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Table of Contents   
CASE REPORT  
Year : 2012  |  Volume : 23  |  Issue : 3  |  Page : 434
Sublingual drug dispensing prosthesis


Department of Prosthodontics, Saveetha Dental College, Chennai, India

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Date of Submission04-Apr-2011
Date of Decision08-Aug-2011
Date of Acceptance13-Dec-2011
Date of Web Publication11-Oct-2012
 

   Abstract 

Sublingual mode of drug administration is one of the fastest and predictable methods of drug delivery to the patient. Some patients, due to the pathological or psychological reasons, experience considerable difficulty in retaining the sub-lingual tablets. Therefore, often they either swallow or chew the sublingual tablets, thus reducing the efficacy of the medicines. Sublingual drug dispensing prosthesis is a special type of appliance that helps such patients to house the sublingual tablets in special slots in an intra-oral appliance, and thus enhances proposed drug delivery and improves the patient's health.

Keywords: Drug absorption, drug metabolism, prosthesis, sublingual drugs

How to cite this article:
Ganapthy D, Ariga P, Selvaraj A. Sublingual drug dispensing prosthesis. Indian J Dent Res 2012;23:434

How to cite this URL:
Ganapthy D, Ariga P, Selvaraj A. Sublingual drug dispensing prosthesis. Indian J Dent Res [serial online] 2012 [cited 2020 Jul 8];23:434. Available from: http://www.ijdr.in/text.asp?2012/23/3/434/102254
Disease has inflicted severe suffering upon mankind since its evolution. Humans have fought against diseases through every possible avenue and major therapeutic modalities in treating those diseases are through administration of the medicines and by surgery. Medicinal drugs have played very significant roles in combating diseases. The modes of drug administration can be manifold viz, oral, nasal, dermal, intramuscular, rectal, ocular, intravenous, spinal, and sublingual. Amongst these techniques, sublingual [1] administration is one of a very powerful method of drug delivery.


   Case Report Top


A male patient aged 45, reported to the Department of Prosthodontics, Saveetha Dental College, Chennai, from the Department of Internal Medicine with a primary complaint of difficulty in retaining the sublingual drugs, which were prescribed to him to treat an angina and hypertension. History revealed that the patient had chest pain 3 months back and was diagnosed with angina pectoris with hypertension and was advised Isosorbide-di-nitrate and Nifidepine 5 mg sublingually twice daily, respectively.

Patient experienced an inconvenience in retaining the tablets under the tongue and either chewed or swallowed the tablet. To help the patient retain the sublingual tablets, a sublingual drug dispensing prosthesis was suggested, the concerned procedure explained and an informed consent was obtained from the patient for the same.

Clinical Steps

  • After suitable mouth preparation, a mandibular stock tray was selected and an impression made with putty type additional silicone elastomer (AQUASIL, DENTSPLY, GERMANY). [Figure 1]
  • Figure 1: Mandibular stock tray with impression material in the patients mouth

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  • With the stock tray in place in the patient's mouth, additional material was added on to the lingual sulcular area and the floor of the mouth in an anterior lingual region, followed by functional border molding through tongue movements and repeated swallowing.
  • After the border molding of the sublingual tissues and the floor of the mouth in an anterior lingual region is complete, impression was removed [Figure 2], beading and boxing done [Figure 3] and cast poured with type IV dental stone [Figure 4] (ULTRA ROCK, Kalabhai Karson India Pvt. Ltd.)
  • Figure 2: Completed mandibular impression with anterior lingual border molding

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    Figure 3: Beading and boxing the impression

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    Figure 4: Master cast

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  • The cast was retrieved, trimmed and examined for an appropriate sub lingual anatomical location for placement and dispensing the drugs and the sublingual zone 3 mm distal to the central sub-lingual frenum on either side were identified.
  • The sample drug tablets were selected, coated with die spacer and fixed in an identified anatomical position [Figure 5].
  • Figure 5: Tablets placed on the selected sublingual anatomical site

    Click here to view
  • The cast was surveyed, undercuts blocked out, and a lingual plate resin major connector was designed and fabricated using clear auto polymerizing resin (DENTAL PRODUCTS OF INDIA, MUMBAI) using sprinkle-on technique. Then, the fabricated resin lingual plate major connector was retrieved from the cast which was trimmed, finished and polished; and the two slots in the tissue side of the prosthesis, housing the sample drug tablets were identified [Figure 6]. The tablets were carefully peeled to expose the receptacle for the chamber housing the drugs.
  • Figure 6: Lingual plate resin major connector with tablets in the slots

    Click here to view
  • The drugs prescribed to the patient, were fitted into the receptacle slots on the tissue side of the prosthesis [Figure 7] and tried in the patient's mouth [Figure 8] and post insertion instructions were given.
  • Figure 7: Tablets in the sub lingual slots of the prosthesis

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    Figure 8: Prosthesis try in

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  • Patient was requested to wear the prosthesis for half an hour and patient expressed comfort, ease and no difficulty in retaining the sub lingual drugs.



   Discussion Top


Sublingual route of drug administration is one of the most effective methods of drug delivery in patients. The advantages include the protection of drugs from enzymatic gastro-intestinal degradation and by passing the first pass metabolism in the liver. [2] The connective tissue beneath the sub lingual epithelium is profusely supplied by capillaries, hence facilitating direct diffusion of drugs into the blood stream, thus ensuring the fast onset of action. Several drugs for angina pectoris like Isosorbide dinitrate, Anti-hypertensives, [3],[4],[5] anti-depressants, vitamins can be administered sublingually [5],[6],[7] with highly predictable rapid clinical onset and efficacy. [8] Some patients may experience considerable difficulty in retaining the sub lingual tablets in the oral cavity, due to various pathologic reasons like  Parkinsonism More Details, myofacial dyskinesia, neuro-muscular disorders, stroke, psychological and psychiatric disorders. In such cases, sublingual drug dispensing prosthesis can greatly help the patients, because it retains the tablet in the chamber and thereby protects them from the displacing action of the tongue. It also ensures uniform and predictable delivery of the drugs and provides desired therapeutic benefits to the patients.


   Conclusion Top


The sublingual drug dispensing prosthesis greatly aids in successful and predictable release of sublingual medications in patients experiencing difficulty in retaining the sublingual tablets in the oral cavity and can be indicated to deliver faster and desired therapeutic doses in suitable clinical situations warranting their indication.

 
   References Top

1.Goswami T, Jasti B, Li X. Sublingual drug delivery. Crit Rev Ther Drug Carrier Syst 2008;25:449-84.  Back to cited text no. 1
[PUBMED]    
2.De Boer AG, De Leede LG, Breimer DD. Drug Absorption By Sublingual And Rectal Routes. Br J Anaesth 1984;56:69-82.  Back to cited text no. 2
[PUBMED]    
3.Harris D, Robinson JR. Drug delivery via the mucous membranes of the oral cavity. J Pharm Sci 1992;81:1-10.  Back to cited text no. 3
[PUBMED]    
4.Motwani JG, Lipworth BJ. Clinical pharmacokinetics of drug administered buccally and sublingually. Clin Pharmacokinet 1991;21:83-94.  Back to cited text no. 4
[PUBMED]    
5.Cummings DM, Amadio P Jr, Nelson L, Fitzgerald JM. The role of calcium channel blockers in the treatment of essential hypertension. Arch Intern Med 1991;151:250-9.  Back to cited text no. 5
[PUBMED]    
6.Angeli P, Chiesa M, Caregaro L, Merkel C, Sacerdoti D, Rondana M, et al. Comparison of sublingual captopril and nifedipine in immediate treatment of hypertensive emergencies: A randomized, single-blind clinical trial Angelo Archives of Internal Medicine. Arch Intern Med 1991;151:678-82.  Back to cited text no. 6
[PUBMED]    
7.Schoenberger JA, Testa M, Ross AD, Brennan WK, Bannon JA. Efficacy, safety, and quality-of-life assessment of captopril antihypertensive therapy in clinical practice. Arch Intern Med 1990;150:301.  Back to cited text no. 7
[PUBMED]    
8.Bunn WH Jr, Chremos AN. Clinical Evaluation of Sublingual Nitrates:Onset and Duration of Action of Nitroglycerin and Isosorbide Dinitrate. Angiology 1963;14:48-54.  Back to cited text no. 8
[PUBMED]    

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Correspondence Address:
Dhanraj Ganapthy
Department of Prosthodontics, Saveetha Dental College, Chennai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.102254

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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    Abstract
   Case Report
   Discussion
   Conclusion
    References
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