Polyfarmaci og odontologisk praksis
Tandlæger møder i stigende grad patienter, som er i behandling for flere medicinske sygdomme med mange forskellige lægemidler. En væsentlig forklaring herpå er forbedret diagnostik og forbedret medicinsk behandling. Ydermere øges andelen af ældrebefolkningen, og det medfører øget forekomst af kroniske sygdomme, som kræver farmakologisk behandling. Et stigende antal patienter er multimedicinerede, idet randomiserede, kliniske studier har vist, at behandlingsregimer med en kombination af flere lægemidler for samme lidelse kan reducere morbiditet og mortalitet betydeligt. Det gør sig bl.a. gældende for behandling af patienter med type 2-diabetes og hjerteinsufficiens. Imidlertid øger samtidig indtagelse af mange lægemidler (polyfarmaci) risikoen for uønskede bivirkninger og interaktioner, og det er usikkert, hvorledes effekten af fx antihypertensiva påvirkes, hvis patienten samtidig behandles med fx analgetika og antidepressiva. Som konsekvens af ovennævnte vil tandlægen blive stillet overfor krav om indsigt i flere kroniske sygdomme og deres behandling, herunder polyfarmaci, samt hvorledes disse forhold kan influere på odontologisk diagnostik og behandling. I nærværende artikel gennemgås begrebet polyfarmaci, forekomsten af polyfarmaci samt tilfælde, hvor polyfarmaci kan udgøre et problem i relation til odontologisk udredning og behandling.
Klinisk relevans:
Polypharmacy and odontological practice The number of patients who take several medications on a regularly daily basis is increasing, also in the dental practice. A major reason for this is improvements regarding diagnostics and medical treatment of chronic medical diseases. With the population becoming increasingly older, the general dentist will be confronted with patients who have several chronic systemic diseases that that require pharmacological treatment. An increasing number of patients are multi-medicated as randomised clinical trials have shown that treatment regimens with a combination of several drugs for a single disease reduce morbidity and mortality significantly. This applies particularly to the treatment of patients with type-2 diabetes and heart failure. However, polypharmacy increases the risk of adverse reactions and interactions, and it is uncertain how the effects of, for example antihypertensives are influenced by the simultaneous intake of medicine such as analgetics and antidepressants. As a consequence of the above, dentists need to have knowledge about chronic medical diseases and their treatment, including polypharmacy, and how these factors may influence the dental diagnosis and treatment. This article includes a review on the term polypharmacy, the prevalence of polypharmacy and the potential impact of polypharmacy on odontological diagnosis and treatment.
