CLINICAL MANAGEMENT OF DENTAL PATIENTS ON MULTIPLE DRUG THERAPY /cosmetic dentistry courses

INDIAN DENTAL ACADEMY
Leader in continuing Dental
Education
www.indiandentalacademy.com

INDIAN DENTAL ACADEMY
Leader in continuing Dental Education

- Clinical management of patients with
multiple diseases and on multiple
medications is not only complex but
involves considerable risk.
- Adverse drug reactions can occur with a
single drug or with multiple drugs.
- However the risk of ADR multiplies
with “POLYPHARMACY”

Indian Dental academy
• www.indiandentalacademy.com
• Leader continuing dental education
• Offer both online and offline dental courses

Pathology
Immunology

MAGNITUDE OF PROBLEM WITH
POLYPHARMACY
6 %
50 %
100 %

LIMITATION OF STUDYING ADR THROUGH
RESEARCH

RISK OF ADRRISK OF ADR
HEALTH
AGE

WHY DENTIST??
Therapeutic challenges to a practising dentist:
 Medical conditions necessitating polypharmacy will impact
patients oral health.
 Oral side effects occur with administration of many
medications.
 Current list of medications of the patient alters the dentist’s
prescribing pattern.

 Presence of chronic diseases may impair communication,
 cognition and ability to comply with a drug regimen.
 Limited recall ability of older patients.
 Pts may not remember the names and dosages of the
drugs being taken.
 Consumption of Over The Counter drugs.
 Use of herbal medicines.

TWO AREAS OF CONCERN FOR A
DENTIST IN SUCH A SITUATION
-The impact of medical conditions
DRUG-CONDITION-INTERACTION
--The impact of patient’s current list of
medications
DRUG-DRUG INTERACTION

DRUG CONDITION INTERACTIONS
1.Cardiovascular diseases
2. Respiratory diseases
3. Liver diseases
4. Endocrine diseases
5. Renal diseases
6. Neurogenic diseases
7. Sexually transmitted diseases
8. Blood diseases
9. Pregnancy & breast feeding

DRUG-DRUG INTERACTION

STEPS IN ASSESSMENT

ASSESSMENT OF MCP
• -
• - Health history- use reasonable prudence in taking
• medical and drug history.
• - Date of last physical examination
• - Medical condition being treated
• - Medications being used
• - Allergies and emergencies
• - Hospitalisation
“FIRST KNOW YOUR
PATIENT”

MANAGEMENT TOOLS
 Lab tests-Complete Blood Count
Platelet count
TLC, DLC
 PT/INR, BT,PTT
 LFT
 Renal profile
 FBS,PPBS,Hb1Ac
 CD4 count and viral load
 Knowledge of Analgesic, Antibiotic, Anaesthetic

Reviewing the existing
medication list
Consideration prior to
administering dental
related medication

aking
REVIEWING THE EXISTING
MEDICATION LIST
1. Could any of these drugs be required
medical emergency?
Nitroglycerine-angina
Inhalers-COPD exacerbation

2. Why is the patient taking these particular
medications? Group by category to aid
in assessing over all risk in patient care?
Anti-hypertensives
Anti-coaggulants
Immunosuppressants

3. Do any of these drugs have potential to
complicate or even create an emergency
situation?
Warfarin-excessive bleeding
Prednisone-adrenal insufficiency

4.Could any of these drugs compromise our
dental treatment outcome?
Corticosteroids –delayed healing

5. Do any of these drugs have potential oral
side effects?
Dilantin, Nifedipine-gingival enlargement
Diuretics-Xerostomia
Calcium channel blockers-lichenoid reaction

CONSIDERATIONS PRIOR TO
PRESCRIBING MEDICATIONS
1. Does the person have specific drug
allergy to the drug you intend to
prescribe?
Penicillin-skin rash

2. Is the drug contraindicated for use?
NSAIDs with history of gastrointestinal ulcers.
• 3. Is there a potential for an adverse drug
interaction with the patients existing
medication?
Erythromycin reducing warfarin clearance by 30%.

4. Where will the dental drug be metabolized
and is there any indication that the drug
elimination will be a problem for the
patient?
Elderly may have decreased elimination of
penicillin, erythromycin, cephalosporin.

5.Could any of the dental drugs continue to
an emergency situation?
Prednisone-risk of non-compliances and patient
failing to take prescribed dose resulting in
adrenal crisis.

6. Is the dose prescribed in a safe range for
the patient’s size and state of health. i.e., at
or below the maximum safe dose?
Acetaminophen prescribed should not exceed 4g
per day for adults, but hepatotoxicity has
occurred with <4g in patients with cirrhosis.

CONCLUSION

ACKNOWLEDGEMENT
Dr Renuka Ammanagi Reader
Dr Zameera A Naik Reader
All my colleagues

REFERENCES
 J Contemp Dent Practice 2005 November; (6)
4:144-151
 Dent Clin N Am 2002; 46: 857-868
 J Am Geratr Soc 1996; 44: 194-197
 Am J Clin Nutr 1990; 51: 2233
 J Gerontol A Biol Sci Med Sci 1998; 53A:
M59-M63
 J Am Dent Assoc 1999; 130(2): 236-251
 J Am Dent Assoc 1999; 130(2): 701-709

ADVERSE EFFECT OF DRUGS
DRUG CAUSING XEROSTOMIA
• One of the MC and potentially destructive oral side
effect.
• in caries and suscIncrease eptibility to oral fungal
infections.
• In elderly- easy trauma to mucosal tissues
• Alters taste, impairs speech and swallowing.
drugs are the most common cause of reduced
salivation.
Most commonly implicated drugs are-
TCA, antipsychotics, atropine and antihistamines

CLINICAL MANAGEMENT OF DENTAL PATIENTS ON MULTIPLE DRUG THERAPY /cosmetic dentistry courses

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