Medication Matters: Protecting Oral Health in Older Adults

As the U.S. population ages, dentistry is at a turning point. Today’s older adults live longer, retain more natural teeth, and take more medications than any generation before them, which is great for managing chronic disease, but it also changes the oral health landscape. For dentists in practice, this creates a unique challenge and an opportunity.

As a dentist working with the older population, knowing which medications commonly affect the mouth, their mechanisms of action, and practical ways to reduce harm will make the dental treatment safer and more effective.

Why This Matters in Geriatric Dentistry

Polypharmacy is common in older adults, and many medications have anticholinergic, anticoagulant, and other effects that directly affect oral tissues, salivary flow, bleeding risk, wound healing, and even treatment outcomes. Medication related problems are a leading contributor to possible oral disease burden and to complications of routine dental care in older adults. Therefore, medication review should be a part of every geriatric dental visit. [1]

Common Medications and Their Oral Side Effects

Many drugs used by older adults such as antidepressants, antihistamines, bladder medications and some antipsychotics, have anticholinergic activity that reduces salivary flow.

Chronic dry mouth increases the risk of dental caries, candidiasis, mucosal soreness, denture discomfort, and difficulties swallowing and speaking. Assess salivary flow when possible and ask the patient about potential dry mouth symptoms at each recall appointment. [1]

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Clinical Tips

• Review medication list for anticholinergic burden and discuss possible deprescribing with the prescriber when appropriate (2)
• Recommend saliva stimulants, topical saliva substitutes, frequent sips of water, and additional fluoride for caries prevention.
• Consider more frequent recalls, fluoride treatment, and oral hygiene instructions

Antiresorptive agents used for osteoporosis and cancer (oral and IV bisphosphonate and denosumab) are strongly associated with MRONJ. The absolute risk is low for oral bisphosphonates used for osteoporosis but higher with IV formulations and antiangiogenic regimens. Prevention is key for patients who have been on these medications long term. Dental evaluation and completion of invasive dental care before starting high risk antiresorptive therapy is highly recommended. If the patient is on these medications, coordinate with the physician and follow the current MRONJ guidance for surgical decision making and management [3, 4]

Clinical Tips

• Take a thorough medical history and medication history (name, dose, route, start date, and indication)
• For patients staring IV therapy, clear any active infection and complete needed extractions or restorative work beforehand, if possible
• If MRONJ is suspected (exposed bone, non-healing sockets, pain, swelling), refer to and follow the MRONJ guidance [4]

Older adults commonly use blood altering medications such as anticoagulants (DOACs: apixaban, rivaroxaban, dabigatran) or antiplatelet medications. Guidance from the American Dental Association recommends not stopping most anticoagulants for routine dental procedures, but to plan procedures carefully, use hemostatic measures, and discuss potential bleeding risks and/or complex medical histories with the prescribing physician. Guidance for DOAC timing around higher risk procedures may vary by drugs and the patient’s thrombotic risk. Many national organizations advise scheduling early day appointments and possibly delaying the morning dose for high bleeding risk procedures after consulting with the prescriber [5].

Clinical Tips

• Review medical history, medication and the last dose of anticoagulant/antiplatelet medications
• Use local hemostasis measures: sutures, firm pressure, staged extractions, and possible tranexamic acid mouthwash [5]
• Communicate with the patient’s physician when the thrombotic risk is the highest or when multiple agents are being used.

Certain drugs commonly used by older adults can cause gingival hyperplasia (phenytoin, cyclosporine, calcium channel blockers like nifedipine/amlodipine). Enlarged gingiva increases plaque retention, increases periodontal disease risks, and can complicate denture fit. The severity may vary by the medications, oral hygiene and individual susceptibility [6]

Clinical Tips

• Emphasize oral hygiene and professional cleaning; coordinate with the prescriber about a possible alternative if applicable
• Gingival reduction surgery may be considered for severe cases, but oral hygiene/plaque control are the first steps.

Selective serotonin reuptake inhibitors and other antidepressants commonly result in dry mouth. In addition, they have also been associated with medication induced bruxism (awake or sleep grinding), which can accelerate wear and cause temporomandibular and restorative complications. Some observational studies suggest SSRI use may modestly affect implant success, but evidence is mixed and likely confounded. Screen for grinding, use appliances where indicated and manage dry mouth proactively with these patients (7)

As the aging population grows, medication related side effects are no longer rare exceptions; they are part of daily geriatric dentistry. By staying informed and applying evidence based strategies, dentists can not only improve treatment outcomes by also help older adults maintain comfort, function, and quality of life.

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Reference

1. Arany S, Kopycka-Kedzierawski DT, Caprio TV, Watson GE. Anticholinergic medication: Related dry mouth and effects on the salivary glands. Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 Dec;132(6):662-670. doi: 10.1016/j.oooo.2021.08.015. Epub 2021 Aug 29. PMID: 34593340; PMCID: PMC9112430.
2. Prado-Mel, E., Ciudad-Gutiérrez, P., Rodríguez-Ramallo, H. et al. Association between anticholinergic activity and xerostomia and/ or xerophthalmia in the elderly: systematic review. BMC Pharmacol Toxicol 23, 94 (2022). https://doi.org/10.1186/s40360-022-00637-8
3. Kim JW, Kwak MK, Han JJ, Lee ST, Kim HY, Kim SH, Jung J, Lee JK, Lee YK, Kwon YD, Kim DY. Medication Related Osteonecrosis of the Jaw: 2021 Position Statement of the Korean Society for Bone and Mineral Research and the Korean Association of Oral and Maxillofacial Surgeons. J Bone Metab. 2021 Nov;28(4):279-296. doi: 10.11005/jbm.2021.28.4.279. Epub 2021 Nov 30. PMID: 34905675; PMCID: PMC8671025.
4. Ruggiero, S. L., Dodson, T. B., Aghaloo, T., Carlson, E. R., Ward, B. B., & Kademani, D. (2022). American Association of Oral and Maxillofacial Surgeons’ Position Paper on Medication-Related Osteonecrosis of the Jaws – 2022 Update: Strategies for management of patients with, or at risk for, MRONJ. Journal of Oral and Maxillofacial Surgery, 80(5), 920-943
5. American Dental Association. (2022). Oral anticoagulant and antiplatelet medications and dental procedures: Guidance on perioperative management. Retrieved from https://www.ada.org/resources/ada-library/oral-health-topics/oral-anticoagulant-and-antiplatelet-medications-and-dental-procedures
6. Tungare S, Paranjpe AG. Drug-Induced Gingival Overgrowth. [Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
7. Garrett AR, Hawley JS. SSRI-associated bruxism: A systematic review of published case reports. Neurol Clin Pract. 2018 Apr;8(2):135-141. doi: 10.1212/CPJ.0000000000000433. PMID: 29708207; PMCID: PMC5914744.