EARN 2 UNITS This self-study CE course is written for dentists, dental hygienists and dental assistants. ORAL COMPLICATIONS OFMedication Usage AN OVERVIEW OF ORAL SIDE EFFECTS OF COMMON DRUGS, AND RECOMMENDATIONS FOR PREVENTION AND MANAGEMENT OF THESE SYMPTOMS By Ann Eshenaur Spolarich, RDH, PhD EDUCATIONAL OBJECTIVES After reading this course, the participant should be able to: 1. Explain the prevalence of medication usage among the U.S. population, and common oral side effects. 2. Describe key properties of saliva and mechanisms that can affect salivary flow. 3. List risks and adverse oral sequelae associated with drug- induced xerostomia. 4. Discuss the variety of drugs associated with oral side effects. P atients who have multiple medical conditions often present for dental treatment with complex medical and pharmacological histories. Recent statistics from the U.S. Centers for Disease Control and Preven- tion (CDC) reveal that 49% of the U.S. population has taken at least one medication, 23% has taken three or more, and 12% has taken five or more prescription drugs within the last 30 days.1 Medication usage typically increases with age, and older adults present with both polypharmacy and polyherbacy. The more medications consumed, including herbal and dietary supplements (HDS), the greater the risk for a drug-drug or drug-HDS interaction.2 Clinicians should routinely assess medicated patients for complaints and/or presentation of adverse drug effects. This article will review common oral side effects of med- ication use and recommendations for prevention and management. Each manufacturer reports known side effects of medication use in the drug monograph. Side effects are organized and reported by the body system affected, with adverse oral side effects listed under the gastrointestinal system. Adverse oral drug effects include xerostomia, oral ulcerations, gingival hyper- plasia, taste alteration, lichenoid drug reaction and mucositis, which are dis- cussed here. Others include dysesthesias (altered sensations), osteonecrosis, malignancy, intraoral pigmentation and angioedema.3 Clinicians should consult a drug reference resource to identify whether a patient’s medication use is neg- atively impacting oral health. With the notable exception of xerostomia, gen- erally, oral side effects occur in only a small minority of users. DRUG-INDUCED XEROSTOMIA Drug-induced xerostomia or dry mouth is the most frequently reported oral side effect among older adults, who may present with multiple comorbidities and depression.4,5 A recent review suggests the incidence of xerostomia increases with the number and dose of medications taken.6 Salivary secretion is stimulated via excitation of both the parasympathetic and sympathetic divisions of the autonomic nervous system. Salivary gland cell-surface receptors receive stimuli from neurotransmitters, which transmit signals within the cells that comprise the glands. Serous saliva, which is high in volume and ions, but low in protein, comprises the majority of the volume of saliva. Parasympathetic stimulation also results in vasodilation of the blood vessels that support salivary glands. Serous saliva is essential for the breakdown of the food bolus, swallowing and digestion.7,8 Stimulation of the sympathetic nervous system produces saliva that is high in proteins, but low in volume. Stimulation produces vasoconstriction of the blood vessels that supply the glands, reducing the rate of salivary secretion and causing glandular cells to produce more mucinous saliva. Sympathetic stimulation inhibits flow rate due to central nervous system influences from Belmont Publications, Inc. is an ADA CERP-recognized provider. Belmont Publications, Inc. designates this activity for 2 credit hours of self-study continuing education units. This course is released December 2017 and expires December 2020. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to the Commission for Continuing Education Provider Recognition at ada.org/cerp. 30 Decisions IN DENTISTRY • December 2017 Approved PACE Program Provider FAGD/MAGD credit Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement July 1, 2016 to June 30, 2019 Provider ID 317924 AGD Subject Code: 730 DecisionsInDentistry.com DNY59/ISTOCK/GETTY IMAGES PLUS
