Pharmacists as Members of the Oral Healthcare Team

Anna Morin, PharmD

(1) The Foundation has created an inter-disciplinary framework for pharmacists to play an active role in oral disease prevention, identification, assessment, and referral. Community pharmacists are among the most accessible health professionals and are in a unique position to disseminate information on oral health, especially to those who lack or have limited access to dentists and other oral health professionals.

Levels of pharmacist involvement in the promotion of oral health initiatives include providing advice and education regarding:

• Over-the-counter (OTC) and prescription oral products

• Smoking cessation

• Signs and symptoms of oral conditions

• Referrals to and endorsement of advice from oral health professionals

• The link between oral health and chronic systemic diseases

• Medication adverse effects including: mouth ulcers, xerostomia, or osteonecrosis

• Healthy eating with a reduction in and frequency of sugar consumption

Older patients, in particular, can benefit from oral health services provided by pharmacists. These patients are often taking several prescription and OTC medications for numerous chronic diseases. Pharmacists should monitor patients’ pharmacotherapy for adverse oral health events and talk with both patients and caregivers about the relationship of oral hygiene and overall health. The Beers list of medications serves as an evidence-based guide for identifying the most problematic drugs that should be avoided in older adults. (2) Medications, such as anticholinergics, cause dry mouth or xerostomia, which increases the volume of caries-causing bacteria and plaque and causes a more acidic pH ultimately leading to dental caries. Pharmacists can suggest to patients to talk to their providers about medications that cause xerostomia, saliva substitutes, and the use of fluoride rinses to protect teeth. As part of smoking cessation interventions, pharmacists should discuss oral health advantages of quitting smoking with tobacco users and recommend treatments that can help them stop using tobacco products. Dental pain and oral lesions are the most common reasons patients seek advice on OTC products in pharmacies. Products include topical and oral analgesics for tooth pain and oral lesions, such as canker sores, ulcerations, stomatitis, and candidiasis. Being knowledgeable about the signs and symptoms of oral cavity cancer (i.e., mouth pain; difficulty or painful swallowing; white or reddish patches inside the mouth; lip or mouth sores that do not heal), allows pharmacists to appropriately refer patients with these symptoms for medical care. (3) Sugar (in the form of fructose, glucose, and sucrose) is a well-known cause of tooth decay and is often used as flavoring in liquid forms of medication, particularly those used by children. Pharmacists can support prevention of early childhood caries by suggesting and/or compounding medications containing sugar-free flavoring alternatives.

Oral health is essential to overall health and quality of life. Efforts to promote oral health should be standard of care and incorporated as part of the pharmacist’s medication therapy management services for all patients. Knowledgeable, well-respected and accessible, community pharmacists are in an ideal position to team up with oral health professionals to reduce the incidence of potentially preventable oral conditions including dental caries, gum disease, and oral cancer. Ongoing education and training is important for pharmacists to provide patient-centered care in the area of oral health.

References:

1. The American Pharmacists Association (APhA) Foundation: Oral Health Initiatives. Available at: https://www.aphafoundation. org/oral-health/our-work. Accessed November 19, 2020.

2. American Geriatrics Society 2019 Beers Criteria Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674–94.

3. Mouth cancer: symptoms and causes. Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/mouth-cancer/ symptoms-causes/syc-20350997. Accessed November 19, 2020.

Anna Morin, PharmD Dean, School of Pharmacy-Worcester/Manchester MCPHS University