Side effects of drugs in Multiple Sclerosis
Multiple Sclerosis medical history
In general most of the patients don’t consider important to reveal their medical conditions or information regarding the medications intake they are using to the dentist and in most cases they don’t report them. Its our responsibility as practitioners to inform and educate the patient how these systemic conditions of their health can change the dental treatment outcome. Most of the drugs that patients might be using interfere with drugs that are used in dentistry. The effects might be unpredictable if the dentist hasn’t been informed about the pharmacological history during the medical assessment. This can potentially compromise client’s safety and function.
How is a dental professional related to ms patients?
One of the reasons why dentists or the dental hygienist need to have a general idea about the progression of this disease is the medications that these patients take to reduce the negative effects in their lifestyle caused by the disease it self. A dental professional should consider the fact that almost all the drugs that cure MS have enormous side effects. Dental professionals need to know the effect of the drugs and how can they interfere with the dental treatment. Ms drugs have enormous side effects that not only interfere with the dental treatment but they can cause dental emergencies unexpectedly as well.
First steep in assessing patient’s pharmacological history
First thing a clinician should do is making a list of all the medications that the patient is taking including prescription drugs, over the counter OTC drugs, frequency of the intake, and the instructions that are suggested to use. If any concerns may arise during the interview with the patient a consultation with the physician that has prescribed these documents should be considered.
Preparing for Multiple Sclerosis treatment?
A Dental Hygienist should ask him self:
What is the condition that the patient is taking these medications?
- It could be an acute systemic disease. Usually drugs for these types of conditions are prescribed for a short duration to eliminate infections, pain, cough, cold etc.
- It could be a Chronic disease – in these kinds of conditions medications are prescribed to treat a disease that has been present from time to time or constantly in patients body. The effect of these medications is longer the ones used in acute conditions.
- It could be to prevent a systemic condition from happening. For example taking oral contraceptives to avoid pregnancy ( these meds can change the hormonal balance), or hypertensive patients take antihypertensive drugs to control their blood pressure.
- Some patients might be narcotic substance abusers like cocaine or substances with no clinical needs like alcohol.
The symptoms reported from the patient, are they caused by drugs usage or the disease it self?
Investigate the symptoms of the disease. This is a very challenging question that can’t be always successfully answered. Dentist or dental hygienist should try to mach the findings and the symptoms of the patient with the drugs effect that the patient is taking. Once this match is clear then a decision to weather to continue the treatment or not depends on how these factors will interfere with the dental treatment.
What are the adverse reactions of the drugs that the patient is taking?
Drugs are regulated to ensure quality and promote health by FDA Food and Drugs Administration, but it doesn’t mean that these drugs that are FDA approved cant cause secondary harm. Because almost all the drugs have adverse reactions in the humans body concerns to the dental practitioner are always present since some specific drug adverse effects can complicate the dental treatment. To better understand how to take the right decision when dealing with patients that are going under pharmacological treatment a dentist or dental hygienist should first understand the undesirable reactions specific drugs cause. There are three important points to remember. Adverse drug effects include
1) Side effects, (when a drug is administered it effects not only the primary tissue where its supposed to react, but it also effects nontarget tissue or organs)
2) Toxicity, drugs sometimes induces toxicity which is an active metabolite produced in liver or kidneys due to complicated biochemical reactions caused from the drug and one of these two organs. Drug toxicity can biologically damage the human cells and it becomes life threatening if involves entire systems like the breathing system.
3) Drug hypersensitivity, happens when the drug chronically causes a specific immune response that can lead to anaphylactic reaction or simply a mild allergic reaction. Usually patients that report allergies to a specific classification of drug will be allergic to all the drugs that enter in the same classification. Sometimes drugs from different classifications can interact with each other and cause a cross sensitivity reaction.
Some drugs can cause teratogenicity which means that the drugs can effect the fetal development in pregnant women ( that’s why it is strongly advised not to take any medications during the pregnancy, especially the first trimester). This happens to avoid any unknown complications that drugs might cause to the fetus since drugs can cross the placenta and effect the baby’s health.
If patient is taking more then one medication in the same time can they interact with each other?
By knowing the effect of drug interaction we can prevent the undesired consequences, or at least worsen them. If patient is taking one medication and we prescribe another one, the second drug might increase the effect of the first drug till a point where it can cause a medical emergency. By knowing the effects of the interactions we can avoid complications. It is important to know if the patient is self-medicating, expiration of the meds and instructions prescribed from the physician or the pharmacist.
Can the medication cause oral side effects? Can it require intervention?
Some meds can cause oral traumas, infections or even tooth loss. These side effects increase patient’s discomfort and decrease normal oral functionality. One of the most common oral side effects is drug induced xerostomia. Some drugs can reduce the salivary flow within the oral cavity and change the ph into acidic. Acid environment in the oral cavity leads to multiple dental concerns. For example acid combined with food and plaque leads to carries. Xerostomia induced dental carries is usually seen along the exposed roots (associated with severe recession), along the gingival margins of the tooth or crowns and bridges. If for example the patient suffers from leukemia and he is taking immunosuppressant medications like corticosteroids, should the patient discontinue the corticosteroids just because it causes xerostomia? Absolutely not! We can avoid carries activity progression by prescribing saliva stimulants (e.g pilocarpine), placing the patient under active fluoride therapy treatment and give frequent oral hygiene instructions to improve and interface oral self care at home or prescribe oil base mouth rinses to reduce micro bacterial flora in the oral cavity and avoid micropathogens cause infections since the patients immune system is suppressed.
Drugs cocktails are assumed to be number one cause of deaths in the states. Michael Jackson died because of a heart attack due to anesthetic and pain killer mixture