Ouch! Why fall precautions matter in dental offices

Dental professionals focus on oral health, but there's another crucial risk you can't ignore—falls. A simple fall can be life-altering or even deadly for older adults. In fact, unintentional falls claimed the lives of more than 38,000 older adults in 2021, making it the leading cause of injury-related deaths for those 65 and older.¹

Moving from a reclined dental chair to standing can be tricky for some patients, especially those on medications that cause dizziness or sedation. As dental providers, being aware of fall risks and the medications that exacerbate them is key to keeping your patients safe.

The Beers Criteria: Your tool for fall prevention

The Beers Criteria is a list of medications that may be inappropriate for older adults due to the increased risk of side effects. Developed by Dr. Mark Beers in 1991 and maintained by the American Geriatrics Society (AGS) since 2011, the Beers Criteria helps ensure you provide the safest patient care.²

Since the list can be quite extensive, using resources such as the dentistry-specific Digital Drug Handbook, which highlights medications flagged by the Beers Criteria, makes it easier to:

• Prevent injuries: Medications can impair balance, increase dizziness, or cause sedation. By flagging these, you help protect patients from serious falls.
• Avoid hospital visits: The last thing anyone wants is for a routine dental visit to result in a trip to the ER. The Beers Criteria helps minimize those risks.
• Prescribe safely: Where possible, you can recommend safer alternatives or coordinate with a patient's health-care team to find the best medication options.

Watch out for these common culprits

Certain medications used by older patients that may be prescribed by dentists have a higher risk of causing falls, and it's important to know which ones. The Beers Criteria categorize these medications into several classes:

• Benzodiazepines: Long-acting drugs such as diazepam can impair cognitive function, cause sedation, and significantly increase the risk of falls. These should be avoided or used with caution for the shortest time possible. A suitable alternative would be short-acting benzodiazepines like alprazolam and lorazepam, which provide similar side effects to long-acting ones, but with less intensity.
• Opioids: Commonly prescribed pain relievers such as oxycodone, tramadol, and morphine are associated with sedation, constipation, and a higher risk of falls and fractures. Dental providers should explore alternative pain management strategies where possible, especially for older patients.
• NSAIDs: Medications such as ibuprofen, naproxen, and diclofenac are frequently used in dental care but carry risks of gastrointestinal bleeding, kidney injury, and dizziness. Long-term use should be avoided in older patients.
• Muscle relaxants: Drugs such as cyclobenzaprine and carisoprodol, often prescribed for muscle pain, have strong sedative effects and increase the risk of confusion and falls. These should generally be avoided in elderly patients. A better alternative could be baclofen or tizanidine.
• Antihistamines: First-generation antihistamines such as diphenhydramine and hydroxyzine have anticholinergic effects that can cause confusion, sedation, and dizziness. Safer alternatives like cetirizine or fexofenadine should be considered for older adults.
• Sedative-hypnotics: Medications such as zolpidem, used to treat insomnia, can impair balance and coordination, making falls more likely. Dental providers should be aware of these risks and take extra precautions during and after treatment.

Putting safety into practice: Simple steps for fall prevention

What can you do in your practice to protect patients from falls? Here are a few easy actions:

1. Review medications: Always ask elderly patients about the medications they're taking. Use tools like the Digital Drug Handbook to spot possible interactions or contraindications with your dental treatment plan, which helps save you in the long run. Collaboration with the patient’s health-care team can also help with safer alternatives.
2. Assist with mobility: Elderly patients can feel dizzy moving from a dental chair to standing, especially after a long procedure. Place the chair in an upright position for a few minutes to prevent hypotension, dizziness, etc. Make sure the patient places both feet solidly on the ground, and assist the patient out of the chair and when walking in the office if they appear unsteady.
3. Educate patients: Remind them to stand up slowly after sitting or lying down and to ask for assistance when they feel lightheaded. A few simple instructions can go a long way in preventing falls.
4. Monitor vital signs: Before starting any procedure, check the patient's blood pressure and pulse. This can help detect any issues that might lead to dizziness or lightheadedness, helping you plan accordingly.

The bottom line: Keep patients safe and prevent unnecessary liabilities

Falls don't have to be part of the dental visit. By understanding the medications that put elderly patients at risk and incorporating simple fall precautions, you can ensure a safe visit for every patient. The Beers Criteria is one tool that can help do that, and it’s a powerful one. When you protect patients from falls, you protect their overall well-being. By taking proactive steps, you can do your part in reducing the alarming rate of falls among the elderly and safeguarding their health.

References

1. Nonfatal and fatal falls among adults aged ≥65 years—United States, 2020–2021. Centers for Disease Control and Prevention. September 1, 2023. https://www.cdc.gov/mmwr/volumes/72/wr/mm7235a1.htm

2. Beers Criteria. Cleveland Clinic. Last reviewed May 3, 2023.  https://my.clevelandclinic.org/health/articles/24946-beers-criteria