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Volume3 Issue1
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upporting
Y
our
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ractice
ThusNSAIDsmust beusedwithcaution, andbloodpres-
sure shouldbecloselymonitoredduring treatment. Finally,
calciumchannel blockers, inconjunctionwithpoor oral
hygiene, causedrug-inducedgingival enlargement inabout
20%of thepopulation taking thesemedications.
18
Evidence
demonstrates a strongassociationbetweenperiodontitis
andathlerosclerosis,
15
thus theremaybemorepatientson
antihypertensivemedication inaperiodontal practice.
Dietary supplements and vitamins
Dietary supplementswere the secondmost common
medications takenby studypatients (21.7%),whilevitamins
were fourth (12.1%). Ingeneral,medications commonly
prescribedbydental professionals canbegivenwithout
regard to interactionswithdietary supplements, although
patients takingginkgobiloba, St. John’swort, evening
primroseor valerian shouldconsultwith their primary
careprovider before taking these supplementswith
other prescribedmedications.
19
Dental professionals can
consult clinical databases suchas theNaturalMedicines
ComprehensiveDatabase
9
tohelpunderstand supplement-
drug interactions. This tool andothers like it arehelpful in
classifying interactions according to the level of risk they
pose to thepatient.
20-23
Antithromboticmedication (blood thinners)
Anticoagulants (2.2%) andantiplatelet agents (10.2%) have
obvious implications for dental care. Inaddition towarfarin,
3newer anticoagulants arenowcommonlyavailable
(dabigatran, rivaroxabanandapixaban), and, inaddition to
aspirin, anumber of newer antiplatelet agents (clopidogrel,
ticlopidine, prasugrel, ticagrelor andvorapaxar) arealso
available. The timingof thesemedicationswith respect
todental surgery is important as treatment schedules
mayhave tobemodified to reduce the riskof prolonged
bleeding following surgery.
24-26
Stopping someof these
medicationsbefore treatment couldput patients at riskof
a thromboembolicevent. Consultationwith the treating
physician isoftenneededbecauseof thepropensityof
thesedrugs for interactionswithother drugs, diet and
supplements, and thecritical natureof coagulation.
Centrally acting and psychiatricmedication
Thesemedicationswereusedby9.9% in thepopulation
studied. Oral complications resulting from these therapies
commonly include xerostomia,with riskof oral anddental
complicationsof hyposalivationand increasedor altered
muscle function.
27,28
Selective serotonin reuptake inhibitors
(SSRIs), suchas fluoxetineandparoxetine, havebeen
associatedwith increasedbruxismand riskof dental attri-
tionand temporomandibular disorders,
29,30
whereas tricyclic
antidepressants (TCAs) have significant anticholinergic
effects in somepatients, includinghypertension, increased
intraocular pressureand xerostomia.
31,32
Interactionsmay
occurwithmedications commonlyused indentistry.
For example, levonordefrinhas a significantlyhigher riskof
causinghypertensionamongpatientsonTCAs. As such,
anesthetics containing this vasoconstrictor (e.g.,mepivicaine
3%with1:20000 levonordefrin) shouldbeavoided. Also,
patients takingSSRIs shouldavoid takingNSAIDs as there is
an increased riskof gastrointestinal bleedingwith long-term
useover 4days.
8,33
Diabetesmedication
Patientsonmedications for diabetes comprised9.0%of
thepatients surveyed. Therearemanywell-established
associationsbetweendiabetes, periodontal disease
andwoundhealing
34
; thusdental professionalsmust
know thepatient’shistoryandglycemiccontrol. Peo-
plewithdiabetes areat increased riskof periodontitis,
peri-implantitis, xerostomia, secondary fungal infections
and tastechanges.
35-37
Inaddition, glycemiccontrol can
becompromised followingdental treatment if oral pain
is experiencedandoral intake is compromised. Those
withuncontrolleddiabetesmaybeat greater riskof oral
complications; healingof surgicalwoundsmaybedelayed
inpoorlycontrolleddiabetics and theneed for perioperative
antibioticprophylaxismaybeconsidered.
38,39
Hypolipidemic (cholesterol)medication
Hypolipidemicmedicationwas takenby7.5%of patients,
with statinsbeing themost prevalent prescription. Although
this isnot typicallyacause for concern indental treatment,
itmaybeassociatedwithanumber of drug interactions,
includingwithdrugs commonlyprescribed indentistry
(clarithromycin, andazoleantifungals suchas fluconazole).
8
Analgesics
Analgesicswereusedby7.5%of thepopulation studied; half
were takingNSAIDs, and theotherhalf opioidanalgesics.
Patientsmaybe takingNSAIDschronically for various reasons,
and fewcausedental concerns.Notably, concerns include the
patient’sability toachieveadequatepostoperativehemostasis,
as thesemedications inhibitplatelet aggregationandprolong
bleeding time in somepatients.
40
NSAIDs andacetaminophenare thedrugsof choice in
managingpostoperativedental pain that is secondary
to inflammation. Opioids arenot considered thedrugs
of choice for this indication.
41,42
Onlyafter thedoseof the
NSAIDor acetaminophenhasbeenoptimized shouldopioid
medicationbeprescribed for the shortest timepossible
postoperatively (3daysor less).
According to theUnitedStates FoodandDrug
Administration (FDA), NSAIDs can interferewith the
antiplatelet effect of low-doseaspirin (81mg/day), potentially
rendering it less effectivewhenused for cardioprotection
and strokeprotection.
40
Should thesedrugsbeused
concomitantly, theFDA recommends that ibuprofenbe
takenat least 30minutes after aspirin ingestionormore
