Useful Medications for Oral Conditions*

Board takeaway

• Select: Choose the indication first, then the drug and formulation.

• Check age, weight, allergies, interactions, renal/hepatic considerations, administration ability, and the relevant maximum.

• Units: mg/kg/day divided into doses and mg/kg/dose are different instructions.

• Scope: This AAPD resource supplies reference regimens, not permission to prescribe every listed drug to every listed age group.

• Label conflicts: The entries below distinguish its regimens from product-label conflicts.

• Maximum: Pediatric doses generally should not exceed adult doses; the source explicitly describes an exception for fluconazole.

• Conversion: Use the actual dispensed concentration when converting milligrams to milliliters.

Convert a prescription without changing its meaning

• Daily dose: For example, 25 mg/kg/day for a 20-kg child, divided every 12 hours, means 500 mg/day and 250 mg per dose, not 500 mg each time.
• Liquid dose: A 250-mg/5-mL liquid would provide that dose in 5 mL.
• Arithmetic only: This demonstrates arithmetic only; indication, drug selection, age eligibility, and maximum doses still determine whether a regimen is appropriate.

Analgesics

• Acetaminophen, < 12 years: 10–15 mg/kg/dose every 4–6 hours as needed; maximum 75 mg/kg/day, never over 4,000 mg/24 hours. Acute and chronic exposure can cause hepatotoxicity.
• Ibuprofen, < 12 years: 4–10 mg/kg/dose every 6–8 hours as needed; maximum single dose 600 mg. The alternative age table begins at 6 months; it does not establish dosing for younger infants.
• Naproxen, children/adolescents: 5–7 mg/kg/dose every 8–12 hours as needed; maximum 1,000 mg/day. Base 200 mg equals sodium salt 220 mg; sodium may provide faster onset for acute pain.
• Older-patient ceilings in the source: acetaminophen 4,000 mg/day; ibuprofen 3,200 mg/day; adult naproxen 1,250 mg on day 1, then 1,000 mg/day. These are reference maxima, not targets.
• Codeine, oxycodone, hydrocodone, morphine, and tramadol are not recommended as first-line pediatric analgesics, including for moderate/severe pain.

Systemic antibiotics: pediatric reference regimens

• Amoxicillin: >3 months and < 40 kg, 20–40 mg/kg/day divided every 8 hours (500 mg/dose maximum), or 25–45 mg/kg/day divided every 12 hours (875 mg/dose maximum). The printed cutoff omits exactly 40 kg; confirm the dose with the prescriber.
• Amoxicillin–clavulanate: >3 months through 40 kg, 25–45 mg/kg/day of the amoxicillin component, divided every 12 hours; maximum 875 mg/dose and 1,750 mg/day.
  • Use suspension/chewable formulation in this group.
  • Minimize clavulanate to reduce gastrointestinal effects; formulation ratio matters: 4:1 examples use three daily doses, 7:1 examples use two.
• Azithromycin: day 1, 10–12 mg/kg once (maximum 500 mg); then 5–6 mg/kg once daily for another 2–5 days.
  • Extended-release dosing depends on indication.
  • Option for Type I beta-lactam allergy; pre-existing conduction defects raise arrhythmia concerns.
• Cephalexin: mild/moderate infection, 25–50 mg/kg/day divided every 6–12 hours (maximum 2,000 mg/day); severe infection, 75–100 mg/kg/day divided every 6–8 hours (maximum 4,000 mg/day).
  • Avoid after penicillin/ampicillin-associated anaphylaxis, angioedema, or urticaria.
• Clarithromycin: 7.5 mg/kg/dose every 12 hours, maximum 500 mg/dose. Type I beta-lactam allergy option with the same conduction-defect caution as azithromycin.
• Clindamycin, soft-tissue infections: 20–30 mg/kg/day divided every 8 hours, maximum 450 mg/dose; source lists 30–40 mg/kg/day for MRSA. Covers specified aerobic/anaerobic organisms, but serious C. difficile colitis is a concern.
• Doxycycline, >8 years: 2.2 mg/kg/dose every 12 hours, maximum 100 mg/dose.
  • Tetracycline-related tooth/enamel and pigmentation concerns generally discourage use in pregnancy and children < 8.
  • Preserve the exception: necessary doxycycline courses < 21 days for specific infections are supported by AAP because clinical evidence of developing-tooth discoloration is lacking for such courses.
• Penicillin V: 25–50 mg/kg/day divided every 6 hours, maximum 2,000 mg/day. Assess prior IgE-mediated/beta-lactam reactions because anaphylaxis can occur.
• Metronidazole: adds anaerobic coverage.
  • This resource gives no pediatric recommendation for off-label anaerobic odontogenic infection; adolescents/adults receive 500 mg every 8 hours with penicillin, or a second/third-generation cephalosporin if penicillin-allergic.
  • Avoid alcohol and propylene glycol-containing products during therapy; animal carcinogenicity warning is stated.

Selected periodontal regimens and prophylaxis

• Antibiotics accompany periodontal debridement in selected periodontal cases.
• Amoxicillin 25–35 mg/kg/day divided every 8 hours (maximum 500 mg/dose) plus metronidazole 10 mg/kg/dose every 8 hours (maximum 250 mg/dose), both for 7 days.
• Penicillin-allergic periodontal options: azithromycin 10–12 mg/kg once daily for 3 days (maximum 500 mg/day), or metronidazole 10 mg/kg/dose every 8 hours for 7 days (maximum 250 mg/dose), including necrotizing gingivitis.
• When endocarditis prophylaxis is indicated, give a single dose 30–60 minutes before the procedure: amoxicillin or cephalexin 50 mg/kg (maximum 2,000 mg); azithromycin or clarithromycin 15 mg/kg (maximum 500 mg).
• Doxycycline prophylaxis: < 45 kg, 2.2 mg/kg; >45 kg/adults, 100 mg. The printed cutoff omits exactly 45 kg; confirm the dose with the prescriber.
• Clindamycin is no longer recommended for dental endocarditis prophylaxis. This resource does not define qualifying cardiac conditions/procedures; consult the dedicated prophylaxis guidance.

Local antimicrobial agents

• Chlorhexidine 0.12%: ≥8 years, 15 mL twice daily for 30 seconds, then expectorate; gingivitis/periodontitis, with stomatitis use off-label. Prefer alcohol-free solution for children. If unable to rinse/spit, supervised small-area application with a soft/foam brush or cotton applicator is described.
• Mupirocin 2%: external localized impetigo/skin infection only; exclude < 2 months. Small amount three times daily for 5–10 days; reevaluate if no response after 5 days.
• Retapamulin 1%: external localized impetigo; >9 months, twice daily for 5 days. Information below 9 months is limited.

Candidiasis and angular cheilitis

• Fluconazole, systemic: infants/children/adolescents with oropharyngeal candidiasis, 6–12 mg/kg once daily for 7–14 days, maximum 400 mg/dose.
  • Hepatic enzyme inhibition creates interaction concerns with CYP-metabolized drugs; source allows pediatric dosage to exceed adult dosage because of pharmacokinetics.
  • Current product labeling differs: for patients ≥6 months, 6 mg/kg on day 1, then 3 mg/kg daily for at least 2 weeks.
  • Verify indication, age, and regimen before using the AAPD summary. DailyMed fluconazole label.
• Clotrimazole 10-mg lozenge: >3 years, dissolve one five times daily for 7–14 days; no food/drink for 30 minutes afterward. Therapy may continue beyond clinical resolution; not for < 3 years.
• Miconazole 50-mg buccal tablet: >13 years, one daily for 14 days above the upper lateral incisor.
  • Current product labeling: ORAVIG is indicated for adults; safety/effectiveness below 16 years are unestablished, and milk-protein hypersensitivity is a contraindication.
  • Verify pediatric eligibility and product-specific placement instructions. DailyMed ORAVIG label.
• Nystatin suspension: infants, 200,000 units (2 mL) four times daily, half on each side; older patients, 400,000–600,000 units (4–6 mL) four times daily, swish several minutes and swallow.
  • Use 7–14 days; older-patient instructions continue ≥48 hours after symptoms resolve and avoid food/drink for 30 minutes.
  • High sucrose content (30–50%); sugar-free compounding is possible.
• Angular cheilitis: clotrimazole 1% cream or nystatin cream/ointment, all ages; miconazole nitrate 2% cream/ointment, >2 years. Thin application at commissures 2–4 times daily for 7–14 days or until healing.
• Nystatin–triamcinolone, off-label for cheilitis: >2 months, twice daily; maximum 2 weeks, preferably only 3–5 days in children.

Herpetic disease: systemic agents

• Primary herpetic gingivostomatitis: acyclovir and valacyclovir use is off-label.
• Acyclovir: 20 mg/kg/dose four times daily for 5–7 days, maximum 800 mg/dose; immunocompromised children, 7–10 days. Immunocompromised adolescents: 400 mg three times daily for 5–10 days or until resolution.
• Valacyclovir: ≥3 months, 20 mg/kg/dose twice daily for 5–7 days, maximum 1,000 mg/dose; immunocompromised children/adolescents, 10–14 days. Suspension may be pharmacist-compounded.
• Herpes labialis: start systemic treatment at the earliest symptoms. Off-label acyclovir in infants/children: 20 mg/kg/dose four times daily for 7–10 days or resolution, maximum 400 mg/dose; adolescents/adults, 400 mg three times daily for 5–10 days or resolution.
• Valacyclovir, immunocompetent patients ≥12 years: 2,000 mg every 12 hours for one day only (two doses; maximum 4,000 mg/day).
  • Immunocompromised adolescents/adults: 1,000 mg every 12 hours for 5–10 days, with a stated ceiling of 3,000 mg/day. The regimen totals 2,000 mg/day; the ceiling is not a target and does not authorize a higher dose.
  • US product label: efficacy and safety for treating herpes labialis in immunocompromised patients are not established. Use indication- and host-specific specialist guidance; review renal function, duration, and disease severity. VALTREX prescribing information.
• Famciclovir: adult regimen, 1,500 mg once at symptom onset; immunocompromised adult regimen, 500 mg twice daily for 5–10 days.
  • The source also lists adolescents in these regimens while stating their safety/efficacy are unestablished; adolescent dosing is omitted.
  • Current product labeling: famciclovir is not recommended for recurrent herpes labialis in patients 12 to < 18 years. DailyMed famciclovir label.

Herpes labialis: local agents

• ≥12 years: docosanol 10% five times daily up to 10 days; acyclovir 5% cream five times daily for 4 days; penciclovir 1% every 2 hours while awake for 4 days.
• Acyclovir 50-mg buccal tablet: ≥12 years, one application at upper canine-fossa gingiva; minimal transmucosal absorption.
  • Current product labeling: SITAVIG is indicated for immunocompetent adults; pediatric safety/effectiveness are unestablished, and milk-protein hypersensitivity is a contraindication.
  • Verify eligibility before pediatric use. DailyMed SITAVIG label.
• Acyclovir 5%/hydrocortisone 1% cream, ≥6 years: five times daily for 5 days.

Topical corticosteroids

• Intended for noninfectious ulcers/mucocutaneous lesions: aphthae, localized contact allergy, symptomatic benign migratory glossitis.
• Triamcinolone 0.1% dental paste, medium potency: children/adolescents/adults, 2–4 times daily after meals/at bedtime; avoid food/drink for 30 minutes.
• Adolescents/adults: fluocinonide 0.05% (high potency) or clobetasol 0.05% (super-high potency), thin application 2–4 times daily; oral use off-label.
• Dexamethasone 0.5 mg/5 mL, off-label oral use: adolescents/adults rinse 5 mL for 2 minutes, 2–4 times daily, then spit; contains alcohol.
• All listed oral steroid courses have a 14-day maximum.

Fluoride: formulation and ingestion safety

• Supervise patients unable to spit; store prescription products away from young children. Ingestion can cause acute toxicity or chronic fluorosis.
• 5,000-ppm gel/paste: ages 6–16, thin ribbon once daily instead of regular toothpaste, preferably bedtime; spit and rinse with water. >16 years, avoid rinsing.
  • Both groups avoid food/drink for 30 minutes.
• 900-ppm rinse: ≥6 years, 10 mL once weekly for 1 minute, then spit; no rinsing/food/drink for 30 minutes.
• Assess all dietary fluoride sources and establish deficient community/well-water fluoride before supplements. Source explicitly cautions that this schedule was not revised after adoption of 0.7-mg/L municipal water and fluoride toothpaste for dentate infants.

Supplement table amounts are milligrams of fluoride per day, not per dose. The source's historic schedule requires the exposure assessment described above.

• Exactly 0.6 ppm: AAPD's narrative and table differ. This table alone does not resolve supplementation at that boundary; see the fluoride-therapy note.

Common board traps

Answer aloud

How do mg/kg/day and mg/kg/dose prescriptions differ?

A daily amount must be divided by doses per day; a per-dose amount is given at each stated interval.

• Arithmetic example: 25 mg/kg/day × 20 kg = 500 mg/day.
• Every 12 hours means two doses: 250 mg each.
• At 250 mg/5 mL, each dose is 5 mL.
• Check indication, age, concentration, and maxima separately; this is arithmetic, not a patient prescription.

A penicillin-allergic child needs dental endocarditis prophylaxis. How do you choose?

Confirm the cardiac/procedure indication and allergy phenotype before selecting a single-dose alternative.

• Avoid cephalexin after penicillin/ampicillin anaphylaxis, angioedema, or urticaria.
• Check age/weight, interactions, and conduction history for alternatives.
• Clindamycin is no longer recommended for this prophylaxis.
• Give the indicated dose 30–60 minutes before the procedure.

How does treatment of thrush differ from treatment of aphthous ulcers?

Treat candidiasis with an antifungal and noninfectious aphthous lesions with an appropriate topical corticosteroid.

• Do not put steroid-only therapy on an assumed fungal lesion.
• Product-specific food/drink restrictions and label differences matter.

What acyclovir regimen does the AAPD resource list for primary herpetic gingivostomatitis in infants, children, and adolescents?

Off-label: 20 mg/kg/dose four times daily for 5–7 days; maximum 800 mg per dose.

• Keep this primary-gingivostomatitis regimen separate from recurrent herpes labialis dosing.
• Review host status, renal function, disease severity, and the indication before prescribing.

What acyclovir regimen does the AAPD resource list for herpes labialis in infants and children?

Off-label: 20 mg/kg/dose four times daily for 7–10 days or until clinical resolution; maximum 400 mg per dose.

• The 400-mg maximum belongs to this labialis regimen; do not substitute the primary-gingivostomatitis maximum.
• Review host status, renal function, and disease severity before prescribing.

What is the one-day valacyclovir regimen for herpes labialis in an immunocompetent patient aged at least 12 years?

2,000 mg every 12 hours for one day only: two doses, with a 4,000-mg daily maximum.

• Keep the age and immune-status restrictions attached to this regimen.
• Review renal function and indication before prescribing; this is not the multi-day immunocompromised-host regimen.

How does AAPD's valacyclovir regimen for herpes labialis in immunocompromised adolescents and adults differ from US product labeling?

The AAPD resource lists 1,000 mg every 12 hours for 5–10 days; the US label does not establish efficacy and safety for treating herpes labialis in immunocompromised patients.

• The listed schedule supplies 2,000 mg/day; the resource's 3,000-mg/day ceiling is not a dosing target.
• Use indication- and host-specific specialist guidance; review renal function, duration, and disease severity.
• This is an AAPD resource regimen with a distinct supplemental labeling limit. VALTREX prescribing information.

What must you verify before prescribing fluoride supplements?

Confirm risk and deficient water fluoride after assessing total exposure.

• Include home/daycare/school water, drinks, foods/formula, toothpaste, and other sources.
• Use the age/water schedule only after this assessment.
• Counsel about measured dosing, storage, and avoiding excess ingestion; the resource notes the historic schedule's limitations.

Can every formulation and age band in AAPD's medication chart be treated as current product labeling?

No. Identify the product and check labeling where the resource and label differ.

• Fluconazole's pediatric oropharyngeal regimen differs from the cited product label.
• ORAVIG and SITAVIG are adult indications with pediatric limitations and milk-protein contraindications.
• Famciclovir is not recommended by the cited label for recurrent labialis at ages 12 to under 18.
• These are supplemental label findings, not revised AAPD recommendations.

Which acetaminophen regimen does the AAPD medication resource list for children under 12?

10–15 mg/kg/dose every 4–6 hours as needed, up to 75 mg/kg/day; never exceed 4,000 mg in 24 hours.

• Check hepatic and other patient risks; use the lowest effective dose.
• These are reference ceilings, not targets. Opioids are not first-line pediatric analgesics.

Which ibuprofen regimen does the AAPD medication resource list for children under 12?

4–10 mg/kg/dose every 6–8 hours as needed, with a 600-mg per-dose ceiling.

• The age table begins at six months; it does not establish younger-infant dosing.
• Check renal, bleeding, and other patient risks; use the lowest effective dose.

Which naproxen regimen does the AAPD medication resource list for children and adolescents?

5–7 mg/kg/dose every 8–12 hours as needed, up to 1,000 mg/day.

• Check renal, bleeding, and other patient risks; use the lowest effective dose.
• This is the resource's regimen and ceiling, not a target dose.

How does the amoxicillin dosing unit differ from an individual administration?

The resource lists milligrams per kilogram per day, divided among administrations.

• For children over three months and under 40 kg: 20–40 mg/kg/day divided every eight hours, maximum 500 mg per dose; or 25–45 mg/kg/day divided every 12 hours, maximum 875 mg per dose.
• These regimens describe dosing after an antibiotic indication is established; localized pulp disease usually needs source control.
• Amoxicillin-clavulanate dosing is based on the amoxicillin component; verify the formulation and clavulanate ratio.
• The chart omits the exact 40-kg boundary; confirm the dose with the prescriber rather than interpolating.

What safety findings change the choice of an alternative antibiotic?

Match the allergy phenotype, age, interactions, and infection indication to the agent.

• Avoid cephalosporins after penicillin/ampicillin anaphylaxis, angioedema, or urticaria.
• Clindamycin carries substantial C. difficile risk; it is not an automatic preferred alternative.
• Macrolides require attention to QT/conduction risk and interactions.
• Short-course doxycycline exceptions in children under eight concern selected infections; they do not authorize unrestricted dental prescribing.