceeding the maximum dose and taking into account the patient’s age, weight and relevant health conditions.