Tufts OpenCourseware
Authors: John Morgan, Bonnie F. Zimble


Issues and Risks

Special Care in Dentistry
John Morgan, DDS
Tufts University School of Dental Medicine, 2008

Study Questions:

  1. What are some of the risks associated with pharmacotherapy in general?

  2. Describe rates of (a) adverse drug reactions, (b) physician visits and (c) hospitalizations associated with polypharmacy in the elderly.

  3. Identify one dental risk associated with polypharmacy.

Some Major Issues in Polypharmacy 

Polypharmacy refers to drug treatment (pharmacotherapy) with multiple medications. There are several issues associated with pharmacotherapy in general that are frequently encountered with persons with intellectual disability. The following issues should be considered: 

  • Risks/benefits of medication need to be fully considered (e.g., drugs which adversely affect cognition, either directly or through sedation).

  • Informed consent is required to support the prescription or administration of psychotropic medications.

  • Medications need to be integrated as part of a comprehensive treatment plan. Communication between prescribing physician and other therapists is necessary.

  • Care must be taken to avoid multiple representatives from the same medication class.

  • Over time, doses must be adjusted appropriately, so only the minimum dose at which a medication remains effective is used.

Elderly Patients  

Patients in their eighties are commonly prescribed 8 to 12 medications, and the potential dangers in the form of adverse effects are well known. Here are some facts for elderly persons taking more than 5 medications: 

  • There is a 35% chance of developing an adverse drug reaction each year

  • Seventy percent (70%) of such patients will require a physician visit

  • Ten percent (10%) will be hospitalized

Other Issues 

  • There are many issues regarding the long term utility and effects on overall health


Risks of Polypharmacy 

  • Dental: There is an increased risk of xerostomia-induced caries secondary to the use of anticholinergics

  • Other systems can be adversely affected:

    • Gastrointestinal

    • Pulmonary

    • CNS

    • Cardiovascular

    • Genitourinary

  • Sleep disturbances and psychiatric changes can also occur.


In summary, regular and thorough evaluation of the effectiveness of a patient's medications by health care providers is crucial to minimize the risks of polypharmacy.