I read with interest Dr. Michael Glick’s December editorial, "Did You Take Your Medications?: The Dentist’s Role in Helping Patients Adhere to Their Drug Regimen" (
JADA 2006;137[12]: 1636–7[Free Full Text]
), and would like to comment on it.
In general, I think it is a great idea to encourage dentists to engage in health promotion activities that go beyond what we typically consider the dental domain. Such a move recognizes dentists as sharing the responsibility for patients’ general health, together with other members of the health care team.
As a primary care discipline, dentistry can contribute much in reducing morbidity and mortality due to many common diseases. In addition, research (for instance, on tobacco-use cessation) has shown that patient compliance increases with the frequency of reminders from different health care providers in different settings. The increasingly recognized interplay between oral and general health is another argument that supports Dr. Glick’s suggestion.
However, I see two problems with operationalizing his recommendation. First, for many dentists the patient is the sole source of information about medications. Anecdotal evidence suggests that many medication histories obtained by dentists are fragmentary at best. Many patients wonder why a dentist would ask about their medications, and are thus often ill-prepared to provide a detailed and accurate medication history.
Extraction of teeth and their replacement with implants is becoming more popular as implant success rates, predictability and quality continue to improve.
Second, while many medications are taken using a standard regimen, this does not apply to all medications. In order for dentists to be effective in helping ensure medication compliance, they should have access not only to a complete, correct and up-to-date list of medications, but also to the instructions for administration.
In my opinion, one way to help facilitate this goal is to take the patient out of the equation and allow dentists to obtain medication histories with administration instructions directly from the patient’s physician or the pharmacy. Most likely, the pharmacy is the better source of information, because physicians often are unaware of the medications that colleagues have prescribed to the same patient.
One low-tech solution that could be imagined is that dentists request medication histories from the pharmacy/ physician, and, in response, receive a fax or an e-mail. However, due to the work and effort involved, this strategy is not likely to succeed. A better approach would be to exchange this information through the emerging National Healthcare Information Infrastructure (NHII), which is planned to provide transparent access to care-related clinical data needed by health care providers.
Using the NHII, obtaining the medication history may be as simple as pushing a button after the patient’s and dentist’s requests have been verified and authenticated. While this may sound like science fiction, the NHII’s development is progressing quite rapidly, and we thus may have the appropriate capabilities within the next five to 10 years.
Thank you very much for bringing this issue to the attention of JADA readers and the profession.
