Navigating medication risks in elderly patients: Essential tips for dental hygienists

The “Silver Tsunami” is here. By 2030, one in five Americans will be over the age of 65, sending a wave of medically complex patients to dental offices.¹ As life expectancy rises, so does the prevalence of chronic conditions and medication use, making it more critical than ever for dental professionals to recognize and mitigate medication-related risks.

Many seniors take medications that affect their oral health, while others face physical and cognitive challenges that make maintaining oral hygiene difficult. Dental hygienists play a crucial role in recognizing these factors and ensuring they’re addressed appropriately. By staying vigilant about medication effects, mobility restrictions, and cognitive changes, hygienists can help facilitate proper care through collaboration with dentists.

This guide highlights key considerations for managing medication risks, assisting patients with physical and cognitive challenges, and supporting preventive care strategies tailored to the needs of older adults.

Consider medication effects during treatment

Many older patients take medications that impact their oral health,² and hygienists should be aware of potential risks while performing cleanings and assessments. When treating older patients, understanding how medications interact is key to preventing complications. Resources such as the American Geriatrics Society’s Beers Criteria and the MedAssent DDS Digital Drug Handbook can help dental professionals quickly assess drug interactions and adjust treatment plans accordingly.^3,4

As life expectancy rises, so does the prevalence of chronic conditions, increasing the need for oral health care among seniors.⁵ Notable considerations include:

● Hydration and dry mouth. Many common medications, including anticholinergics, SSRIs, and SNRIs (antidepressant medications), cause xerostomia, which increases the risk of caries, oral infections, and difficulty wearing dentures.^6-9 If a patient presents with signs of dry mouth, inform the dentist, who may recommend interventions such as fluoride treatments, or simple solutions such as hydration, sugar-free lozenges or gum, and saliva substitutes.

● Bleeding risks. Patients on anticoagulants, cardiovascular medications, NSAIDs, or baby aspirin may be at an increased risk for excessive bleeding during procedures.¹⁰ Before performing deep cleanings or probing, check for any indications of prolonged bleeding and notify the dentist if concerns arise. Routine screenings for candidiasis and proactive bleeding management may also be beneficial.

● Identifying warning signs. Medication side effects can contribute to gingival overgrowth,¹¹ xerostomia, bruxism, oral infections, and periodontal disease. Anticonvulsants such as phenytoin and lamotrigine, or calcium channel blockers such as amlodipine, can lead to excessive gingival hyperplasia, complicating oral hygiene.¹² Emerging research highlights the connection between periodontal disease and systemic health, indicating that oral bacteria can enter the bloodstream and potentially contribute to cardiovascular issues, pneumonia, and Alzheimer’s disease.¹³ If you observe these symptoms, they should be documented and brought to the dentist’s attention.