Polypharmacy in older adults significantly increases the risk of adverse drug reactions affecting the oral cavity, which frequently manifest as functional salivary impairment and structural modifications like gingival overgrowth, according to a prospective observational case series. Conducted over six months at a tertiary care teaching hospital, the interdisciplinary study evaluated 10 adult patients taking five to eight concurrent medications, classifying 80% of the observed oral adverse drug reactions as probable using the Naranjo scale.
Interdisciplinary Hospital Evaluation Identifies Oral Adverse Drug Reactions in Patients on Polypharmacy
Managing multimorbidity often requires older adults to take five or more concurrent systemic medications, creating a clinical environment where adverse drug reactions frequently develop.
The study enrolled ten adult patients who developed new-onset oral lesions or functional oral impairment while taking five to eight concurrent medications. Led by an interdisciplinary team comprising a dentist alongside pharmacologists and prescribing physicians, the protocol combined comprehensive medication reconciliation with structured oral examinations. Researchers utilized the Naranjo Adverse Drug Reaction Probability Scale, the Modified Hartwig and Siegel Severity Assessment Scale, and the Schumock and Thornton preventability criteria to evaluate each case.
Antihypertensives and Anticonvulsants Implicated in Functional and Structural Oral Impairments
The patient cohort evaluated at the hospital had a mean age of 67.8 years, ranging from 55 to 80 years old, with 60 percent male and 40 percent female participants. Underlying comorbidities among the group included hypertension in 40 percent of patients and type 2 diabetes mellitus in 50 percent. The resulting oral adverse drug reactions spanned both functional impairments and structural modifications, with drug-induced xerostomia and fibrotic gingival overgrowth each accounting for 20 percent of the observed cases.
Causality assessments using the Naranjo scale classified eight of the ten reactions, or 80 percent, as probable, while the remaining two reactions were categorized as possible. The medication classes most frequently implicated in these toxicities were antihypertensives, anticholinergics, and anticonvulsants. Individual cases also identified pseudomembranous candidiasis, oral mucositis, and a suspected early case of medication-related osteonecrosis of the jaw.
Severity Grading and Preventability Criteria Reveal Moderate Clinical Impacts
Evaluating the clinical impact of these oral complications showed that 70 percent of the reactions were moderate, requiring a change in treatment, specialist referral, or targeted dental intervention under the Modified Hartwig and Siegel scale. The remaining 30 percent of cases were classified as mild, and no severe reactions were observed. Preventability assessments using the Schumock and Thornton criteria determined that 60 percent of the adverse drug reactions were probably preventable, 10 percent were definitely preventable, and 30 percent were not preventable.
Interdisciplinary management successfully paired pharmacological modifications, such as drug substitution or dose tapering, with targeted topical treatments and dental scaling.
Frequently Asked Questions About Polypharmacy and Oral Health
What oral conditions are most commonly linked to polypharmacy?
The study identified xerostomia, or severe dry mouth, and fibrotic gingival overgrowth as the most frequently encountered oral adverse drug reactions, each accounting for 20 percent of the evaluated patient cohort.
Which medication classes most often cause oral toxicity in older adults?
Antihypertensives, anticholinergics, and anticonvulsants were the drugs most frequently implicated in the observed oral lesions and functional impairments.