Due to the achievements of modern health care, a significant increase in life expectancy can be observed. By 2050, 21.1% of the world population will be aged 60 years and older.
As a consequence of this development, a growing proportion of people with multimorbidity is attending dental offices as well as clinical units. Multi morbidity has been commonly defined as the co-occurrence of multiple diseases, often with a cut-off of two or more chronic medical conditions in one person.
Polypharmacy-related issues include adverse drug effects, drug-drug interactions, drug-disease interactions, reduced health-related quality of life, disability and hospitalizations, decreased treatment efficacy and lower overall survival for some cancers, and reduced medication compliance. Polypharmacy is a risk factor for poor compliance in the elderly but also in adolescents and young adults.
While beyond the scope of this article, other medication-induced intraoral adverse effects, depending on the medication, include soft tissue conditions such as lichenoid reactions (e.g., NSAIDs, antihypertensives, anticonvulsants, immunomodulatory drugs), aphthous ulcers and erythema multiforme (e.g., certain biologics), as well as osteonecrosis, and opportunistic infections.
Polypharmacy was found to increase the likelihood of xerostomia by 38% for individuals taking between 4 and 6 medications, and doubled and more than tripled the likelihood, respectively, for individuals taking 7 to 10 or eleven or more medications.
The functions of saliva include dental hard tissue protection through salivary clearance and dilution, buffering capacity, as a source of calcium, phosphate, mucins, proteins, and fluoride (if ingested). As such, medication-induced dry mouth results in an elevated risk for dental caries, as well as dental erosion
In the presence of dry mouth, oral mucosa protection afforded through lubrication, salivary clearance and dilution, prevention of adhesion of microorganisms and antimicrobial agents present in saliva decreases. Bolus formation when eating, a reduced supply of zinc and gustin that are involved in taste sensation, and salivary enzymes that start the digestive process, can impact nutrition, and lubrication for eating, speaking and smiling are similarly reduced.
Decreased salivary flow and quality also places patients at risk for oral fungal infections, fissured tongue, burning mouth and mucositis.29 Furthermore, in one study of older adults, after adjusting for confounders dry mouth was a significant factor in the risk for physical frailty.
The identification and care of patients with polypharmacy-induced dry mouth begins with a thorough medical history including a detailed medication history and oral evaluation. Since patients may not believe it is necessary to mention all medications or morbidities, it is helpful to review the information with patients and ask if there is anything else happening with their health or if there are other medications (including over the counter) that they may be taking. During the oral evaluation, hyposalivation can be assessed and any clinical presentations associated with dry mouth identified.
For preventive care, recommendations include in-office application of 5% sodium fluoride varnish as well as home use of a prescription-level 5000 ppm fluoride toothpaste. Prompt intervention using fluoride therapy helps to prevent incipient lesions and to arrest and reverse existing caries lesions. Fluorides are also protective against dental erosion.
Although oral health may not be a priority in this population group, it should be taken into consideration, since many medical conditions and medications are closely related to oral health. Drugs have been directly or indirectly associated with the development of caries, periodontal diseases, oral mucosal pathologies, difficulties in mastication, xerostomia, aspiration pneumonia, or complications related to dentures
Polypharmacy is a major health issue that has increased in prevalence over the last three decades. Elderly patients are living longer, with multiple morbidities and complex conditions that result in an increased prevalence and levels of polypharmacy. However, it is important to recognize that both older and younger patients can experience polypharmacy and be affected by the systemic and oral adverse events. Patients experiencing polypharmacy, and in the case of younger patients their parents/guardians, should be educated on the potential adverse effects. With respect to oral health, more frequent dental visits and an increased focus on oral hygiene, diet, and prevention are essential for patients experiencing polypharmacy. Collaboration with medical professionals is also recommended to help optimize care.
Some medications may also contain sugar causing a rise in dental decay. Oral bacteria thrives on any sugar content in these medications and turn them to acids that will harm your tooth enamel (hard-protective outer layer). Normal salivary flow will help wash away these acids thus protecting the tooth but if combined with dry mouth syndrome these acids can lead to detrimental effects to your teeth. Special care must be given to control this condition otherwise the affects can be devastating.
Medications can also lead to changes in the mouth such as redness, white patches or ulcers on the soft tissues (cheeks, tongue, gums). It is important to regularly check inside your mouth and let your dentist know of any changes in appearance or concerns at your regular appointment.
Special care must be given to control this condition otherwise the affects can be devastating.
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