Knowing your patient’s current medical state is important in making recommendations and addressing oral care needs. For our polypharmacy patients it is key we know about this and that patients understand the negative effect medications causing dry mouth can have. Sometimes, this can be challenging.
Identifying the sources of changes you observe
Have you seen your 6-month recare patient and it seemed as if you were looking in the mouth of someone completely different than your patient you had previously seen? What questions do you begin asking yourself before you ask the patient? You look at the medication list and see the patient hasn’t filled anything in. The medical history may or may not have anything checked off, even if your patient has medical/medication needs. Many of our patients don’t disclose all of their medical history and do not feel their medications have anything to do with their dental visit. It’s important we communicate what we see and ask our patients about any changes in medications and/or their medical history. Specific questions
It’s not uncommon for patients to omit mentioning medications when filling out the medical history. One way to take care of this is to read out the medications you have on file for them and to then ask if they are taking anything you didn’t read off. Also ask them if they have stopped taking any that you did read off from their previous medical history. It’s important to remind patients that you need to know about all of the over-the-counter, prescription and homeopathic medications they are taking. Particularly among our older population, patients may be taking multiple medications (polypharmacy) for several different conditions, including comorbidities. In one recent survey, slightly over half of older individuals who were dependent were taking between five and nine medications, and 20% were taking ten or more. Polypharmacy increases risk for dry mouth. Your patient may or may not have complained of oral discomfort and dryness. It is up to us to ask questions to find out. Examples could be whether they wake up with a dry mouth, whether their mouth feels dry and uncomfortable during the day, whether they sip water a lot and whether they keep water by their bedside.
So what do we do?
Once you understand all of the medications your patient is taking and their health conditions, it is important to give them the puzzle pieces put together. We can use a Caries Risk Assessment to give an objective analysis (and we can compare it to their previous one) and help them understand their risk for dental caries. Visual confirmation can be effective if this is already evident. Taking intraoral photos can assist you not only at the present appointment, but also in future appointments. Showing the patient how their risk increases with additional medications can help make sense of our very intentional conversation. Our patients need to understand how certain medications can impact their oral health, especially when they are taking multiple medications, and to receive advice and care.
Educating our Polypharmacy Patients and Making Recommendations
Once our polypharmacy patient understands the negative effect their medications are having on their oral health, we can educate them more on what to do and provide preventive care. For these patients with a higher risk for caries, preventive care calls for application of in-office fluoride two to four times per year, such as Colgate PreviDent Varnish. Daily use of prescription-level 5000 ppm fluoride toothpaste, such as Colgate PreviDent 5000 Booster Plus, is also recommended. Giving your patient the information that in-office fluorides and home use of 5000 ppm fluoride toothpastes are recommendations from the American Dental Association is important. We can let them know it is based on a review of available studies and research. If our patients understand the benefit, they will be more likely to follow through. The ADA also stresses the importance of discussing behavioral modification. This includes improving oral hygiene and dietary advice to promote a healthier diet. Patients can also be advised to chew sugar-free gum with xylitol, which will help with salivation, and given recommendations for a gel, lozenge or mouth rinse that will help to relieve dry mouth. Simple recommendations can help.
It’s important to note that it is not our responsibility to influence which, or how many, medically-necessary medications our patients should or shouldn’t take. It is our responsibility to educate our patients and make recommendations based on our findings.
- Have complete conversations about the medications your patient is taking.
- Make sure polypharmacy patients are aware of their increased risk for caries
- Use the Caries Risk Assessment tool, and recommend and provide preventive care
- Give your patient valuable and applicable resources to help them live more comfortably!
Our polypharmacy patients are relying on their medications to treat multiple conditions to improve their health and increase their quality of life. It’s our responsibility to help ensure they have the information, recommendations and preventive care available to help with their oral health.
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