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than8hoursbeforeaspirin ingestion, toavoidattenuation
of aspirin’s effect.Withoccasional useof ibuprofen, the risk
of anyattenuationof theantiplatelet effect aspirin is likely
tobeminimal, becauseof a long-lastingeffect of aspirinon
platelets.
43,44
Patients takingopioidsmayhave increaseddry
mouthas a sideeffect, and sedativeagents shouldbeused
withcautionor avoidedbecauseof potential synergistic
central nervous systemdepression that canbecausedby
this combination.
8
Thyroidmedication
Thyroidmedicationwas takenby6.2%patients. Hypothyroid
agents, suchas levothyroxine, affect thebasalmetabolic rate
andcanhavean impact on systemic status, includingblood
pressure, energyandmood.
Bisphosphonates
Anumber of patients (5.3%) in the studywere taking
bisphosphonates, primarily for osteoporosis,which should
beconsidered in thecontext of thepotential impact of
thesedrugsonwoundhealing. Although this risk is low
comparedwith thehigh riskof osteonecrosis associatedwith
intraveinousbisphosphonateadministration inoncology,
oral useaffects surgicalmanagement.
45-58
Dose, routeof
deliveryanddurationof bisphosphonate therapy shouldbe
addressed in thehistory. Newagents, osteolytic inhibitors,
arenowavailableanddosesused inoncology require the
sameconsiderations asbisphosphonates.
49
Respiratory andallergymedications
Respiratoryandallergymedicationshave implications for
dental care, inparticular if general anesthesia is considered.
Thesemedications shouldalert dentists topatientswhomay
haveaconstrictedairwayor inwhom intubationmaybea
challenge. Furthermore, theyareoftenassociatedwithdry
mouth, and their usemay impact oral anddental status
secondary tochronic, drug-inducedhyposalivationor
xerostomia. In this study5.0%were takingmedications for
chronicobstructivepulmonarydiseaseor asthma. Because
asthmaattacks canbebrought onby stressful situations
or exposure to inhaledaerosols, thesepatients shouldbe
encouraged tohave theirmedicationsonhandat all times.
Chemotherapy, immunosuppressants,
corticosteroids
Patientsonchemotherapy (2.2%), immunosuppressants
(1.6%) or corticosteroids (0.9%)mayhavedelayedor
poor postoperativehealingandmaybeat increased
riskof surgical infectionsor secondary fungal infections.
Perioperativeantibioticprophylaxismaybewarranted in
somecases and shouldbeplannedwithmedical or oral
medicineconsultation.
51
Hormonal therapy
Theuseof hormone replacement therapy (4.4%) or oral
contraceptives (2.2%) is known tohave implications for blood
clot formationandwoundhealing following surgical dental
care.
52,53
Inaddition, antibiotic interactionsmay reduce the
effectivenessof oral contraceptives, andpatients shouldbe
informedof this risk. Fromaperiodontal standpoint, patients
onoral contraceptiveshavean increased riskof plaque-
inducedgingival diseases, as theyexperienceaheightened
inflammatory response toplaquebiofilm.
54
Adverse reactions andallergies
Allergy riskwas alsoevaluatedasdentistsprescribe
medicationswith thepotential tocauseallergicand
anaphylactic reactions. Allergies toantibioticswere themost
commonly reportedallergies (18.9%). Penicillinproduced the
highest prevalenceof allergies (10.9%),with sulfamedications
second (5.3%).
Thenatureof the reactionmust be investigatedasmany
patients confuseallergic reactionswith intolerances. For
example,most gastrointestinal symptoms are sideeffectsof
medications rather thanallergic reactions. This is important
informationaspatientswhoareallergic toamedication
shouldavoidexposureandclinicians shouldavoidprescrib-
ing them suchdrugs.
Conclusion
Given theprevalenceof theuseof bothprescriptionand
OTCdrugs, accurate recordingof apatient’smedication
profile isnecessary toguidecontemporarydental practice
andmitigatepotential risk.Medicationuseandmedication
allergiesprovide informationabout apatient’smedical
historyanddiagnoses thatmayaffect theoral conditionand
deliveryof dental care. Additional concerns includepotential
interactionsbetween frequentlyusedmedications reported
bypatients andmedications that arecommonlyused in
dentistry,with the result thatmedicationusebypatients can
impact care incontemporarydental practice. Closeconsider-
ationof these issues is required toprovide thebest careand
optimal patient safety.
a
