Review of Top 10 Prescribed Drugs and Their Interaction with Dental Treatment

Necessity of providing dental care to medically compromised patients in Japan's super-aged society and the way forward

Devising an appropriate dental treatment plan for patients with pre-existing medical conditions is a demanding task. Dentists must consider the sometimes life threatening, interactions between ongoing medical conditions and dental treatment. Stakes are particularly high for the elderly on prescription drugs and other therapies for medical conditions while they seek dental care for advanced oral diseases. Given that Japan is an ageing society, it is crucial to create avenues for medical and dental practitioners to share patient information and collaborate.to,improve care This paper examined trends from demographic data to suggest that there is an impending further rise in the number of medically compromised elderly seeking dental treatment. For patient safety and improved public health, it is important that dental practitioners evaluate the nature and ongoing treatment of pre-existing medical conditions amongst new patients and account for their impact on dedicated and dental status. This paper supports the relevance of comprehensive clinical practice guidelines and the need to train dental practitioners to adopt a multidisciplinary approach to dental care. In order to meet the future needs of an ageing population, the Japanese Society of Dentistry for Medically Compromised Patients needs to take initiative and suggest mechanisms to exchange patient information freely and encourage multidisciplinary dental practices.

An environmental scan of pharmacists supporting pre-doctoral dental education institutions

PURPOSE/OBJECTIVES

Reports have described pharmacists providing services within academic dental settings. The full scope of these activities and where they exist is unreported. This environmental scan was performed to identify and summarize the levels in which pharmacists provide support to predoctoral dental education programs.

METHODS

A survey was circulated in summer 2019 to all CODA accredited dental schools through the American Dental Education Association (ADEA) clinical dean listserv. The IRB approved survey consisted of 23 questions pertaining to the pharmacist's role in predoctoral dental education programs. Institutions were asked whether pharmacists were used and what kinds of services pharmacists provided. Pharmacist roles were classified into standard pharmacy services, clinical pharmacy services, medication inventory, education, and administration/research. Univariate analysis was performed on responses and reported using descriptive statistics.

RESULTS

A response rate of 59.1% from 66 institutions was achieved. Of those responding, 28.21% reported utilizing a pharmacist at their institution. Of the institutions responding positively to utilizing a pharmacist, the most common standard pharmacy services used were patient counseling regarding a disease state (50%), and medication errors/adverse event reporting (60%). Some clinical pharmacy services provided were medication history collection (70%), advising antimicrobial selection (50%), and treatment plan consultation (60%). Pharmacists were also found to be active in education, school administration, and research.

CONCLUSION

Pharmacists are utilized at just over a quarter of responding CODA accredited predoctoral dental education institutions in the United States. Where deployed, pharmacists provide a wide array of services.

A Pharmacist's Role in a Dental Clinic: Establishing a Collaborative and Interprofessional Education Site

BACKGROUND

Dental patients often have comorbidities and take multiple medications, some of which could impact their dental health and treatment. A pharmacist in a dental clinic can assist with the gathering, documentation and evaluation of a dental patient's medication history as it pertains to their dental visit and overall health.

PURPOSE

To develop and implement a collaborative and interprofessional education program with a pharmacist providing services in a dental school clinic.

SUMMARY

Creighton University School of Dentistry, a student-operated dental clinic located in Omaha, Nebraska, provides dental care by student dentists, faculty and staff to the surrounding community in a learning-focused environment. A pharmacist was incorporated into the dental clinic to create and establish an interprofessional relationship with both dental students and faculty beginning August 2014. Pharmacy students on an ambulatory care advanced pharmacy practice experience rotation were eventually added to the team. The pharmacy team provided medication therapy management services including disease state and medication counseling, medication reconciliation, identifying drug-related problems and dental implications of medications, and recommendations for prescribed medications.

CONCLUSION

The pharmacy team's presence was largely accepted by dental faculty, staff, dental students, and patients. Pharmacists can play an important role in a dental clinic by performing thorough health and medication histories and communicating with dental and medical providers involved in a patient's care.

Influence of Amlodipine Enantiomers on Human Microsomal Cytochromes P450: Stereoselective Time-Dependent Inhibition of CYP3A Enzyme Activity

Amlodipine (AML) is available as a racemate, i.e., a mixture of R- and S-enantiomers. Its inhibitory potency towards nine cytochromes P450 (CYP) was studied to evaluate the drug–drug interactions between the enantiomers. Enzyme inhibition was evaluated using specific CYP substrates in human liver microsomes. With CYP3A, both enantiomers exhibited reversible and time-dependent inhibition. S-AML was a stronger reversible inhibitor of midazolam hydroxylation: the K_i values of S- and R-AML were 8.95 µM, 14.85 µM, respectively. Computational docking confirmed that the enantiomers interact differently with CYP3A: the binding free energy of S-AML in the active site was greater than that for R-AML (−7.6 vs. −6.7 kcal/mol). Conversely, R-AML exhibited more potent time-dependent inhibition of CYP3A activity (K_I 8.22 µM, K_inact 0.065 min⁻¹) than S-AML (K_I 14.06 µM, K_inact 0.041 min⁻¹). R-AML was also a significantly more potent inhibitor of CYP2C9 (K_i 12.11 µM/S-AML 21.45 µM) and CYP2C19 (K_i 5.97 µM/S-AML 7.22 μM. In conclusion, results indicate that clinical use of S-AML has an advantage not only because of greater pharmacological effect, but also because of fewer side effects and drug–drug interactions with cytochrome P450 substrates due to absence of R-AML.