Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 27

Let's Talk About That

consult physicians regarding the medication benefits and orthodontic risks to their patients prior
to orthodontic therapy. For difficult orthodontic
cases, it might be best to start orthodontics three
to four months after the physician plans to stop
these medications, understanding that bisphosphonates have integrated into the bone and
might still decrease tooth movement based on
the previous duration of treatment, especially
over five years.
PT: The overprescribing of antibiotics has been
implicated as a partial cause of the development
of resistant strains of bacteria. In orthodontic
treatment, for what instances should systemic
antibiotics be prescribed, and what is the appropriate antibiotic and dosage?
JZ: Localized infections of soft tissue should have
the infectious material removed and home care
including saltwater rinses. A topical antimicrobial
may be used. Peroxyl (1.5% hydrogen peroxide)
can be applied with a toothbrush to local areas,
or swished and spit twice daily. Chlorhexidine
0.12% with 15mL swish and spit twice daily may
also be used. Antibiotics are usually recommended if the infection is more diffuse, with
lymph node swelling. Antibiotics are required in
severe infections demonstrating facial swelling
or systemic effects of fever or tiredness. If the
infection source cannot be found or eliminated in
patients demonstrating lymph node swelling,
facial swelling, or systemic signs, an immediate
referral to an appropriate specialist is suggested.
Patients with severe infections should be seen or
called daily for two days, and they should be
instructed that if infection worsens, they must
go to a specialist or ER immediately. Antibiotics
usually take 48 hours to provide a clinical
response. Amoxicillin 500mg TID for seven days
in adults (child dose: 10-13mg/kg TID for seven
days, up to the adult dose) is usually the antibiotic of choice for oral soft tissue or bone infections. If a penicillin allergy is present, either

Fall 2017  PCSO Bulletin

azithromycin (soft tissue) or clindamycin (soft tissue or bone infection secondary to TAD placement) would be a good alternate choice. Adult
dose for azithromycin is 500mg first day, with
250mg daily for the next four days (child dose:
10-12 mg/kg first day, with 5 to 6mg for next four
days, up to the adult dose). Azithromycin may be
contraindicated in certain heart problems (e.g.,
prolonged QT interval) or with certain medications metabolized by cytochrome p450. Medication history is important, so a call to the
physician may be in order. Adult dose for clindamycin is 300mg TID for seven days (child dose:
4-5mg/kg TID for seven days, up to the adult
dose). Clindamycin can cause diarrhea, which
may be severe. Should diarrhea occur, instruct
the patient to stop clindamycin, do not take antidiarrheal medication, and drink lots of fluids. If
diarrhea becomes worse or continues for two
days, advise the patient to see a physician to
rule out pseudomembranous colitis, which can
be serious.
If an infection has occurred from extra- and intraoral trauma: cephalexin 500mg QID for seven
days (child dose: 10-15 mg/kg QID for seven days)
is a good choice to cover staphylococcus from
skin and intraoral bacteria. If penicillin allergic,
do not prescribe cephalexin due to 5% to 10%
cross allergy. For penicillin allergy, clindamycin is
a good alternate antibiotic that covers staphylococcus and intraoral bacteria.
PT: Is there anything that I didn't touch upon that
you'd like to address?
JZ: After a history of prescribed and OTC medications is taken, the use, action, and contraindication of every medication should be known. Do
the medications dry out oral tissues or decrease
salivary flow, possibly increasing caries or decalcifications? Do the medications decrease inflammation or decrease osteoclastic/osteoblastic
activity that might decrease tooth movement or

27



Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Fall 2017

No label
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - No label
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 2
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 3
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 4
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 5
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 6
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 7
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 8
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 9
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 10
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 11
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 12
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 13
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 14
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 15
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 16
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 17
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 18
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 19
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 20
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 21
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 22
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 23
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 24
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 25
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 26
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 27
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 28
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 29
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 30
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 31
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 32
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 33
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 34
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 35
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 36
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 37
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 38
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 39
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 40
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 41
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 42
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 43
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 44
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 45
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 46
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 47
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 48
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 49
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 50
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 51
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 52
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 53
Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 54
http://www.brightcopy.net/allen/pcso/94-03
http://www.brightcopy.net/allen/pcso/94-02
http://www.brightcopy.net/allen/pcso/93-3
http://www.brightcopy.net/allen/pcso/93-2
http://www.brightcopy.net/allen/pcso/93-1
http://www.brightcopy.net/allen/pcso/92-3
http://www.brightcopy.net/allen/pcso/92-2
http://www.brightcopy.net/allen/pcso/92-1
http://www.brightcopy.net/allen/pcso/91-4
http://www.brightcopy.net/allen/pcso/91-3
http://www.brightcopy.net/allen/pcso/91-2
http://www.brightcopy.net/allen/pcso/91-1
http://www.brightcopy.net/allen/pcso/90-04
http://www.brightcopy.net/allen/pcso/90-3
http://www.brightcopy.net/allen/pcso/90-2
http://www.brightcopy.net/allen/pcso/90-1
http://www.brightcopy.net/allen/pcso/83-4
http://www.brightcopy.net/allen/pcso/89-3
http://www.brightcopy.net/allen/pcso/89-2
http://www.brightcopy.net/allen/pcso/89-1
http://www.brightcopy.net/allen/pcso/88-4
http://www.brightcopy.net/allen/pcso/88-3
http://www.brightcopy.net/allen/pcso/88-2
http://www.brightcopy.net/allen/pcso/88-1
http://www.brightcopy.net/allen/pcso/87-4
https://www.nxtbook.com/allen/pcso/87-03
https://www.nxtbook.com/allen/pcso/87-2
https://www.nxtbook.com/allen/pcso/87-1
https://www.nxtbook.com/allen/pcso/86-4
https://www.nxtbook.com/allen/pcso/86-3
https://www.nxtbook.com/allen/pcso/86-2
https://www.nxtbook.com/allen/pcso/86-1
https://www.nxtbook.com/allen/pcso/85-4
https://www.nxtbook.com/allen/pcso/85-3
https://www.nxtbook.com/allen/pcso/85-2
https://www.nxtbook.com/allen/pcso/85-1
https://www.nxtbook.com/allen/pcso/preview-program-2013
https://www.nxtbook.com/allen/pcso/84-4
https://www.nxtbook.com/allen/pcso/84-2
https://www.nxtbookmedia.com