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Whereas compounding is a rewarding departure from the pharmacy norm, compounding for dental patients and practices can be particularly rewarding, as well as lucrative. Conditions including chronic mucositis, infectious processes, and oral pain syndromes may call for specialized treatments and delivery methods not available on the commercial market.1 In addition, some dental practices order and maintain certain preparations in stock, as well as prescribing for individual patients preparations that are to be dispensed at the pharmacy.
Oral ulcerations can be caused by a number of disease states and may be recurrent. Disorders include lichen planus, oral pemphigus, Behcet's disease, and aphthous ulcers (canker sores).2 Oral ulcerations also may be drug-induced and are more common in patients with compromised immune systems. These oral conditions are quite painful and may interfere with the patient's ability to eat, drink, or speak.
Topical applications can be prepared to reduce pain and inflammation and, in some cases, may help prevent or cure the problem. Compounds for treating oral mucositis frequently include the following:
Mouthwashes and rinses are the most common dosage forms for dental patients, although compounding allows for such options as pastes, troches, or hard candies and, in some situations, lollipops. It is, however, important to choose a vehicle with little or no alcohol when preparing compounds for oral mucositis, because alcohol tends to cause dryness and irritation, which can exacerbate oral ulcerations. Compounding pharmacists also have the benefit of being able to flavor custom medications according to the patient's individual preferences?which typically increases compliance.
A particularly useful preparation for aphthous ulcers is one that was once commercially available but was removed from the market by its manufacturer. Polyphenol sulfonic acid complex, which was marketed under the name Negatan, is applied directly to the site. Although it burns when applied, the sore is essentially instantly cauterized, and in most cases no further symptoms are reported. In some situations, however, an additional application is needed.3
Another highly effective compounded treatment for oral lesions is a preparation of misoprostol in a mucoadhesive anesthetic powder.4 This dry powder blend of misoprostol and dyclonine, when applied to the site, forms a sticky gel that adheres to the lesion and forms a protective barrier.5 This gel is more resistant to friction, and, because the sore is protected under this mucosal "bandage," pain and irritation are greatly reduced, making it easier for patients to function normally.
For oral pain relief, tetracaine or benzocaine lollipops or lozenges can be used every few hours as needed. The candy taste is a winner with adults and children alike. This dosage form, however, should be used in children only with strict supervision by parents and caregivers. Dental practitioners also may use this dosage form in the office as an antigag preparation or even as a sedation prior to an examination or procedure.
Other compounds may be ordered for office use as well. Presurgical sedations may be made into rapid-dissolving tablets, lollipops or lozenges, or liquid suspensions, all of which are usually administered in the office under medical supervision. Gels or pastes containing tetracycline and corticosteroids, such as hydrocortisone or dexamethasone, often are requested for use in preparing a tooth for crowning.6 These preparations are typically applied 1 to 2 days prior to mounting the crown. The corticosteroid component in this type of compound is effective in reducing inflammation, whereas the tetracycline lowers the risk of infection.
This article was contributed by: International Journal of Pharmaceutical Compounding and CompoundingToday.com
Ms. Fields is with the International Journal of Pharmaceutical Compounding and is a pharmacy technician at Innovative Pharmacy Services in Edmond, Okla.
1. Marek CL. Issues and opportunities: compounding for dentistry. International Journal of Pharmaceutical Compounding. 1999;3(1):4-7.
2. Paoletti J, McCord K. Compounding mouthwashes and rinses for oral ulcerations. International Journal of Pharmaceutical Compounding. 1999;3(1):8-10.
3. Fields S. Treating mouth ulcers. Pharmacy Times. 2005;11:96.
4. Allen LV Jr. Misoprostol mucoadhesive anesthetic powder. International Journal of Pharmaceutical Compounding. 1999;3(1):49.
5. Polyox [product information]. New York, NY: Union Carbide Corp.
6. Vail J. Compounding for diseases of the oral cavity: a discussion with Stu Sommerville, RPh. International Journal of Pharmaceutical Compounding. 2002;6(1):16-18.