Drug-Induced Tooth Discolouration

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There are a number of drugs that cause tooth discolouration, which may be categorised as arising either intrinsically or extrinsically. Extrinsic discoloration is defined as stains that occur on the outer surface of the tooth structure and are caused by topical or extrinsic agent, and occur after the tooth has erupted.

Exposure to the drug subsequently causes this type of discolouration. Many drugs have been implicated – for example, cholorhexidine produced tooth discolouration in over half of patients who used a mouthwash or rinse for more than six months.

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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.

Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.

Vaccines and a Spoonful of Sugar

A good cold chain and some reliable electricity production, as well as reliable drug fridges are pretty important out bush. I’ve even written a few posts on the subject (listed at bottom of post). I even have a couple in draft form so watch out!

vaccinationI was very interested in this news article Spoonful of sugar helps the medicine keep cool. There is a lot of work being done on a couple of viruses, pox and adenovirus to be able to use them as a platform for a range of other vaccines including HIV-Aids, tuberculosis and malaria.

Live vaccines need to be refrigerated. And of course the parts of the world where these diseases are most prevalent are the more remote and poorest areas without electricity.

By using a couple of sugars currently used as biological stabilisers, and slowly drying this virus-sugar mix they can vitrify (basically wrap it in “glass”) the product so it retains its stability without refrigeration at up to 45C for six months. You then take it to the remote location, reconstitute and start vaccinating. Now this has only been done in a lab but is exciting for the future.

Of course it will change the way we handle vaccines around the world, not just in the Third World. Out bush our temperatures during transport can get quite high. This graph is the temperature monitored by a data logger on it’s way from remote central Australia to Tasmania.

graph showing temperatures reached during transportation

It will also dramatically cut costs. The World Health Organisation estimates it costs 20% more than other drugs in cold chain transfers and storage (logistics).

Out where I am we might have a refrigeration mechanic out every few months. He may or may not have the right parts. If not, we wait a month until they arrive and then another few months until a refrigeration mechanic is out again. I try to minimise this delay by having a number of spares already out bush to be available when required.

But I’m in a first world country and can afford to do this.

Reference: R. Alcock, M. Cottingham, C. Rollier, J. Furze, S. D. De Costa, M. Hanlon, A. Spencer, J. Honeycutt, D. Wyllie, S. Gilbert, M. Bregu, A. V. S. Hill, Long-Term Thermostabilization of Live Poxviral and Adenoviral Vaccine Vectors at Supraphysiological Temperatures in Carbohydrate Glass. Sci. Transl. Med. 2, 18ra12 (2010).

Other Cold Chain Posts::
Cold Chain
Cold Chain 2
Data Loggers

Drug-Induced Gingival Hyperplasia RGH E-Bulletin

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The latest RGH E-Bulletin is now available. It looks at the topic of drug induced gingival hyperplasia.

Gingival hyperplasia, otherwise known as gingival overgrowth, is a condition characterised by widespread swelling of the gums (gingiva) and can affect speech, mastication, tooth mobility and aesthetics. Among other things, it can be caused by a variety of medications, and was first noticed in 1939 in patients treated with phenytoin.

Some other medications commonly known to cause gingival hyperplasia are the immunosuppressant cyclosporin, and calcium channel blockers frequently used for the treatment of hypertension.

It can be downloaded as a small PDF from the link below.

[download id=”13″] Volume 35 (10): September 28, 2009

The 2009 RGH E-Bulletins are archived by topic here.

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Drug Interactions with Urinary Alkalinisers RGH E-Bulletin

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Urinary alkalinisers are used to relieve the discomfort associated with urinary tract infections, help treat certain types of renal stones, or may be used in the specialist setting to treat some metabolic and renal disorders.

The E-Bulletin contains a table of some of the drugs that may interact (some quite dramatically) with urinary alkalinisers.

Download the RGH E-Bulletin: [download id=”7″]

The 2009 RGH E-Bulletins are archived here.

If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.

Image source: OpenClipArt.org, public domain.

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