We have all been educated to review our patients’ health histories prior to every dental appointment, but are we seeing the red flags some health histories wave? With today’s over-prescribed pain and anti-depressant medications, close attention needs to be paid to the patient sitting in our dental chair. We are in a prime position to be a positive influence in more than their dental care, but perhaps their quality of life as well.
The obvious dental-medication connection we observe is the devastating effect multiple medications may have on a patient’s oral health. Dental decay and decalcification, medication-induced xerostomia, excess biofilm build-up, Candida infections, burning mouth syndrome, and fissured tongue, are interrelated and often the result of prescription medications.
We have been educated to treat many of the above conditions with in-office fluoride treatment and at-home fluoride trays, as well as rinses, toothpaste, and other dry mouth products, which can soothe and comfort a dry mouth. If Candida is involved, the patient often leaves with yet another prescription to fill. Good oral home care is key to keeping the excessive biofilm a dry-mouth attracts to a minimum, so extra time is also given to oral hygiene instruction. However, are we just treating the side-effects and looking right past the cause?
Being a dental provider can present frustrating limitations, in that, we dare not interfere with a patient/physician relationship; even when we treat a patient who presents with a list of medications so long, they cannot fit all of them on one side of the health history. Something inside us yearns to scream at the system. A system of over-prescribed, prescription medications which treat symptoms, but don’t necessarily address or treat the definitive cause.
Several months ago, a young woman presented in my chair, so over-medicated with pain medications and anti-depressants she simply was a sluggish shell of a person. Yes, her oral health was a concern. However, her quality of life was an even bigger concern. I spoke up and had a very personal chat with her. To my dismay, she opened up with a story that rattled me to the core. This young lady had been raped as a child and again as an adult. She had been prescribed so many prescription medications to numb the feelings she was having because of what had tragically happened to her, she did not even “feel” anymore. No one helped her deal with her feelings of extreme anxiety, depression, uselessness, and demoralization. The medications only kept her from feeling anything at all, which was a suicidal, red flag.
Upon taking radiographs, a lead apron was placed on her, and when I removed it, she asked me to please leave it on her, as it helped comfort her and seemed to lessen her anxiousness. Of course, the lead apron stayed on for the entire appointment. As we were chatting, I Googled a website for a “weighted blanket” and gave the information I found to her in case she was interested in getting one for sleep. Because as we all know, anxiety also affects our sleep.
As we walked through our appointment, I tread very carefully and cautiously as I treated her. We took breaks, and these opportunities allowed me to discuss Buteyko breathing, which can effectively lessen anxiety attacks.1 I gave her the name of a local performance coach who I thought might be helpful to discuss the cause of her anxieties… being raped. At the end of the appointment, I looked at that red flag, took a deep breath, and asked her if she would be willing to discuss her medications with her physician.
I recently saw this young woman again, and could not believe I was talking to the same person. After our appointment, she spoke with her physician, who refused to change her medications. The physician told her because she had been on them for so many years, she really needed them. Her dosages were actually increased, despite her expressing she thought they made her feel worse. So, helplessly, she went home. Thankfully, she has a wonderful husband who walked in on her trying to commit suicide.
After hospitalization and a good therapist, she came home to the same over-prescribed medications. This time she was strong. She learned to breathe through her anxieties, use what she learned from her therapist, and was able to discontinue her medications (except one, she takes on rare occasions). She has changed to a vegetarian diet; no GMOs, no high-fructose, no fermentable carbohydrates, and is reading labels and exercising. This patient got her life back! Her teeth are getting their luster back, her pride is back, and she has regained who she is, a beautiful young lady, with a life worth living for. She left the dental office with a pep in her step, and I got a beautiful, heartfelt hug from her. Before she left that appointment, I did encourage her to write her story to help others in their struggle, as she has permitted me to write about her.
On the other hand, two years ago, I had a patient who presented with a very similar situation. I remember thinking, too many medications were slowly killing her. Unfortunately, my thoughts were right, and she lost her battle with prescription drugs. Maybe if I had spoken up with more conviction when I saw her red flags, she would be here today.
Please pay attention to those red flags. You could save a life.
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- McKeown P. Anxiety Free: Stop Worrying And Quieten Your Mind. PatrickMcKeown.net; 2010: 43, 44.