Oral Herpes, Within a Dentist's scope?

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Herpes within scope?


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definitely within scope, DMD/DDS students get multiple path courses to ID & tx oral herpes & other dz's, that's good enough for me. though my DMD friend said "i probably wouldn't go near that one...i'd write the script and refer the pt to their PCP."

...that makes even less sense...if you dont want to go near it- don't write the script. Writing it means you are agreeing to treat the condition. Seems like your friend should either do one or the other- write the script OR refer the pt to their PCP...not both

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I'd be OK with it, after all it is oral herpes we are talking about. It seems to me this is a "letter of the law"/"spirit of the law" argument.

After all, it is your license, do what you wish with it.
 
Boys and Girls:

And I am old enough to call you boys and girls. I can call names with the best of them, but this is getting wildly out of hand. While I believe that this is within the scope of practice for a dentist, I can see where others would disagree. I love good strong argument, but hold back on the personal attacks, please......

Remember this is theoretical. When you are in the real world, you better be damn sure before you just turn down an RX cold. You could be dancing before the State Board.
Ah, perspective. Thanks, Old Timer.
 
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I just had to post.

Some of you guys have absolutely no clue of the training some of the dentists go through.

I'm an ER resident going into my 3rd year, I've worked with dentists who are OMFS (that means oromaxillofacial surgery for those who don't know) in the Trauma and TICU (trauma ICU).

These guys handle the entire back room, they handle ALL the sick patients in the trauma intensive care unit and write for more than just "acyclovir". They manage vents, lines, tubes, and meds including drips.

I don't get it. You guys need to know that these guys can do more than just look in the mouth all day.

That's like saying all you pharmacists only count pills.
 
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I just had to post.

Some of you guys have absolutely no clue of the training some of the dentists go through.

I'm an ER resident going into my 3rd year, I've worked with dentists who are OMFS (that means oromaxillofacial surgery for those who don't know) in the Trauma and TICU (trauma ICU).

These guys handle the entire back room, they handle ALL the sick patients in the trauma intensive care unit and write for more than just "acyclovir". They manage vents, lines, tubes, and meds including drips.

I don't get it. You guys need to know that these guys can do more than just look in the mouth all day.

That's like saying all you pharmacists only count pills.

OMFS have 4 years of extra training beyond the DDS/DMD and often have an MD in addition to the dental degree. I think the question is not whether they are qualified to treat oral herpes. I think think it's more a question of whether or not they are legally allowed to treat it. If they can treat herpes on the face, why not herpes on the crotch?

Though, I think I side with the people who think it's within their scope.
 
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OMFS have 4 years of extra training beyond the DDS/DMD and often have an MD in addition to the dental degree. I think the question is not whether they are qualified to treat oral herpes. I think think it's more a question of whether or not they are legally allowed to treat it. If they can treat herpes on the face, why not herpes on the crotch?

Though, I think I side with the people who think it's within their scope.

I don't know about you, but my dentist doesn't normally see my crotch during a visit, whereas s/he would probably see anything on/around my mouth...just saying
 
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As per NYS law, Dentists restore and maintain dental health by diagnosing and treating, operating on, or prescribing for any disease, pain, injury, deformity or physical condition of the oral and maxillofacial area. In general, this means the teeth, gums, jaws, and other areas of the head and neck as long as the mouth is involved. Under the supervision of a dentist, dental hygienists provide treatment to prevent cavities and gum diseases.

Sounds like oral herpes is well within. Anybody who says refer to pcp is a *****. What is the PCP going to do that will be any different from the dentist? If anything, you are delaying treatment and limiting treatment options. Do most of you guys have any idea on how anti virals work???
 
OMFS have 4 years of extra training beyond the DDS/DMD and often have an MD in addition to the dental degree. I think the question is not whether they are qualified to treat oral herpes. I think think it's more a question of whether or not they are legally allowed to treat it. If they can treat herpes on the face, why not herpes on the crotch?

Though, I think I side with the people who think it's within their scope.

OMFS does not always have to have an MD in addition to their DDS/DMD degree. Most of the ones I've met do not.

And how do we know that the DDS who prescribed the acyclovir is not OMFS trained?

I understand they should be legally within their scope, but an oral lesion is still an oral lesion.
 
Sounds like oral herpes is well within. Anybody who says refer to pcp is a *****. What is the PCP going to do that will be any different from the dentist? If anything, you are delaying treatment and limiting treatment options. Do most of you guys have any idea on how anti virals work???

In general I feel like follow-up with a pcp is easier than going to the dentist simply for a check up on your oral herpes. I'm not quite sure what you're talking about regarding delayed treatment or limiting treatment options...dentists don't have anything special up their sleeves for treating something like this that a pcp wouldn't have (since they can prescribe the same thing in this instance). Also, it's not like you can cure the problem so it's not some huge time crunch.

However I do agree that it's within the scope, not arguing that
 
In general I feel like follow-up with a pcp is easier than going to the dentist simply for a check up on your oral herpes. I'm not quite sure what you're talking about regarding delayed treatment or limiting treatment options...dentists don't have anything special up their sleeves for treating something like this that a pcp wouldn't have (since they can prescribe the same thing in this instance). Also, it's not like you can cure the problem so it's not some huge time crunch.

However I do agree that it's within the scope, not arguing that

I don't think someone would go to the dentist to check up on oral herpes. It's more likely that they went in for some dental work, asked about the herpes, and got a script for Acyclovir. For me, it was just a question of knowing what dentists do besides cleaning teeth, putting in new teeth, braces, etc. If they go through as much school as some others have posted, then yeah I'd fill the script.
 
I don't think someone would go to the dentist to check up on oral herpes. It's more likely that they went in for some dental work, asked about the herpes, and got a script for Acyclovir. For me, it was just a question of knowing what dentists do besides cleaning teeth, putting in new teeth, braces, etc. If they go through as much school as some others have posted, then yeah I'd fill the script.

Fill the script and tell them to follow up with their PCP.

Look folks, herpes outbreaks of the oral mucosa need to be treated as soon as possible for acyclovir to have any efficacy. A dentist is performing his or her duty by providing that initiation of care to the patient who, as stated above, probably came in for an unrelated issue. I see absolutely nothing wrong with that. It is your job to then delve deeper, get a medication history if possible, allergies, etc, and dispense the damn drug. Some of you guys are making acyclovir into a C I substance or something...

1) guy/gal got herpes on the oral mucosa (you may even be able to observe this in your capacity as a pharmacist)
2) guy/gal has a valid prescription from a licensed practitioner to treat diseases of the mouth
3) guy/gal has no absolute contraindications to said drug
4) Rx counsel new prescription and send the unlucky patient on his/her way.
 
I don't think someone would go to the dentist to check up on oral herpes. It's more likely that they went in for some dental work, asked about the herpes, and got a script for Acyclovir. For me, it was just a question of knowing what dentists do besides cleaning teeth, putting in new teeth, braces, etc. If they go through as much school as some others have posted, then yeah I'd fill the script.

All I meant was that follow-up would be easier with a pcp (which is what a pcp would do differently than a dentist, why I replied to the previous post). What I was getting at was fill with the dentist if they were the first on the scene to treat, and follow up with pcp.
 
All I meant was that follow-up would be easier with a pcp (which is what a pcp would do differently than a dentist, why I replied to the previous post). What I was getting at was fill with the dentist if they were the first on the scene to treat, and follow up with pcp.

yeah this is what people meant when saying refer to PCP. herpes isn't exactly a wham bam one time thank you ma'am type of thing...this thing needs serious follow-up upon new dx that a once-every-six-months DDS/DMD appt. won't necessarily accomplish.

Plus, there (probably) are other things involved...a PCP will the best place to manage any likely co-morbidities (ie chlamydia, gonorrhea, HIV, etc...)
 
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...that makes even less sense...if you dont want to go near it- don't write the script. Writing it means you are agreeing to treat the condition. Seems like your friend should either do one or the other- write the script OR refer the pt to their PCP...not both

well this was my friend talking to me...she said she'd rather not go down that road and become primary on the herpes tx. see my above reply, this was what she was getting at....she'll ID, tx, and refer to PCP for f/u testing & dz mgmt. It's within her training to ID/tx but the practical issue is the pt RTC-ing to her practice vs. a PCP.

It's like getting an eye exam by your OD and getting referred to an optho for further care. Your OD is trained to do certain things, but, for practicality purposes, you'll be referred elsewhere for continuing care.
 
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yeah this is what people meant when saying refer to PCP. herpes isn't exactly a wham bam one time thank you ma'am type of thing...this thing needs serious follow-up upon new dx that a once-every-six-months DDS/DMD appt. won't necessarily accomplish.

Plus, there (probably) are other things involved...a PCP will the best place to manage any likely co-morbidities (ie chlamydia, gonorrhea, HIV, etc...)

I think we are talking about oral herpes here...
 
Personally as a registered pharmacist and a registered dentist it is with in the scope of dental practice. herpes oral lesions occur throughout the mouth soft tissue areas within the oral cavity dentist treat teath and soft tissues within the oral cavity
 
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And I thought my wife was bad with bringing up old s*** to argue about.


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Nice necro, in my opinion I'd do it though so long as it's oral herpes lesion. I did refuse a simvastatin script once from a Dentist who pulled the "I'm a doctor" line, I told him I'm a doctor too and what he's doing isn't legal. That went over well. Had another dentist prescribe oxy for a patient on zubsolv, had to tell him due to their therapy they can't take opiates and that it's unwise to prescribe one unless necessary and in consult with their other MD (had similar convos with PAs/NPs). When I said no opiates they tried to say "lets do tramadol then" and I'm like.... We settled on ibuprofen 800.

If anything pharmacists need to us the "doctor" title to let provider's know we know more about the medications than they do. If a chiro can go by "doctor" we should too. In most states we have more prescriptive authority than they do anyway (if the argument is about providing an RX or direct patient care).
 
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I would assume so. But it's silly to assume a dentists can treat a bacterial infection in the mouth but not a viral infection. Dentists perform difficult surgeries, grow artificial bone, place implants. To assume they can't treat an oral viral infection is silly....
I know I'm necroplying, but this is poor logic.
Just because an individual has demonstrated proficiency in one area doesn't mean they're competent in a loosely related area.

No one is making the argument that they lack the potential or mental faculties to understand the concepts and perform the treatment.
The question is not *could* but *should*

Personally as a registered pharmacist and a registered dentist it is with in the scope of dental practice. herpes oral lesions occur throughout the mouth soft tissue areas within the oral cavity dentist treat teath and soft tissues within the oral cavity
Just curious:

if the patient develops herpes of the eye and goes after the DDS, would the DDS be OK?
 
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I know I'm necroplying, but this is poor logic.
Just because an individual has demonstrated proficiency in one area doesn't mean they're competent in a loosely related area.

No one is making the argument that they lack the potential or mental faculties to understand the concepts and perform the treatment.
The question is not *could* but *should*

A dentist can treat any infection in the mouth. That is their scope of practice. You would have to show me your state law that says they can't. If they can treat a bacterial infection in the mouth, they can logical
extension they can treat a viral infection in the mouth.
 
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What if pt is having major dental work done, and has a herpes lesion in the corner of his mouth and has difficulty opening mouth fully. I see no reason why the DDS couldn't prescribe an antiviral.
 
A dentist can treat any infection in the mouth. That is their scope of practice. You would have to show me your state law that says they can't. If they can treat a bacterial infection in the mouth, they can logical
extension they can treat a viral infection in the mouth.
A dentist can treat any infection in the mouth. That is their scope of practice. You would have to show me your state law that says they can't. If they can treat a bacterial infection in the mouth, they can logical
extension they can treat a viral infection in the mouth.
Lol. I was going to bring up points about whether or not it's a primary outbreak blablabla, but who cares.

I bet a dentist would try to perform a liver transplant if he tied a piece of floss from a tooth to the belly button as well.
 
Lol. I was going to bring up points about whether or not it's a primary outbreak blablabla, but who cares.

I bet a dentist would try to perform a liver transplant if he tied a piece of floss from a tooth to the belly button as well.

Better to be silent and thought a fool than open your mouth and remove all doubt......
 
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Better to be silent and thought a fool than open your mouth and remove all doubt......

You covered that pretty well with your
"Aren't antibiotics and antivirals pretty much the same thing?" post earlier
 
You covered that pretty well with your
"Aren't antibiotics and antivirals pretty much the same thing?" post earlier

I guess if you don't understand what an analogy is, my words are lost on you. BTW: Still no citation from you on your state law that would prohibit it, and I don't think you'll produce one.
 
I guess if you don't understand what an analogy is, my words are lost on you. BTW: Still no citation from you on your state law that would prohibit it, and I don't think you'll produce one.
I think you are ignorant of totally ignorant of what the stomatognathic system is and how that is the limiter for dentists.

This might help you:

Again, even if the board didn't specifically list what parts of the mouth are included,
a competent professional should be able to understand that it's a dumb idea.
Does a dentist routinely assess serum creatinine?
Would a dentist know about the risk for thrombocytopenia?



Texas Occupational Code § 251.003(a)

Texas Occupational Code § 251.003(c)

"Based on the language in the statute, the [Dental] Board has determined that the use of facial cosmetic procedures outside the stomatognathic system is not within the scope of practice for a dentist who does not have the specialty of oral and maxillofacial surgery."


Like I stated previously, dentists are infamous for trying to slowly push outside of the scope of their practice.
TMA famously went toe to toe with their board because of the scandal around dentists running sleep apnea clinics.

If you just want to Lick 'N Stick that's up to you.
 
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I think you are ignorant of totally ignorant of what the stomatognathic system is and how that is the limiter for dentists.

Again, even if the board didn't specifically list what parts of the mouth are included,
a competent professional should be able to understand that it's a dumb idea.
Does a dentist routinely assess serum creatinine?
Would a dentist know about the risk for thrombocytopenia?



Texas Occupational Code § 251.003(a)

Texas Occupational Code § 251.003(c)

"Based on the language in the statute, the [Dental] Board has determined that the use of facial cosmetic procedures outside the stomatognathic system is not within the scope of practice for a dentist who does not have the specialty of oral and maxillofacial surgery."
This is the best you can do? Treating an oral viral infection is not a cosmetic procedure. And absolutely no physician performs a serum creatine level in an otherwise healthy patient who has Herpes Simplex-1 infections. Nice try. Want to try again?

The Stomatognathic system includes:

Lip
Cheek
Roof
Gums
Glands
Teeth
Tongue

Me thinks this is:
A) Part of the Stomatognathic system
B) Not cosmetic
 
This is the best you can do? Treating an oral viral infection is not a cosmetic procedure. And absolutely no physician performs a serum creatine level in an otherwise healthy patient who has Herpes Simplex-1 infections. Nice try. Want to try again?

The Stomatognathic system includes:

Lip

Tongue

Me thinks this is:
A) Part of the Stomatognathic system
B) Not cosmetic
So it's limited for a cosmetic procedure, but not for systemic viral infections. Gotcha.

So you're arguing that your average DDS is qualified to remove portions of the buccal fat pad as well? That's interesting.

Also, no one is saying that a physician runs an SCr for a primary herpes outbreak.

What I am saying is that a grandma with renal failure might get a script from the DDS and she doesn't know to mention the state of her kidneys.

I feel like you're being intentionally ignorant just to defend your point.

It's fine. Keep filling prescriptions from dentists that have no dental purposes because they probably know what they're doing.

Cheers
 
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So it's limited for a cosmetic procedure, but not for systemic viral infections. Gotcha.

So you're arguing that your average DDS is qualified to remove portions of the buccal fat pad as well? That's interesting.

Also, no one is saying that a physician runs an SCr for a primary herpes outbreak.

What I am saying is that a grandma with renal failure might get a script from the DDS and she doesn't know to mention the state of her kidneys.

I feel like you're being intentionally ignorant just to defend your point.

It's fine. Keep filling prescriptions from dentists that have no dental purposes because they probably know what they're doing.

Cheers

You really are quite something. Immune to logic and immune to the rules of debate. I suggest you look up straw man. Your senior citizen with renal impairment is a classic straw man. The law is the law. This is clearly in his scope of practice and the only citation you have posted proves my point. Whether it is wise for a dentist to do so is another matter. But is it legal, yes it is. Prove me other wise and I'll be happy to shut up.
 
So it's limited for a cosmetic procedure, but not for systemic viral infections. Gotcha.
Cheers

Tell me what you proved. Besides, English escapes you along with logic and reason. Treating an infection is never a cosmetic procedure. You might get a cosmetic result, but it would never be seen as primarily a cosmetic procedure. No, they can't inject collagen in the lips because it is a primarily a cosmetic procedure. I like a good debate, but if you just say stuff it doesn't make it so. You could say Trump passed more legislation than any other President since FDR. That would be about as true as your statement that dentists can't treat oral lesions due to Herpes Simplex Virus.
 
You really are quite something. Immune to logic and immune to the rules of debate. I suggest you look up straw man. Your senior citizen with renal impairment is a classic straw man. The law is the law. This is clearly in his scope of practice and the only citation you have posted proves my point. Whether it is wise for a dentist to do so is another matter. But is it legal, yes it is. Prove me other wise and I'll be happy to shut up.
Your logic is one dimensional.
The lips are considered part of the system, but have nothing to do with the dental purposes.
If someone is having a "debate" with you about CO2 levels in the atmosphere, and they start talking about sea levels, are you going to start throwing up the strawman card?
It's a clear example directly related to the exact medication we're discussing.
It's not a strawman just because you don't like being wrong.
Thanks for conveniently avoiding the TTP point, as well.

Did you even read TOC § 251.003(a) and § 251.003(c)? They have nothing to do with that quote about cosmetic procedures.
Please look them up.

Boys and Girls:
I love good strong argument, but hold back on the personal attacks, please......

Kinda ironic that you're now the person hurling insults about English, logic, and reason escaping people.
 
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Your logic is one dimensional.
The lips are considered part of the system, but have nothing to do with the dental purposes.
If someone is having a "debate" with you about CO2 levels in the atmosphere, and they start talking about sea levels, are you going to start throwing up the strawman card?
It's a clear example directly related to the exact medication we're discussing.
It's not a strawman just because you don't like being wrong.
Thanks for conveniently avoiding the TTP point, as well.

Did you even read TOC § 251.003(a) and § 251.003(c)? They have nothing to do with that quote about cosmetic procedures.
Please look them up.



Kinda ironic that you're now the person hurling insults about English, logic, and reason escaping people.

First of all cold sores can be on the lips or inside the mouth. So , no. you are NOT correct. The dentists treats all of these.

Second, your argument is a straw man. It's a classic straw man. It's legal for a PCP to prescribe Valtrex in patients with decreased renal function. It's just not wise. The same for a dentist. It's legal, just not wise.

Finally, I read the exact citations and your entire argument is the lips are not part of the mouth. That's amazing.

The question at hand is this plain and simple. Is a dentists legally allowed to prescribe an oral anti-viral, in this case Valtrex to treat Herpes Simplex of the mouth? The drug itself is irrelevant. A dentists can prescribe Amoxicillin for a dental infection, just not for otitis media. There is not a list of drugs dentists cannot prescribe. They cannot prescribe Lidex cream for poison ivy, but they can for Lichen plantis. They can prescribe oral steroids post surgical extraction not for joint inflammation.

You made a declarative statement that you cannot prove.

Why don't you Google laser treatment of Cold Sores and look at all the dentists nationwide that you laser to treat cold sores. They can laser them away, but not give drugs?

I do have a hard time when people don't read what I write or try to obfuscate the situation at hand.
 
How does one contract herpes of the eye? Never mind, don't want to know!


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Oral sex is a thing. And once you've got herpes in the mouth, it's pretty easy to spread it to other areas. Plus there's getting good 'ol fashioned oral herpes in your eye. Have oral herpes, sneeze in your hand, later wipe your eye without thinking about it before you can wash it and there you go, you've potentially inoculated yourself. It's not like it takes some freaky eye sex to happen, and it's kind of a big deal- ocular herpes is the leading cause of corneal blindness in the industrialized world.
 
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Oral sex is a thing. And once you've got herpes in the mouth, it's pretty easy to spread it to other areas. Plus there's getting good 'ol fashioned oral herpes in your eye. Have oral herpes, sneeze in your hand, later wipe your eye without thinking about it before you can wash it and there you go, you've potentially inoculated yourself. It's not like it takes some freaky eye sex to happen, and it's kind of a big deal- ocular herpes is the leading cause of corneal blindness in the industrialized world.

Aerosolization of the virus is also very, very possible with the powered tools that dentists use
 
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Aerosolization of the virus is also very, very possible with the powered tools that dentists use
Dentists have it incredibly bad. Their constant exposure to HSV-1 and oral fluids leaves them incredibly prone to herpetic whitlow, freakin' hand herpes.
 
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First of all cold sores can be on the lips or inside the mouth. So , no. you are NOT correct. The dentists treats all of these.
Second, your argument is a straw man. It's a classic straw man. It's legal for a PCP to prescribe Valtrex in patients with decreased renal function. It's just not wise. The same for a dentist. It's legal, just not wise.
Finally, I read the exact citations and your entire argument is the lips are not part of the mouth. That's amazing.
The question at hand is this plain and simple. Is a dentists legally allowed to prescribe an oral anti-viral, in this case Valtrex to treat Herpes Simplex of the mouth? The drug itself is irrelevant. A dentists can prescribe Amoxicillin for a dental infection, just not for otitis media. There is not a list of drugs dentists cannot prescribe. They cannot prescribe Lidex cream for poison ivy, but they can for Lichen plantis. They can prescribe oral steroids post surgical extractin not for joint inflammation.
You made a declarative statement that you cannot prove.
Why don't you Google laser treatment of Cold Sores and look at all the dentists nationwide that you laser to treat cold sores. They can laser them away, but not give drugs?
I do have a hard time when people don't read what I write or try to obfuscate the situation at hand.

I literally did not. Please re-read the post where I originally called out your poor logic.

Sorry, but you're being silly and presenting it as a position of authority.
You're demanding the text of the law that delineates whether or not a specific medication can be prescribed by a specialty, when such a thing doesn't exist for any medication or profession outside of Optometry.

You're whining that I'm not participating correctly in a debate that only you brought up, and that only you are interested in.

Furthermore, the original post I made, and the intent of the thread was whether or not it's in the scope of practice.
There are no black and white statements.

You dragged me into a "debate" trying to force me to provide an answer to a binary argument when that's never what my post set out to do.
Please re-read the posts I've made in the thread.
I attempted to answer the question you created, and now here we are.

You can get all worked up and demand that I post sections of the law, but that's because you're being intellectually lazy.
You know for a fact that they don't exist, and that determining scope of practice is, of course, never a black and white issue.


It's also perfectly legal for a dentist to sedate someone for in office procedures, but one only has to look at the disciplinary notices for the Dental boards to realize what a stupid idea it is.
Sure it's legal. Would I ever allow a dentist to sedate a family member? Absolutely not.
It may very well be legal for a dentist to write "Valtrex" on a prescription pad.
If they wrote it as a sidenote in a routine 6 month cleaning, you bet your booty I'm calling them and telling them it's not appropriate.

I'll put this in bold so you understand it.

Your logic is poor regarding "if it's legal, it's OK to fill." Even though something may be legal, or even a legal gray area, you have a duty to scrutinize unusual prescriptions as a pharmacist.
You can perform logical gymnastics to say that a viral infection unrelated to the teeth, jaws, or interior of the mouth is a dental problem, but the fact remains that there are complications, risks, and potential problems that a dentist will not understand or check for.

Throwing your hands up and saying "lol it's legal whatever" is no excuse.
 
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