Medication Use and Its Potential Impact on the Oral Health Status of Nursing Home Residents in Flanders (Belgium)

Background: Polypharmacy is considered the most important etiologic factor of hyposalivation, which in turn can initiate oral health problems.

Objectives: To describe the medication use of nursing home residents, to identify the medications related to hyposalivation and to find possible associations between the different classes of medication, the number of medications, and the oral health status of the residents.

Design: A cross-sectional study.

Participants: The study population consisted of the residents of a nonrandom sample of 23 nursing homes from 2 Belgian provinces, belonging to the oral health care network Gerodent. All residents of the sample visited the Gerodent mobile dental clinic between October 2010 and April 2012.

Measurements: For each resident, oral health data, demographic data, and an overview of the total medication intake were collected.

Results: The study sample consisted of 1226 nursing home residents with a mean age of 83.9 years [standard deviation (SD) 8.5]. The mean number of medications per person was 9.0 (SD 3.6, range 0-23, median 9.0). Of all prescribed medication, 49.6% had a potential hyposalivatory effect with a mean number per person of 4.5 (SD 2.2, range 0-15, median 4.0). In the bivariate analyses, associations were found between medication use and oral health of residents with natural teeth: the higher the number of medications (with risk of dry mouth) and the overall risk of medication-related dry mouth, the lower the number of natural teeth (P = .022, P = .005, and P = .017, respectively). In contrast, the total treatment need tended to decrease with rising medication intake, resulting in a clear increase of the treatment index with rising medication intake (P = .003, P <.001 and P = .002). The logistic regression model analysis confirmed that the proportion of carious teeth diminished and the treatment index increased in case of rising medication intake, especially when considering the number of medications with a risk of dry mouth and the overall risk of medication-related dry mouth. A possible explanation for this trend might be the finding that in the group with a high medication use, the teeth most sensitive to caries and plaque retention could already have been extracted at the moment of screening for the study, because of a lifelong history of caries pathology.

Conclusions: This study shows a high level of medication use, including the substantial intake of medication with a possible hyposalivatory effect. Moreover, clear associations were found between the medication intake and the oral status of the residents. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.