Polypharmacy and Oral Health: Managing Medication Side Effects What Do You Need to Know?

What is Polypharmacy?

Polypharmacy is a term that might sound complex, but it simply means the use of five or more medications at the same time (1-3). However, the issue is not only about the number of medications. Polypharmacy also includes situations where medications are used for inappropriate reasons, unnecessarily combined, or prescribed to treat the adverse effects of other drugs. The World Health Organization and various studies, including systematic reviews of definitions, have highlighted the increasing prevalence of polypharmacy, especially among older individuals. This trend is important to recognize because the implications of polypharmacy are far-reaching and can significantly affect both oral health outcomes and overall health, particularly in elderly individuals.

Risk Factors for Polypharmacy 

There are two main categories of risk factors contributing to polypharmacy: those related to patients and those associated with the healthcare system (1,4-6). 

Patient-Related Factors 

As people age, they often need more medications to manage chronic diseases, like diabetes mellitus, Parkinson’s disease, and multiple sclerosis, all of which require long-term pharmacological management. This increase in medication use can lead to polypharmacy (7). Additionally, having multiple diseases at once (known as multimorbidity) can also result in polypharmacy along with other side effects (8). 

  Many older people also experience cognitive decline, difficulties with activities of daily living, and need complex treatment plans. These conditions, along with polypharmacy, contribute to poor oral health, tooth loss, reduced salivary flow, and complications like dry mouth and dysgeusia. Furthermore, the number of teeth often declines with age and is significantly correlated with the degree of oral health status, especially in patients taking medications known to impact salivary flow. 

Health System-Related Factors 

The health system also contributes to polypharmacy. There aren’t enough primary care doctors to manage medications properly, and sometimes doctors don’t know enough about drug side effects and interactions (7). Many healthcare professionals may not be fully aware of the oral health implications of the medications they prescribe, such as tricyclic antidepressants or drugs with anticholinergic properties. The “prescription cascade,” where new medications are added to treat the adverse effects of other medications—further exacerbates the problem (9-10). This is particularly prevalent in the United States, where patients across various stages of life may receive care from multiple providers, making it difficult to track medical records or assess cumulative medication burdens. 

Complications of Polypharmacy 

Polypharmacy can lead to several problems, including adverse drug events (ADEs), inappropriate medication uses in the elderly, drug interactions, higher treatment costs, more hospitalizations, and increased mortality. The more medications you use, the higher the risk of side effects. 

These complications are especially dangerous when they impact the oral cavity. For example, many commonly prescribed drugs can reduce salivary gland function, leading to xerostomia. As salivary flow decreases, patients may develop oral conditions such as dental caries, periodontal disease, and oral infections. These issues not only compromise oral health care but also increase the risk of hospitalizations, elevate treatment costs, and contribute to adverse outcomes, including mortality. 

Polypharmacy and Dry Mouth in Older Adults: A Scientific Perspective 

Polypharmacy is a significant risk factor for dry mouth (xerostomia) in older adults. Older adults are particularly vulnerable to polypharmacy and its associated risks, as they often take multiple medications for chronic conditions. Many commonly prescribed medications have anticholinergic or sympathomimetic side effects that reduce saliva production, leading to various oral health problems and negatively impacting quality of life. 

Mechanism of Dry Mouth: Several medications, including antidepressants, antipsychotics, and antihistamines, can reduce saliva production by affecting the nerves responsible for stimulating salivary glands. Additionally, some medications can cause dehydration or damage salivary glands, further contributing to dry mouth. 

Impact: Additionally, some medications cause dehydration or may even cause long-term damage to salivary tissues, which can be especially problematic for elderly individuals or those with underlying conditions such as cognitive impairment or Parkinson’s disease. The result is often a severe dip in saliva production, contributing to difficulty swallowing, chewing, speaking, and an inability to tolerate dentures comfortably. 

Managing Medication-Induced Dry Mouth 

An effective management plan for medication-induced xerostomia involves several components: 

• Medication Review: Pharmacists and providers should regularly examine medical records to assess for medications contributing to dry mouth, dysgeusia, or other oral health issues. 

• Deprescribing: Where appropriate, providers can consider reducing or discontinuing certain drugs to minimize adverse effects and improve oral health outcomes. 

• Non-Pharmacological Interventions: Patients should be encouraged to adopt thorough oral hygiene practices, avoid alcohol and caffeine, and use sodium fluoride varnish to prevent dental caries and protect tooth enamel. 
• Cholinergic Agonist Medications: These may be prescribed in specific cases to stimulate salivary flow and support oral health. 

Polypharmacy can lead to various oral health problems. MetaQil and Lubricity offer solutions to some of these issues, helping patients manage side effects and improve their overall well-being.

Oral Health Solutions: MetaQil® and Lubricity® 

Addressing Dysgeusia with MetaQil® 

One of the lesser known but highly disruptive consequences of polypharmacy is dysgeusia, a metallic or unpleasant taste in the mouth. This condition interferes with eating, lowers nutritional intake, and contributes to malnutrition, particularly in older adults. MetaQil®, a scientifically formulated oral rinse, helps neutralize metallic taste sensations restoring normal taste function. By enhancing food enjoyment, it plays a critical role in improving nutritional status and activities of daily living.

Relieving Dry Mouth Symptoms with Lubricity® 

Lubricity® is a clinically tested saliva substitute that provides long-lasting relief from dry mouth symptoms caused by polypharmacy. Its unique formulation helps maintain moisture in the oral cavity, making it easier to chew, swallow, and speak comfortably. In doing so, it not only alleviates symptoms of xerostomia but also reduces the risk of oral infections, tooth loss, and periodontal disease. For special care dentistry providers—such as those working in geriatric or palliative settings—Lubricity® is a valuable tool to enhance oral health care and overall health. 

Complementing Broader Polypharmacy Strategies

MetaQil® and Lubricity® are not stand-alone products; they work best when integrated into comprehensive treatment plans for managing polypharmacy. Alongside deprescribing efforts, medication reviews, and patient education, these products help support the oral health and comfort of older individuals. Their use reflects a proactive, preventive approach that aligns with best practices outlined by organizations such as the Journal of the American Geriatrics Society (JAGS) and its coverage of special care dentistry. 

Improving Quality of Life Through Oral Health

By addressing oral health problems associated with polypharmacy, MetaQil and Lubricity can enhance the overall quality of life for patients. They help patients feel more comfortable and enjoy their daily activities without the burden of unpleasant side effects. 

Polypharmacy remains a major challenge for both patients and healthcare providers. However, with the right interventions—including evidence-based oral care solutions like MetaQil® and Lubricity®—it is possible to significantly reduce the impact of polypharmacy on both oral health and quality of life. By addressing the specific needs of elderly individuals and improving their oral conditions, these tools empower patients to regain comfort, function, and enjoyment in their daily lives