With the steady introduction of new and more potent medicines, dentists face an uphill battle to stay abreast of the relevant pharmacology, dosing guidelines, and potential for dangerous drug interactions.
While dentists do not prescribe medications for the wide variety of medical conditions afflicting their patients, oral health professionals must be acutely aware of the implications that many drugs have for dentistry.
A good example is the growing number of dental patients who are prescribed anticoagulation and antiplatelet therapy, and the new class of medications being used by physicians to treat them.
Patients taking drugs such as Xarelto (rivaroxaban), Pradaxa (dabigatran) and Eliquis (apixaban) — used to replace Coumadin (warfarin) — are increasingly being seen in dental practices, yet many dentists are unprepared to safely treat these patients who are at high risk for or who have had blood clots.
As the ADA Science Institute notes, "the serious risk of stopping or reducing these medication regimens need to be balanced against the potential consequences of prolonged bleeding."
Unbeknownst to many dentists, even common pain medications, such as acetaminophen, are the subject of U.S. Food & Drug Administration limits. Guidelines pertaining to narcotics, including commonly prescribed painkillers such as Vicodin (acetaminophen and hydrocodone), are in flux, as state and federal regulators seeks ways to reduce an epidemic of opioid abuse.
A New Medicine Every Other Month
Dr. Leslie Fang, a globally recognized authority on pharmacology and physiology, estimates every other month new drugs are approved that dentists must be alert to in order to safely treat their patients and avoid harmful drug interactions and overdoses.
Importantly, Dr. Fang observes, many dentists are unable to distinguish between these new pharmaceuticals — for example — an antiplatelet agent such as Brilinta (ticagrelor) and a target-specific oral anticoagulant, such as Eliquis.
Dentists should know exactly what each of these drugs is intended to do; what kind of clinical situations they are used in; and how to modify the care of dental patients who are on each specific medication, Dr. Fang says.
When dentists themselves are prescribing medications for patients to use at home, such as a topical anesthetic, antibiotic, or analgesic, it is especially important that they be alert to potentially dangerous drug interactions.
It is also crucial for dentists to be well-informed on the use of medications for patients with specific medical conditions, including pregnancy; hypertension and other cardiovascular ailments; diabetes, hepatitis, HIV, and cancer.
For dentists, on their own, to stay current with all of the vital drug interaction warnings and regulations can be a herculean challenge.
One valuable resource is the American Dental Association’s online Science and Research [http://www.ada.org/en/science-research] section, which offers clinical practice guidelines, a science in the news section, and access to the Journal of the American Dental Association. The Academy of General Dentistry also provides important updates, such as its upcoming AGD Pharmacology Webinar Series.
For dentists seeking an up-to-date chair-side reference, Dr. Fang, a member of the DOCS Education faculty and the John R. Gallagher III and Katherine A. Gallagher Endowed Chair in Clinical Excellence at Massachusetts General Hospital and Harvard Medical School, has co-authored "The Ultimate Cheat Sheets: The Practical Guide for Dentists (2017 Edition)."
The 54-page guide — covering all dental disciplines — is organized by tabs that make it quick and easy to pinpoint answers to dosing and interaction questions as they arise. The Ultimate Cheat Sheets, which are updated annually, are co-authored by Robert C. Fazio, DMD, associate clinical professor of surgery at Yale University; and Tracey Menhall, BS, MS, CPA.
Regardless of which resources dentists turn to, it is incumbent on all oral health practitioners to realize that the gap between dental and medical pharmacology is rapidly narrowing, even as dentists are being tasked with treating ever-more complex cases.
EDITOR’S NOTE: As part of our commitment to dental excellence and patient safety, DOCS Education is offering the latest edition of The Ultimate Cheat Sheets to Incisor subscribers for only $139.95*, the lowest price anywhere.
To learn more about this vital reference guide and take advantage of this limited-time discount, click here.
* Enter the special code, "INCISOR" at checkout to receive your Incisor subscriber’s discount.
The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.