WORCESTER MEDICINE
Oral Health
Pharmacists as Members of the Oral Healthcare Team Continued list of medications serves as an evidence-based guide for identifying the most problematic drugs that should be avoided in older adults.2 Medications, such as anticholinergics, cause dry mouth or xerostomia, which increases the volume of caries-causing bacteria and plaque and causes a more acidic pH ultimately leading to dental caries. Pharmacists can suggest to patients to talk to their providers about medications that cause xerostomia, saliva substitutes, and the use of fluoride rinses to protect teeth. As part of smoking cessation interventions, pharmacists should discuss oral health advantages of quitting smoking with tobacco users and recommend treatments that can help them stop using tobacco products. Dental pain and oral lesions are the most common reasons patients seek advice on OTC products in pharmacies. Products include topical and oral analgesics for tooth pain and oral lesions, such as canker sores, ulcerations, stomatitis, and candidiasis. Being knowledgeable about the signs and symptoms of oral cavity cancer (i.e., mouth pain; difficulty or painful swallowing; white or reddish patches inside the mouth; lip or mouth sores that do not heal), allows pharmacists to appropriately refer patients with these symptoms for medical care.3 Sugar (in the form of fructose, glucose, and sucrose) is a well-known cause of tooth decay and is often used as flavoring in liquid forms of medication, particularly those used by children. Pharmacists can support prevention of early childhood caries by suggesting and/or compounding medications containing sugar-free flavoring alternatives. Oral health is essential to overall health and quality of life. Efforts to promote oral health should be standard of care and incorporated as part of the pharmacist’s medication therapy management services for all patients. Knowledgeable, well-respected and accessible, community pharmacists are in an ideal position to team up with oral health professionals to reduce the incidence of potentially preventable oral conditions including dental caries, gum disease, and oral cancer. Ongoing education and training is important for pharmacists to provide patient-centered care in the area of oral health. +
Oral Health Across Worcester’s Communities Morgan Groover, Connor Hickey Ashwin Panda, Jay Patel Aditya Vangala, Michael Wang shown left to right
D
iversity , one of worcester ’ s greatest
strengths, also poses its greatest healthcare challenge. Below we explore six key populations, each with unique oral healthcare needs. We present their current state of oral health, while commenting on hurdles and next steps. Lastly, we offer conclusions and suggest more integrated care in the healthcare system.
black communities references:
1. The American Pharmacists Association (APhA) Foundation: Oral Health Initiatives. Available at: https://www.aphafoundation. org/oral-health/our-work. Accessed November 19, 2020. 2. American Geriatrics Society 2019 Beers Criteria Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674–94. 3. Mouth cancer: symptoms and causes. Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/mouth-cancer/ symptoms-causes/syc-20350997. Accessed November 19, 2020. Anna Morin, PharmD Dean, School of Pharmacy-Worcester/Manchester MCPHS University
African American (AA) children have higher rates of tooth decay and loss than white non-Hispanic counterparts. Similar disparities exist among access to preventive services, such as sealants. These disparities persist into adulthood. AA adults have the highest rates of tooth decay and are 13% less likely to keep all of their teeth over the course of their life. A 2019 systematic literature review identifies familial and structural factors that have contributed to this inequality. AAs were more likely to utilize treatments which allow for greater autonomy (brushing teeth vs. fluoride treatments). Moreover, a 2016 cross-sectional study indicated nearly half of all AA parents were unaware their children qualified for Medicaid (Como et al., 2019). Racial disparities in oral health are deeply rooted in society and will require a multifactorial solution.
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