The synergy between health-care professionals such as dentists and pharmacists is pivotal to ensure patient safety and optimal therapeutic outcomes. However, the practical realities of this collaboration sometimes reveal gaps in communication and understanding.
To shed light on these issues, I spoke with Barbara Madej, RPh, a pharmacist with more than 40 years of experience. Barbara provided insightful perspectives on how dentists can better align with pharmacists when prescribing medications.
Insights on the pharmacist/dentist relationship
Aubrey Glassberg: What do pharmacists generally wish dentists would be more aware of when prescribing medications?
Barbara Madej, RPh: One key area is to thoroughly review a patient's medication history. We often see prescriptions that don’t consider a patient's existing medications, which can lead to dangerous drug interactions or contraindications. For example, Topamax combined with aspirin, codeine, hydrocodone, or carbamazepine can impact seizure control, something that’s not always on a dentist’s radar.
To help with this, dentists need to verify the complete medication history, including over-the-counter (OTC) drugs and supplements. That’s why I’m involved in developing the Digital Drug Handbook, where I’m collaborating with dentists and developers to create a drug information resource specifically tailored for dental professionals.
One feature, called Rx Check, is especially helpful for dentists when prescribing. It provides example dosing guidelines, suggests alternative medications, and even includes a drug-drug interaction checker. We’re also working on a pediatric dosing calculator, which will make prescribing for children much easier.
Aubrey: How do you think dentists can improve their prescribing practices to foster better patient outcomes?
Barbara: Good communication and careful research are important. Dentists should feel comfortable reaching out to pharmacists when they're unsure about a prescription, and they should take the time to look into the medications their patients are taking.
Continuing education and medication databases are great ways to enhance prescribing practices. In my experience, I've noticed that many dentists don’t stay up to date with current medications; for instance, some still prescribe Dolobid, an older anti-inflammatory, despite the availability of newer and more effective alternatives. Using the tools they have available could improve patient outcomes.
Aubrey: Can you give an example of a common issue than can arise from this lack of information?
Barbara: Certainly. A common situation involves nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, which are often prescribed for pain following dental procedures. With dentists increasingly opting for NSAIDs instead of opioids, it’s important for them to be aware of all the NSAIDs available, including OTC ones, to avoid accidentally prescribing more than one.
Sometimes, patients get their medications from different pharmacies, and one pharmacy might not know a patient is already taking another NSAID, which could lead to a serious GI bleed. Doing a thorough medication check can help prevent these kinds of issues.
Aubrey: Are there specific medications that can lead to complications when prescribing for dental conditions?
Barbara: Yes, antibiotics are a common culprit. Dentists frequently prescribe antibiotics for infections, but they sometimes overlook potential interactions. For instance, combining metformin and cephalexin (Keflex) may increase the risk of lactic acidosis.
Another important thing to consider is that certain antibiotics can reduce the effectiveness of hormonal birth control. Azithromycin, erythromycin, penicillin, amoxicillin, ampicillin, tetracycline, and metronidazole all may decrease the efficacy of oral contraceptives. Antifungals such as nystatin and ketoconazole may also do this. Lack of diligence by the dentist and pharmacist may result in legal action. One case I heard about led to the dentist and pharmacist to paying child support.
Aubrey: What can both professionals do to enhance this interdisciplinary collaboration?
Barbara: Good communication is key to keeping patients safe. Regular team meetings and shared electronic health records (EHRs) can really help bridge information gaps. In my experience, pharmacists are always willing to discuss prescriptions to ensure safety, though this can sometimes frustrate doctors, particularly when it disrupts their workflow.
However, these questions are about clarifying potential issues, not criticizing. For example, I had a patient who was prescribed amoxicillin despite having a penicillin allergy. When I checked with the dentist, he was unaware of the allergy because the patient hadn’t mentioned it. This highlights the importance of open communication and understanding that everyone involved is working toward the best outcome for the patient.
Aubrey: How do patients react when an incorrect prescription is called in?
Barbara: This presents a challenging situation. Playing phone tag with the doctor can take time, and patients often become anxious or frustrated and wonder what's happening. Patients have directly asked me, "Did my dentist make a mistake?" I try to protect the dentist with explanations such as "I just want to double-check the dose," or "I'm checking for interactions." I believe many pharmacists do the same. Unfortunately, this can result in patients directing their frustration at us when we're simply trying to do our job and ensure their safety.
My discussion with Barbara highlights how crucial it is for dentists to work closely with pharmacists. Ensuring patient safety requires more than just good intentions—it demands thorough medication reviews and open communication. Tools like the Digital Drug Handbook offer practical support in this process, helping reduce the risks associated with prescribing, and ultimately improving patient outcomes.
