© Gary Inglese

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Many prescription and over-the-counter medications are known to impact oral health.  With more and more patients taking these medications today, we as dental healthcare providers should be aware of potential drug interactions and side-effects.  An example of such medications includes bisphosphonates, like Fosamax for osteoporosis.  It is well documented that patients taking Fosamax puts them at high risk for osteonecrosis of the mandible following oral surgery.  Additionally, patients taking blood-thinners such as Coumadin and aspirin are at high risk for post-operative bleeding following a tooth extraction. 

In recent years, I have seen many dental malpractice law-suits in which the case is the dentist’s alleged failure to consider and recognize the impact certain medications have on the oral cavity.  One recent case comes to mind involving a patient taking both an antidepressant and an antidiuretic simultaneously.  When combined, these two medications cause severe xerostomia, resulting in rampant caries and dental decay.      

According to a recent dental report, more than three-hundred medications currently list xerostomia as a potential side-effect.  Dentists and dental specialists should be very aware of these medications and advise and treat their patients accordingly.  These patients may require supplemental fluoride treatments or over-the-counter fluoride products to use daily.  Furthermore one should consider the use of saliva substitutes to reduce a patient’s risk for periodontal disease and recurrent decay.

The standard of care requires that a dentist inquire about prescription and non-prescription medications that a patient may be taking. Good treatment protocol requires that a patient complete a medical history that includes a list of medications he or she is taking. Additionally, the medical history as well as medications that he or she is taking should be updated at every recare appointment by either the dentist or the dental assistant.  This information is not always volunteered as patients do not believe there is any relevance in their dental treatment. 

When in doubt about the side-effects of a medication, a dentist should consult with a physician, pharmacist, or Physicians’ Desk Reference.  Good risk management will not only prevent any potential adverse effects in delivering dental care, but may also reduce the adverse effects in being sued.

Risk management benefits dentists and patients

© Gary Inglese