Today's dental patients tend to have more complex medical histories than those in the past. These patients, including seniors, often take a myriad of pharmaceutical drugs with complex interactions and known adverse events.
The medical community has been studying medication errors and adverse drug events for the past two decades, but research into dental complications from medications is rarer. Research suggests that many adverse events are related to medication administration or prescribing, noted study authors general dentist Roy Stevens, DDS, and oral surgeon Daniel Sarasin, DDS, in the CDA Journal article.
"Oftentimes, these errors are associated with the dentist failing to have a thorough understanding of the patient's medical history and the medications used to treat them," Drs. Stevens and Sarasin wrote (CDA Journal, September 2019, Vol. 47:9, pp. 589-591). "In addition, there is often a failure to understand the pharmacodynamic principles associated with the agents administered or prescribed and their interaction with medication that the patient may already be using."
How can dentists help prevent medication-related adverse events? Drs. Stevens and Sarasin shared four tips.
1. Don't prescribe the same for every patient
Dentists should avoid prescribing the same type and quantity of medication to all patients, the authors noted. By doing so, dentists can avoid prescribing excess medication and prescribing medications not intended for a patient's medical status.
2. Take a thorough health history
“Medication errors and adverse drug events are an unfortunate risk of drug administration and prescribing.”
— Roy Stevens, DDS, and Daniel Sarasin, DDS
One of the best ways to prevent an adverse event is to take a thorough health history. Drs. Stevens and Sarasin recommended using a medical history questionnaire followed by asking patients or caregivers about any listed conditions.
The medical history should incorporate a complete medication list, including any over-the-counter medications, supplements, or herbal medicines. Dentists should also ask about the use of illicit drugs or drugs with a social stigma, such as medical marijuana or those used to treat erectile dysfunction.
"Positive responses from the medical history questionnaire should be matched up against the list of medications," the authors wrote. "Medical conditions listed without a pharmacological agent to treat them (or vice versa) should be investigated further."
3. Create a 'cheat sheet'
Dentists should understand how medications work and any potential interactions, particularly interactions with drugs used during dental procedures. One helpful way to do this is to make a list of notable drug interactions with commonly prescribed medications.
Drs. Stevens and Sarasin noted several online databases provide information on drugs and their interactions, such as Epocrates and Lexicomp. Some software systems also include this feature.
4. Get a refresher on anesthetics
Finally, all dentists should have a thorough understanding of local anesthetics, Drs. Stevens and Sarasin noted. This includes which anesthetics are appropriate for a procedure and the maximum recommended dose for each patient.
The authors recommended reviewing online resources, such as the American Dental Society of Anesthesiology's Ten Minutes Saves A Life! smartphone application.
"Medication errors and adverse drug events are an unfortunate risk of drug administration and prescribing," the authors concluded. "Only through diligent preoperative preparation and careful administration and prescribing can these problems be avoided."
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