Commonly used

medications in
Pediatric Dentistry
The administration of drugs to pediatric patients needs to adjust the dosages of
medications to accommodate their lower weight and body size. Following are
some formula or rules for calculating dosage for pediatric patients.

• 1.CLARKS RULE: CHILD DOSE= a) WEIGHT(POUNDS)/150 X

ADULT DOSE. b) WEIGHT(Kg)/70 x ADULT DOSE.
• 2. YOUNGS RULE: CHILD DOSE=AGE OF CHILD/(AGE+12) X
ADULT DOSE
• 3.COWLINGS RULE: CHILD DOSE=AGE OF NEXT BIRTHDAY /
24 X ADULT DOSE.
• 4.DILLINGS RULE: CHILD DOSE=AGE OF CHILD / 20 X
ADULT DOSE.
• 5. BASTEDOS RULE: CHILD DOSE= [(CHILD'S AGE + 3) X
ADULT DOSE]/30
• 6.FRIEDS RULE: (FOR INFANTS UNDER AGE 1) CHILD
DOSE=AGE OF INFANT IN MONTHS/150 X ADULT DOSE
• 7. BOSY SURFACE AREA RULE: CHILD DOSE = CHILDS BSA
(METER2) / 1.73 X ADULT DOSE.
 Antimicrobials are drugs that kill or suppress the
growth of microbes – bacteria, viruses, fungi or
parasites. The most common antimicrobials used in
dentistry are antibiotics, antifungal and antiviral
agents.

Antibiotics are drugs that are produced by microbes or by chemical

methods to deliver an antibacterial action. These are the second
most common drug in dentistry, after local anesthetics. The
duration of antibiotic therapy should extend at least 5 days past
the point of substantial improvement or resolution of symptoms.
In dentistry antibiotics are generally prescribed in case of:
a) contaminated wound management e.g. extraction sockets,
soft tissue laceration, complicated tooth fracture, traumatic
tooth displacement (including avulsion), gingivectomy, severe
ulcerations etc.
b) dental Infection.
c) Pediatric periodontal conditions e.g. Pediatric periodontal
diseases in neutropenia, Papillon‑Lefevre syndrome, leukocyte
adhesion deficiency patients where the immune system is
unable to control the growth of periodontal microbes and
periodontal disease on pediatric HIV patients.
d) Secondarily infected viral conditions
 Empiric choice of antibiotics in odontogenic infection
Stage of infection Preferred Antibiotics
Penicillin V Potassium, Amoxycillin,
Early, First stage of infection Cephalosporins (Cefuroxime, Cefaclor etc.)

Beta-lactamase stable Antibiotics

No improvement within 36 Hrs Clindamycin, Amoxicillin+ Clavulanic Acid

Clindamycin, Clarithromycin,
Penicillin Allergy Azithromycin
Penicillin V potassium + Metronidazole,
Late( More than 3 Days) Amoxicillin+ Metronidazole, 3rd Gen
Cephalosporins (Ceftriaxone etc)
Penicillin Allergy(Late Patients) Clindamycin, Moxifloxacin
 Doses of Empiric choice of antibiotics in odontogenic infection
Dosage
Antibiotics
Adult Children

Penicillin V K 500 mg 6 Hourly for 7 days Up to12 years- 25 – 50 mg/kg/day in

equally divided doses, every 6 hourly
for 7 days. Max dose 3 Gm/day
Amoxicillin 250-500 mg every 8 hourly for 7days Below 40 kg – 20-40mg/kg/day in
equally divided Doses, every 8 hourly
for 7 days. Max dose 2gm/day

Amoxicillin+ Same as Amoxicillin. Clavulanic acid added in different concentrations (31.25 &
Clavulanic Acid* 62.5 mg with 125 mg Amoxicillin, 125 mg with 250/ 500/875 mg of Amoxicillin.
Clindamycin 150-450 mg every 6 hourly for 7 days 08-25 mg/kg/day in 3 or 4 equally
divided doses for 7 days
Clarithromycine 250 – 500 mg PO 12 hourly for 7 days
15 mg/kg/day PO divided in 12 hourly
doses for 7 days. Max dose 500
*Generally 31.25 mg Clavulanic acid is prescribed upmg/day
to 3 months of age, 62.5 mg is
prescribed up to 40 kg of wt.
 Doses of Empiric choice of antibiotics in odontogenic infection CONTD.

DRUGS ADULT DOSAGE PEDIATRIC DOSAGE

Azithromycine 250- 500 mg OD or in Above 6 months 30- 60mg /kg in OD or
two divided doses. two divided doses
Cefuroxime 250-500 mg every 12 3 months to 12 years - 30mg/kg/day in 2
hourly for 7 to 10 days divided doses for 7 to 10 days. Max dose
1gm/day
Cefaclor 250 – 500 mg every 8 1 month and above 20 – 40 mg/kg/day in
hourly for 7 to 10 days 2 to 3 divided doses for 7 to 10 days. Max
dose 1gm/day
Doses of Empiric choice of antibiotics in odontogenic infection CONTD.
DRUGS ADULT DOSAGE PEDIATRIC DOSAGE
Ceftriaxone 1-2 g/day IV/IM , OD Up to 12 years 50-75 mg/kg/day, IV/IM,
or 2 divided doses for OD or 2 divided doses for 4-14 days.
4-14 days Better not to exceed 1gm/day
Metronidazole 7.5 mg/kg, PO/IV, 6 ˃2kg 30 mg/kg/day PO/IV divided 6
hourly 7-10 days. hourly. ˂2 Kg 15 mg/kg/day PO/IV
Loading dose divided 12 hourly. Max dose 4 g/day.
15mg/kg in severe
infection

Moxifloxacin 400 mg PO/IV once ABOVE AGE OF 8 YEARS – 7.5 to 10

daily 5 to 7 days. mg/kg once daily for 7 to 10 days
 Oral viral infections are most commonly caused by the herpes simplex
virus and herpes varicella-zoster virus involving oral mucosa. Other
commoner virus infections that affects oral cavity like Chickenpox,
Measles, Hand-foot-mouth disease or Herpangina does not respond to any
antiviral drugs and mostly requires symptomatic management.
Herpes Simplex (Primary) :
Acyclovir 200mg tab/syrup. Take 200 mg 5 times/day for 10 days or 400
mg /3 times/day for 10 days

Acyclovir 5% ont./cream for Herpes labialis. Apply 5 times. (begin when

symptoms first appear)
Famciclovir 1500mg as single dosage
Harpies zoster:
Acyclovir 800mg 5 times daily for 7 to 10 days
Famciclovir 500 mg three times daily for 7 days.
Oral fungal infection occurs from alteration of oral microbial flora due to poor oral
hygiene, inadequate nutrition, too much use of broad-spectrum antibiotics, steroids
and due to immunosuppression. The most common fungal infection found in
children is candidiasis. Candidiasis may appear clinically in children as
pseudomembranous candidiasis, angular cheilitis, erythematous candidiasis and
mucocutaneous candidiasis. Treatment of candidiasis is done initially by topical
antifungals. If topical treatment is ineffective then systemic treatment is initiated
Drugs Dosage and Application
Commonly used Topical Antifungals
Nystatin 100000 unit/ml Oral Rinse 5ml for 2 minutes, 4-5
suspension times a day and expectorate
*Adult Dose.
Clotrimazole 1-2 % ww Cream Apply locally 4-5 times a day
Ketoconazole 2% ww Cream Apply locally 4-5 times a day Calculate
Commonly used Systemic Antifungal child dose
Ketoconazole 200 mg Tablet 1 tab once daily * accordingly
Fluconazole 50.100.150,200 mg 200 mg orally on Day 1,
Tablet THEN 100 mg once/day *
Non-narcotic analgesics act directly on the peripheral nerve endings (the
site from which the pain originates). Narcotic analgesics act in the
central nervous system, where pain perception is altered
Narcotic analgesics works poorly in peripheral inflammatory conditions.
The reason for reduced efficacy of the narcotic analgesic than peripherally-
acting analgesics in postoperative dental pain remains uncertain. It may be
related to the poor peripheral action of the Opioids in localized
inflammatory pain. In India most commonly used oral narcotic analgesic is
Codeine. As oral analgesic they are used in combination with NSAIDs for
better relief of pain.
Combining analgesics with different mechanisms of action; may provide
a balanced coverage of moderate to severe pain. It enables individual
agents to act in a synergistic fashion and lowers incidence of adverse
effect of individual agents.
COMMONLY USED ANALGESICS IN PEDODONTICS IS FURNISHED IN NEXT TWO TABLES
ANALGESICS ORAL DOSAGE ADVANTAGES DISADVANTAGES HOW SUPPLIED
ASPIRIN CHILDREN UNDER 12 YEARS ANALGESIC ALLERGIC REACTION TO 50 MG TO
10-15 MG/KG BODY WT EVERY 4- ANTIPYRETIC ASTHMA, ATOPY, NASAL 500 MG
6 HRS. MAX 80-100 MG/KG/DAY ANTI-INFLAMMATORY POLYP PATIENTS, TABLETS IN
ADULT: 325-650 MG/4-6 HRS. DEVELOPMENT OF REY DIFFERENT
MAX 4GM/DAY SYNDROME. GASTRIC DOSES
IRRITANT. LAST CHOICE OF
ANALGESIC FOR CHILDREN

PARACETAMOL CHILDREN UNDER 44 KG ANALGESIC MILD ANALGESIC 125/250 MG/5ML

10-15 MG/KG BODY WT EVERY 4- MAY REQUIRE 1GM NO ANTI INFLAMMATORY SYRUP
6 HRS. MAX 2.6 GM/DAY DOSE. USE WITH CAUTION FOR 125,250,500
CHILDREN ABOVE 44KG/ADULT ANTIPYRETIC LIVER DISORDER PATIENTS AND 650 MG TABLET
325-650 MG/4-6 EVERY HRS
MAX 4.0 GRAM/DAY

IBUPROFEN CHILDRE UNDER 12 YEARS: 4-10 RELIEF OF MODERATE GASTRIC IRRITANT 200-400 MG TABLET.
MG/KG, 4-6 HRLY. MAX 40 TO SEVERE PAIN MAY INTERFARE CLOTTING 100 MG/MI SUSP.
MG/KG/DAY ANTI-INFLAMMATORY
ADULT: 200-400 MG EVERY 4-6 ANTI PYRATIC
HRLY MAX 1.2 GM/DAY

DICLOFENAC CHILD ABOVE 5 YEARS 2-3 ANTI-INFLAMMATORY GASTRIC IRRITANT, RASHES, 50-100 MG TAB
MG/KG/DAY IN 2-4 DIVIDED ANALGESIC FLUID RETENTION, 25MG/ML INJECTION
DOSE. MAX 200 MG/DAY. ADULT ANTIPYRETIC
75-150 IN 2-4 DIVIDED DOSE.
ANALGESICS ORAL DOSAGE ADVANTAGES DISADVANTAGES HOW SUPPLIED
KETOROLAC CHILD ABOVE 02 YEARS: 0.5 POTENT ANALGESIC GASTRIC UPSET AND 10 MG TAB
MG/KG 6 HRLY ORAL/IM MAX EQUIVALENT TO BLEEDING, FACIAL 30 MG INJ
15 MG/DOSE MORPHIN. USED SWELLING, SKIN RASH,
ADULT ABOVE 17 YEARS: 10 FOR MODERATE TO HIGH BLOOD PRESSURE
MG ORAL, 30MG/ML IM/IV. SEVERE PAIN. ANTI-
MAX 40 MG/DAY INFLAMMATORY

IBRUPROFEN CHILD ABOVE 2 YEARS COMBINATION SAME AS IBUPROFEN AVAILABLE AS

AND IBUPROFEN 100 MG+ ANALGISICA AND PARACETAMOL MENTIONED IN
PARACETAMO PARACETAMOL 125 4-6 HRLY. ACTION IS BETTER THE DOSAGE
L ADULT IBUPROFEN 300-400 THAN SINGLE
MG + PARACETAMOL 325-500 ANALGESIC
MG 4-6 HOURLY
DICLOFENAC ABOVE 12 YEARS COMBINATION SAME AS DICLOFENAC AVAILABLE AS
AND PARACETAMOL 325-500 MG+ ANALGESIC ACTION AND PARACETAMOL MENTIONED IN
PARACETAMO DICLOFENAC 50 MG. 4-6 BETTER THAN THE DOSAGE
L HRLY. CALCULATE DOSE FOR SINGLE ANALGESIC
CHILD ACCORDING TO AGE
OR BODY WT.
 The term corticosteroid is used clinically to describe
agents with similar action of cortisol, the endogenous
glucocorticoid. It has several physiological effects like
stimulating glucogenesis by breaking down protein and fat.
It plays a major role in the body’s response to stress. It helps
to maintain blood glucose concentrations by increasing
gluconeogenesis and by blocking the uptake of glucose into
tissues and in to central nervous system. It also helps to
maintain blood pressure by stimulating the constrictive
effects of catecholamines on blood vessels.
Pharmacologic use of corticosteroids is commonly to
suppress or prevent signs and symptoms of allergic
responses or inflammation, or to suppress an inappropriate
or unwanted immune response
COMMONLY USED STEROIDS IN PEDODONTICS IS FURNISHED IN NEXT TWO TABLES
 DISEASES PEDIATRIC TOPICAL SYSTEMIC TREATMENT
INCIDENCE TREATMENT
PEDIATRIC 2-3 % OF TOTAL ONT TRIAMCINOLONE INTRALESIONAL TRIAMCINOLONE ACETONIDE 5 TO
LICHEN PLANUS INCIDENCE ACETONIDE 0.1% / ONT 10 MG PER ML OR ORAL PREDNISOLONE 40-60MG
FLUOCINONIDE 0.05% DAILY/METHYL PREDNISOLONE PULSE 32MG
WEEKLY. TAPERING DOSE
ERYTHEMA FAIRLY 0.05 % CLOBETASOL PREDNISONE 0.5-1.0 MG/KG/DAY/
MULTIFORME COMMON MOUTHWASH METHYLPREDNISOLONE PULSE 1 MG/KG/DAY FOR
3 DAYS FOR 2-3 WEEKS
PEDIATRIC 1.2-3.7% OF 0.05% FLUOCINOLONE PREDNISOLONE 5-8 MG/KG/DAY IN
PEMPHIGUS TOTAL CASES ACETONIDE 0.05% APPROXIMATELY 2 WEEKS TAPERING.
CLOBETASOL METHYLPREDNISOLONE PULSE 1 GM/DAY I.V. FOR
PROPIONATE. 5 DAYS AND PULSE DEXAMETHASONE 136 MG
/DAY I.V. FOR 3 DAYS
CHILDHOOD 20% OF TOTAL NONE HIGH DOSE METHYLPREDNISOLONE IV 30
ONSET SYSTEMIC CASES MG/KG/DOSE, MAXIMUM DOSE OF 1 G AND ORAL
LUPUS PREDNISOLONE AT 1 G/KG/DAY. +
ERYTHEMATOSUS IMMUNOSUPPRESSIVE DRUGS
 DISEASES PEDIATRIC TOPICAL SYSTEMIC TREATMENT
INCIDENCE TREATMENT
CENTRAL GIANT FAIRLY COMMON. NONE 50/50 MIXTURE OF 2% LIDOCAINE WITH
CELL GRANULOMA TX OF SMALL AND 1:100,000 EPINEPHRINE AND TRIAMCINOLONE 10
DEVELOPING LESION MG/ML TWICE WEEKLY FOR 6 WEEKS AND TO
INJECT 2 ML/1 CM OF LESION AS SEEN ON A
PANOREX X-RAY
PEDIATRIC FAIRLY COMMON NONE SHORT COURSE OF ORAL PREDNISONE 1-2 MG/KG
INFECTIOUS STEROID TX ONLY IN DAILY FOR 3-7 DAYS
MONONUCLEOSIS SEVERE CASES

MUCOCELE FAIRLY COMMON NONE 1 ML OF BETAMETHASONE 4 MG/1 ML OR 1ML

OF 8MG/ML DEXAMETHASONE INTRALESIONAL
INJ ONCE WEEKLY FOR 3-4 WEEKS
PEDIATRIC LOW. INCREASING IN NONE INTRALESIONAL INJ 2ML DEXAMETHASONE 4 MG
SUBMUCOUS DEVELOPING WITH LIGNOCAINE 2% WAS GIVEN WEEKLY FOR 2
FIBROSIS COUNTRIES MONTHS