Dental professionals are already keenly aware of the widespread prevalence of cardiovascular disease, and observe many of their patients dealing with the related consequences of living with chronic cardiac conditions and related health challenges. Consistently, medications used to treat cardiovascular diseases are among the most commonly prescribed drugs in the United States.(1) It is important to remember that many classes of cardiac drugs have multiple indications, so clinicians should question their patients as to why the drug is being used and note any observations that they or their patients have made about side effects and/or efficacy. Pharmacists, physicians, and/or a drug reference guide may need to be consulted to verify each patient's drug indications and optimal treatment regimens. Compliance with taking cardiac medications and medical follow-up is often less than ideal due to intolerance of side effects, dosing schedules, cost and the need for frequent monitoring. For example, dental hygienists should never assume that a patient's blood pressure is being adequately controlled just because the patient reports having a prescription for an antihypertensive medication: vital signs taken at each visit and a historical record of blood pressure readings documented across time should be used to assess the clinical status of each patient. Many factors can alter a patient's blood pressure, including time of day, level of stress, compliance with medication regimens, and drug interactions.
Sometimes, a patient unknowingly alters his blood pressure control from a drug interaction with an over-the-counter medication that goes unreported in the health history review. For example, chronic use of NSAIDS (e.g. taking for longer than 3 weeks) can reduce the efficacy of some antihypertensive medications, including beta blockers.(2)Many antihypertensive medications cause xerostomia, a chronic problem given that patients often take these medications for life. Oral sequelae of chronic xerostomia include functional difficulties, bacterial, fungal and viral infections, trauma and oral ulceration, and digestive problems. Dental hygienists should assess their xerostomic patients for both clinical signs and reported symptoms, and recommend appropriate therapies to provide symptomatic relief as well as to reduce and prevent oral disease risks.(3) Recommendations may include the use of power toothbrushes, oral irrigators, fluorides, xylitol, remineralization therapies and chemotherapeutic dentifrices and mouthrinses. Sonic brushing (Sonicare) has been shown to stimulate salivary flow in xerostomic patients and improve fluoride uptake in Streptococcus mutans biofilm.(4,5) Most antihypertensive medications cause orthostatic hypotension, so caution should be used when repositioning the patient to an upright position after dental treatment. Allow the patient to sit upright for several minutes prior to standing to reduce the risk of falls.(2)
1. Top 200 Medications for 2009. Source: SDI/Verispan, VONA, www.drugtopics.com.2. Wynn RL, Meiller TF, Crossley HL. Drug Information Handbook in Dentistry. 17th ed. Hudson, Lexi-Comp Inc., 2011.3. Spolarich AE. Xerostomia and oral disease. Dimensions of Dental Hygiene, November 2011;9(11; Special Supplement):43-54.4. Papas A, Singh M, Harrington D, Rodríguez S, Ortblad K, de Jager M, Nunn M. Stimulation of salivary flow with a powered toothbrush in a xerostomic population. Spec Care Dentist. 2006;26:241-6.5. Stoodley P, Nguyen D, Longwell M, Nistico L, von Ohle Ch, Milanovich N, de Jager M. Effect of the Sonicare FlexCare power toothbrush on fluoride delivery through Streptococcus mutans biofilms. Compend Contin Educ Dent. 2007;28:15-22.6. Wynn RL. An update on calcium channel blocker-induced gingival hyperplasia. Gen Dent, 1995;43(3):218-222.7. Malamed SF. Handbook of Local Anesthesia. 5th ed. St. Louis, Elsevier Mosby, 2004.
Ann Eshenaur Spolarich, RDH, PhD, is Clinical Associate Professor and Associate Director of the National Center for Dental Hygiene Research & Practice at the Herman Ostrow School of Dentistry at the University of Southern California.To read a previous article in RDH eVillage FOCUS written by Ann Eshenaur Spolarich, go to article.