Professor of Clinical Pharmacology and Medical Education, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2SP; Honorary Consultant Physician/Associate Medical Director, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TT; Director, Yellow Card Centre West Midlands, City Hospital, Dudley Road, Birmingham, B18 7QH, UK
All dental practitioners will treat patients who take medicines. An ageing population, combined with improved management of patients with multiple long-term co-morbidities, has seen a rise in complex medication regimens. Healthcare specialization, a widening drug market and better access to medicines has also contributed to more patients taking multiple medicines for conditions, often managed by a variety of specialists. Whether these medicines are prescribed or bought over-the-counter, dental practitioners must understand the implications that these treatment regimens can have on dental care.
CPD/Clinical Relevance: Prescribing medicines is a small but essential part of dental practice. This paper describes various aspects of prescribing, the potential implications of dental treatment to a patient's medication regimen, and important considerations to reduce the risk of medication errors and improve patient safety.
In 2017, 4.7 million prescription items in England were prescribed by dentists, accounting for 0.4% of all prescriptions dispensed in the National Health Service.1 With an ageing population and advances in modern medical practice, the general dental practitioner (GDP) will increasingly be faced with patients who have multiple co-morbidities and are prescribed complex treatment regimens. GDPs, like other prescribers, need to have knowledge of the medicines they prescribe to inform prescribing decisions and non–pharmacological interventions. This article highlights some key prescribing considerations and provides links to resources that can support safe prescribing in dental practice.
The UK population is ageing, with more than 11 million people over the age of 65 years.2 With ageing comes a greater likelihood of disease. More than 50% of those aged over 65 years are multimorbid3,4 (ie have two or more long-term conditions), and for those over 85 years this rises to more than 80%.5,6 Multimorbidity can lead to the prescription of multiple medicines, often known as polypharmacy.7 It is of particular concern in this patient group because the physiological changes that occur with age and/or chronic disease (eg decreases in lean body mass, body water, bone mass, renal clearance and hepatic function) can alter the pharmacokinetics and pharmacodynamics of a drug and increase the risk of Adverse Drug Reactions (ADRs), unless treatment regimens are adjusted accordingly. The use of multiple drugs also increases the potential for drug-drug interactions (DDI) and may lead to a cascade of prescribing where signs and symptoms of an ADR or DDI trigger prescription of more medicines where they are not needed,8 known as problematic polypharmacy.7 The safe prescription of medicines requires consideration of many issues.
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