37
Volume3 Issue1
|
S
upporting
Y
our
P
ractice
OutpatientMedication:
Use and Implications
forContemporaryDental Practice
The following is based on a research article originally published
in the “AppliedResearch” section of
jcda.ca
—CDA’s online,
open access scholarly publication that features articles indexed in
Medline, Journal CitationReports and ScienceCitation Index.
Data from theCanadian Institute forHealth Information (CIHI) shows that 62%of Canadians
age65andolder areusing5ormoreclassesof prescriptiondrugs.
3
Age-relatedphysiological
changes, agreater degreeof frailty, a largernumber of coexistingandcomorbidconditions
andpolypharmacyhaveall beenassociatedwith increased riskof adverseevents.
4,5
Knowledge
of apatient’smedicationuse is thereforecrucial tomap theirmedical historyandmay
have implicationson thedeliveryof dental care. Inaddition, oral complicationsof systemic
medicationshave repercussions inoral care, andpotential interactionsbetween these
medicationsandmedicationsused indentistry shouldbe recognized.
Toget abetter pictureof thecurrent situationand to review theoral implicationsof commonly
usedmedications, a research team recordedmedicationuse inpatients referred toa largeprivate
periodontal practice inOttawa.
A total of 322patients enrolled in the study; 164were femaleand158male. Theirmedian
agewas 52years (range6–94years).Medicationuse, self-reported inhealthhistory forms
onadmission,was confirmed throughpatient interviews. Thehigher proportionof older
patientsmakesperiodontal practices agood setting inwhich toexaminemedicationuse in
ademographicgroup that typically takesmanymedications. In this study, 63.7%of patients
reported takingat least 1medication. The total number ofmedications taken ranged from
0 to14per patient.
Antihypertensivemedication
Anumber of factors canalter control of bloodpressure, and treatingpatientswith
uncontrolledhypertensionmaybeassociatedwith serious risks. For patientson
antihypertenisvemedication (35.4%of the studypopulation),measuring their bloodpressure
beforeandafter procedures canbothminimize the risk (e.g., detectingacutehypertensive
or hypotensivecrises) andprovidevaluable feedbackon thehypertensive therapy for the
patient and their clinician. Duringdental appointments, bloodpressure shouldbemonitored
and recorded, and local anesthetics containingavasoconstrictor shouldbedelivered
cautiously followingcareful aspiration.
13
If hypertension isnot controlled, dental treatment
shouldbedelayedandmedical attention sought.
14
Antihypertensives arecommoncausesof xerostomiaand somedrugclasses, suchas the
angiotensinconvertingenzyme (ACE) inhibitors, are known tocauseoral complications
includingburningmouthandmucosal reactions, suchas lichenoiddrugeruptions.
16
Nonselectivebeta-blockers (e.g., propranolol, nadolol) enhance thepressor response to
epinephrine, resulting inhypertensionandbradycardia. Also, cliniciansmust exercisecaution
whenprescribingnon-steroidal anti-inflammatories (NSAIDs) to thoseonACE inhibitorsor
beta-blockers asNSAIDs reduce theexcretionof antihypertensives, that can result in in-
creased serumconcentrations and increasedbloodpressurebyanaverageof 5mmHg.
17
ResearchSummary
JacobFitzgerald
JoelB.Epstein
DMD,MSD,FRCD(C),FDS,RCSE
MarkDonaldson
BSP,PHARMD,FASHP,FACHE
GordonSchwartz
DDS,DipPerio,PhD
CameronJones
DDS,DipPerio
KarenFung
DMD,MPH,DipPerio,FRCD(C)
Completearticleand
references availableat
MoreOnline
