Oral Herpes, Within a Dentist's scope?

[Old Timer]

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.

I officially retire. Your lack of understanding of law, logic and argument is as mind bending as week of LSD. Scope of practice is a legal issue. Plain and simple. It is either legal or its not legal. It is clearly legal. I said so, a dentist also said so and the fact that dentists all over the country are treating this disease state with laser treatments make it clearly within their scope of practice. If you chose not to fill it, that is your professional prerogative. I would think you a fool. What the State Board would do, I could care less. You don't even know how to read the original post.

Had an Rx for acyclovir for herpes (cold sores) from a dentist tonight. Do you think this is within his scope? Personally, I think it's boarderline

The answer to the OP is
YES
​

The rest of the discussion is drivel.
Old person with CKD - Straw Man
Ocular Herpes - Straw Man

He is legally allowed to prescribe it. You are legally allowed to refuse to fill it.

If think he is not within the scope of his practice prove if not, shut up.

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[Old Timer]

This isn't what a dentist could treat or know how, this is what a dentist is legally able to treat. I could treat host of disease states but I'm not legally able too. They deal with the oral cavity, legally does this include the dermal tissue around the mouth? It's not in the oral cavity. Where does this line stop? Can they treat acne around the mouth since it's the same physical area as herpes?

It's worth debating because it's your license on the line. What would happen if they treated it and for some reason the pt died due to the dentists' action (misdiagnosis of something more serious as herpes, drug contraindication, etc). The pharmacist is likely to come under serious fire for filling the RX, especially if it's seen as outside the dentist's scope.

Clearly within the scope of practice. The only argument is the lips are not part of the mouth. Make if you want. Just Google Laser Treatment of Cole Sores and you will see the hundreds if not thousands of dentists who not only treat it but advertise this option on their websites.
Technically if the cold sore is on the face and not the lips or mouth it would be out of the scope of practice.....

 

[waiter]

Yes.

 

[CetiAlphaFive]

I officially retire. Your lack of understanding of law, logic and argument is as mind bending as week of LSD. Scope of practice is a legal issue. Plain and simple. It is either legal or its not legal. It is clearly legal. I said so, a dentist also said so and the fact that dentists all over the country are treating this disease state with laser treatments make it clearly within their scope of practice. If you chose not to fill it, that is your professional prerogative. I would think you a fool. What the State Board would do, I could care less. You don't even know how to read the original post.

The answer to the OP is
YES​

The rest of the discussion is drivel.
Old person with CKD - Straw Man
Ocular Herpes - Straw Man
He is legally allowed to prescribe it. You are legally allowed to refuse to fill it.
If think he is not within the scope of his practice prove if not, shut up.

Lifetime CVS Lick 'N Stick RPh who are too busy/ don't care enough to challenge bad prescribing are the reason that dentists elbow their way into stuff they have no business doing.

"It's legal, therefore it must be OK"

Agree to disagree, and I hope your patients don't get resistant to good meds because some people refuse to be an actual pharmacist.

 

[Old Timer]

Lifetime CVS Lick 'N Stick RPh who are too busy/ don't care enough to challenge bad prescribing are the reason that dentists elbow their way into stuff they have no business doing.

"It's legal, therefore it must be OK"

Agree to disagree, and I hope your patients don't get resistant to good meds because some people refuse to be an actual pharmacist.

You have no idea of my history. I question people all of the time. I'm just not the kind of pharmacist who invent things out of whole cloth with no legal basis. Just make ****e up because they feel like it. Some imaginary BS based on more imaginary BS.

 

[BidingMyTime]

I can't believe people are arguing 7 years later concerning whether a dentist can prescribe acyclovir. The answer is clearly yes, the dentist can prescribe acyclovir. Throwing in red herrings about dentists who don't know how to dose clindamycin, or dentists who don't know how to dose drugs for CRCL is irrelevant. I'm sure one could find MD's/DO's who don't, and that is why pharmacists are supposed to be doing their job and looking at more of the prescription, than just the quantity. Dentists can diagnose and treat oral herpes, and if there is an issue with dosing, than the pharmacist should call them, just as they would if there was issue with dosing on a prescription that a MD/DO prescribed.

 

[ABCPharmD]

I had a dentist call in sumatriptan today and thought about this thread. And no I didn't fill it.

 

[zelman]

I had a dentist call in sumatriptan today and thought about this thread. And no I didn't fill it.

Maybe for trigeminal neuralgia?

 

[theleatherwalle]

My Wife is a pharmacist and I am a dentist. I do not know about scope of practice in every state: I am sure some differ.

Would I write for anti virals?-NO. General rule of thumb I follow is not to write for something that requires long term care. I am not their PCP, and I am not keeping up with it.

Would my wife fill the medication?-Yes. She claims that she would be fine to fill it until they went to their PCP who could then manage the condition. She claims if she had time she would call the doc afterwards to see why this is a chronic issue.

I don't have hand herpes.

 

[npage148]

Well. All this walking the line has snowballed and I had to tell an out of state dentist (from Florida no less) that a valid DEA license did not entitle him to prescribe adderall to a 10 year old for the mgmt of adhd. Despite his protest that he can write for "whatever he feels like" I declined to fill it. I'm pretty sure he as drilling a patient while yelling at me based on the background noise. He may have also tried to argue that the md in dmd made it somehow acceptable

 

[Old Timer]

I am a dentist. Would I write for anti virals?-NO. General rule of thumb I follow is not to write for something that requires long term care. I am not their PCP, and I am not keeping up with it.

That is not the question. The question is are you legally allowed to treat oral Herpes Simplex?

 

[ABCPharmD]

Maybe for trigeminal neuralgia?

No the sig was "no more than 2 tabs in 24 hours prn migraine"

 

[theleatherwalle]

Sorry for not answering your question, but I decided to look it up since I haven't really haven't encountered this problem. I can prescribe anything under the sun for treatment of teeth, gums, and mouth. Are your lips part of your mouth? I would argue that yes they are, but I again stress my point that I do not think DMD should manage herpes long term.

For the poster above, I am sorry for your experiences with that dentist. I'll admit they're several people who I graduated with who will always introduce themselves as doctor whoever. Maybe Adderal for a combative patient, but give them xanax and go about your day.

 

[Seriously Serious]

Oral herpes
Oral herpe
Oral herp
Oral her
Oral he
Oral h
Oral

hmm...

 

[sosoo]

people on this forum are ok refusing sales of this type of scripts, but they're spitting garbage when i turn away drug abusers and large quantity of opioids? LoL. what's next? you're gonna refuse sales for finasteride because these men wanted it for boob enlargement? ^_^

 

[CetiAlphaFive]

Sorry for not answering your question, but I decided to look it up since I haven't really haven't encountered this problem. I can prescribe anything under the sun for treatment of teeth, gums, and mouth. Are your lips part of your mouth? I would argue that yes they are, but I again stress my point that I do not think DMD should manage herpes long term.
For the poster above, I am sorry for your experiences with that dentist. I'll admit they're several people who I graduated with who will always introduce themselves as doctor whoever. Maybe Adderal for a combative patient, but give them xanax and go about your day.

Precisely, and there is no such thing as short term management.

Old Timer is relying on poor logic. He is either totally ignorant of the law that leaves the "is it legal" question up to professional judgement or he's being intentionally obtuse by asking us to cite a law that was left intentionally vague.

 

[TanMan]

I'll chime in as a dentist. Yes, I prescribe acyclovir when there's an acute outbreak of HSV in the oral cavity. I also give them magic mouthwash so that they can feel better in terms of eating and providing pallative care, BUT, I also refer them to their PCP for long-term management. Whether you choose to fill it or not is another story. Why would I choose to give my patients that combination?

1. We've been trained in the differential diagnosis of oral pathologies of the oral cavity, which include lips, mucosa, hard/soft palate, gums, hard tissue, etc...
2. A patient that has either recurring or initial symptoms is most likely in a good amount of pain. Why would I turn them away? I'll control the acute exacerbation/incident, let them know that they are most likely contagious and precautions to take, and coordinate for them to see their PCP or any physician if they don't have a PCP.

So... what makes pallative care illegal or unethical, especially when it is within the scope of practice, we have been trained in the diagnosis and treatment of oral pathologies, and the patient is in pain. You'll be surprised how much a physician may not know about the oral cavity but vice versa. I don't claim to know more about other parts, but only their interconnections with the oral cavity.

Also with respect to sedatives, this is state dependent and whether your state allows you to sedate a patient IV or oral, whether you have a license for it, the boundaries between anxiolytic and sedation, etc... That one is a lot more iffy, but still within the scope of practice as long as it is part of the dentist's license.

Now, with blood pressure medication. I've only had to prescribe it ONE time, for 2 tabs of clonidine (0.1mg) for a patient that came in with severe pain and swelling. Their BP was around 240/120. I called their physician, told them hey, patient is in severe pain very high BP, I suspect the pain is causing his BP to shoot up like crazy, suggested I give 2 tabs clonidine, dropped bp to a more manageable level 190/100, administered anesthetic w/o epi, bp dropped to 140/80, did the extraction, and patient was on their way. Now, I wouldn't prescribe it on my own on a routine basis but in an emergency basis, I would work with their physicians to get them out of pain and also get their BP down too. I heard nothing from the pharmacist. Now, if you see a dentist prescribing a 30 day dose, that's not within their scope of practice.

If you have doubts about a dentist's prescription, you can always call them up to see if they have a legitimate reason. Hear them out at least.

 

[CetiAlphaFive]

I'll chime in as a dentist. Yes, I prescribe acyclovir when there's an acute outbreak of HSV in the oral cavity. I also give them magic mouthwash so that they can feel better in terms of eating and providing pallative care, BUT, I also refer them to their PCP for long-term management. Whether you choose to fill it or not is another story. Why would I choose to give my patients that combination?

1. We've been trained in the differential diagnosis of oral pathologies of the oral cavity, which include lips, mucosa, hard/soft palate, gums, hard tissue, etc...
2. A patient that has either recurring or initial symptoms is most likely in a good amount of pain. Why would I turn them away? I'll control the acute exacerbation/incident, let them know that they are most likely contagious and precautions to take, and coordinate for them to see their PCP or any physician if they don't have a PCP.

So... what makes pallative care illegal or unethical, especially when it is within the scope of practice, we have been trained in the diagnosis and treatment of oral pathologies, and the patient is in pain. You'll be surprised how much a physician may not know about the oral cavity but vice versa. I don't claim to know more about other parts, but only their interconnections with the oral cavity.

Also with respect to sedatives, this is state dependent and whether your state allows you to sedate a patient IV or oral, whether you have a license for it, the boundaries between anxiolytic and sedation, etc... That one is a lot more iffy, but still within the scope of practice as long as it is part of the dentist's license.

Now, with blood pressure medication. I've only had to prescribe it ONE time, for 2 tabs of clonidine (0.1mg) for a patient that came in with severe pain and swelling. Their BP was around 240/120. I called their physician, told them hey, patient is in severe pain very high BP, I suspect the pain is causing his BP to shoot up like crazy, suggested I give 2 tabs clonidine, dropped bp to a more manageable level 190/100, administered anesthetic w/o epi, bp dropped to 140/80, did the extraction, and patient was on their way. Now, I wouldn't prescribe it on my own on a routine basis but in an emergency basis, I would work with their physicians to get them out of pain and also get their BP down too. I heard nothing from the pharmacist. Now, if you see a dentist prescribing a 30 day dose, that's not within their scope of practice.

If you have doubts about a dentist's prescription, you can always call them up to see if they have a legitimate reason. Hear them out at least.

Very interesting, thanks for posting.

So, it seems like the consensus from you and the other people saying it's ok is that the scope of practice for dentists is a fluid spectrum.

It's in the scope of practice for the 1st visit only, but refer to pcp for follow up because long term management isn't in scope of practice.


If you'll allow me to indulge in a theoretical example:
If someone called and made an appointment with you for the sole reason of a herpes outbreak on the lips would you refuse the appointment and refer them to their PCP?
What if they want you to treat the lesions on their lips and the patient refuses to open their mouth?

If so, is oral hsv only in scope of practice for a dentist if they happen to be in the dental office for a dental reason?

I'll admit that I was thinking of the issue in a far too binary way.

Obviously scope of practice is much more nuanced for dentists than I'd thought.

EDIT:

Wow, great job in bringing down the blood pressure in that patient.

Even the outpatient M.D.s in my area will send a patient to the ER once they enter a measured hypertensive urgency.

 

[gwarm01]

So, it seems like the consensus from you and the other people saying it's ok is that the scope of practice for dentists is a fluid spectrum.

I think it is a fluid spectrum. You have to take each case on its own merit. I'd hate to have a hard and fast cutoff for these things, because there may be situations that I deem appropriate based on the circumstances.

Funny thing though, I once had to call on some post-op orders for a patient that had been shot in face, bitten by a dog, something like that. The prescriber had DDS as their credentials. I called and just asked "uhm.. are you a dentist?" because it was so out of place. Turned out he was a dentist, but was also a trauma surgeon resident. He was working PRN as a dentist while he completed his residency. Apparently he got these calls all of the time because he was still marked as a dentist in the EMR.

 

[Old Timer]

Old Timer is relying on poor logic. He is either totally ignorant of the law that leaves the "is it legal" question up to professional judgement or he's being intentionally obtuse by asking us to cite a law that was left intentionally vague.

No he is relying on

• Sound Logic
• Common Sense
  
• 35 years of experience

 

[TanMan]

Very interesting, thanks for posting.

So, it seems like the consensus from you and the other people saying it's ok is that the scope of practice for dentists is a fluid spectrum.

It's in the scope of practice for the 1st visit only, but refer to pcp for follow up because long term management isn't in scope of practice.


If you'll allow me to indulge in a theoretical example:
If someone called and made an appointment with you for the sole reason of a herpes outbreak on the lips would you refuse the appointment and refer them to their PCP?
What if they want you to treat the lesions on their lips and the patient refuses to open their mouth?

If so, is oral hsv only in scope of practice for a dentist if they happen to be in the dental office for a dental reason?

I'll admit that I was thinking of the issue in a far too binary way.

Obviously scope of practice is much more nuanced for dentists than I'd thought.

EDIT:

Wow, great job in bringing down the blood pressure in that patient.

Even the outpatient M.D.s in my area will send a patient to the ER once they enter a measured hypertensive urgency.

No, I wouldn't refer them outright. I take patient's reported diagnosis over the phone with a grain of salt. My front staff will still give them an appointment for an evaluation before making any referrals. Just like I wouldn't give a patient a prescription without seeing them.

I've never had a patient refuse to open their mouth and tell me just look at the lips, unless it hurts really really bad. Even then, a patient will open their mouth if they can physically do it because they would want me to figure out what's causing their pain. I will need to, to be able to see if its spread in any other region (self-inocluation) onto lips, tongue, palate, etc... HSV will not prevent you from opening, but a TMJ issue or myofascial issues (usually from abscessed 3rd molars) will.

You're not practicing if you're not looking. Just like with any profession, you have to be seen by a practitioner (physician, dentist, podiatrist, optometrist, etc...), otherwise, you're just guessing and I believe there's some kind of malpractice with that. So yes, Oral HSV is in the scope of practice. A dentist with sufficient training can do long term management if they really wanted to, but rarely would you ever find that unless they are in an academic setting under Oral Medicine. I wouldn't want to take cultures, followups, etc... leave that to the PCP.

 

[CUninja]

Having not read most of the posts....I believe oral herpes is in the scope of practice of a dentist. It clearly affects the area they are trained in. I've rejected Chantix from dentists before as outside scope, because to me tobacco use is only incidentally related to dentistry and the dentist was not going to see the patient again to do necessary followup.

That's why they have professional judgment...YMMV.

 

[CetiAlphaFive]

Having not read most of the posts....I believe oral herpes is in the scope of practice of a dentist. It clearly affects the area they are trained in. I've rejected Chantix from dentists before as outside scope, because to me tobacco use is only incidentally related to dentistry and the dentist was not going to see the patient again to do necessary followup.

That's why they have professional judgment...YMMV.

 

[bp2313]

Hello all. I had a dentist call in a script for Vigamox for his wife (left in VM). I retrieved it when he was as the counter and I asked if he was a dentist or medical doctor (oral surgeon- idk if this the right term). He said he's a dentist and I said prescribing Vigamox doesn't fall within his normal prescribing right of a dentist. My wording might be wrong on this one but anyway, he made some objections and walked away. Later on he came back and we spoke for a few minutes. According to him, he has full prescribing privilege and has written for abx opth ointment for pt with local infection in the past. He questioned who determines what a dentist can/cannot presribe. To satisfy my own curiosity, I looked up on the Texas state board of dentistry and I couldn't find an answer so i don't know if anyone knows. I don't want to get into the whole scope of practice argument, I just want to know if there's a specific document from the state board that says "dentists can prescribe this/that" or "unlimited prescribing authority", etc. Btw he's a frequent customer and usually very nice.

 

[CetiAlphaFive]

Hello all. I had a dentist call in a script for Vigamox for his wife (left in VM). I retrieved it when he was as the counter and I asked if he was a dentist or medical doctor (oral surgeon- idk if this the right term). He said he's a dentist and I said prescribing Vigamox doesn't fall within his normal prescribing right of a dentist. My wording might be wrong on this one but anyway, he made some objections and walked away. Later on he came back and we spoke for a few minutes. According to him, he has full prescribing privilege and has written for abx opth ointment for pt with local infection in the past. He questioned who determines what a dentist can/cannot presribe. To satisfy my own curiosity, I looked up on the Texas state board of dentistry and I couldn't find an answer so i don't know if anyone knows. I don't want to get into the whole scope of practice argument, I just want to know if there's a specific document from the state board that says "dentists can prescribe this/that" or "unlimited prescribing authority", etc. Btw he's a frequent customer and usually very nice.

Well, according to the advice given in this thread, if you can't find the exact words
"Dentists can't prescribe vigamox or treat ophthalmic infections" in the text of the law, then it must be legal.
Just kidding.

You should call the state board of pharmacy and ask them what you should do.

When I called to ask about dentists overstepping their sleep apnea bounds, the board was extremely helpful and even faxed me the pertinent laws.

 

[moose10]

Took a prescription for Zyban written by a DDS today....i didn't fill it and told patient to have PCP write for it instead. What do the good pharmacists here think about this one?

 

[CetiAlphaFive]

Took a prescription for Zyban written by a DDS today....i didn't fill it and told patient to have PCP write for it instead. What do the good pharmacists here think about this one?

I think a DDS is already stirring their fallacy cauldron to come up with some wacky explanation as to how it's related to the mouth

 

[owlegrad]

I mean if smoking cessation doesn't fall under a dentist prescribing privileges I don't know what does.

Sent from my SAMSUNG-SM-G920A using SDN mobile

 

[Sine Cura]

Some dental boards do allow Chantix and the like. YMMV

 

[zelman]

I think a DDS is already stirring their fallacy cauldron to come up with some wacky explanation as to how it's related to the mouth

Where you you stick your cigarettes?

 

[CetiAlphaFive]

Where you you stick your cigarettes?

I guess I'm gonna refer all potential DM II patients to their dentists because they eat using their mouth

 

[zelman]

I guess I'm gonna refer all potential DM II patients to their dentists because they eat using their mouth

As you should

 

[allantois]

As you should

Don’t forget heart disease:
Dental Health and Heart Health: Is There a Connection?

 

[CetiAlphaFive]

As you should

What is the starting dose for Xigduo to treat a cavity?

 

[zelman]

What is the starting dose for Xigduo to treat a cavity?

You just wet it until it's mush and put a pea sized amount on your toothbrush. Did you learn nothing in therapeutics?

 

[TanMan]

Smoking cessation was taught in our curriculum as part of the preventive/oral medicine department. However, I wonder if being taught smoking cessation strategies and pharmacotherapy implies prescribing privileges or which board(s) would determine whether that is in the scope of our practice.

There are some aspects that are mouth related, that doesn't mean we're going to treat them (such as HTN or DM). We can spot the effects of conditions or medications on the oral cavity, but ultimately, those are the responsibility of their physician.

Examples where I've had to refer to physicians:
- Nifedipine induced gingival hyperplasia: severely swells up the gums, we try and get them off this medication since it tends to swell up gums, promote periodontal disease, and loosen teeth up over time. Most of the time, physicians are willing to try and use alternative HTN meds. Otherwise, my hands are tied and I'll have to manage the gum swelling surgically.
- DM: If we suspect issues with blood glucose right before we pull out teeth, I can use a blood glucose meter to check their blood sugar, refer as needed. Sometimes, we catch patients with BG>400+

I suspect that dentist that try to chronically "manage" these conditions are using it as a shortcut so they don't have to go to their physician as a matter of convenience. Even if dentistry is headed towards a medical model, our scope of practice is pretty much the oral cavity and adjoining structures. There are some instances where the lines are blurred, but for the most part, if its systemic, not my field, unless it's originating from the oral cavity itself.

 

[moose10]

So, I ended up calling both boards in my state to clarify. According to my state BOP (MD)- dentists do have prescribing authority..... Accord to dental board, smoking cessation is within the scope of dental practice, they released a clarification statement several years ago allowing this, in the manner that smoking cessation can prevent/treat oral cavity disease, so they would have no problem with dentists prescribing smoking cessation products.