Dental notes

Prepared by Michael McCullough, Chair, Therapeutics Committee, Australian Dental Association

(Aust Prescr 2010;33:107)

Dental notes

Vitamin D deficiency in adults

Bone metabolism involves highly complex interactions of multiple factors, not the least of which is the patient's level of serum vitamin D. Skeletal bone health has become a topic of considerable interest to dentists over the last 5–6 years with the recognition of osteonecrosis of the jaw in patients taking bisphosphonates long term. Although this is an uncommon event – probably occurring after tooth extraction in 1/500 to 1/1500 patients on oral bisphosphonates for the prevention of osteoporosis1 – the condition can be devastating with limited available effective treatment. Dental treatment must be undertaken with informed consent and there are good guidelines for this.2 Vitamin D supplementation may play a part in the management of our patients' bone health, but dentists need to be aware that treatment of bone disease, and any changes in medication for bone health, should only be made in consultation with the treating physician and never on our recommendation alone.

References

  1. Lo JC, O'Ryan FS, Gordon NP, Yang J, Hui RL, Martin D, et al. Prevalence of osteonecrosis of the jaw in patients with oral bisphosphonate exposure. J Oral Maxillofac Surg 2010;68:243-53.
  2. Therapeutic Guidelines: Oral and Dental. Melbourne: Therapeutic Guidelines Limited; 2007.

Combination analgesics in adults

Most patients presenting to dentists with pain have some form of acute pain. This can usually, and predictably, be managed by removing the cause of the problem through a thorough diagnosis and effective dental treatment. However, some pain may remain for a short period of time after treatment. It is essential that dentists ascertain whether the patients have been taking analgesics or other medications to help manage their pain. The prescription of any analgesia after treatment should be done carefully to ensure minimisation of potential adverse effects, interactions and overdoses particularly in patients who have already been self-medicating to obtain pain relief. Some patients may use extra medications without the dentist's knowledge so all patients should be informed and educated about safe drug use and doses. If there is any doubt, patients should adhere to the dosage stated on the packet and take the drug in accordance with the manufacturer's instructions, unless the prescribing doctor advises otherwise.


Finding medicines information online

Following the closure of the Therapeutic Advice and Information Service (TAIS) on 1 July 2010, NPS has compiled a guide to medicines information resources on its website, which can be accessed via the health professional webpage. Please note that some of the listed resources are freely available and others need a subscription fee. The URL is www.nps.org.au/medicines_information_guide
Change of number for Medicines Line

As of 1 July 2010, the number for the NPS consumer telephone information service Medicines Line has changed to 1300 MEDICINE (1300 633 424). Medicines Line provides information to consumers about prescription, over-the-counter and complementary medicines. NPS is collaborating with healthdirect Australia to deliver Medicines Line and all calls are answered in the first instance by a registered nurse. Questions may be answered on the spot, or callers may be referred to their general practitioner, pharmacist or another health professional. Complex enquiries may be triaged to an NPS pharmacist.
New branding for NPS

NPS has launched a new 'look and feel' as of 1 July 2010. Rather than use the full reference to National Prescribing Service, we are using the NPS acronym which is how many people already refer to us. We have also introduced a new tagline – Better choices, better health. For more information and to view the new logo, visit www.nps.org.au

Content created: August - 2010