Xerogenic Medications as a Predictor for Dental Health Intervention in People with Dementia

Article type: Research Article

Authors: Tan, Edwin C.K.^{a; b; c; d; *} | Lexomboon, Duangjai^e | Häbel, Henrike^f | Fastbom, Johan^b | Eriksdotter, Maria^{g; h} | Johnell, Kristinaⁱ | Sandborgh-Englund, Gunilla^{e; j}

Affiliations: [a] The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia | [b] Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden | [c] Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden | [d] Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia | [e] Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden | [f] Institute of Environmental Medicine, Division of Biostatistics, Karolinska Institutet, Stockholm, Sweden | [g] Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden | [h] Theme Aging, Karolinska University Hospital, Huddinge, Sweden | [i] Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden | [j] Academic Center for Geriatric Dentistry, Stockholm Sweden

Correspondence: [*] Correspondence to: Edwin C.K. Tan, PhD, The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Rm S303, Pharmacy and Bank Building A15, The University of Sydney, NSW, 2006, Australia. E-mail: edwin.tan@sydney.edu.au.

Abstract: Background:Older adults with dementia often have poor oral health. Chronic use of xerogenic medications may contribute to adverse dental outcomes. Objective:To investigate the impact of xerogenic medication classes on the predicted risk for dental interventions in people with dementia. Methods:This was a population-based cohort study involving 30,955 individuals registered in the Swedish Dementia Registry (SveDem) from 2008 to 2015. Data were linked with other national registers. The exposure was xerogenic medication classes used in the three years prior to dementia diagnosis (baseline). The primary outcome was the composite of number of tooth extractions and dental restorations over the three-year follow-up period. Secondary outcomes included the number of tooth extractions and number of dental restorations. Poisson regression models were used to estimate the association between the exposure and outcomes. Analyses were adjusted for age, gender, Mini-Mental State Examination, living arrangement, dementia disorder, average number of medications, Charlson’s comorbidity index, number of dental visits, and number of teeth. Results:After adjusting for potential covariates, the use of urological drugs (incidence rate ratio [IRR] 1.16, 95% CI 1.04–1.28), proton pump inhibitors (IRR 1.13, 95% CI 1.04–1.23), and opioids (IRR 1.19, 95% CI 1.06–1.34) were significantly associated with the primary composite outcome. Conclusion:The use of specific classes of xerogenic medications was associated with an increased risk for tooth extractions and restorations in people with dementia. The risks and benefits of xerogenic medications, in the context of oral health, should be carefully assessed in this vulnerable population.

Keywords: Dementia, dental care, longitudinal studies, medication, polypharmacy, registers, tooth loss, xerostomia

DOI: 10.3233/JAD-200148

Journal: Journal of Alzheimer's Disease, vol. 75, no. 4, pp. 1263-1271, 2020