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Useful Medications for Oral Conditions*
    DISCLAIMER: Drug information is constantly changing and is often subject to interpretation. While care has been taken to ensure the
    accuracy of the information presented, the American Academy of Pediatric Dentistry is not responsible for the continued currency of the
    information, errors, omissions, or consequences resulting from the use of these medications. Decisions about drug therapy must be based
    upon the independent judgment of the clinician, changing drug information, and evolving healthcare practices.
   * Pediatric dosage should not exceed adult dosage.
Analgesics
Mild/Moderate Pain1
Acetaminophen
 Important: Both acute and chronic doses of acetaminophen are associated with hepatotoxicity. For this reason, this drug has been reformulated
 so the products are limited to 325 mg per dosage unit.
 Forms: Liquid, tablet, oral disintegrating tablet, caplet, rectal suppository, injectable
 Usual oral dosage:2-5
     Children <12 years: 10-15 mg/kg/dose every 4-6 hours as needed (maximum daily dose 75 mg/kg, but not to exceed 4,000 mg/24 hours)
               OR        ALTERNATIVE DOSING BASED ON AGE OF CHILD3
                         Age                         Weight             Dosage
                                              lbs               kg       mg 3
                         0-3 months          6-11             2.7-5.3     40
                         4-11 months         12-17            5.4-8.1     80
                         1-2 years           18-23        8.2-10.8        120
                         2-3 years           24-35        10.9-16.3       160
                         4-5 years           36-47        16.4-21.7       240
                         6-8 years           48-59        21.8-27.2     320-325
                         9-10 years          60-71        27.3-32.6     325-400
                         11 years            72-95        32.7 - 43.2   480-500
      Children >12 years, adolescents, and adults: 325-650 mg every 4-6 hours
                OR 1,000 mg 3-4 times daily as needed (maximum daily dose 4,000 mg)
Ibuprofen
  Forms: Liquid, tablet, injectable
  Usual oral dosage:2-5
     Infants and children <12 years: 4-10 mg/kg/dose every 6-8 hours as needed (maximum single dose 600 mg)
               OR        ALTERNATIVE DOSING BASED ON AGE OF CHILD 3
                            Age                      Weight             Dosage
                                              lbs               kg       mg
                         6-11 months         12-17            5.4-8.1     50
                         12-23 months        18-23        8.2-10.8       75-80
                         2-3 years           24-35        10.9-16.3       100
                         4-5 years           36-47        16.4-21.7       150
                         6-8 years           48-59        21.8-27.2       200
                         9-10 years          60-71        27.3-32.6     200-250
                         11 years            72-95        32.7 - 43.2     300
      Children >12 years and adolescents: 200-400 mg every 4-6 hours as needed (maximum daily dose 3,200)
      Adults: 200-400 mg/dose every 4-6 hours as needed
               OR 600-800 mg every 6-8 hours as needed (maximum daily dose 3,200)                      Medications continued on the next page.
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Naproxen
      Important: Dosage expressed as 200 mg naproxen base is equivalent to 220 mg naproxen sodium. For acute pain, naproxen sodium may be
      preferred because of increased solubility leading to faster onset, higher peak concentration, and decreased adverse drug events.4
      Forms: Suspension, tablet
      Usual dosage:2-5
         Children and adolescents: 5-7 mg/kg every 8-12 hours as needed (maximum daily dose 1,000 mg)
         Adults: Initial dose of 500 mg, then 250-500 mg every 12 hours
            OR 250 mg every 6-8 hours as needed (maximum daily dose 1,250 mg on day 1, then 1,000 mg/day thereafter)
Moderate/Severe Pain
      Important: The use of codeine and its alternatives, oxycodone, hydrocodone, morphine, and tramadol, for children as an analgesic is not
      recommended by the American Academy of Pediatrics.6 An overview of the benefits and risks of analgesic medications for the management of
      acute dental pain has been summarized.7
Systemic Antibiotics
Amoxicillin
      Forms: Suspension, chewable tablet, tablet, capsule
      Usual oral dosage:2-5
          Infants >3 months, children, and adolescents <40 kg: 20-40 mg/kg/day in divided doses every 8 hours (maximum single dose 500 mg)
                                                                OR 25-45 mg/kg/day in divided doses every 12 hours (maximum single dose 875 mg)
          Adolescents >40 kg and adults: 250-500 mg every 8 hours
                               OR 500-875 mg every 12 hours
      Endocarditis prophylaxis:3,4,8
          Infants, children, and adolescents: 50 mg/kg (maximum single dose 2,000 mg) 30-60 minutes before procedure
          Adults: 2,000 mg 30-60 minutes before procedure
      Periodontal disease treatment for select cases using oral regimen combination of amoxicillin and metronidazole 9
      Children and adolescents: Amoxicillin: 25-35 mg/kg/day in divided doses every 8 hours for 7 days (maximum single dose 500 mg)
                           AND Metronidazole: 10 mg/kg/dose every 8 hours for 7 days (maximum single dose 250 mg)
      Adults: Amoxicillin: 375-500 mg every 8 hours for 7 days
       AND Metronidazole: 250 mg every 8 hours for 7 days
      Caution: For individuals who are allergic to penicillin, see alternative regimens under azithromycin and metronidazole
Amoxicillin clavulanate potassium
      Important: Use the lowest dose of clavulanate combined with amoxicillin available to decrease gastrointestinal adverse drug events. The
      frequency of dosing is generally based on the ratio of amoxicillin to clavulanate.4
      Forms: Suspension, chewable tablet, tablet
      Usual oral dosage:2-5 (based on amoxicillin component):
         Children >3 months of age up to 40 kg: 25-45 mg/kg/day in doses divided every 12 hours (maximum single dose 875 mg;
                                                   maximum daily dose 1,750 mg) (prescribe suspension or chewable tablet due to clavulanic
                                                   acid component)
         Children >40 kg, adolescents, and adults: 500-875 mg every 12 hours (prescribe tablet)
      Examples of formulations and dosing schedule:3,4
         4:1 formulations are dosed 3 times daily (amoxicillin 125 mg/clavulanate 31.25 mg; amoxicillin 250 mg/clavulanate 62.5 mg;
                                                  amoxicillin 500 mg/clavulanate 125 mg)
         7:1 formulations are dosed 2 times daily (amoxicillin 200 mg/clavulanate 28.5 mg; amoxicillin 400 mg/clavulanate 57 mg;
                                                  amoxicillin 875 mg/clavulanate 125 mg)
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Azithromycin
  Important: Doses may vary for extended release suspension depending on the reason for prescribing the antibiotic.
  This drug is an option for patients with Type I allergy to penicillin and/or cephalosporin antibiotics.
  Caution: This drug can cause cardiac arrhythmias in patients with pre-existing cardiac conduction defects.3,4
  Forms: Tablet, capsule, suspension, injectable
  Usual oral dosage:2-5
     Infants, children, and adolescents: 10-12 mg/kg on day 1, single dose, (maximum 500 mg), followed by 5-6 mg/kg once daily
                                         for remainder of treatment (2-5 days)
     Adults: 500 mg on day 1, single dose, followed by 250 mg daily as a single dose (maximum 250 mg) for 2-5 days
  Endocarditis prophylaxis:3-5,8
     Infants, children, and adolescents: 15 mg/kg (maximum single dose 500 mg) 30-60 minutes before procedure
      Adults: 500 mg 30-60 minutes before the procedures
  Periodontal disease treatment for select cases using oral regimen of azithromycin only, when allergic to penicillin 9
  Children and adolescents: 10-12 mg/kg once daily for 3 days (maximum daily dose 500 mg)
  Adults: 500 mg once daily for 3 days (maximum daily dose 500 mg/day)
Cephalexin
  Caution: This antibiotic should not be used by an individual who has a history of anaphylaxis, angioedema, or urticaria with penicillin
           or ampicillin.3-5
  Forms: Suspension, tablet, capsule
  Usual oral dosage:2-5
     Infants, children, and adolescents: Mild to moderate infections: 25-50 mg/kg/day divided every 6-12 hours
                                                                          (maximum daily dose 2,000 mg)
                                                       Severe infections: 75-100 mg/kg/day divided every 6-8 hours
                                                                          (maximum daily dose 4,000 mg)
                                                                     OR 500 mg every 12 hours
     Adults: 250-1,000 mg every 6 hours (maximum daily dose 4,000 mg)
  Endocarditis prophylaxis:3,4,8
      Infants, children, and adolescents: 50 mg/kg (maximum single dose 2,000 mg) 30-60 minutes before procedure
      Adults: 2,000 mg 30-60 minutes before procedure
Clarithromycin
  Important: This drug is an option for patients with Type I allergy to penicillin and/or cephalosporin antibiotics.
  Caution: This drug can cause cardiac arrhythmias in patients with pre-existing cardiac conduction defects.3,4
  Forms: Suspension, tablet
  Usual oral dosage:2-5
     Infants, children and adolescents: 7.5 mg/kg/dose every 12 hours (maximum single dose 500 mg)
     Adults: 500 mg every 12 hours
  Endocarditis prophylaxis:3,4,8
     Infants, children, and adolescents: 15 mg/kg (maximum single dose 500 mg) 30-60 minutes before procedure
     Adults: 500 mg 30-60 minutes before procedure
Clindamycin
  Important: This is an option for patients with Type I allergy to penicillin and/or cephalosporin antibiotics. This antibiotic is effective for
  infections (e.g., abscesses) with gram-positive aerobic bacteria and gram-positive or gram-negative anaerobic bacteria. However, Clostridioides
  difficile colitis is a serious adverse reaction with this antibiotic.3-5
  This antibiotic is no longer recommended for endocarditis prophylaxis for dental procedures.8
  Forms: Suspension, capsule, injectable
  Usual oral dosage for soft tissue infections:2-5
     Infants, children, and adolescents: 20-30 mg/kg/day in divided doses every 8 hours (maximum single dose 450 mg); higher doses
                                           of 30-40 mg/kg/day for Methicillin-resistant Staphylococcus aureus (MRSA) infections
     Adults: 300-450 mg every 6-8 hours (maximum daily dose 1,800 mg)
                                                                                                                       Medications continued on the next page.
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Doxycycline
      Important: Tetracycline may cause permanent tooth discoloration, enamel hypoplasia in developing teeth, and hyperpigmentation of the soft
      tissues. Due to these side effects, this drug usually is not recommended for women who are pregnant and children <8 years old. However,
      short-term use of doxycycline (<21 days) is recommended by the American Academy of Pediatrics for specific infections when necessary
      because there is lack of clinical evidence that this form of tetracycline results in discoloration of developing teeth when used for <21 days.3,4,10
      Forms: Suspension, tablet, delayed release tablet, capsule, injectable
      Usual oral dosage:2-5
         Children >8 years and adolescents: 2.2 mg/kg/dose every 12 hours (maximum single dose 100 mg)
         Adults: 100 to 200 mg/day once a day or divided 2 times daily every 12 hours
      Endocarditis prophylaxis:3,4,8
         Children >8 years and adolescents: children <45 kg, 2.2 mg/kg
                                              children >45 kg, 100 mg 30-60 minutes before procedure
         Adults: 100 mg 30-60 minutes before the procedure
Metronidazole
      Important: Metronidazole is a useful addition to an antibiotic regimen when coverage of anaerobic bacteria is needed. Patients should
      avoid ingestion of alcohol as a beverage or ingredient in medications or propylene glycol-containing products while taking metronidazole.
      There is a warning with the drug because it has been shown to be carcinogenic in mice and rats.3.4
      Forms: Tablet, tablet extended release, capsule, suspension, injectable
      Usual oral dosage:
          For anaerobic odontogenic infections (off-label use):3-5
                Children: No recommendations available
                Adolescents and adults: 500 mg every 8 hours with penicillin or a second or third generation cephalosporin, if allergic to penicillin
          For periodontal disease, including necrotizing gingivitis:4,5,9
                Children and adolescents who are allergic to penicillin: 10 mg/kg/dose every 8 hours for 7 days (maximum single dose 250 mg)
                Adults who are allergic to penicillin: 250-500 mg every 8 hours for 7 days
                See amoxicillin and azithromycin above for other periodontal treatment approaches. In addition, concurrent periodontal debridement is
                important for disease management.
          For young children or individuals who are unable to swallow pills, a metronidazole suspension (50 mg/mL) is available in a compounding kit.
Penicillin V Potassium
      Important: Anaphylactic reactions have been demonstrated in patients receiving penicillin, most notably those with a history of beta-lactam
      hypersensitivity, sensitivity to multiple allergens, or prior IgE-mediated reactions (e.g., angioedema, urticaria, anaphylaxis).3
      Forms: Liquid, tablet
      Usual oral dosage:2-5
         Children and adolescents: 25-50 mg/kg/day in divided doses every 6 hours (maximum daily dose 2,000 mg)
         Adults: 250-500 mg every 6-8 hours
Antimicrobial Agents
Chlorhexidine gluconate
      Important: Most brands contain alcohol.
      Forms: Dental solution 0.12% (118 mL, 473 mL)
      Usual dosage for gingivitis/periodontitis and stomatitis (off label use for stomatitis):2-5
         Children ≥8 years, adolescents, and adults: Rinse with 15 mL 2 times daily (after breakfast and before bed) for 30 seconds and expectorate.
Mupirocin
      Important: For external use only; not for use in patients <2 months of age.
      Forms: Ointment 2%; cream 2%
      Usual dosage for localized impetigo or skin infection:2-5
         Infants, children, adolescents, and adults: Apply a small amount of ointment to the affected area 3 times daily for 5-10 days. If no
                                                        clinical response after 5 days, then reevaluate.
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Retapamulin
   Important: For external use only; limited information on age group <9 months of age.
   Forms: Ointment 1%
   Usual dosage for localized impetigo:2-5
      Infants >9 months, children, adolescents, and adults: Apply a small amount of ointment to the affected area 2 times daily for 5 days.
Antifungal Agents for Candidiasis
Systemic antifungal agent for oral candidiasis
Fluconazole
   Important: The drug requires acidic pH in the stomach to disintegrate and dissolve for oral absorption; therefore, absorption is decreased by
   medications that increase gastric pH. Also, prescribe with caution for patients taking other medications metabolized by CYP enzymes because
   fluconazole is a hepatic enzyme inhibitor.3,4 Pediatric dosage may exceed adult dosage due to the pharmacokinetic properties in children.
   Form: Suspension 10 mg/mL, 40 mg/mL; tablet: 50 mg, 100 mg, 150 mg, 200 mg; injectable: 100mg/50 mL, 200 mg/100 mL,
          400 mg/200 mL.
   Usual dosage for oropharyngeal candidiasis:2-5
      Infants, children, and adolescents: 6-12 mg/kg/dose once daily for 7-14 days (maximum single dose 400 mg)
      Adults: Single dose of 200 mg on day 1, then 100-200 mg/dose once daily for 7-14 days
Topical or transmucosal agents for oral candidiasis
Clotrimazole
   Important: This drug is not for use in patients <3 years of age.
   Form: Lozenge 10 mg
   Usual dosage:2-5
      Children >3 years, adolescents, and adults: Dissolve 1 lozenge 5 times daily for 7-14 days. Treatment may extend beyond clinical
                                                      resolution.
Miconazole
   Important: This dosage form contains milk protein concentrate.
   Form: Buccal tablet 50 mg
   Usual dosage:3,4
      Adolescents >13 years and adults: 1 tablet daily for 14 days; apply to the gum region, just above the upper lateral incisor.
Nystatin
   Form: Suspension (100,000 units/mL)
   Usual oral dosage:3,4,10
      Infants: 200,000 units (2 mL) 4 times daily; ½ of dose placed in each side of mouth. Use for 7-14 days.
      Children, adolescents, and adults: Swish 400,000-600,000 units (4-6 mL) 4 times daily for several minutes and swallow; continue
                                         at least 48 hours after symptoms resolve. Use for 7-14 days.
Topical agents for angular cheilitis
Clotrimazole
   Form: Cream 1%
   Usual dosage:4,11
      All ages: Apply a thin layer to the corners of the mouth 2-4 times daily for 7-14 days or until complete healing.
Miconazole nitrate
   Forms: Ointment 2%; cream 2%
   Usual dosage:4,11
      Children >2 years, adolescents, and adults: Apply a thin layer to the corners of the mouth 2-4 times daily for 7-14 days or
                                                  until complete healing.
                                                                                                                   Medications continued on the next page.
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Nystatin
      Forms: Ointment, cream (100,000 units/g)
      Usual dosage:2,4,11
         For all ages: Apply a thin layer to corners of mouth 2-4 times daily for 7-14 days or until complete healing.
Nystatin, triamcinolone acetonide (not Food and Drug Administration [FDA]-approved for this use)
      Forms: Ointment, cream (100,000 units nystatin/g and 0.1% triamcinolone acetonide)
      Usual dosage:4,11
         All ages >2 months: Apply a thin layer to the corners of the mouth 2 times daily for no longer than 2 weeks. Should be used for the
                             shortest period of time in children (3-5 days).
Antiviral Agents
Systemic agent for primary herpetic gingivostomatitis
Acyclovir (not FDA-approved for this use)
      Forms: Suspension 200 mg/5 mL; tablets 400 mg, 800 mg; capsules 200 mg; injectable 50 mg/mL
      Usual dosage:3-5
         Infants, children, and adolescents: 20 mg/kg/dose 4 times daily for 5-7 days (maximum single dose 800 mg)
         Immunocompromized children: 20 mg/kg/doses 4 times daily for 7-10 days
         Immunocompromized adolescents: 400 mg 3 times daily for 5-10 days or until resolution
         Adults: 400 mg 3 times daily for 5-10 days
Valacyclovir (not FDA-approved for this use)
      Forms: Suspension may be compounded by pharmacist; tablets 500 mg, 1,000 mg
      Usual dosage:3-5
         Infants ≥3 months, children and adolescents: 20 mg/kg/dose 2 times daily for 5-7 days (maximum single dose 1,000 mg)
         Immunocompromised children and adolescents: 20 mg/kg/dose 2 times daily for 10-14 days
         Adults: 1,000 mg 2 times daily for 7-10 days
Systemic agents for herpes labialis
Acyclovir (not FDA-approved for this use)
      Form: Suspension 200 mg/5 mL; tablets 400 mg, 800 mg; capsules 200 mg; injectable 50 mg/mL
      Usual dosage:2-5 (Begin treatment at the earliest signs/symptoms)
         Infants and children: 20 mg/kg/dose 4 times daily for 7-10 days or until clinical resolution (maximum single dose 400 mg)
         Immunocompromised children: 20 mg/kg/dose 4 times daily for 7-10 days or until clinical resolution
         Adolescents and adults: 400 mg 3 times daily for 5-10 days or until clinical resolution
Famciclovir
      Form: Tablet 125 mg, 250 mg, 500 mg
      Usual dosage: 2-5
         Children and adolescents: Safety and efficacy have not been established.
         Adolescents and adults: 1,500 mg as a single dose at the first sign or symptom of infection
         Immunocompromised adolescents and adults: 500 mg 2 times daily for 5-10 days
Valacyclovir
      Form: Tablet 500 mg, 1,000 mg
      Usual oral dosage:2-5
         Children ≥12 years, adolescents, and adults: 2,000 mg every 12 hours for 1 day (2 doses); initiate at first signs or symptoms of infection
                                                      (maximum daily dose 4,000 mg for one-day regimen)
         Immunocompromised adolescents and adults: 1,000 mg every 12 hours for 5-10 days (maximum daily dose 3,000 mg)
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Topical agents for herpes labialis
Docosanol (over-the-counter)
   Form: Cream 10%
   Usual dosage:2-5
      Children ≥12 years, adolescents, and adults: Apply a thin layer on the lesion 5 times daily for up to 10 days.
Acyclovir
   Form: Cream 5%
   Usual dosage:3-5
      Children ≥12 years, adolescents, and adults: Apply a thin layer on the lesion 5 times daily for 4 days.
Acyclovir (minimal transmucosal absorption)
   Important: This dosage form contains milk protein concentrate.
   Form: Buccal tablet 50 mg
   Usual dosage:3-5
      Children ≥12 years, adolescents, and adults: Apply 1 tablet 1 time to the upper gums in area of canine fossa.
Acyclovir with hydrocortisone
   Form: Cream (5% acyclovir with 1% hydrocortisone)
   Usual dosage:3-5
      Children ≥6 years, adolescents, and adults: Apply a thin layer on the lesion 5 times daily for 5 days.
Penciclovir (by prescription only)
   Form: Cream 1%
   Usual dosage:2-5
      Children ≥12 years, adolescents, and adults: Apply a thin layer on the lesion every 2 hours while awake for 4 days.
Topical Corticosteroids
Use for noninfectious ulcers and mucocutaneous lesions, including aphthous ulcers, localized contact allergic reactions, and symptomatic
benign migratory glossitis.
Triamcinolone acetonide (medium potency corticosteroid)
   Form: Dental paste or ointment 0.1%
   Usual dosage:3,4,11
      Children, adolescents, and adults: Apply paste to ulcers 2-4 times daily, after meals and at bedtime; not to exceed 14 day course.
                                         Avoid eating or drinking for 30 minutes after application
Fluocinonide (high potency corticosteroid; not FDA-approved for oral application)
   Form: Gel, ointment 0.05%
   Usual dosage:4,11
      Adolescents and adults: Apply thin amount of gel or ointment to ulcers 2-4 times daily; not to exceed 14 day course.
Dexamethasone (high potency corticosteroid; not FDA-approved for oral application)
   Form: Elixir, solution 0.5 mg/5 mL (contains alcohol)
   Usual dosage:11
      Adolescents and adults: Rinse with 5 mL 2-4 times daily for 2 minutes and expectorate; not to exceed 14 day course.
Clobetasol (super-high potency corticosteroid; not FDA-approved for oral application)
   Form: Gel, ointment 0.05%
   Usual dosage:4,11
      Adolescents and adults: Apply thin amount of gel or ointment to ulcers 2-4 times daily, not to exceed 14 day course.
                                                                                                                Medications continued on the next page.
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References
 1. American Academy of Pediatric Dentistry. Policy on pediatric dental pain management. The Reference Manual of
    Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2023:159-61.
 2. Jeske AH. Mosby’s Dental Drug Reference. 13th ed. St. Louis, Mo.: Elsevier, Inc.; 2022.
 3. Lexicomp Online, Pediatric and Neonatal Lexi-Drugs Online. Hudson, Ohio: Wolters Kluver Clinical Drug Information,
    Inc.; 2023. Available at: “http://webstore.lexi.com/Pediatric-Lexi-Drugs”. Accessed August 13, 2023.
 4. Lexicomp Online, Lexi-Drugs Online. Hudson, Ohio: Wolters Kluver Clinical Drug Information, Inc.; 2023. Available
    at: “http://www.wolterskluwercdi.com/lexicomp-online/”. Accessed August 18, 2023.
 5. ClinicalKey Online, Gold Standard Drug Monographs Online. North America: Elsevier, Inc.; 2023. Available at: “http://
    www.clinicalkey.com/#!/content/drug_monograph/”. Accessed August 13, 2023.
 6. Tobias JD, Green TP, Coté CJ, Section on Anesthesiology and Pain Medicine, American Academy of Pediatrics Committee
    on Drugs. Codeine: Time to say “no”. Pediatrics 2016;138(4):e20162396.
 7. Moore PA, Ziegler KM, Lipman RD, et al. Benefits and harms associated with analgesic medications used in the
    management of acute dental pain. An overview of systematic reviews. J Am Dent Assoc 2018;149(4):256-68.
 8. Wilson WR, Gewitz M, Lockhart PB, et al. Prevention of viridans group streptococcal infective endocarditis. A scientific
    statement from the American Heart Association. Circulation 2021;143(20):e963-e978. Epub 2021 Apr 15. Available
    at: “https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000000969”. Erratum in: Circulation 2021;144(9):e192.
    Available at: “https://www.ahajournals.org/doi/10.1161/CIR.0000000000001012”. Accessed August 13, 2023.
 9. American Academy of Pediatric Dentistry. Risk assessment of periodontal diseases and pathologies in pediatric dental
    patients. The Reference Manual of Pediatric Dentistry, Chicago, Ill.: American Academy of Pediatric Dentistry; 2023:
    508-26.
10. Committee on Infectious Diseases, American Academy of Pediatrics. Antimicrobial agents and related therapy, Section 4.
    In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021-2024 Report of the Committee on
    Infectious Diseases. 32nd ed. Itasca, Ill.: American Academy of Pediatrics; 2021:863-1006.
11. Miller C, Rhodus NL, Treister NS, Stoopler ET, Kerr AR. Little and Falace’s Dental Management of the Medically
    Compromised Patient. 10th ed. St. Louis, Mo.: Elsevier, Inc.; 2023.
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