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                                                        DR. DAN PETERSON

                                                                      1415 SAGE STREET ~ GERING, NEBRASKA 69341 
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Your medications can be affecting your dental health!

Pharmaceutical therapies have oral manifestations.

     Studies show that two out of every five adults take some type of medication that could have dental related side effects.  With age, this chance doubles!

     Some of the more common side effects are:


Dry mouth-Antihistamines are know to decrease saliva leaving your mouth prone to inflamed, painful gums making them susceptible to infection.  Decrease in saliva can cause an increase in tooth decay.  Denture wears can develop sores.


Aspirin Damage
People who often chew aspirin over a prolonged period could severely damage their teeth.
The first case focused on a 52-year-old woman  that had been taking four to eight aspirin tablets a day for one to two years to relieve headaches. She typically held the aspirin tablets on the tooth surfaces and crushed them until they dissolved causing the tooth surfaces that most often came in contact with aspirin to eroded the most. A 42-year-old male patient stated that he had used aspirin or acetaminophen daily. He took an average of six aspirin a day. He put the aspirin in his mouth on his right posterior teeth and crushed them.  When we showed the tooth destruction to the patient, he confirmed that the worst areas were, indeed, where he held the aspirin tablets. Journal of the American Dental Association (JADA)7/04


Soft-tissue reactions-Medications for blood pressure control, immunosuppressive agents, oral contraceptives and chemotherapeutic agents can cause oral sores, inflammation and discoloration of gum tissue.


Abnormal bleeding-Aspirin, anticogulants, like warfarin and heparin can cause bleeding and blood clotting problems during oral surgery or periodontal treatment .


Coumadin-is a blood thinner that works by interfering with the liver's production of vitamin K dependent blood clotting factors. When you take a blood thinner, there are concerns that you may bleed unusually heavily after an extraction or having your teeth cleaned.  It is important that your doctorís office contact us with a recent INR result before you have a cleaning, root planing, or any kind of dental surgery including extraction or gum surgery.  The INR result helps decide whether we can do the procedure with a high level of safety.    We canít stress enough that our office must have good communication  with your doctor to insure the greatest safety for you. Doctors relay on a blood test called Prothrombin Time to know if levels are too high or low.  Normal PT reading if 1.0 which is equivalent to 10-12 seconds.  People on coumadin generally have 2.0 or twice the normal reading.  When PT number increases, there is a greater risk of increased bleeding.  PT times between 1.5-1.8 or less are safe readings for a person to have dental surgery.  Due to taking coumadin you may need additional measures to stop the bleeding from dental surgery like packing and stitching of the socket.  


Gum tissue overgrowth-This is know as gingival hyperplasia.  It is associated with anti-seizure medication, medications for organ transplants and calcium channel blockers. This condition makes good oral hygiene care difficult.


Tooth discoloration-Tetracycline products used when teeth are developing can cause permanent staining in teeth.


Where to report drug interactions:

   Keep a list of all the medications, over the counter medicines and herbal remedies you are currently using and bring it to each of your appointments with your doctor or dentist.

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Top ten most commonly prescribed drugs are:
  1. Hydrocodone/APAP (generic)
  2. Atorvastatin (Lipitor)
  3. Levothyroxine (Synthroid)
  4. Atenolol (generic)
  5. Azithromycin (Zithromax)
  6. Amoxicillin (generic)
  7. Furosemide (generic)
  8. Hydrochlorothiazide (generic)
  9. Amlodipine (Norvasc)
  10. Lisinopril (generic)

To learn more about prescriptions your patients may be taking, visit

Prescription drugs can interact with a variety of foods

Eating fruits and vegetables is essential to living a long and healthy life, yet research has shown they can cause dangerous interactions with medicines.  Foods can increase or decrease the activity and toxicity of orally-administered drugs (intravenous drugs are not altered).

One of the most studied of these interactions is the inhibition of CYP3A4 enzymes caused by grapefruit or its juice. CYP3A4 enzymes are responsible for the metabolism of more than 60 percent of orally-administered drugs. Drugs that interact with grapefruit include:

bulletcardiovascular agents
bulletcentral nervous system agents
bulletgastrointestinal agents
bulletHistamine H1 antagonists
bulleterectile dysfunction drugs.

Dental patients in particular should be aware of interactions with the sedatives triazolam, midazolam and diazepam which could cause excessive sedation.

As little as 6.0 oz of grapefruit juice may lower the amount of a drug needed to produce the desired effect, which could cause an overdose. The blood that absorbs nutrients passes through the liver before reaching the general circulatory system (the first-pass). The ability of a drug to successfully pass from the GI tract to the plasma is called its bioavailability. Grapefruit juice inhibits first-pass drug metabolism, increasing bioavailability.

Many elderly patients vacation or spend winters in southern states such as Florida , where they may be more likely to consume grapefruit and other fruits that may interact with prescribed medicines. The components of grapefruit juice believed to be clinically active are also found in limes, pumellos, and Seville oranges. Natural food products, citrus products and cabernet sauvignon wine are also known to interact with drugs. This interaction can increase the concentration of drugs in the bloodstream and enhance their potency, which can result in toxicity.

While most people know to ask their pharmacists about possible interactions between medicines, many don't realize they should also be asking about the foods in their refrigerator.  Remember use caution because there are probably more food and beverage interactions that have not yet been discovered.

There are ways to protect against food/drug interactions.

bulletPatients should refrain from grapefruit consumption for 24 to 48 hours before and during drug therapy.  
bulletBe sure to read the drug information flyer provided in every prescribed drug and question their pharmacist.
bulletBe sure to report any unusual drug effect.

AGD 10/05

February 06, 2008

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PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
This site is privately and personally sponsored, funded and supported by Dr. Peterson.  We have no outside funding.
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