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Interactions and other complications with taking medication make conversations with patients about what they’re on essential—even if they are a little challenging. By John Burfitt
Adelaide practitioner Dr Peter Alldritt still recalls the consultation with a new patient when, after identifying an extraction was required, he inquired about the range of medications the patient was on.
“This person was very surprised and said I didn’t need to know any of that as the medications he was on were for medical problems, and as I just looked after teeth, had nothing to do with me,” Dr Alldritt says.
“It highlighted the disconnect with many patients who do not understand the fact the mouth is connected to the rest of the body, and oral health is a major part of overall wellbeing. They seem to think any medication they are taking, be it for heart issues or blood thinning, has no impact on what is going on within their mouth.”
In the wake of the Australian Dental Association (ADA) report ‘A review of drugs that contribute to bleeding risk in general dental practice’, the theme of this year’s Dental Health Week—Mind, Body, Mouth: It’s all connected—was chosen to highlight the importance of the connections between oral health and general health.
Knowledge of such connections in terms of different medications can play a vital role in dental treatment plans. There can be increased bleeding risks from some prescription medications, such as antidepressants, non-steroidal anti-inflammatory drugs and blood thinners, and risks can be heightened if anti-clotting drugs interact with other medications.
But it is not just prescription medication that can be of concern. Over-the-counter treatments and alternative therapies can also cause significant problems. The ADA report identified that certain supplements and herbal remedies such as garlic, ginger, turmeric, evening primrose oil and fish oil can increase the risk of post-operative bleeding.
The problem of sharing
Dr Scott Davis, ADA vice-president at the time this story was first published (now President), believes the issue stems from a lack of understanding about the importance of such information, as well as a hesitancy of patients in how much they are willing to share. But he says it’s crucial practitioners access important details as a standard part of a consultation.
“Dentists need to know as much as a GP about what medications the patient is taking, but we also need to be more effective in explaining why such details are so crucial in keeping the patient safe while under our care,” Dr Davis says.
Which is why the way a dentist accesses such information requires close evaluation. “I find it works best by having patients complete a medical history form including a list of all their medicines and treatments before the consultation, and then at the beginning of an examination, asking specific questions, and explaining it is for their wellbeing that we need to know.”
This is when building rapport in the dentist-patient relationship is paramount. “Much of this is about trust, so important information may not be offered in the first appointment, but it might be in the second and third appointments when patients will disclose what else they are taking. This needs to be an ongoing discussion at each appointment, rather than a set-and-forget on the first visit that is then filed away.”
Maya Carson, senior business coach at Prime Practice consultancy, believes the patient experience needs to be consistent from the time of the initial phone call right through to when they’re sitting in the dental chair, followed by any follow-up communication.
“It needs to start with the front office team,” she says. “When a new patient books in, ask them to fill out their forms beforehand, and explain why there is a section about what medicines they are taking and how that information may be important for their safety.
“Allowing them to do this beforehand and in their own space gives them the chance to think through their list of medications and treatments, rather than being overwhelmed by being in the reception area and relying on their memory on the spot. From there, it’s crucial for the dentist to ask for more details if necessary.”
The importance of trust
Trust is essential, Dr Alldritt says, especially if there is any sensitivity in revealing what some of the medications are. “Some patients won’t tell you everything they are taking as they might be a little embarrassed,” he says. “It might be they also use viagra or are on treatments for their mental health, or maybe taking recreational drugs and are cautious about revealing that. This is when you need to assure the patient anything discussed is confidential, and you avoid any big reaction to discovering what else is going on in their life. Instead, make it clear that knowing such information might prove essential in deciding on the best treatment plan that keeps them safe.”
PharmaAdvice offers information to dentists about medications, particularly regarding interactions and side effects. It is run by clinical pharmacist Dr Geraldine Moses, who has been working with the dental profession for over 20 years.
“The majority of calls are about the impact of the patient’s medicines on dental procedures as dentists are highly skilled in dentistry, but they have not had a huge amount of education about medications.”
Dr Moses advises dentists on a four-stage approach in a consultation. The first step is documenting the patient’s history of previous side effects to medications, the second is obtaining a comprehensive list of what they’re currently on, the third is explaining the impact of those drugs on the dental procedure or interactions with the drugs the dentist may use during the procedure, and the fourth is outlining any potential interactions of medications when the patient home.
“I aways say if a dentist ever gets a sense they need to check on something, then call me as often I can take a call on the spot,” Dr Moses says. “Drugs have changed so much in recent years. It is not worth the risk of relying on what you learned 20 years ago. Too much has changed since then.”