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Suite A
Lompoc, CA 93436


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Dentistry Compounding

DENTISTRY COMPOUNDING

At Agewell we customize each prescription formulation specifically to each patients' individual requirements.  We strive to provide the utmost in customer care on every order.  Please call us with any questions pertaining to your compounding request, we are here to discuss any questions or concerns you may have pertaining to your prescription.

 

Compounded Medications:

  • Tetracaine 0.5% Solution in long stem sprayer bottle (various flavors) for office use

  • Carbamide Peroxide bleaching gels

  • Chlorhexidine 0.12% rinse, alcohol-free, flavored

  • Deoxy DG2 0.2% cream for cold sores

  • Electrolyte Troches for dry mouth

  • Oral Rinse #5 (contains: nystatin, triamcinolone, chlorpheniramine, and (2)deoxy-d- glucose) for apthous ulcers

  • Ketoprofen 2% oral gel

  • Chloral Hydrate gummy stars, flavored

  • Hydroxyzine gummy bears, flavAored

  • KLMP cream (contains: ketoprofen, lidocaine, misoprostol, and phenytoin) for healing ulcers

  • Triamcinolone 0.2% Mouth Rinse, flavored, for canker sores

  • Lidocaine 4% mucosal bandage

  • Grossman’s Dental Sealer

 

Dexamethasone Suspension

-as a mouth rinse

-4mg per teaspoon

Triamcinolone Mouth Rinse

-triamcinolone 0.1% or 0.2%

 

Lidocaine Rinse

-with misoprostol 0.0024% (promotes healing)

-with trimcinolone 0.1%

-with maalox

 

Combination Rinses

-Apthous Ulcers

-Radiation Mucositis

 

Basic BLM Rinse

-Benadryl Elixir

-Lidocaine 2% viscous

-Maalox, Carafate or Alovera liquid

-1-1-1 

Oral Rinse

-nystatin

-etracycline

-chlorpheniramine

-triamcinolone

-deoxy-d-glucose

 

Miracle Mouthwash

-dexamethasone

-diphenhydramine

-nystatin

-tetracycline

 

Stanford Mouthwash

-nystatin

-tetracycline

-chlorpheniramine maleate

-hydrocortisone

Diphenhydramine Plus Oral Gel

-diphenhydramine 5%

-deoxy-d-glucose .2%

-lidocaine 1%

 

Chloral Hydrate

-capsule 500mg

-suppository 500mg

-syrup 100mg/ml (1289)

-gummy stars

-gelatin troche

Hydroxyzine Pamoate

-syrup 25mg/5ml (0811)

-gummy bears 25mg

 

 

 


 

DRY MOUTH, STOMATIS AND MUCOSITIS:

 

Treatment for Dry Mouth, Stomatitis, and Mucositis

Loss of saliva (xerostomia) is one of the most common complaints among patients who have received radiation therapy of the head and neck. Xerostomia contributes to radiation-induced periodontal infection, dental caries, osteoradionecrosis, and poor digestion of carbohydrates. Ask us about sialogogues (saliva stimulants) in customized dosage forms.

 

Aust Dent J 2002 Sep;47(3):249-53


An investigation into the use of pilocarpine as a sialagogue in patients with radiation induced xerostomia.

 

Frydrych AM, Davies GR, Slack-Smith LM, Heywood J.
School of Dentistry, The University of Western Australia, Crawley.

 

In order to access the PubMed abstract of this article, visit this website link.

 

When a person is receiving chemotherapy or radiation, mouth tenderness and infections can interfere with the ability to eat. Malnutrition may result, yet it is often preventable. Our pharmacy can compound medications which may enable patients to enjoy eating again. We can compound numerous medications into a preparation such as an oral rinse that contains the needed concentrations of each drug.

A three-drug mouthwash (lidocaine, diphenhydramine and sodium bicarbonate in normal saline) can provide effective symptomatic relief in patients with chemotherapy-induced mucositis.

Support Care Cancer. 2000 Jan;8(1):55-8


Efficacy of treatment to relieve mucositis-induced discomfort.

Turhal NS, Erdal S, Karacay S.
Department of Medicine, Marmara University Hospital, Istanbul, Turkey.

 

In order to access the PubMed abstract of this article, visit this website link.

 

 

MIRACLE MOUTHWASHES:

 

Compounding dental mouthwashes or rinses may offer numerous advantages over commercially available dosage forms. Elixirs, syrups, and suspensions often contain preservatives such as alcohol which can cause reactions or gastrointestinal irritation, or sugar which makes the preparation undesirable for prolonged use in the mouth or for diabetic patients. A customized preparation without unnecessary excipients - i.e., a sugar-free, dye-free, lactose-free, and preservative-free dosage form - can eliminate concerns of palatability, alcohol content, and dyes which may stain exposed mucosa.

Various preparations are also available to treat burning mouth syndrome and anesthetic/analgesic and antibiotic/anti-infective mouthwashes are commonly requested.

Tranexamic acid solution (4.8%) used as a mouthwash has been used successfully to prevent postsurgical bleeding after oral surgery without dose modification of oral anticoagulants.

J Oral Maxillofac Surg 1993 Nov;51(11):1211-6


Prevention of postsurgical bleeding in oral surgery using tranexamic acid without dose modification of oral anticoagulants.

Ramstrom G, Sindet-Pedersen S, Hall G, Blomback M, Alander U
Department of Oral and Jaw Diseases, Karolinska Hospital, Stockholm, Sweden.

 

 

PERIODONTAL THERAPY:

Compounding allows countless active ingredients to be incorporated into customized mouthwashes, gels, troches, etc. For example, to treat periodontal disease, antibiotics can be formulated as a mouthwash, or added to an oral adhesive paste or a plasticized gel that will maintain the contact between the tissue and medication for a prolonged period of time.
Metronidazole 25% in a lipogel-type base provides an efficient treatment of anaerobic infection when applied topically in the periodontal pockets.

Click on the following citations for abstracts/more information:
J Int Acad Periodontol. 2000 Jul;2(3):64-70
Vojnosanit Pregl. 2005 Jul-Aug;62(7-8):565-8
Minerva Stomatol. 2000 Jan-Feb;49(1-2):59-67
J Clin Periodontol. 1992 Oct;19(9 Pt 2):693-7

 

 

SUPPRESSING THE GAG REFLEX:

 

The gag reflex can cause a patient considerable discomfort as well as interfere with dental procedures. An electrolyte tablet administered and retained intraorally a few minutes before the start of a procedure can suppress the gag reflex, allowing a mandibular block to be given with much greater ease, which further reduces the gagging reflex.

Tablets can be prescribed for home use for patients who can not properly perform oral hygiene procedures due to the gagging problem. Severe gaggers may need to repeat a dose in 15 to 20 minutes. (Dent Today. 1991 Dec;10(9):68-71)

Some patients and dentists prefer to use electrolyte lollipops.

 

 

THERAPY FOR TMJ:

 

We believe that Transdermal application of NSAIDs such as ketoprofen results in significantly higher tissue levels beneath the site of application than are achieved with oral administration. Additionally, side effects such as gastrointestinal irritation are avoided.

 

The below mentioned article describes how topical non-steroidal anti-inflammatory drugs are effective in relieving pain in acute and chronic conditions.

 

BMJ. 1998 Jan 31;316(7128):333-8


Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs.

Moore RA, Tramer MR, Carroll D, Wiffen PJ, McQuay HJ.
University of Oxford, Oxford Radcliffe Hospital, Headington.

 

In order to access the PubMed abstract of this article, visit this website link.

 

Free full text article available at bmj.com: http://bmj.bmjjournals.com/cgi/content/full/316/7128/333

 The following article reports "The systemic concentrations of ketoprofen have also been found to be 100 fold lower compared to tissue concentrations below the application... Topically applied ketoprofen thus provides high local concentration below the site of application but lower systemic exposure."

Pharm Res. 1996 Jan;13(1):168-72


The below mentioned article investigates the Percutaneous absorption of ketoprofen from different anatomical sites in man.

 

Shah AK, Wei G, Lanman RC, Bhargava VO, Weir SJ.
Pfizer Inc., Central Research Division, Groton, Connecticut 06340, USA

 

In order to access the PubMed abstract of this article, visit this website link.

 

 

Iontophoretic delivery of dexamethasone and lidocaine may be effective in improving mandibular function in patients with temporo-mandibular disorders who have concurrent temporo-mandibular joint capsulitis and disc displacement without reduction.

J Orofac Pain 1996 Spring;10(2):157-65


Temporomandibular joint iontophoresis: a double-blind randomized clinical trial.

Schiffman EL, Braun BL, Lindgren BR.
TMJ and Craniofacial Pain Clinic, School of Dentistry University of Minnesota, Minneapolis 55455

In order to access the PubMed abstract of this article, visit this website link.

 

 

TOPICAL THERAPY FOR PAIN AND INFECTION:

Agewell Pharmacy believes there are a variety of options to help patients with oral and perioral pain problems such as neuropathies, burning mouth syndrome, neuromas and neuralgias. Vehicle-carrier agents and bases have been developed that can penetrate the mucosa and cutaneous tissues and transport the active medication to the treatment site. Dentists have been using topical agents with increasing frequency as part of the therapeutic protocol for orofacial painful neuropathy.

Several topical intraoral medications are used in the treatment of oral ulcerations and infections, including antifungals; nonsteroidal anti-inflammatory drugs (NSAIDs); and corticosteroids. Because of their rapid onset and low side-effect profile, topical medications offer a distinct advantage over systemic administration for orofacial disorders. Medicated lollipops, lozenges, and adhering powders are ideal for keeping an antibiotic or antifungal in contact with an infected area in the mouth.

Topical Anesthetics

Methemoglobinemia (MHb) is a potentially serious blood condition and an uncommon adverse reaction known to be associated with benzocaine. This condition reduces the ability of red blood cells to deliver oxygen throughout the body, which can lead to bluish discoloration of the skin, nausea and fatigue. It can progress to stupor, coma and death. Almost all reported cases of benzocaine-induced MHb were associated with high-concentration preparations (14 percent to 20 percent benzocaine). Compounding pharmacies can formulate low concentration or benzocaine-free topical anesthetics, including combinations of other topical anesthetics such as lidocaine and tetracaine or prilocaine.


Updade on Burning Mouth Syndrome
Burning mouth syndrome (BMS), also referred to as glossopyrosis or glossodynia (when the burning occurs on the tongue only) is usually described as oral burning pain, sometimes with dysesthetic qualities similar to those present in other neuropathic pain conditions. The dorsal tongue, palate, lips and gingival tissues, individually or in combination, are the most common sites involved. Bilateral or unilateral oral burning pain has been found to be associated with jaw pain or uncontrollable tightness, taste changes, subjective dry mouth, geographic and fissured tongue, painful teeth, headache, neck and shoulder pain, difficulty speaking, nausea, gagging and swallowing difficulties. BMS has been reported to follow dental treatment, antibiotic usage and a severe upper respiratory infection. The lack of pathology to account for the pain can be frustrating. Pain is constant, progressively increases over the day, and usually decreases during eating. Patients, who are frequently distressed by their unremitting symptoms, may demonstrate psychological abnormalities including anxiety and depression.

Therapy for BMS involves the use of centrally acting medications for neuropathic pain, such as tricyclic antidepressants, benzodiazepines or gabapentin. Clonazepam is a benzodiazepine used either topically or in low doses orally, which appears to have excellent efficacy in the relief of the symptoms related to BMS. Topical medications, including clonidine, may be considered for application to local sites.

 

A combination of oral medications for the management of BMS (clonazepam, gabapentin, baclofen, and lamotrigine) significantly decreased pain in 38 or 45 patients. The most common adverse effect reported with the medication protocol was drowsiness followed by dizziness and perceived changes in mood. These results suggest that BMS may be treated with lower doses of a combination of medications rather than higher doses of a single medication, which may help to limit adverse effects such as drowsiness or dizziness.

Adv Otorhinolaryngol. 2006, 63:278-287 

The formulation for a mouthrinse containing clonazepam 1 mg per 5 ml has been reported. It is hypothesised that clonazepam acts locally to disrupt the mechanism(s) underlying stomatodynia. Topical formulations of gabapentin, ketamine, clonidine, and baclofen have been used to treat chronic neuropathic pain at various bodily sites.

Int J of Pharmaceutical Compounding July/Aug 2005, 9(4):310

 

In order to access the PubMed abstract of this article, visit this website link.


Pain Med. 2000 Mar;1(1):97-100  

 

 

TRANSDERMAL ANTI-EMETICS:

 

Topical application of anti-emetics in a gel formulation provides a rapid onset and offers an effective alternative to oral administration. Oral surgeons have found this formulation to be particularly useful.

Promethazine is commonly compounded for topical or transdermal application to treat nausea, vomiting, and vertigo, but this preparation may be used as an antiemetic for cases ranging from chemotherapy to motion sickness. The dose is typically 25mg for adults, and the dose is decreased for children. The gel is applied to an area of soft skin, such as the inside of the wrist or arm, the side of the torso, or the inside of the thigh. For children, the gel is often applied to the inside of one wrist, and then the wrists are rubbed together.
US Pharmacist, August 1999; 74-5

Other dosage forms include suppositories and lollipops.

 
 

 

 

 

Dentistry Categories:

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Dry mouth, Stomatis and Mucositis

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Miracle Mouthwashes

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Periodontal Therapy

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Suppressing the Gag Reflex

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Therapy for TMJ  

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Topical Therapy for Pain and Infection

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Transdermal Anti-Emetics

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