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| With increasing life expectancy, polypharmacy is common in older adults, especially those over 65. Many take multiple medications, such as anti-hypertensives, anti-coagulants, and anti-depressants, which can cause dry mouth and severely impact oral health. |
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| The Scale of the Problem |
| Polypharmacy has increased significantly, with many anti-drugs reducing saliva production. Dry mouth (xerostomia) weakens saliva’s protective role, increasing the risk of caries, especially with sugary drinks and poor plaque control, leaving teeth vulnerable to decay. |
| The Role of Dentists in Addressing Medication-Induced Oral Health Risks |
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| Comprehensive Medication Review: |
| Dentists should carefully review patients' medical histories, particularly those on multiple medications. Asking about dry mouth and checking for signs of caries or deterioration around existing restorations is crucial. Regular monitoring can help identify problems early, enabling proactive interventions. |
| Educating Patients About Medication Risks: |
| Dentists should have open discussions with patients about the risks associated with medications and advising patients to avoid sugary drinks. |
| Aggressive Prevention Strategies: |
| To combat the effects of dry mouth, dentists should encourage aggressive oral hygiene practices. Using smartphone technology, dentists can create personalized records to track patients’ oral health and progress with daily cleaning routines. Providing video instructions on the proper use of interdental brushes and single-tufted brushes ensures that patients (and their carers) follow a consistent and effective oral care regimen. |
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| Proactive Remineralization Approaches: |
| Customized mouthguards that hold fluoride toothpaste in reservoirs can be an effective tool. The mouthguards should be made to fit the patient's teeth precisely, with reservoirs placed in the most vulnerable areas (e.g., cervical areas). Patients should be instructed to wear these mouthguards for 1-2 hours, twice a week, or more frequently if they are at high risk. |
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| Alternative Remineralizing Agents |
| For patients who are concerned about fluoride or who experience sensitivity, dentists can consider alternative remineralizing agents such as casein phosphopeptides or amorphous calcium phosphate. |
| Ethical Considerations and Patient Autonomy |
| It's essential for dentists to respect patient autonomy, ensuring that patients are fully informed about the risks and benefits of their prescribed medications. The BRAN (Benefits, Risks, Alternatives, and Need) framework can be a helpful tool for guiding these discussions. Informed consent requires that patients understand the dental risks of anti-drugs and know what steps they can take to mitigate these risks. |
| Conclusion |
| As polypharmacy increases, dental professionals must proactively address oral health challenges caused by anti-drugs. Through thorough medication reviews, patient education, and effective prevention and remineralization strategies, dentists can protect older patients' dental health. |
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| GGI-CO-A1-AQS-300032384-ELC-L24-0923 |
| Reference: |
| Kelleher MG, Ruparelia R, Blum IR. Doctors’ Drugs and the Dangers of Dental Decay. Primary Dental Journal. 2023;12(1):63-71. doi:10.1177/20501684231156958 |
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