September/October 2009 Medications and Oral Health Margaret tried several different medications for her urinary incontinence. The problem was so acute that she avoided going out in public. Recently, her physician prescribed a new drug that has almost completely stopped the incontinence. She feels more confident and is relaxed enough to go out to lunch with friends. However, at her last dental visit, her dentist was shocked to find multiple new areas of tooth decay. After noting that her mouth was very dry, he asked her about any changes in medications. He was concerned about her use of a drug to treat incontinence that is known to have significant drying effects on the mouth, which can cause tooth decay. But she is reluctant to give up the medication that has effectively controlled her incontinence. What happened to Margaret is not unusual. Many older adults find that a medication that works for one chronic disease has adverse side effects in another area. Maintaining oral health is crucial for the overall well-being of older adults because gum disease, tooth decay, and the pain associated with these conditions can impair an individual’s ability to eat, speak, and socialize and can adversely affect an elder’s quality of life. Many frail older adults are at high risk for poor oral health due to a decline in their ability to independently maintain their daily oral hygiene. Some medications, including prescription medications, over-the-counter products, and herbal preparations, can adversely affect oral health. It is important for older adults to be aware of the potential oral health risks of medications since many are using multiple medications for chronic health conditions. Additionally, elders should communicate with their physicians, pharmacists, and dentists to identify potential strategies to prevent and/or manage the potentially harmful side effects of their medications. Troublesome Oral Conditions Xerostomia Medications that can cause dry mouth are those with anticholinergic side effects, such as anti-Parkinson’s drugs, antidepressants, antipsychotics, sedative hypnotics, antihistamines, and antianxiety medications. Tricyclic antidepressants and the selective serotonin reuptake inhibitors used to treat depression are well known to cause dry mouth. Patients using either the older antipsychotic agents, such as haloperidol and thorazine, or the newer antipsychotic medications, such as risperidone, olanzapine, and quetiapine, have reported problems with dry mouth. Xerostomia is also a known adverse effect of antianxiety and sedative hypnotic medications such as lorazepam, oxazepam, temazepam, zolpidem, and triazolam. Some medications that are prescribed to treat urinary incontinence (oxybutynin and tolterodine), as well as many common over-the-counter antihistamines, decongestants, antinausea agents, and iron supplements, also have been associated with dry mouth. While medication-induced xerostomia is common among older adults, this condition is often reversible, as medications affect only salivary secretion and do not actually damage salivary glands. Discontinuing the use of such medications and switching to products with less potential to cause dry mouth is an effective strategy to address this problem. Mucosal Problems Gum Problems Taste Disturbance Angiotensin-converting enzyme inhibitors commonly used to treat hypertension have been reported to cause reversible distortion of taste. Medications used to treat fungal infections in nails, namely griseofulvin and terbinafine, when taken by mouth, can also lead to reversible taste disturbance. Anti-infective medications such as metronidazole and clarithromycin have been reported to cause either loss of taste or altered taste. Penicillamine, a medication used to treat Wilson’s disease, has been reported to cause dose-related loss of taste that is reversible within eight to 10 weeks without discontinuing the medication. Infections Management of Medication-Induced Oral Conditions Shifting the intake time of some medications from bedtime to mealtime is a self-care measure to reduce potential complications of dry mouth, as salivary flow rate is lowest at bedtime. Food stimulates salivary secretion and can counteract the drying effect of some medications. However, this change in medication intake time can be done only when there are no contraindications, such as reduced absorption of the drug or interactions with food or other drugs. Increasing fluid intake by taking small sips of water throughout the day can reduce feelings of dry mouth and moisturize oral tissue. Saliva substitutes in spray, gum, liquid, and gel form are available commercially. The simple act of chewing can increase salivary secretion, and chewing sugarless gum has been reported to reduce feelings of dry mouth. It’s important for older adults to be aware of the many potential side effects of medications on oral health. The best strategy is to raise questions about any potential adverse effects when a new medication is prescribed and to maintain good communication with the primary care provider, pharmacist, and dentist when signs of oral problems arise. What may seem like a normal change in the mouth may actually be a serious condition that can be prevented through elders’ greater awareness and involvement of elders’ healthcare teams. — Annie Lam, PharmD, CGP, FASCP, is director of the University of Washington School of Pharmacy Residency Programs, codirector of the university’s School of Pharmacy Plein Certificate Program in Geriatric Pharmacy Practice, and a pharmacy department senior lecturer. |
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