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Dental Compounding 4:3 PCCA Convention 2013 - Chicago

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Paul J

on 2 April 2013

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Transcript of Dental Compounding 4:3 PCCA Convention 2013 - Chicago

Capsules & Liquids Compounding
Equipment Compounded Dosage Forms How Dental Compounding
Will Help Your Practice by Kevin Oberlander, R.Ph. Dakota Pharmacy * Dakota Precision Rx Labs
Dakota Natural Health Center
705 E Main Ave, Bismarck ND 58501
(800) 290-7028 www.dakotarx.com Pharmacy The Triad "What is Compounding?" "Compounding is the traditional
method of preparing customized
medications to help meet unique
physician and patient needs." Compounding pharmacists focus on
providing innovative patient care.
Also known as a problem solver, a compounding pharmacist's ultimate goal in preparing customized medications is to help the dental staff and patient achieve a more positive therapeutic outcome. The art or profession of preparing and preserving drugs, and of compounding
and dispensing medications
according to the prescriptions of physicians. Early 20th Century Webster Dictionary Compounding As defined in the NABP Model State Pharmacy Act: Manufacturing As defined in the NABP Model State Pharmacy Act: Compounding vs.
Manufacturing Manufacturing The preparation, mixing, assembling, packaging, or
labeling of a drug or device (i) as a result of a practitioner's prescription drug order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice, or (ii) for the purpose of or as an incident to research, teaching, or chemical analysis, and not for resale or dispensing.
Compounding also includes the preparation of drugs or
devices in anticipation of prescription drug orders based on routine, observed patterns. The production, preparation, conversion, or processing of a drug or device....and includes any packaging, or repackaging of the substance(s) or labeling or relabeling of it's container, and the promotion and marketing of such drugs or devices. Manufacturing also includes the preparation and promotion of commercially available products from bulk compounds for resale by the pharmacist, practitioners, or other persons. No specific patient in mind when drug is produced
Has prescribers matching patients to the product available
Economic considerations limit choices in drug dosages and dosage forms Compounding Making the formula match the patient's needs
Administer the drug to the site of action in the most effective dosage form available ....by solving the problem: Avoidance of dyes, preservatives, fillers, actives
Palatable liquid medications
Administrable dosage forms
Dose, dosage form, or medication not commercially available
Discontinued medications or dosage forms
Cost effective therapy
Unique dosage form designed for specific problem Transdermals Lollipops & Troches Suppositories Additional Dosage Forms Compounded
Sterile Products Compounded Capsules Medications formulated in capsules enable the patient to get the exact dosage needed, while avoiding unwanted dyes and fillers. Customized Flavors Compounding pharmacists can provide more than 100 flavors to help patients comply. Compounded Oral Liquids Preparing medications in a liquid form allows the patient who can't swallow pills to get the appropriate medicine in a vast range of flavors, such as tutti-frutti or vanilla butternut Compounded Oral Liquids continued... Difficulty swallowing
Medication not available as liquid
Infants, children, geriatrics, hospice
Avoid unwanted ingredients
Free of dyes, sugar, alcohol and preservatives
Increased compliance
Much more palatable preparations with choice of multiple sweeteners and flavors
Anhydrous formulations
May be used if aqueous stability a concern The foundation of the profession Patient Dentist Pharmacist Relationships Transdermal Gels A specially prepared emulsion that penetrates the skin and gets medication into the bloodstream quickly
Effective dosage form for the patient who can't swallow
May be used for systemic or local effects Transdermal Drug Delivery
for Dentistry Drug Classes Used in Transdermals NSAIDS
Muscle Relaxants
Anti-nausea agents
Anti-inflammatory agents
Anesthetics ....the key to compounding Medicated Lollipops Local effects Troches Soft flavored-gelatin troches, like gummy bears, or chewable troches, provide medications in an easy-to-take and good tasting form. Systemic Effects Troches Local effects for better therapeutic outcome Anesthetic
Healing agents Medicated Lollipops Anti-anxiety
Analgesic Antiviral
Anti-flammatory Anesthetic
Saliva stimulant
Healing agents Putting medicine into suppositories allows the patient who can't swallow to receive the required drug. Topical Sticks and Tubes Dispensing medication in deodorant stick or chap stick-like containers allows the patient to self-administer drugs easily for PRN doses. Tubes allow creams, ointments and gels to be relatively light and oxidation free. Medicated Powders Try a combination of an anti-fungal, antibiotic, antiviral, steroid and an anesthetic with an oral adhesive for canker sores or other oral lesions The Polyox Bandage Designed for oral use
Superior oral bandage
Stays in place for hours even if "rubbed"
Used for any drug therapy desired
Antihistamine, anesthetic, antiviral, anti-fungal,
anti-inflammatory, etc., or combinations
Also used for wound care
No touching of wound for application
No removal of new tissue growth
Advantageous in oozing wound Compounded Topical Formulations Creams
Water-in-oil emulsions
Oil-in-water emulsions
Anhydrous vehicles:
PEG, Petrolatum
Carbomer, HEC, HPC, HPMC
Specialty lipstick forms
Penetration agents to enhance effects Injections -- aqueous and oil vehicles
Irrigating solutions Electronic (Digital) Balance This device is absolutely necessary
for efficient and accurate compounding. Electronic and Electro Mortar & Pestles The electronic and electro mortar & pestles provide
pharmacists with the modern way to
compound creams,
gels, ointments
and suspensions. Homogenizer A homogenizer is a high-
performance dispersing
instrument suited to a
variety of applications,
including the reduction of particle size for
suspensions (including
parenteral compounds) and lotions. Flow Hood Capsule Machine The capsule machine
provides pharmacists with a better way to make capsules. It is designed to avoid labor-intensive hand-punching, and accommodates oil-filled capsules, with the capacity to compound 100 or 300 capsules at a time. The flow hood enables pharmacists to conduct
various types of sterile compounding, such as
chemo, ophthalmic or injectable medications. Ointment Mill The ointment mill mixes powers, crystals and creams into a smooth, finished product. Lollipop Mold The lollipop mold enables pharmacists to make lollipops with a variety of substances, such as sorbitol, gelatin, polyethylene glycol and sucrose bases. Tube Sealer The tube sealer provides an effective way to seal plastic tubes, bags, suppository shells and sleeves. Rectal Suppository Molds Troche Mold This dosage form provides rapid sub-lingual administration in a variety of flavors. Meeting unique needs in: Hospice
Pain Management
Natural Bio-identical Hormone Replacement Therapy
Veterinary applications
Household pets
Exotics Podiatry
Sports Dental Dental Needs Common Problems that Compounding Can Address Service Areas Topical Anesthesia
Aphthous Ulcers
Dry Socket
Hypersalivation Xerostomia
Angular Cheilosis
Cold Sores
Burning Mouth Syndrome
Necrotic Tooth Abscesses
Erosive Lichen Planus
Periodontal Disease Hemostatics
Bleaching gels
Root canal & dry socket mixtures
Topical anesthetics
Repository antibiotics for abscesses
Plaque removal rinses
Adhesives Local Anesthetic Options Lidocaine
Dyclonine Commonly Compounded Topical Anesthetic Combinations Lidocaine 10% Prilocaine 10% Tetracaine 4% gel (Tricaine)
Lidocaine 20% Tetracaine 4% Phenylephine 2% gel
Dyclonine 0.5% and 1% solutions
Tetracaine 0.5% lollipops
Lidocaine 3% gel or Lidocaine 6% gel Compound Options for Aphthous Ulcers Betamethasone 0.05% / Lidocaine 2% in oral adhesive paste
Triamcinolone / Lidocaine Muscosal Bandage
Betamethasone 0.05% oral rinse can also add 2% lidocaine
Betamethasone / Lidocaine / Tetracycline suspension
Fluocinonide / Lidocaine oral pastes
Magic / Miracle Mouthwashes
Combinations of Benadryl / Maalox / Nystatin
Stanford Mouth Wash (multiple options) Compounded Options for Aveolar Osteitis (Dry Socket) Oxytetracycline / Hydrocortisone suspension
Benzocaine / Lanolin / Clove Oil Dry Socket Paste
Bipps Paste (bismuth, iodiform, petrolatum) Compounded Hemostatics Tranexamic acid (antithrombolytic)
Use in hemopheliacs, general patient population, and patients on anticoagulant therapy
Oral solution: 4.8% soln
Typically, irrigate with 10ml after surgery, then pt rinses with 10ml QID x 7 days. Do not eat or drink anything for 1 hr after using
Monsel's (Ferric Subsulfate)
Paste 3-Mix-MP Therapy Used to treat necrotic or abscessed teeth
3-Mix powder (Metronidazole 1gm, Ciprofloxacin 1mg and Minocycline 0.1gm
MP liquid (1:1 combination of Polyglycol 300 and Propylene Gloycol) used to wet the 3-Mix powder
Mixed prior to use by Dentist and placed in pulp chamber, then sealed Xerostomia Treatment Options Electrolyte Troche
Used for dry mouth q4-6 hrs
Used to reduce gag reflux
Sodium chloride
Potassium chloride
Calcium lactate
Magnesium sulfate
Sodium bicarbonate
Sodium phosphate
Pilocarpine Lollipops 5mgs TMJ Disorder Transdermal gels to massage into sore masticatory muscles
Ketoprofen or another NSAID
Pentoxifylline Compounds used for Angular Cheilosis "Chelitis cream"
Betamethasone, Nystatin, Diphenydramine, Mupirocin
"Corner creams"
Betamethasone, Nystatin, Diphenydramine, Dyclonine
Clobetasol, Nystatin, Dyclonine Burning Mouth Syndrome BMS formula containing salicylic acid and ethanol
Add 0.2% Dexy-D-Glucose and 1% beta Glucan
Alpha-Lipoic acid
Amitriptyline or Carbamazepine mouthwash
Estrogen deficiency? Examples of Transdermal Compounds for TMJ Ketoprofen 5% / Gabapentin 5% / Baclofen 5%

Diclofenac 6% / Cyclobenzaprine 1% / Ketamine 5% Lichen Planus Treatment Corticostreroids
Clobetasol 0.05%, triamcinolone 0.1%, fluocinonide 0.5%, fluocinolone acetonide 0.1%,
Rinses and topical applications via ointments and muscosal powders
Topical retinoic acid 0.05%, isotretinoin 0.1%
Oral Vitamin A 50,000 U daily
More Compounded Options
Tacrolimus 0.03% oral suspension
Triamcinolone 0.05%, Diphenhydramine, 1% oral suspension Supplements Most of the population take supplements in response to consumer advertising or word of mouth. A majority of these individuals would
prefer professional help. Multivitamin Foundation important for many metabolic mechanisms
Adequate zinc, copper and selenium
With minerals or add mineral supplement
Take with food in the morning CA / MG + Vitamin D 2:1 "Rule of Thumb" CA : MG
800 - 1000 mg of Calcium
400 - 500 mg of Magnesium
400 - 800 units of Vitamin D3
With meals toward evening
Other important minerals include;
Manganese, zinc, copper, molybdenum, stontium
Additional Bone Builders include;
Boron, vanadium, silica Vitamin D Ergocalciferol (Vit D2)
Prescription, dosed at 50,000 units 1 - 2 x weekly
Cholecalciferol (Vit D3)
OTC, dosed from 400 units - 25,000 units
Vit D3 preferred form
Oil filled capsules
With food Vitamin D Deficiency Serum lab; Vitamin 1,25 20 - 80 ng/ml
Optimum level 50 - 70 ng/ml
www.grassrootshealth.net Probiotics / Prebiotics Probiotics: Pro = positive / Biotic = bacteria
Lactobacillus acidophilus
Bifido Bacteria
Saccharomyces Boulardii
FOS (Fruito-Oligosaccharides)
Insulin (Jerusalem Artichoke) Omega 3 Fish Oils Omega 3 oils 1000mg twice daily
EFA (Essential Fatty Acids)
EPA (Eicosapentaenic Acid)
500 - 700mg daily
DHA (Docosahexaenic Acid)
400 - 600mg daily
Always with food Small study:

Supplementing with EPA, DHA, and/or Alpha-linolenic Acid, subjects had a 15 - 22% decreased risk of poor gum health J Am Diet Assoc. Nov, 2010 Improve Therapeutic Outcomes.... Narcotic
Non-narcotic Open House Learn the Language of a Dental Practice Office Staff State Association Meetings Assist Prescription Writing Hire or Designate a Marketer Bleed Points
Probe Depth
Curettage DDS ~ DMD ~ MD Orthodontics
Maxillofacial Surgeons Hygienists Dental Assistants Office Manager Sponsor Breaks Auxiliary Fund Raisers Befriend Fellow Exhibitors Follow-up Ads in Dental Newsletters Ads on Dental Association Websites Legality of Customized Prescriptions e-Scripts Office Software Generated Prescriptions
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