Using the Beers criteria to identify potentially inappropriate medication use by older adult dental patients.

BACKGROUND: An aging population indicates that increasing numbers of older adults will seek oral health care and have multiple chronic conditions treated with a number of medications. The authors examined the Medicare Current Beneficiary Survey administrative data set to characterize potentially inappropriate medication (PIM) use by older adults visiting the dentist and related adverse experiences that may affect oral health care. METHODS: The authors used the 2015 Beers criteria to identify PIMs for older adults. The authors examined the Medicare Current Beneficiary Survey administrative data set for community-dwelling older adults with dental care visits and reported national prevalence estimates of Beers criteria medication prescribing. The authors used logistic regression to identify sociodemographic and health-related characteristics associated with potentially inappropriate prescribing. The authors described medication-related adverse experiences affecting dental care. RESULTS: Among older adults with dental care visits, 56.9% received a prescription for at least 1 Beers criteria medication, and 28.3% received a prescription for 2 or more Beers criteria medications. Beers criteria medication use was associated most strongly with the number of comorbid diseases as represented by higher Charlson Index scores (odds ratios, > 1.0). CONCLUSIONS: A substantial proportion of community-dwelling older adults visiting dentists had received prescriptions for 1 or more potentially age-inappropriate Beers criteria medications. Many of these medications have adverse effects that could affect patient safety and oral health care. PRACTICAL IMPLICATIONS: These results support the need for clinicians to be aware of PIM use by older adults, recognize associated medication-related adverse events, and avoid prescribing age-inappropriate medications to this vulnerable patient population.

Cost-effectiveness of antibiotic prophylaxis for dental patients with prosthetic joints: Comparisons of antibiotic regimens for patients with total hip arthroplasty.

BACKGROUND: Clinician uncertainty concerning the need for antibiotic prophylaxis to prevent prosthetic joint infection (PJI) after undergoing dental procedures persists. Improved understanding of the potential clinical and economic risks and benefits of antibiotic prophylaxis will help inform the debate and facilitate the continuing evolution of clinical management guidelines for dental patients with prosthetic joints. METHODS: The authors developed a Markov decision model to compare the lifetime cost-effectiveness of alternative antibiotic prophylaxis strategies for dental patients aged 65 years who had undergone total hip arthroplasty (THA). On the basis of the authors' interpretation of previous recommendations from the American Dental Association and American Academy of Orthopaedic Surgeons, they compared the following strategies: no prophylaxis, prophylaxis for the first 2 years after arthroplasty, and lifetime prophylaxis. RESULTS: A strategy of foregoing antibiotic prophylaxis before dental visits was cost-effective and resulted in lower lifetime accumulated costs ($11,909) and higher accumulated quality-adjusted life years (QALYs) (12.375) when compared with alternative prophylaxis strategies. CONCLUSIONS: The results of Markov decision modeling indicated that a no-antibiotic prophylaxis strategy was cost-effective for dental patients who had undergone THA. These results support the findings of case-control studies and the conclusions of an American Dental Association Council on Scientific Affairs report that questioned general recommendations for antibiotic prophylaxis before dental procedures. PRACTICAL IMPLICATIONS: The results of cost-effectiveness decision modeling support the contention that routine antibiotic prophylaxis for dental patients with total joint arthroplasty should be reconsidered.

Use of the Beers criteria to identify potentially inappropriate drug use by community-dwelling older dental patients.

OBJECTIVE: Recognizing drugs with serious adverse experience (AE) potential in an aging population would assist practitioners in preventing drug safety issues. This study identifies drugs with potential for causing serious AEs, describes the AEs, and estimates prevalent use among older adults visiting the dentist. STUDY DESIGN: Drugs with serious AE risk for older adults were identified with the use of the Beers criteria. Analyses of older adults visiting the dentist using the Medicare Current Beneficiary Survey tested associations between demographic and health-related variables and use of these drugs. Potentially serious drug-related AEs are described. RESULTS: More than 3 in 10 older adults visiting the dentist were prescribed a Beers-criteria drug. Commonly prescribed Beers-criteria drugs used in dentistry include benzodiazepines and long-acting nonsteroidal antiinflammatory analgesics. CONCLUSIONS: Awareness of potentially harmful drug-related AEs, their clinical consequences, and prescribing frequency for older adults will assist dentists in clinically managing patients and avoiding inappropriate prescribing.

Dental service trends for older US adults, 1998-2006.

This study of the Medicare Current Beneficiary Survey (MCBS) updates trends in utilization of dental services between 1998 and 2006 for community-dwelling U.S. adults of age 65 years and older. Bivariate comparisons were made between dependent variables (annual dental visits and types of dental procedures) and independent variables (age, gender, race, income, education, population density, marital status, U.S. Census Bureau regions, and self-reported health). The estimated percentage of community-dwelling Medicare beneficiaries with a dental visit for the years studied increased from 45.0% in 1998 to 46.3% in 2006. The age group of respondents who were 85 years and older had the greatest percentage increase in dental visits. Those reporting visits with preventive procedures increased from 87.8% to 91.2% whereas those reporting visits with nonpreventive procedures declined from 63.9% to 58.4%. The prevalence of dental visits continues to trend upward for this population of older adults. Increasing delivery of preventive services will likely impact the future mix of dental services as U.S. adults live longer.

Dental procedures and subsequent prosthetic joint infections: findings from the Medicare Current Beneficiary Survey.

BACKGROUND: The publication of the 2009 American Academy of Orthopedic Surgeons' (AAOS') guidelines for antibiotic prophylaxis after joint replacement (arthroplasty) has renewed debate concerning appropriate prophylaxis for dental patients. The authors examined an administrative data set to assess whether dental procedures were associated with prosthetic joint infections (PJIs). METHODS: Using data for the years 1997 through 2006 from the Medicare Current Beneficiary Survey (MCBS), the authors identified participants who had undergone total joint arthroplasty and those who had experienced a PJI. They explored associations between dental procedures and subsequent PJIs by using time-to-event analyses (N = 1,000). A nested case-control study included case participants who had had PJIs (n = 42) and matched control participants who had had total arthroplasty but had no PJIs (n = 126). The authors calculated hazard ratios (HRs) and odds ratios (ORs). RESULTS: Control participants (people without PJIs) were more likely than were case participants (those with PJIs) to have undergone an invasive dental procedure, though this trend was not statistically significant in either the time-to-event analysis (HR = 0.78; 95 percent confidence interval [CI], 0.18-3.39) or the case-control analysis (OR = 0.56; 95 percent CI, 0.18-1.74). Only four of 42 case participants had undergone an invasive dental procedure in the 90 days before the infection occurred. Consideration of all dental procedures yielded similar results. CONCLUSIONS: Dental procedures were not associated significantly with subsequent risk for PJIs, although this study's power was somewhat low. The clinical importance of prophylactic antibiotics in dentistry for patients who have undergone joint arthroplasty, therefore, may be questioned. CLINICAL IMPLICATIONS: These results support the view that the 2009 AAOS Information Statement on antibiotic prophylaxis for people with prosthetic joints should be reconsidered for patients in that population who are receiving oral health care.

Potentially serious drug-drug interactions among community-dwelling older adult dental patients.

OBJECTIVES: Reducing adverse drug events, including those resulting from drug-drug interactions, will be a health safety issue of increasing importance for dental practitioners in the coming decades as greater numbers of older adults seek oral health care. The purpose of this study was to identify prescription drugs with the potential for serious interactions and estimate prevalent use among older adults visiting the dentist. STUDY DESIGN: The Medicare Current Beneficiary Survey is an ongoing series of nationally representative surveys of Medicare beneficiaries. Potentially serious drug interactions were selected with the use of published work by Partnership to Prevent Drug-Drug Interactions. Drug interactions were identified and prevalence estimates made for community-dwelling older adults visiting the dentist. Analyses were completed to test associations between sociodemographic and health-related variables and the use of prescription drugs with the potential for serious interactions. RESULTS: Overall, 3.4% of those visiting the dentist were estimated to have been prescribed drugs with the potential for a serious drug interaction. Drugs commonly prescribed in dentistry with the potential for serious interactions include the benzodiazepines, macrolide antibiotics, and nonsteroidal antiinflammatory analgesics. CONCLUSIONS: Understanding potentially harmful drug combinations, their clinical consequences, and the frequency with which implicated drugs are being prescribed will assist practitioners in clinically managing patients and avoiding inappropriate prescribing.

Demographic factors associated with dental utilization among community dwelling elderly in the United States, 1997.

OBJECTIVES: The purpose of this study was to characterize dental service utilization in 1997 by community dwelling Medicare beneficiaries. METHODS: The Medicare Current Beneficiary Survey, or MCBS, is a continuous annual series of nationally representative surveys of Medicare beneficiaries. Univariate comparisons were made between dependent variables (dental utilization and types of dental services) by each of the independent variables (age group, gender, race, income, education, population density, marital status and U.S. Census Bureau regions using weighted proportions to test for independence between dependent and independent variables. RESULTS: Overall, an estimated 41% of the population had a dental visit. Although utilization declined with aging, 24% of those 85 and older visited a dentist. CONCLUSIONS: This descriptive study provides important information about dental utilization and services in the American elderly population. Younger, high income, white or educated elderly Americans had higher dental utilization.