Navigating medication risks in elderly patients: Essential tips for dental hygienists

The “Silver Tsunami” is here. By 2030, one in five Americans will be over the age of 65, sending a wave of medically complex patients to dental offices.¹ As life expectancy rises, so does the prevalence of chronic conditions and medication use, making it more critical than ever for dental professionals to recognize and mitigate medication-related risks.

Many seniors take medications that affect their oral health, while others face physical and cognitive challenges that make maintaining oral hygiene difficult. Dental hygienists play a crucial role in recognizing these factors and ensuring they’re addressed appropriately. By staying vigilant about medication effects, mobility restrictions, and cognitive changes, hygienists can help facilitate proper care through collaboration with dentists.

This guide highlights key considerations for managing medication risks, assisting patients with physical and cognitive challenges, and supporting preventive care strategies tailored to the needs of older adults.

Consider medication effects during treatment

Many older patients take medications that impact their oral health,² and hygienists should be aware of potential risks while performing cleanings and assessments. When treating older patients, understanding how medications interact is key to preventing complications. Resources such as the American Geriatrics Society’s Beers Criteria and the MedAssent DDS Digital Drug Handbook can help dental professionals quickly assess drug interactions and adjust treatment plans accordingly.^3,4

As life expectancy rises, so does the prevalence of chronic conditions, increasing the need for oral health care among seniors.⁵ Notable considerations include:

● Hydration and dry mouth. Many common medications, including anticholinergics, SSRIs, and SNRIs (antidepressant medications), cause xerostomia, which increases the risk of caries, oral infections, and difficulty wearing dentures.^6-9 If a patient presents with signs of dry mouth, inform the dentist, who may recommend interventions such as fluoride treatments, or simple solutions such as hydration, sugar-free lozenges or gum, and saliva substitutes.

● Bleeding risks. Patients on anticoagulants, cardiovascular medications, NSAIDs, or baby aspirin may be at an increased risk for excessive bleeding during procedures.¹⁰ Before performing deep cleanings or probing, check for any indications of prolonged bleeding and notify the dentist if concerns arise. Routine screenings for candidiasis and proactive bleeding management may also be beneficial.

● Identifying warning signs. Medication side effects can contribute to gingival overgrowth,¹¹ xerostomia, bruxism, oral infections, and periodontal disease. Anticonvulsants such as phenytoin and lamotrigine, or calcium channel blockers such as amlodipine, can lead to excessive gingival hyperplasia, complicating oral hygiene.¹² Emerging research highlights the connection between periodontal disease and systemic health, indicating that oral bacteria can enter the bloodstream and potentially contribute to cardiovascular issues, pneumonia, and Alzheimer's disease.¹³ If you observe these symptoms, they should be documented and brought to the dentist’s attention.

Assist patients with physical and cognitive challenges

● Arthritis and limited mobility. Some patients may struggle with effective brushing and flossing due to arthritis or limited dexterity. Noting these limitations can help the dentist provide recommendations for adaptive oral hygiene tools, such as the Radius brand, which designs toothbrushes to reduce discomfort and enhance daily oral hygiene,¹⁴ or electric toothbrushes, which can make brushing easier and more effective for those with limited dexterity.

● Memory loss and dementia. Patients with cognitive decline may have difficulty maintaining oral hygiene or may become resistant to care.¹⁵ For seniors with dementia, emotional connection is often more effective than reasoning.¹⁶ A gentle, reassuring approach that prioritizes nonverbal communication, patience, and clear step-by-step instructions can foster cooperation during cleanings. Every patient is unique, so tailor interactions based on their comfort level and cues. Some may need reminders to maintain oral hygiene, while others might become anxious or resistant to brushing and flossing. By observing their responses and adjusting accordingly, hygienists can help create a more comfortable experience for the patient and caregiver. If hygiene neglect is observed, inform the dentist so appropriate recommendations can be made.

Encouraging preventive care through the dentist

●  Fluoride treatments and sealants. Patients at a high risk for decay due to medication-related dry mouth may benefit from additional protective measures. Hygienists should recognize at-risk patients and inform the dentist about potential fluoride or sealant needs.

● Personalized care recommendations. Each elderly patient has unique challenges that should be noted and discussed with the dentist. Mobility limitations, cognitive issues, and systemic health conditions should be considered when developing a long-term oral care plan.

The aging population is growing, and with it comes an increasing number of patients with complex medical needs. Caring for older adults is not just about managing oral health—it’s about safeguarding their ability to eat, speak, and smile without pain or complication.

With a proactive, informed approach that integrates medication awareness, preventive strategies, and cross-disciplinary collaboration, dental teams can help prevent unnecessary suffering and improve patient outcomes. At the heart of it all is a simple but essential goal: ending smile denial.

Editor's note: This article appeared in the April/May 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

References

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3. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372
4. The Digital Drug Handbook. MedAssent DDS Inc. Accessed February 4, 2025. https://www.medassentdds.com
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10. Medications and herbs that affect bleeding. Stanford Medicine. Accessed February 6, 2025. https://med.stanford.edu/content/dam/sm/ohns/documents/Sinus%20Center/Stanford_Medication_and_Herbs.pdf
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12. Chan L, Mendoza T. The 3 C medications causing gingival hyperplasia. DrBicuspid. August 7, 2024. Accessed February 4, 2025. https://www.drbicuspid.com/dental-hygiene/article/15680910/the-3-c-medications-causing-gingival-hyperplasia
13. McMains V. Healthy mouth, healthy body. National Institute of Dental and Craniofacial Research, U.S. Department of Health and Human Services. May 8, 2024. Accessed February 6, 2025. https://www.nidcr.nih.gov/news-events/nidcr-news/2024/healthy-mouth-healthy-body
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