Dentists know that drugs are helpful for patients but that some care must always be given to make sure that the entire spectrum of activity of a drug is considered. We spend a lot of our clinical formation learning how they will impact our decision making. And though we encounter many of the same drug names over and over, occasionally there are some that require a review.
First, let’s get into the mindset of the clinician.
Generally we seek to understand the action a drug has on our patients. But let’s remember that in addition to an “action” drugs can have two additional effects. They can cause a reaction and have an interaction. Consider examples of each:
1. A example of a drug action is an antibiotic killing bacteria.
2. An example of a drug reaction is an antibiotic causing an overgrowth of opportunistic infections such as Candida Albicans in the oral cavity.
3. An example interaction is (the antibiotic) erythromycin potentiating the effects of coumadin.
In this blog I’m going to focus on reactions. What are the reactions of interest to the dentist?
1. Taste alteration
2. Gingival overgrowth (gums growing up onto the tooth)
3. Xerostomia (dry mouth)
4. Drug induced oral lesions
5. Candidiasis (fungal infection)
Taste alteration can be aggravating for a patient, and might influence adopting a more risky diet that increases caries risk or impacts sugar control if the patient is diabetic.
Gingival overgrowth can potentially impede home care, and can increase risk for caries or periodontal disease.
Xerostomia may have a disastrous effect related to the absence of the cleansing and buffering effect of the saliva. Long term xerostomia may be depressing for patients and affect dietary intake as well as affect the processing of food.
Drug induced oral lesions may be painful, portals of entry for organisms and create diagnostic dilemmas for clinicians.
Candidiasis can be painful and affect successful use dental prosthesis.
Being aware of possible drug reactions is important. But this important task of researching and advising patients if their medications might be causing some of their oral problems is time consuming. If there is evidence of a drug reaction, it is the responsibility of the dentist to address the situation. Patients might report taste alterations and xerostomia in their dental history and possibly point out a lesion because of pain or simply noticing the change in the appearance of the tissue. And the oral examination provides the opportunity to note lesions and alteration of normal anatomy.
Is there a way to make this process easier? Is there any tool that can get “into the dentist’s mind” to support clinical decision-making? The answer is yes.
Wanting to be able to say yes to this question was part of my motivation for coming up with the idea of Dental Symphony’s “pre-clinical assessment” feature. Combining medical and pharmacological expertise at the point of care with an easy to use software platform is meant to enable a dentist’s clinical cognition for every patient he or she sees.
Built into the online patient registration portal’s behind the scenes functionality, Dental Symphony’s ePatient will alert me of any reports of xerostomia and taste alterations.
Example of support information
It will also analyze the medications a patient takes for potential for gingival overgrowth, oral lesions and candidiasis. This is done automatically and is presented to the clinical staff in the information delivered to the clinical staff as the patient registers via Dental Symphony. You can’t get much faster than automatic.