Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Systemic medicines taken by adult special care dental patients and implications for the management of their care

Abstract

Introduction Significant changes have taken place in the profile of prescription medicines being taken by the adult UK population over the last decade. The aims of this article are to review the literature to understand the overall trends and underlying factors, and then to compare this with the medication profile of a cohort of adult special care dental (SCD) patients.

Materials and method Five hundred patient records were examined and retrospective data on systemic medicines being taken were obtained and classified according to the index used in the British National Formulary (BNF).

Results The results revealed a high level of polypharmacy with 57% of SCD patients taking three or more medicines compared to 24% of the population in England. Antiepileptic drugs were the most frequently taken group of medicines (42%), followed by antidepressants (39.7%) and antipsychotics (37.6%).

Conclusions Our results demonstrate the medical complexity of patients in this cohort and enable clinicians to increase their familiarity with the most commonly taken medicines and the tools available to manage the implications for dental care.

Key points

  • Highlights the importance of the medication list in assessing a patient's medical history.

  • Provides an overview of the most commonly taken medicines that clinicians are likely to come across in adults including those accessing specialist special care dentistry.

  • Covers the implications for dental care and summarises the clinical tools available to manage them.

This is a preview of subscription content

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Ransford N, Tait D, Randall C. Retrospective audit of the prescribed systemic medication taken by adults using salaried primary care dental services in Warwickshire and implications for dental care. J Disabil Oral Health 2009; 10: 169-174.

  2. 2.

    NHS England. Guides for Commissioning Dental Specialties - Special Care Dentistry. 2015. Available https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/09/guid-comms-specl-care-dentstry.pdf (accessed April 2020).

  3. 3.

    Patel N, Broadfield L, Mellor A. Medical profile of patients accessing hospital based dental care. Oral Surg 2014; 7: 26-32.

  4. 4.

    Cutfield N, Tong D. Common medications among dental outpatients: considerations in general dental practice. N Z Dent J 2012; 108: 140-147.

  5. 5.

    Fernández-Feijoo J, Garea-Gorís R, Fernández-Varela M, Tomás-Carmona I, Diniz-Freitas M, Limeres-Posse J. Prevalence of systemic diseases among patients requesting dental consultation in the public and private systems. Med Oral Patol Oral Cir Bucal 2012; 1: 89-93.

  6. 6.

    NHS Digital. Prescriptions dispensed in the community - statistics for England, 2006-2016. 2017: Available online https://digital.nhs.uk/catalogue/PUB30014 (accessed April 2020).

  7. 7.

    Office for National Statistics. Population estimates time series dataset. 2017. Available online https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/timeseries/enpop (accessed April 2020).

  8. 8.

    Ewbank L, Omojomolo D, Sullivan K, McKenna H. The rising cost of medicines to the NHS: What's the story? 2018. Available online https://www.kingsfund.org.uk/publications/rising-cost-medicines-nhs (accessed April 2020).

  9. 9.

    Moody A, Mindell J. Health survey for England 2016 - Prescribed medicines. 2017. Available online https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/health-survey-for-england-2016 (accessed April 2020).

  10. 10.

    Duerden M, Avery T, Payne R. Polypharmacy and medicines optimisation. 2013. Available online https://www.kingsfund.org.uk/publications/polypharmacy-and-medicines-optimisation (accessed April 2020).

  11. 11.

    Barber N D, Alldred D P, Raynor D K et al. Care homes' use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people. Qual Saf Health Care 2009; 18: 341-346.

  12. 12.

    Wickware C. Pharmacists could be expected to conduct millions of medication reviews under NHS England plans. 2020. Available https://www.pharmaceutical-journal.com/news-and-analysis/news/pharmacists-could-be-expected-to-conduct-millions-of-medication-reviews-under-nhs-england-plans/20207546.article (accessed September 2020).

  13. 13.

    Lee L, Shafe A, Cowie M. UK stroke incidence, mortality and cardiovascular risk management 1990-2008: time trend analysis from the general practice research database. BMJ Open 2011; DOI: 10.1136/bmjopen-2011-000269.

  14. 14.

    Zheng S, Roddick A. Association of aspirin use for primary prevention with cardiovascular events and bleeding events a systematic review and meta-analysis. JAMA 2019; 323: 277-287.

  15. 15.

    Spence R, Roberts A, Ariti C, Bardsley M. Focus on: antidepressant prescribing - trends in the prescribing of antidepressants in primary care. 2014. Available https://www.health.org.uk/sites/default/files/QualityWatch_FocusOnAndidepressantPrescribing.pdf (accessed April 2020).

  16. 16.

    Royal College of Psychiatrists: Position statement on antidepressants and Depression. 2019. Available (accessed May 2020).

  17. 17.

    Arthur A, Savva G M, Barnes L E et al. Changing prevalence and treatment of depression among older people over two decades. Br J Psychiatry 2020; 216: 49-54.

  18. 18.

    Donegan K, Fox N, Black N, Livingston G, Banerjee S, Burns A. Trends in diagnosis and treatment for people with dementia in the UK 2005-2015: a longitudinal retrospective cohort study. Lancet Public Health 2017; DOI: 10.1016/S2468-2667(17)30031-2.

  19. 19.

    Curtis H J, Croker R, Walker A J, Richards G C, Quinlan J, Goldacre B. Opioid prescribing trends and geographical variation in England 1998-2018: a retrospective database study. Lancet Psychiatry 2019; 6: 140-150.

  20. 20.

    Montastruc F, Loo S Y, Renoux C. Trends in first gabapention and pregabalin prescription in primary care in the UK 1993-2017. JAMA 2018; 32: 2149-2151.

  21. 21.

    Taylor S, Annand F, Burkinshaw P et al. Dependence and withdrawal associated with some prescribed medicines: an evidence review. 2019. Available https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/829777/PHE_PMR_report.pdf (accessed June 2020).

  22. 22.

    NICE. Commonly used treatments for chronic pain can do more harm than good and should not be used. 2020. Available https://www.nice.org.uk/news/article/commonly-used-treatments-for-chronic-pain-can-do-more-harm-than-good-and-should-not-be-used-says-nice-in-draft-guidance (accessed September 2020).

  23. 23.

    British Medical Association. PHE report underlines support needed for patients suffering with prescription drug dependence. 2019. Available online https://archive.bma.org.uk/news/media-centre/press-releases/2019/september/phe-report-underlines-support-needed-for-patients-suffering-with-prescription-drug-dependence (accessed June 2020).

  24. 24.

    Nicholas J M, Ridsdale L, Richardson M P, Ashworth M, Gulliford M C. Trends in antiepileptic drug utilisation in UK primary care 1993-2008: cohort study using the general practice research database. Seizure 2012; 21: 466-470.

  25. 25.

    Powell G, Logan J, Kiri V, Borghs S. Trends in antiepileptic drug treatment and effectiveness in clinical practice in England from 2003-2016: a retrospective cohort study using electronic medical records. BMJ Open 2019; DOI: 10.1136/bmjopen-2019-032551.

  26. 26.

    Tomson T, Battino D, Bonizzoni E et al. Declining malformation rates with changed antiepileptic drug prescribing: an observational study. Neurology 2019; 27: 831-840.

  27. 27.

    Medicines and Healthcare products Regulatory Agency. Valproate medicines: contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met. 2018. Available https://www.gov.uk/drug-safety-update/valproate-medicines-epilim-depakote-contraindicated-in-women-and-girls-of-childbearing-potential-unless-conditions-of-pregnancy-prevention-programme-are-met (accessed June 2020).

  28. 28.

    Roberts R, Neasham A, Lambrinudi C, Khan A. A quantitative analysis of antipsychotic prescribing trends for the treatment of schizophrenia in England and Wales. JRSM Open 2018; DOI: 10.1177/2054270418758570.

  29. 29.

    NHS England. Stopping over medication of people with a learning disability, autism or both (STOMP). 2016. Available https://www.england.nhs.uk/learning-disabilities/improving-health/stomp/ (accessed April 2020).

  30. 30.

    Sheehan R, Hassiotis A, Walters K, Osborn D, Strydom A, Horsfall L. Mental illness, challenging behaviour and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. BMJ 2015; DOI: 10.1136/bmj.h4326.

  31. 31.

    Bloom C I, Elkin S L, Quint J K. Changes in COPD inhaler prescriptions in the United Kingdom, 2000 to 2016. Int J Chron Obstruct Pulmon Dis 2019; 14: 279-287.

  32. 32.

    NICE. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. 2018. Available online https://www.nice.org.uk/guidance/ng115 (accessed May 2020).

  33. 33.

    Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. 2018. Available https://goldcopd.org/wp-content/uploads/2017/11/GOLD-2018-v6.0-FINAL-revised-20-Nov_WMS.pdf (accessed May 2020).

  34. 34.

    NICE. Asthma: diagnosis, monitoring and chronic asthma management. 2017. Available online https://www.nice.org.uk/guidance/ng80 (accessed May 2020).

  35. 35.

    Curtis HJ, Dennis J M, Shields B M et al. Time trends and geographical variation in prescribing of drugs for diabetes in England 1998-2017. 2018. Available online http://hdl.handle.net/10871/32973 (accessed May 2020).

  36. 36.

    Wilkinson S, Douglas I, Stirnadel-Farrant H et al. Changing use of antidiabetic drugs in the UK: trends in prescribing 2000-2017. BMJ Open 2018; DOI: 10.1136/bmjopen-2018-022768.

  37. 37.

    Bekkering G E, Agoritsas T, Lytvyn L et al. Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline. BMJ 2019; DOI: 10.1136/bmj.l2006.

  38. 38.

    Ko Y-J, Kim J Y, Lee J et al. Levothyroxine Dose and Fracture Risk According to the Osteoporosis Status in Elderly Women. J Prev Med Public Health 2014; 47: 36-46.

  39. 39.

    NICE. Thyroid disease: diagnosis and management NICE guideline [NG145]. 2019. Available online https://www.nice.org.uk/guidance/ng145 (accessed June 2020).

  40. 40.

    Vaezi M F, Yang Y-X, Howden C W. Complications of proton pump inhibitor therapy. Gastroenterology 2017; 153: 35-48.

  41. 41.

    Othman F. 2016 Proton Pump inhibitor prescribing patterns in the UK: a primary care database study. Pharmacoepidemiol Drug Saf 2016; 25: 1079-1087.

  42. 42.

    Medicines and Healthcare products Regulatory Agency. Proton pump inhibitors in long term use: increased risk of fracture. 2014. Available https://www.gov.uk/drug-safety-update/proton-pump-inhibitors-in-long-term-use-increased-risk-of-fracture (accessed June 2020).

  43. 43.

    Gwee K A, Goh V, Lima G, Setia S. Coprescribing of proton-pump inhibitors with nonsteroidal anti-inflammatory drugs: risks versus benefits. J Pain Res 2018; 11: 361-374.

  44. 44.

    NICE. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. 2014. Available https://www.nice.org.uk/guidance/cg184/resources/gastrooesophageal-reflux-disease-and-dyspepsia-in-adults-investigation-and-management-pdf-35109812699845 (accessed July 2020).

  45. 45.

    NICE. Antimicrobial stewardship: Prescribing antibiotics. 2015. Available online https://www.nice.org.uk/advice/ktt9 (accessed April 2020).

  46. 46.

    Curtis H J, Walker A J, Mahtani K R, Goldacre B. Time trends and geographical variation in prescribing of antibiotics in England 1998-2017.J Antimicrob Chemother 2019; 74: 242-250.

  47. 47.

    McKay J, Begley E, Kerlin P et al. An analysis of the clinical appropriateness of out of hours emergency dental prescribing of antibiotics in Northern Ireland. Br Dent J 2020; 228: 598-603.

  48. 48.

    Audi S, Burrage D R, Lonsdale D O et al. The 'Top 100' drugs and classes in England: an updated 'starter formulary' for trainee prescribers. Br J Clin Pharmacol 2018; 84: 2562-2571.

  49. 49.

    American Dental Association. Managing xerostomia and salivary gland hypofunction. 2015. Available (accessed May 2020).

  50. 50.

    Villa A, Abati S. Risk factors and symptoms associated with xerostomia: a cross-sectional study. Aust Dent J 2011; 56: 290-295.

  51. 51.

    NICE. Oral Health for Adults in Care Homes. 2016. Available online https://www.nice.org.uk/guidance/ng48 (accessed May 2020).

  52. 52.

    Beaumont J, Chesterman J, Kellett M, Durey K. Gingival overgrowth: Part 1: aetiology and clinical diagnosis. Br Dent J 2017; 222: 85-91.

  53. 53.

    Hatahira H, Abe J, Hane Y et al. Drug-induced gingival hyperplasia: a retrospective study using spontaneous reporting system databases. J Pharm Health Care Sci 2017; DOI: 10.1186/s40780-017-0088-5.

  54. 54.

    Mavrogiannis M, Ellis J S, Thomason J M, Seymour R A. The management of drug induced gingival overgrowth. J Clin Periodontol 2006; 33: 434-439.

  55. 55.

    Jinbu Y, Demitsu T. Oral ulcerations due to drug medications. Jap Dent Sci Rev 2014; 50: 40-46.

  56. 56.

    Wakefield Y, Theaker E, Pemberton M. Angiotensin converting enzyme inhibitors and delayed onset recurrent angiooedema of the head and neck. Br Dent J 2008; 205: 553-556.

  57. 57.

    Kennedy W A, Laurier C, Gautrin D et al. Occurrence and risk factors of oral candidiasis treated with oral antifungals in seniors using inhaled steroids. J Clin Epidemiol 2000; 53: 696-701.

  58. 58.

    SDCEP. Management of dental patients taking anticoagulants or antiplatelet drugs. 2015. Available online https://www.sdcep.org.uk/published-guidance/anticoagulants-and-antiplatelets/ (accessed May 2020).

  59. 59.

    SDCEP. Oral health management of patients prescribed bisphosphonates. 2017. Available online https://www.sdcep.org.uk/published-guidance/bisphosphonates/ (accessed May 2020).

  60. 60.

    Specialist Pharmacy Service. What is the clinical significance of potential drug interactions with local anaesthetic preparations used in primary care dentistry? 2015. Available online https://www.sps.nhs.uk/wp-content/uploads/2015/10/NW-QA152.4-Local-anaesthetic-drug-interactions-.pdf (accessed May 2020).

  61. 61.

    Becker D E, Reed K L. Essentials of local anaesthetic pharmacology. Anesth Prog 2006; 53: 98-108, quiz 109-110.

  62. 62.

    Becker D. Cardiovascular drugs: Implications for dental practice. Part 1 - Cardiotonics, Diuretics, and Vasodilators. Anesth Prog 2007; 54: 178-185, quiz 186-187.

  63. 63.

    Bitter R, Demler T, Opler L. Safety evaluation of the concomitant use of clozapine and benzodiazepines: a retrospective, cross-sectional chart review. J Psychiatr Pract 2008; 14: 265-270.

  64. 64.

    Broderick D, Clarke M, Stassen L. Midazolam and drug-drug interactions in dental conscious sedation. J Ir Dent Assoc 2014; 60: 38-43.

  65. 65.

    Patel R, Clayton S, Quintero E, Gill J. Chronic opioid users are more difficult to sedate than alcoholics and controls. South Med J 2015; 108: 744-747.

  66. 66.

    Robb N, Hargrave S. Tolerance to intravenous midazolam as a result of oral benzodiazepine therapy: a potential problem for the provision of conscious sedation in dentistry. Anesth Pain Control Dent 1993; 2: 94-97.

  67. 67.

    Becker D. Psychotropic drugs: implications for dental practice. Anesth Prog 2008; 55: 88-99.

  68. 68.

    SDCEP. Drug prescribing for dentistry: Dental Clinical Guidance (Third Edition). 2016. Available http://www.sdcep.org.uk/wp-content/uploads/2016/03/SDCEP-Drug-Prescribing-for-Dentistry-3rd-edition.pdf (accessed June 2020).

  69. 69.

    Dechanont S, Maphanta S, Butthum B, Kongkaew C. Hospital admissions/visits associated with drug-drug interactions: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf 2014; 23: 489-497.

  70. 70.

    Marengoni A, Pasina L, Concoreggi C et al. Understanding adverse drug reactions in older adults through drug-drug interactions. Eur J Intern Med 2014; 25: 843-846.

  71. 71.

    Davidson B L, Verheijen S, Lensing A W A et al. Bleeding Risk of Patients with Acute Venous Thromboembolism Taking Nonsteroidal Anti-Inflammatory Drugs or Aspirin. JAMA Intern Med 2014; 174: 947-953.

  72. 72.

    Moore P A, Ziegler K M, Lipman R D, Aminoshariae A, Carrasco-Labra A, Mariotti A. Benefits and harms associated with analgesic medications used in the management of acute dental pain: an overview of systematic reviews. J Am Dent Assoc 2018; 149: 256-268.

  73. 73.

    Crighton A J, McCann C T, Todd E J, Brown A J. Safe use of paracetamol and high-dose NSAID analgesia in dentistry during the COVID-19 pandemic. Br Dent J 2020; 229: 15-18.

  74. 74.

    NHS Digital. Prescription cost analysis of prescriptions dispensed in the community in England 2018. 2019. Available online https://digital.nhs.uk/data-and-information/publications/statistical/prescription-cost-analysis/2018 (accessed April 2020).

Download references

Acknowledgements

The authors would like to thank Dr Rupert Ransford, Consultant Gastroenterologist and British Society of Gastroenterology Clinical Guidelines Lead; Dr Alex Crighton, Consultant/Honorary Senior Lecturer in Oral Medicine; Dr Nick Walker, Occupational Health Physician; Anne-Marie Rawlins for data capture; and Heather Lewis for the presentation of Appendix 1.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Nicholas Ransford.

Ethics declarations

The authors declare no conflicts of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ransford, N., Marnell, B., Randall, C. et al. Systemic medicines taken by adult special care dental patients and implications for the management of their care. Br Dent J 231, 33–42 (2021). https://doi.org/10.1038/s41415-021-3180-z

Download citation

Search

Quick links