Geriatric Pharmacology

Summary

The intention of medical drugs is to stabilize or reverse disease processes. When they are taken properly and are working effectively, the patient is actually safer for dental treatment than if they are not taking the drugs. There are several things in dentistry that are most commonly associated with causing problems in dental patients including geriatric patients and medically complex patients. One is stress. Stress leads to the flight or fight response, which elevates the body's epinephrine level leading to increased blood pressure and cardiac rate. This increase puts an overload on several physiological systems, most importantly, the cardiac system. Management of stress is accomplished by working in a competent and reassuring manner, in a calm environment. This is sometimes augmented pharmacologically with a sedative or antianxiety drug such as a benzodiazepine.

It is also possible to create adverse drug reactions/interactions in geriatric and medically complex patients because of the drugs used in dentistry, but such an occurrence is relatively rare, because the medications we use in dentistry are not particularly toxic, they are used in a safe dose range and for a relatively short time. The most common complications are increased bleeding in patients taking anticoagulants, if aspirin or nonsteroidal antiinflamatory agents (NSAIDS) are prescribed, risk of liver damage in patients with liver problems if acetaminophen or NSAIDS are prescribed and the risk of drug interactions with drugs that are metabolized in the liver, when erythromycin or ketoconazol are prescribed. It is relatively easy to avoid most drug associated problems, especially if the dentist has a reasonable level of awareness about the potential for drug-physiological and drug-drug interactions.

Another possible problem in patients taking medical drugs are adverse drug reactions. Locally in the oral cavity, there can be irritation, allergic reactions, autoimmune reactions, and color changes. Systemic problems, caused by medical drugs, such as bleeding, immunosuppression, or poor healing, can also effect the oral cavity or impact dental management.

Please recall that, when evaluating the patient and the drugs they are taking, relative to adverse drug reactions, many things are possible, but not much is probable. If you eliminate or compensate for the probable problems, that is all that usually needs to be done to insure a safe outcome.

If your patient is taking a medical drug and you are concerned about an adverse drug reaction, then look the drug up on the internet or in a reference text.

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