Polypharmacy

Author: Kimberly N. Powell, DDS, MS, FAGD

What is this? In a recent article on Colgate Oral Health Network, polypharmacy refers to the use of multiple medications, with the most accepted definition referring to a count of five or more medications. As stated in the article, the prevalence of polypharmacy was higher among individuals at least 65 years-of-age. Per the article, polypharmacy-related issues include adverse drug effects, drug-drug interactions, drug-disease interactions, reduced health-related quality of life, disability and hospitalizations. It is important as dental healthcare providers that all medications including over the counter ones are listed in the medical history as we are introducing yet another drug into the patients system when anesthetic is needed for scaling and root planing, fillings, crown preparations, extractions, etc.  

 Polypharmacy can cause dry mouth/xerostomia and 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. Why is this important? Dry mouth increases the risk of dental caries and dental erosion and this erosion can cause exposure of dentin and tooth sensitivity. Saliva helps to clear the mouth of debris and dilute the environment so its not so acidic. An acidic environment in the oral cavity can wear away tooth structure. The reduction in saliva also decreases the content of calcium, phosphate, fluoride ions in the oral cavity thus decreasing the protective effects it affords and demineralization of enamel can occur and remineralization of enamel reduced. Demineralization is the lost of minerals like calcium and phosphate in enamel and remineralization occurs when those minerals fill in the weakened enamel. Some medications that can cause dry mouth include proton pump inhibitors (Omeprazole), benzodiazepines (Valium), skeletal muscle relaxants (Flexeril), opioids (Codeine), anti-depressants.  

After identifying patients with polypharmacy-induced dry mouth, some treatment options include more frequent recare visits with the hygienist, in-office fluoride applications, prescribing toothpaste with more fluoride, and consultations with the patients medical provider to reduce or substitute medications. We would not advocate any patient not taking their medication as prescribed by their medical provider but we do advocate having a conversation with their provider that could improve their systemic and oral health.