Postmenopausal females and the link between oral bisphosphonates and osteonecrosis of the jaw: a clinical review.

PURPOSE: To increase awareness for nurse practitioners (NPs) of new information concerning the plausible link between the oral bisphosphonate drug classification and necrosis in the jaw. DATA SOURCES: Selected research and clinical articles. In addition, several peer-reviewed, refereed medical and dental journals were consulted. CONCLUSIONS: Oral bisphosphonates are commonly prescribed by NPs for postmenopausal females with the diagnosis of osteoporosis to arrest bone loss and preserve bone density. Recent reports have shown a link between these medications and osteonecrosis of the jaw, which is a complication resulting in necrotic bone inside the mouth. IMPLICATIONS FOR PRACTICE: NPs must be able to determine early warning signs of osteonecrosis to ensure prompt referral to a dental specialist in order to prevent irreversible sequelae. Because of the aging population, osteoporosis is predicted to increase; therefore, treatment with these drugs and the side effects that go along with them will most likely also increase.

The importance of oral health in long-term care.

Emerging evidence has shown a strong link between the effects of chronic oral inflammation and general health. The mouth is the visible gateway to the rest of the body and reflects what is happening deep inside. Periodontal disease has been linked to systemic disease; likewise, systemic disease can have an impact on oral health. In fact, there are over 100 systemic diseases that have oral manifestations, such as cardiovascular disease, stroke, respiratory infections, pancreatic cancer, diabetes, and nutritional problems. This is a bidirectional relationship and the link is inflammation. Oral health problems can have an adverse effect on the quality of life and are more prevalent in older adults, but are not caused by aging. Approximately 75% of baby boomers will enter long-term care facilities with the majority of their natural teeth and this trend is expected to continue. Studies indicate that residents with good oral care require less health care dollar expenditures. Therefore, dental professionals, such as the dental hygienist, should be part of the multidisciplinary team to assist in providing expert regular dental care and training to caregivers and other health care professionals in long-term care facilities.

Clinical and economic outcomes of a fall-focused pharmaceutical intervention program.

The effects of a fall-focused pharmaceutical intervention program (FFPIP) on the clinical and economic outcomes of elderly patients who fall while residing in a rehabilitation center are described. The objectives of this retrospective observational study were to identify the differences in the number of patient falls among elderly patients before and after pharmaceutical interventions, identify the cost savings related to decreasing the number of falls, and determine whether a relationship exists between falls among the elderly and specific medication classes. A data collection tool was developed by the investigators to record demographics and medication use. Two hundred patients were randomly selected from the preintervention (October 1, 1999-September 30, 2000) and postintervention (October 1, 2000-September 30, 2001) periods. Two data collectors collected data from patient medical records to test the data collection tool and ensure accuracy. The number of patient falls was reduced in the postintervention group by 47%, resulting in a future savings of $7.74 per patient per day. The use of several classes of medication also decreased in the postintervention period: cardiovascular agents, 10.7%; analgesics, 6.3%; psychoactive drugs, 18.2%; and sedatives and hypnotics, 13.9%. Patients most likely to fall were male, greater than 76 years of age, had a cardiovascular- or orthopedic-related diagnosis, and were taking analgesics, cardiovascular agents, and central nervous system agents, yet the intervention had a more significant effect on female patients. Implementation of an FFPIP decreased falls by 47% and decreased the use of cardiovascular drugs, analgesics, psychoactive medications, and sedatives and hypnotics.