HJAR Sep/Oct 2020

44 SEP / OCT 2020 I  HEALTHCARE JOURNAL OF ARKANSAS ORAL HEALTH by the dental and medical provider is essen- tial. Through future policy changes promot- ing education of the whole body approach in both academics and clinical practice, the public will benefit from better health out- comes 14 . Communication in interdisciplin- ary practice will promote positive health outcomes for treating in the patient’s best interest. n REFERENCES 1 Martin CB, Hales CM, Gu Q, Ogden CL. Prescription drug use in the United States, 2015–2016. NCHS Data Brief, no 334. Hyattsville, MD: National Center for Health Statistics. 2019. 2 Swager,LaurenW.M.,and Susan K.Morgan.“Psycho- tropic-induced dry mouth: don’t overlook this poten- tially serious side effect: routine screening,education can help patients avoid substantial sequelae.”Current Psychiatry, vol. 10, no. 12, 2011, p. 54+. Accessed 12 July 2020. 3 Guggenheimer J, Moore PA. Xerostomia: etiol- ogy, recognition and treatment. J Am Dent As- soc. 2003;134(1):61-119. doi:10.14219/jada. archive.2003.0018 4 Ciancio SG.Medications’impact on oral health.JAm Dent Assoc. 2004;135(10):1440-1469. doi:10.14219/ jada.archive.2004.0055 5 Hans R, Thomas S, Garla B, Dagli RJ, Hans MK. Effect of Various Sugary Beverages on Salivary pH, Flow Rate, and Oral Clearance Rate amongst Adults. Scientifica (Cairo). 2016;2016:5027283. doi:10.1155/2016/5027283 https://www.ncbi.nlm. nih.gov/pmc/articles/PMC4802044/ 6 Kalra S, Jain V. Dental complications and manage- ment of patients on bisphosphonate therapy: A re- view article.J Oral Biol Craniofac Res.2013;3(1):25-30. doi:10.1016/j.jobcr.2012.11.001 7 Spadari F, Rossi M, Costantino D, Azzi L, Bombec- cari GP. C-terminal cross-linking telopeptide test in course of bisphosphonate-associated osteonecrosis of the jaws.Ann Stomatol (Roma).2014;5(2 Suppl):46. Published 2014 May 9. 8 Kandaswamy E,Kumar P,Oral Effects of Cancer Care. Decisions in Dentistry. 2018, Nov. 6.https://decision- sindentistry.com/article/oral-effects-of-cancer-care/ 9 Tungare S,ParanjpeAG.Drug Induced Gingival Over- growth (DIGO) [Updated 2019 Dec 20]. In: StatPearls [Internet].Treasure Island (FL): StatPearls Publishing; 2020 Jan-.Available from: https://www.ncbi.nlm.nih. gov/books/NBK538518/ 10 Samudrala P, Chava VK, Chandana TS, Suresh R. Drug-induced gingival overgrowth: A critical insight into case reports fromover two decades.J Indian Soc Periodontol. 2016;20(5): 496-502. doi:10.4103/jisp. jisp_265_15 11 Lionel D, Christophe L, Marc A, Jean-Luc C. Oral mucositis induced by anticancer treatments: phys- iopathology and treatments. Ther Clin Risk Manag. 2006;2(2):159-168. doi:10.2147/.tcrm.2006.2.2.159 12 Chahine J, Khoudary MN, Nasr S. Anticoagulation Use prior to Common Dental Procedures: A System- atic Review. Cardiol Res Pract. 2019;2019:9308631. Published 2019 Jun 2. doi:10.1155/2019/9308631 13 Boccio E, Hultz K, Wong AH. Topical Tranexamic Acid for Hemostasis of an Oral Bleed in a Patient on a Direct Oral Anticoagulant. Clin Pract Cases Emerg Med. 2020;4(2):146-149. Published 2020 Mar 27. doi:10.5811/cpcem.2020.1.45326 14 Gambhir RS.Primary care in dentistry -An untapped potential.J FamMed PrimaryCar 2015;4:13-8. bleeding and intraoral ulceration. This con- dition makes it difficult to eat and swallow. Many times, it can be so severe that a feeding tube is placed for the first couple of weeks, until the inflammation has subsided. Use of alcohol, tobacco products, poor oral hygiene, diabetes, HIV, or kidney disease can worsen the condition. Anticoagulants, or blood thinners, are a major drug prescribed for many stroke, ar- rhythmia, and cardiovascular patients. The key is knowing the dosage, and preparing for dental treatment 12 . These drugs not only make gums and tissues bleed when given to a patient with poor oral health, they can cause mouth irritation due to inflammation, and ex- hibits in patient discomfort. For many stroke patients, they are advised not to stop antico- agulants before dental treatment or surgery, as it poses a risk for stroke. It is extremely important to understand and interpret plate- let levels in the anticoagulant patient, and especially in the medically compromised, before proceeding with dental surgery. Stopping the anticoagulant is an option, although this presents a risk for the stroke patient. If stopping this drug is the option, it is important to treat as much in a single visit, versus delivering treatment in multiple vis- its and stopping this anticoagulant multiple times. Other treatment modalities are used, such as tranexamic acid, which is used topi- cally in liquid form when performing tooth extractions 13 . Tranexamic acid is an antifibri- nolytic agent used to control bleeding. Interdisciplinary treatment of the patient ultimately best to have dental treatment first, before taking a bisphosphonate. Injections and infusions have the largest impact, but a patient who has taken oral bisphosphonates for multiple years can have a CTX test, which measures the bisphosphonate amount, and gives a baseline number. This test measures the rate of bone turnover, and gives health- care providers knowledge in determining if patients are at risk of developing osteone- crosis if they have taken this drug 7 . Cardiovascular medications, non-steroi- dal anti-inflammatory, respiratory inhalants, chemotherapy, and smoking cessation drugs can cause dysgeusia (altered taste) or ageusia (loss of taste) in the oral cavity. Usually, sweet sensations are lost initially, followed by dys- geusia, then ageusia. In radiation therapies, dysgeusia is reported to be a 70 percent inci- dence in patients receiving radiation therapy 8 . Gingival overgrowth, or tissue hypertro- phy, can be caused by anticonvulsants, im- munosuppressants, and calcium channel blockers 9 . The gum tissue becomes swollen as it grows over the teeth, which can increase the risk of developing periodontal disease. Often times, this excess tissue must be surgi- cally removed if not maintained adequately with proper oral hygiene. This occurs espe- cially in the special needs population, and in those who do not exhibit meticulous oral hygiene 10 . Mucositis, which is inflammation of the mucosa intraorally, can be caused by che- motherapy medications and radiation ther- apy 11 . It is a painful swelling, which leads to “The bisphosphonate class of drugs has a huge impact on oral health. It is recommended that a drug “holiday” be taken to rid the drug in the patient’s system if dental surgery is warranted.”