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

INDIAN DENTAL ACADEMYLeader in continuing Dental Education

www.indiandentalacademy.com


INDIAN DENTAL ACADEMYLeader 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

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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 www.indiandentalacademy.com

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

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