Administration of analgesics may provide some advantages in the management of postoperative pain after dental implant placement, but further research is warranted. While the available literature offers some

analgesic protocols for dental pain based on anticipatedpostprocedural pain level ,specific evidence-based analgesic schemes for dental implant

surgery remain undefined. Unfortunately, the wide surgical

variability of the implantology practice and the large quantity

of molecules and protocols available in the literature prevent from

providing indications about the best treatment for postoperative

pain control. Further research including studies with adequate

sample size comparing standardized implant approaches is

needed to inform best practices in this domain.

drugs affecting osseointegration could be classified into 4 groups:

•drugs affecting wound healing and homeostasis,

•drugs affecting central pathways,

•drugs affecting immune pathways,

•and drugs affecting bone cell interactions.

Regarding drugs interfering with wound healing and homeostasis, this includes some medications that

Exert beneficial effects on bone, including antidiabetic drugs, such as metformin, glucagon-like peptide-1, and dipeptidyl peptidase-4 inhibitors.

However, some of these drugs can have a negative effect on bone. This includes the antidiabetic drug thiazolidinedione, heparin, and antineoplastic drugs, such as anti vascular endothelial growth factor (anti VEGF), radium-223, and exemestane.

Second group-drugs interfering with central pathways-

•This includes some medications that exert beneficial effects on bone, , such as:

• acetylcholinesterase inhibitors and melatonin;

• antihypertensive medications, such as β-blockers, thiazide diuretics, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers;

•and hormonal therapies, such as parathyroid hormone, calcitonin, thyroid, gastric inhibitory polypeptide, and sex steroids.

However •some drugs regulating central pathways could have a negative effect on bone. This includes drugs targeting the CNS, such as selective serotonin reuptake inhibitors (SSRIs) , antiepileptic drugs, opioids, glucocorticoids, and alcohol.

•SSRI usage and alcohol have been found to be associated clinically with increased dental implant failure.

Third group-immune pathway. NSAIDs have been shown to negatively affect osseointegration in vivo and dental implants clinically.

Fourth group-bone cells interaction:

•This includes some medications that exert beneficial effects on bone, including calcium channel blockers, bisphosphonate, denosumab, sclerostin inhibitors, statins, and antihistamines.

•Also, it includes some drugs that have a negative effect on bone, including proton pump inhibitors (PPIs), chemotherapeutic agents, and antiretrovirals.

• Among these drugs, PPIs seem to negatively affect osseointegration and dental implant survival, whereas statins exert a positive effect on osseointegration.

Many medications can affect the health of your teeth and gums. Some drugs dry out the tissues in your mouth in ways that leave you vulnerable to dental problems, for example, while other drugs can cause abnormal bleeding of your gums.

Medications affecting your dental health may be prescription or nonprescription drugs. Even herbal medications can cause oral health issues.

Prescription and Non-Prescription Drugs and Their Effects on Dental Health

Antihistamines, Painkillers, Decongestants, Muscle Relaxants, Antidepressants and Dry Mouth

More than 400 medications can cause dry mouth. The list of drugs includes antihistamines, decongestants, high blood pressure medications, antidepressants, painkillers, drugs for Parkinson’s disease and antacids. Dry mouth is one of the main dental health problems associated with medications. Antihistamines, painkillers, decongestants, muscle relaxants, and antidepressants can cause dry mouth. Medications for high blood pressure, Parkinson’s disease, and urinary incontinence can also lead to dry mouth.

Dry mouth is a condition where there is an inadequate amount of saliva in your mouth. Saliva contains important elements that neutralize plaque acids produced by bacteria living in your mouth. Plaque acids dissolve minerals at the surface of your teeth, increasing your risk for tooth decay and oral infections. Dry mouth also causes irritation to the tissues in your mouth, and this irritation leaves the tissues vulnerable to infection. Medications that cause dry mouth increase your risk of tooth decay and oral infections.

Inhalers and Thrush

People who use oral inhalers for asthma or other respiratory conditions can develop a type of oral infection, known oral thrush or oral candidiasis. Thrush causes creamy white lesions that look like cottage cheese on your tongue, inner cheeks and sometimes on the roof of your mouth. Rinsing your mouth with water after using your inhaler can reduce your risk of oral thrush.

Anticoagulants and Bleeding Gums

Aspirin and anticoagulants can affect your dental health. Aspirin is a pain reliever and blood thinner, also known as an anticoagulant. Because aspirin and other anticoagulants thin your blood, they may affect your dental health by causing your gums to bleed after you brush or floss your teeth.

Heart medications, nerve drugs, NSAIDs, inhalers and smoking cessation products may alter the taste of food

Some medications make the food taste bitter or metallic, or affect your ability to taste food. These include medications to treat heart and blood vessel problems, central nervous system (CNS) issues, non-steroidal anti-inflammatory drugs (NSAIDs), respiratory inhalants, and nicotine skin patches.

Blood pressure medications, oral contraceptives and chemotherapy can cause soft tissue reactions

Medications to reduce high blood pressure can cause soft tissue reactions, such as inflammation, mouth sores, and discoloration of the tissues in your mouth. Oral contraceptives, immunosuppressive agents, and some types of cancer treatments can also cause these soft tissue reactions.

Anti-seizure and immunosuppressant drugs, and enlarged gums

Medications to reduce rejection after organ transplant and seizures can cause enlarged gums, also known as gingival overgrowth. The anti-seizure medication phenytoin can cause the condition. Certain heart medications, known as calcium channel blockers, can cause gingival overgrowth.

Sugar and tooth decay

Many medications contain sugar, which leads to tooth decay. Liquid medications, cough drops, antacids, vitamins, and anti-fungal agents commonly contain sugar. Taking medications containing sugar for a long time can increase your risk for tooth decay.

Syrup-based medications and tooth decay

Syrup-based medications leave a sweet, sticky residue on your teeth. This is a special concern for children, as many pediatric medications have a syrup base. Rinsing your mouth with water after using a syrup-based medication can reduce your risk for dental health problems.

Cancer treatments may affect your dental health

Various cancer treatments can affect your dental health. Speak with your dentist about how cancer drugs may affect your teeth and gums, preferably before you start treatment. Your dentist may be able to recommend treatments to help you maintain good oral health.

For more information on medications that affect dental health, consult with your dentist. Be sure to tell your dentist about all the medications you take, including non-prescription drugs or alternative medicines.