THE WHOLE TRUTH, NOTHING BUT THE TRUTH

One of the most important things you do when visiting a new physician or dentist is to fill out a medical history form. Many patients balk at filling out these forms, and in my experience, a high percentage of patients fill them out incompletely. There are many risks involved with not including all prescribed and self-prescribed medications.

The most frequently prescribed medications by therapeutic category are anti-hypertensives (blood pressure), cholesterol regulators, antiplatelet and anticoagulant agents (blood thinners), respiratory agents, antiulcer drugs, antidepressants, hypnotics, and anti-diabetic medications. In addition to including any of these medications on your history form, it is also very important to include any over-the-counter (OTC) drugs, as well as vitamins and supplements.

Many patients regard questions about current or previous medications as irrelevant to dental treatment and sometimes even obstacles to treatment. However, there are many drug-drug and drug-disease interactions that can occur with medications prescribed in the dental office. In addition, it is equally important to know everything that is being taken in the rare event of a medical emergency in the dental office.

Analgesics, such as acetaminophen, ibuprofen, and naproxen, are commonly prescribed or recommended in dental therapy. Acetaminophen, which is primarily metabolized in the liver, is dangerous for patients who take certain medications, such as anti-seizure and anti-depressants, as well as for those who consume moderate amounts of alcohol. Interactions with even small doses of acetaminophen can lead to liver toxicity. In addition, acetaminophen should not be used in patients on anti-coagulants as it may enhance the effects of the blood thinning agents.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also react adversely with many of the same drugs. Prolonged use of NSAIDs can cause gastrointestinal ulceration or perforation and reduced kidney function. They should be avoided if you have pre-existing gastrointestinal or renal disease. NSAIDs have also been known to reduce the efficacy of certain blood pressure medications, interfere with the cardio-protective effects of daily low-dose aspirin, and should be avoided in the last trimester of pregnancy.

Antibiotics, such as penicillin or amoxicillin, can also interact with frequently prescribed medications. For example, these antibiotics may inhibit vitamin K formation and potentiate the effects of anticoagulant medications. They are also thought to decrease the efficacy of oral contraceptive agents.

Although you should be questioned at each visit to determine if your health status or medication list has changed, always let your dental hygienist or dentist know if there have been any changes. Review the list of medications, and anything else you take, even if you don’t consider it important, to make sure it is accurate.