In an article in this month’s edition of Australian Prescriber, dental experts Drs Alan Deutsch and Emma Jay look at the effect of medicines on oral health in frail older people, and provide six ways this can be improved.
Poor oral health can lead to poor general health. Dental and gum infections can affect other organs in the body. Some bacteria that cause gum disease have been linked to Alzheimer’s disease. Improving oral hygiene can reduce the risk of respiratory illnesses like pneumonia.
Some medicines that are often used by frail older people reduce saliva—the body’s own first line of protection against dental, oral and some general health problems. The more of these medicines that are used, the greater the risk of having poor saliva function.
“Saliva is important for speech, digestion and swallowing,” Dr Deutsch said. “It also kills bacteria in the mouth and prevents decay and tooth wear.
“Many people may not be aware that there are medicines which are often used by frail older people that reduce saliva production. These include medicines for urinary incontinence, antidepressants and antipsychotics. They can cause a dry mouth, which can lead to dental problems.
“Indeed, over half of people taking more than five medicines have a dry mouth,” Dr Deutsch added.
“To reduce the risk from these medicines, doctors should review, switch, reduce, time, divide and check.”
- Review the medicines and consider stopping some when appropriate.
- Switch to medicines without a saliva-reducing effect.
- Reduce the doses of these medicines if possible.
- Time the dose to when saliva production is highest.
- Divide the doses into smaller doses throughout the day.
- Check for interactions with other medicines that cause the saliva-reducing medicines to stay in the body longer.
“It is important for doctors to remember oral health and to look into the mouths of their older, frail patients, and refer to a dentist if problems are suspected. Oral health is so important for general health,” Dr Deutsch said.
“With increasing frailty, older people need active family support to arrange visits to the dentist more frequently to prevent dental and oral problems.”