By: Dr. Aisyah Ahmad Fisal, Dr. Goh Yet Ching
Polypharmacy, the concurrent use of multiple medications, is a growing global public health concern. According to a 2023 article in The Lancet, polypharmacy increases the economic burden on healthcare systems by driving up drug costs and expenses associated with managing medication-related harm. In response, the World Health Organization (WHO) launched the “Medication Without Harm” initiative in 2017 to address these concerns, particularly for older adults with multiple chronic conditions.
A 2020 study in Nature Scientific Reports found that polypharmacy is especially prevalent among the elderly, with approximately 46.6% of older adults experiencing it. This practice is associated with significantly higher risks of hospitalization and mortality, underscoring the adverse impact of polypharmacy on health outcomes in vulnerable populations. The prevalence of polypharmacy is expected to increase, posing a significant health challenge for patients with multimorbidity, or two or more long-term conditions.
Polypharmacy generally refers to the use of at least five medications, including prescription drugs, over-the-counter medicines, and traditional or complementary remedies. While appropriate polypharmacy can be beneficial by achieving specific therapeutic objectives, inappropriate polypharmacy—where unnecessary medications are prescribed—raises the risk of adverse effects.
Factors like comorbidities, clinical conditions, allergies, and potential drug interactions should be carefully considered when prescribing medications. Vulnerable patient groups, particularly those over 65 years of age, frail individuals, and those dependent on others for daily activities, are especially susceptible to adverse drug reactions, medication adherence issues, and drug-drug interactions.
Impact on oral health
Polypharmacy can significantly affect oral health. Side effects such as dry mouth (xerostomia), gingival overgrowth, altered taste, increased risk of fungal infections, and a burning sensation in the mouth are common among patients taking multiple medications. Medications like antihistamines, antidepressants, anticholinergics, muscle relaxants, and diuretics often reduce saliva production, leading to dry mouth. Since saliva is crucial for moisturizing the oral cavity and maintaining a balanced oral environment, reduced saliva can increase the risk of tooth decay, gum disease, and oral infections. For patients with dentures, dry mouth may cause discomfort and affect the fit of their dentures, potentially leading to difficulties in eating and increased risk of malnutrition.
Certain drugs, such as anticonvulsants (e.g., phenytoin) and calcium channel blockers, can cause gum enlargement (gingival hyperplasia), which complicates oral hygiene and raises the risk of periodontal disease. Additionally, some medications may alter taste perception, impacting appetite and nutrition, which can further affect overall health.
The risk of oral infections in patients with polypharmacy can also increase due to immunosuppressive medications or conditions like dry mouth. Immunotherapy and cancer treatments, for instance, may weaken the immune system and heighten susceptibility to infections. The most common oral infection among those on polypharmacy is Candidal infection, often presenting as removable white patches (thrush) in the mouth.
A collaborative approach to managing polypharmacy
Effectively addressing polypharmacy requires a multidisciplinary approach. Raising awareness among patients is crucial, empowering them to play a central role in preventing and recognizing inappropriate medication use. Healthcare professionals, including physicians and pharmacists, should conduct regular medication reviews for patients at high risk of polypharmacy—such as those taking five or more medications, those with multiple comorbidities, and nursing home residents who are often elderly and frail.
Dentists should also play an active role by encouraging regular dental check-ups, especially for patients on multiple medications who are prone to dry mouth and other oral health issues. Oral health education should emphasize managing the effects of polypharmacy, with recommendations like maintaining effective oral hygiene, using saliva substitutes, and making dietary adjustments such as sipping water frequently to stay hydrated.
We urge patients, caregivers, and healthcare providers to take proactive steps. Patients and their families should keep a detailed list of all medications, including over-the-counter and herbal products, and discuss it with their healthcare team during every visit. Regularly consult with your dentist, especially if you are taking multiple medications, to address any oral health issues early. By staying informed, asking questions, and scheduling regular check-ups, we can all work together to ensure safer medication use and improve overall health outcomes.
Dr. Aisyah is from the Department of Paediatric Dentistry and Orthodontics, while Dr. Goh is from the Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya.