Medication Without Harm in Dentistry

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27 September 2022

RCSEd Communications Team

As part of a series of blog posts surrounding World Patient Safety Day 2022's theme of 'Medication Safety', Dental Representative on the Patient Safety Group Mrs Claire Morgan looks at medication without harm in dentistry.

In 2017 the WHO published a seminal document Medication Without Harm which lays out the issues of the theme for this year's World Patient Safety Day which took place on 17 September. Harm from Medication accounts for 50% of the overall preventable harm in medical care; US$ 42 billion of global total health expenditure worldwide could be avoided if medication errors are prevented. Harm from medication can also occur in dentistry - the Faculty of Dental Surgery of the Royal College of Surgeons of Edinburgh fully endorse minimising risks to patients.

Patients and Public

Empower patients - to understand their medications by discussing their medications with them
Advise patients - to carry written up to date list of all their medications which can be supported using systems such as My Medication Passport

Dental Care Professionals

Medical records - medical histories should be regularly updated with alongside medications
Keep up to date - download the British National Formulary (BNF) App

Medicines

Be aware of the guidance for the management of patients taking:

Anti-resorptive and Anti-angiogenic drugs - the risk of osteonecrosis is variable and well explained to DCPs and patients in current guidance, allowing for appropriate patient management in primary care
Anticoagulant and antiplatelet therapy - with a multitude of new anticoagulant therapies, guidance has just been updated to allow safe care patient for described dental procedures
Antimicrobial resistance - in 2014 the O’Neill report informed that if antimicrobial resistance was not addressed this would result in 10 million deaths globally every year by 2050 with a cost of £66 trillion to the global economy. Understanding antimicrobial resistance and appropriate antibiotic prescribing will impact on this. Training is available from BOAS e-learning which will also provide 3 hours of GDC mapped e-CPD
Chemotherapy - when treating patients who are undergoing chemotherapy platelets and white blood cell counts before carrying out any invasive treatment ensure clotting risk and white blood cell count risks are fully understood. Discuss with oncology care teams. Do not extract teeth when platelet counts are below 50 × 10³/μL and neutrophil counts are below 1,000/μL

Systems and Practices of Medications

Tooth ache - educate patients that antibiotics do not cure toothache, this will allow appropriate first line management of acute pulpitis and periapical periodontitis such as pulp extirpation, tooth extraction and pus drainage. Be aware of the dental antimicrobial stewardship (AMS) toolkit
Oral pain relief - when advising patients to take oral pain relief ensure they are aware of maximum safe dosage and risks: 4000mg paracetamol in a 24 hour period, 2400mg ibuprofen in a 24 hour period
Drug interactions - consult the BNF for example the effect of Metronidazole on Warfarin
Allergies - always inform patients to stop taking any medication when prescribed if they develop a rash

Claire Morgan is a Consultant in Restorative Dentistry and an RCSEd Dental Council Member.

Dental

Patient Safety

The College

Medication Safety: Putting the Patient First

World Patient Safety Day 2022: Objectives and Resources