Medication discrepancies in the dental record and impact of pharmacist-led intervention

Abstract

Background: Patients frequently use medications with potential implications for oral health and dental procedures, yet little is known about the accuracy of medication lists available to dentists. The aims of this study were to describe the frequency and clinical implications of medication discrepancies in the dental record (phase 1) and to evaluate the impact of pharmacist intervention on medication reconciliation processes in dental practice (phase 2). Methods: A prospective, single-centre study evaluating adults receiving dental care was conducted. Discrepancies between the dental record and patient-reported medications were identified through a pharmacist-led medication review and were further evaluated for potential clinical significance based on drug-induced orofacial adverse-effect profiles. A multifaceted pharmacist-led intervention was implemented. Data were analysed using Poisson regression with a significance level set at 0.05. Results: One-hundred and thirty patients (48% women; mean age 57 years) were interviewed by a clinical pharmacist (100 before intervention and 30 at follow-up). Of 860 medications reported, 618 discrepancies were identified, medication omission being the most common (71.7%). Of medications omitted, 64.6% had potential oral adverse effects, 7.9% could interact with local anaesthetics/vasoconstrictors and 19.1% had potential bleeding effects. The intervention resulted in a reduction in the number of medication discrepancies and medication omissions (P < 0.001). Conclusions: Medication discrepancies in the dental record occur at an alarming rate and frequently involve medications known to cause oral health problems or complications with dental procedures. A pharmacist-led intervention targeting medication reconciliation processes is an effective strategy for improving the accuracy of the dentist's medication list.

Introduction

Patients presenting for dental care frequently use medications that have potentially negative effects on oral health or on the dental provider's plan of care1., 2., 3., 4., 5.. Medications may affect oral health through their orofacial effects (causing xerostomia, mouth ulceration, oral candidiasis, etc.) 3., 5.. Medications can affect dental management as a result of their direct effects on parameters such as bleeding risk or drug–drug interactions with local anaesthetics and vasoconstrictors6., 7.. In addition, there are potential drug–drug interactions between medications taken by patients and those prescribed by a dental provider2., 8., 9., 10., 11., 12..

Miller et al. reported on findings from a retrospective chart review of over 5,000 patients from two dental school clinics in the US¹. Over 40% of patients in this study were taking medications, with the greatest use occurring among the elderly, women and African Americans. The most common types of potential adverse effects of dental importance associated with medication use were xerostomia (15.8%), gastroesophageal irritation (12.9%) and abnormal bleeding (11.2%). The authors emphasised the need for dentists to be aware not only of the medications taken by their patients but also of the potential effects and drug interactions that can result from their therapies¹. Similar findings were reported in a study from five general dental practices in England, where Brindley et al.² found that over the course of a 5-month period, 26% of patients seen were taking systemic medications, with the majority of such medications having the potential to impact on the dental provider's plan, either because of orofacial adverse effects caused by the medication or potential interference with the dental management of the patient as a result of the medication itself.

The research findings from Brindley et al. and Miller et al. emphasise the need for dentists to identify each medication and its potential effects or interference with the plan of care. However, each of these studies' findings is limited by the presumed accuracy of the medication list in the dental chart or that only prescription medications were assessed. Little is known about discrepancies in medication lists in general dental practices or the clinical significance of those discrepancies on oral health and dental treatment procedures. Although patient medication histories are routinely gathered before the dental visit in most practices, observations from other outpatient care settings suggest that the list generated in the dental provider's office may contain an incomplete and inaccurate record of medication13., 14.. A study by Nassaralla et al.¹³ reported that only 7.7% of medication lists in an internal medicine outpatient clinic were accurate. Even with the use of electronic medical records, discrepancies persist at an alarming rate¹⁴. Discrepancies between the list gathered in the dental provider's office and the patient's actual behaviours may lead to drug interactions, duplicate therapy, unnecessary therapy or failure to recognise adverse oral effects caused by medications.

Given the amount of time since the previous studies were conducted and their limitations, a more accurate estimate of the current frequency of use of medications with potentially negative implications on oral health is needed. Using models for medication reconciliation from other ambulatory care settings and adapting them for use in dental practices may provide a more complete medication list and thus a more accurate estimate of each situation.

To respond to this need, phase 1 of the study was conducted to describe the frequency and clinical significance of medication discrepancies between the lists collected through usual care by dental providers and assistants and medication reconciliation conducted by a clinical pharmacist, and phase 2 of the study was conducted to evaluate the impact of a pharmacist-led training session on the ability of dental professionals to obtain an accurate medication list.

Methods

This study was a prospective analysis of adult patients receiving general dental care at a free health clinic in an urban area. At the time the study was conducted, the dental clinic served adults over the age of 18 who were underinsured or uninsured and with household income less than 200% of the Federal Poverty Level. The clinic also provided free medical care to uninsured patients meeting those same criteria. Pharmacist-led medication reconciliation was an established service for patients receiving medical care as a result of an academic partnership between the free health-care centre and a local school of pharmacy. Clinic administration had interest in expanding the involvement of pharmacy to dental services, and an informal assessment of opportunities and needs suggested potential for improvement in medication reconciliation processes. Phase 1 of the study was conducted to assess the baseline accuracy of medication reconciliation processes, and phase 2 of the study evaluated the impact of a pharmacist-led intervention to improve this process. The findings from phase 1 were used to inform and develop the intervention. This study was conducted in full accordance with the World Medical Association Declaration of Helsinki and was reviewed and approved by the Institutional Review Board at Duquesne University. All patients provided written informed consent before participating in the study.

Patient enrolment

Inclusion criteria for participation were patients 18–80 years of age who were receiving only dental care at a free health clinic (Catholic Charities Free Health Care Center). Data collection for phase 1 occurred during October 2014 to January 2015. The same inclusion criteria were used for patients in phase 2 with exclusions for those having already participated in phase 1. Data collection for phase 2 occurred between April and June 2015. Patients receiving medical care (in addition to dental care) at the clinic were excluded as medication reconciliation services are provided to such patients as part of their usual care during medical appointments, and the medication list is updated in the electronic medical record (EMR) at each visit. Dental providers at the clinic have access to the updated medication lists for medical patients. Because patients presenting only for dental services receive medical care elsewhere, the medication list is not immediately available and must be obtained through the dental provider and/or assistant. The decision to use ‘dental only’ patients provided external validity to the study as in most dental practices the dentist would not have ready access to the EMR of the patients' primary care provider.

Medication review

All dental patients continued to receive the usual care related to collection of their medication history, which was performed by their dentist or, when available, a dental assistant under the dentists' supervision. The clinic used a Volunteer in Medicine model for dental providers; there were approximately 15 general dentists who provided care during the time period under study. The clinic also employed a part-time dental hygienist and one or two dental assistants. As expected, ‘usual care’ varied between different providers but typically included asking the patient if there were any changes to their medications since their last visit or requesting the patient to fill out a history form with a section for medications. The provider (or the assistant under provider supervision) then updated the patient's medication record in the EMR. Following usual care, subjects were independently interviewed by a pharmacist for a medication review. The pharmacist who conducted medication reviews was residency trained, academic and a research fellow in postgraduate training, specialising in ambulatory care. The medication review included the names, doses, regimens and indications of the medications being taken by the patient, including prescriptions, over-the-counter (OTC) medications and supplements. In some instances, patients brought caregivers or medication lists to the appointment, in which case these resources were also used to generate a medication list. Patients with low health literacy or English as a second language were not excluded from the study when a caregiver or an interpreter was available. For patients unable to provide information, the pharmacist collected the information by contacting the patient's community pharmacy with permission given by the patient.

After completion of the medication review, the pharmacist compared the medication list collected via patient interview with the charted medications in the EMR. Discrepancies between the interview and chart were identified and classified according to predefined types: not on medication; medication not on chart; similar medication/class; or different dose/sig. These categories have been identified previously in the literature and were considered relevant to the level of information useful to the dentist¹⁴. Although all four types of discrepancies could be important clinically, ‘medication not on chart’ is probably the discrepancy of most importance for the purposes of this study. Patient use of medications in this category could occur unbeknownst to the dental provider and their implications not considered. Medication discrepancies of this type were further evaluated for potential clinical significance. Clinical significance was also predefined into categories that included oral adverse effects and (using nomenclature from Dental Lexi-Drugs®¹⁵) local anaesthetic/vasoconstrictor precautions, dental health professional considerations, effects on dental treatment and effects on bleeding. Medications were determined to be clinically significant based on a list of medications with reported oral manifestations that was generated by the researchers following a systematic review of the literature. The list was prepared by two student pharmacists and cross-checked by one of the researchers (A.S.) with monographs in Dental Lexi-Drugs®. Each medication with a discrepancy was cross-referenced with this list and also individually assessed in Dental Lexi-Drugs® to evaluate the medication's potential impact on the dental provider's plan of care. Medications not appearing on the list or without warnings in Dental Lexi-Drugs® were considered to be ‘not clinically significant’.

Pharmacist-led intervention

Following the phase 1 data collection, the preliminary study results were assessed, and a multifaceted intervention by a pharmacist was implemented to improve the medication reconciliation process used by the dental providers. The intervention included a pharmacist-designed, interactive, software content object within the EMR to streamline and guide dental providers in the medication reconciliation process (Table 1). The intervention also included a mandatory pharmacist-provided educational session on collecting and updating accurate medication lists during patient encounters. For those who were unable to attend the live educational session, the presentation content was recorded and disseminated to all dental providers. Following the intervention, the phase 2 data collection was conducted to evaluate the change in the frequency and types of discrepancies.

Table 1.

Pharmacist-designed, interactive, software content object

Patient was asked, ‘What medication are you currently taking’ and compared to what is listed in the medication list of the tab

1.Are there any medication discrepancies? Yes No 2.Are you taking any pain medications? Yes No 3.Are you taking any blood pressure medications? Yes No 4.Are you taking any aspirin, warfarin (Coumadin), clopidogrel (Plavix), or any other anticoagulants or ‘blood thinners’? Yes No 5.Are you taking medications for anxiety, depression, or mood disorder? Yes No 6.Are you using any inhaler? Yes No 7.Are you taking vitamins, OTC medications, or herbal supplements? Yes No 8.Are you experiencing any unpleasant symptoms in your mouth such as dry mouth or taste disturbance? Yes No

If Yes, please list symptoms below

If patient answers Yes to any of the above questions- Please enter ALL disclosed medications in the medication section of the dental chart tab

Statistical analysis

All data were collected using a data-collection form adapted by the researchers from a previous study and were entered into Microsoft Office Excel Spreadsheets. Descriptive statistics were used for all parameters and reported as mean ±standard deviation for normally distributed continuous variables. Medication discrepancies were quantified and classified into predefined types, as described above. Statistical analysis compared patient demographics, number of medication discrepancies, number of medication discrepancies according to discrepancy type and number of potential oral health implications as a result of the use of undocumented medications between phase 1 and phase 2. The chi-square test, Fisher's exact test and Poisson regression were used as appropriate to determine whether statistically significant differences were present between the phases. All analyses were conducted with the use of R statistical software, version 3.2.1. Two-sided values of P < 0.05 were considered to be statistically significant.

Results

Frequency and clinical significance of medication discrepancies

Phase 1

One-hundred subjects participated in phase 1; their demographic characteristics are summarised in Table 2. Their mean age was 58 years, and 26% were over 65 years of age. Ninety-seven per cent of subjects reported the use of one or more medications, with an average of 7.49 medications (predicted mean based on Poisson regression) per patient, including prescription and OTC medications. Ninety-six per cent of subjects had one or more discrepancies present in the EMR, with a mean of 6.35±2.52 discrepancies per patient, and a total of 618 discrepancies were identified.

Table 2.

Demographic characteristics of subjects

Characteristics	Phase 1	Phase 2	P
n	100	30
Age (years)	58 ± 11.4 (25–76)	55.4 ± 11.4 (31–78)	0.3152
No. male	48 (48)	19 (63.3)	0.2057
No. white	71 (71)	19 (63.3)	0.4667
No. medications*	7.49 ± 2.74	6.14 ± 2.48	0.0287

Values are given as mean ± standard deviation (range), n (%) or mean ± standard deviation.

^*The means of the number of medications are based on the prediction mean of Poisson regression. Standard deviation of the Poisson distribution is equal to the square root of the mean.

The most common type of discrepancy was medication not documented (71.7%) (Table 3). Of the 443 undocumented medications, 286 (64.6%) medications had at least one potential implication on oral health; these medications are listed according to pharmacological class in Table 4. These 286 medications had a combined total of 600 potential oral health implications. The types of oral health effects potentially caused by these medications are listed in Table 5 with the most common being xerostomia or dry mouth. Additionally, 7.9% of undocumented medications had potential interactions with local anaesthetic/vasoconstrictors, and 19.1% had potential effects on bleeding. The classes of medications most frequently omitted from the chart at baseline included central nervous system drugs, opioids/analgesics and vitamins/supplements (Table 4).

Table 3.

Frequency of medication discrepancies and medication types

Variable	Phase 1	Phase 2	P
Total medications reported	689	171
Total medication discrepancies	618 (89.7)	120 (70.2)	<0.001
Discrepancy type
Not on medication	60 (9.7)	19 (15.8)	0.4089
Medication omission	443 (71.7)	78 (65)	<0.001
Similar medication/class	5 (0.8)	2 (1.7)	0.631
Different dose or sig	110 (17.8)	21 (17.5)	0.2796

Values are given as n or n (%).

Results were obtained from the chi-square test or Fisher's exact test.

Table 4.

Types of undocumented medications with potential oral implications

Variable	Phase 1	Phase 2
Undocumented medications	443	78
Drug class
Central nervous system drugs	69 (15.6)	11 (14.1)
Opioids/analgesics	56 (12.6)	9 (11.5)
Vitamins/supplements	33 (7.4)	5 (6.4)
Cardiovascular	31 (7.0)	4 (5.1)
Diabetes agents	18 (4.1)	1 (1.3)
Blood formation and coagulation	18 (4.1)	3 (3.8)
Electrolytic, caloric and water balance	16 (3.6)	0
Asthma	11 (2.4)	1 (1.3)
Gastrointestinal drugs	9 (2.0)	2 (2.6)
Immunosuppressive agents	5 (1.1)	0
Antihistamines	3 (0.7)	2 (2.6)
Hormones	3 (0.6)	0
Anti-infective agents	2 (0.5)	1 (1.3)
Anticholinergics	2 (0.5)	0
Other	11 (2.4)	5 (6.4)
Total	287 (64.8)	44 (56.4)

Values are given as n or n (%).

Table 5.

Potential clinical implications of undocumented medications

Variable	Phase 1	Phase 2
Undocumented medications	443	78
Potential oral adverse effects
Xerostomia	187 (42.2)	31 (39.7)
Taste disturbance/metallic taste	88 (19.8)	11 (14.1)
Changes in salivary flow	42 (9.5)	5 (6.4)
Stress-induced hypoglycaemia with dental treatment	18 (4.1)	1 (1.3)
Stomatitis/mucositis	18 (4.1)	1 (1.3)
Mouth ulceration	17 (3.8)	0
Oral/oesophageal candidiasis	15 (3.4)	2 (2.6)
Angioedema of face, tongue, lips and mucous membranes	15 (3.4)	1 (1.3)
Gingival hyperplasia	14 (3.2)	3 (3.8)
Bruxism	12 (2.7)	2 (2.6)
Glossitis/tongue mucosal atrophy	11 (2.5)	2 (2.6)
Gingivitis/periodontitis	9 (2.0)	0
Dysphagia	7 (1.6)	0
Toothache	4 (0.9)	0
Dry throat/throat irritation	4 (0.9)	0
Burning mouth syndrome	3 (0.7)	0
Nausea	3 (0.7)	0
Sedation	3 (0.7)	0
Tongue discolouration/tongue coating	3 (0.7)	0
Tooth disorder	2 (0.5)	1 (1.3)
Ulcerative oesophagitis	2 (0.5)	0
Salivary gland swelling	1 (0.2)	0
Gingival haemorrhage	1 (0.2)	0
Osteonecrosis of the jaw	1 (0.2)	0
Local anaesthetic/vasoconstrictor precautions
Prolonged QT interval	21 (4.7)	5 (6.4)
Administer vasoconstrictor with caution and monitor vital signs	11 (2.5)	2 (2.6)
Monitor blood pressure before using local anaesthetic with vasoconstrictor	2 (0.5)	0
May result in tachycardia, peripheral vasodilation or hypotension	1 (0.2)	0
Effects on bleeding
Increased risk of bleeding	39 (8.8)	6 (7.7)
Prolonged bleeding time	33 (7.4)	1 (1.3)
Thrombocytopenia	13 (2.9)	3 (3.8)

Values are given as n or n (%).

Phase 2

Thirty subjects participated in phase 2 for whom the demographic characteristics are summarised in Table 2. The mean age of subjects was 55 years; 20% were over the age of 65. All subjects reported the use of one or more medications, with an average of 6.14 medications (predicted mean based on Poisson regression) per patient, including prescription and OTC medications. Seventy-seven per cent of subjects had one or more discrepancies present in the EMR with a mean of 3.97±1.99 discrepancies per patient and a total of 120 discrepancies identified. Of 120 discrepancies, medication not documented (65%) was the most common type of discrepancy, and 44 medications among these undocumented medications had potential to cause negative effects on oral health (types of medications described in Table 4). These 44 medications had a total of 77 potential oral health implications, the most common being xerostomia.

Impact of pharmacist-led intervention

Following the pharmacist-led intervention, a statistically significant difference in the number of medication discrepancies and undocumented medications was observed (Tables 3 and 6). The estimated mean number of medication discrepancies decreased by 37.5% (from 6.35 to 3.97) between phase 1 and phase 2 (P < 0.001). The frequency of undocumented medications was reduced by 41.3% (P < 0.001). The mean numbers of undocumented medications were 4.43 and 2.60 at phase 1 and phase 2, respectively. There was no statistically significant reduction observed in the frequency of medications with potential oral health implications among undocumented medications (P = 0.2113).

Table 6.

Frequency of discrepancies per patient

Variable	Phase 1 (n)	Phase 2(n)	Reduction(%)	P
Medication discrepancy per patient	6.35	3.97	37.5	<0.001
Medication omission per patient	4.43	2.60	41.3	<0.001

Results are based on Poisson regression with exponential transformation.

Discussion

Medication use is frequent among adults receiving dental care. In this study, a large majority (97.7%) of patients reported taking medications, which is notably greater than the percentage reported by Miller et al.¹ and Brindley et al.² (42.3% and 26% respectively). In this study, the average numbers of medications reported to be taken per patient were 7.49 in phase 1 and 6.14 in phase 2, which are also greater than the 0.68 drugs per person reported in the study by Miller et al.¹. These differences may be explained by the growth of medication use in the USA since 1992 when Miller et al. first described the status of medication use among dental patients. Also, the present study included a greater number of subjects over the age of 65 (24.6%) compared with the studies of Miller et al.¹ (10.2%) and Brindley et al.² (46% compared with 38.7% of patients ≥60 years of age), and medication use typically increases with age. However, this finding can, in part, be explained by the methods used to collect the frequency of medication use, which in previous studies could have underestimated medication use. The present study utilised a more rigorous and thorough procedure to obtain the medication lists compared with previous studies, which used chart review or patient-reported prescription medications. The large number of discrepancies recorded in the current study strongly suggests this as a potential confounder in the study conducted by Miller et al.¹. Overall, this study demonstrates that dental providers may underestimate and underappreciate the prevalence of medication use in their patients and fail to assess or document the use of drug therapies.

In this study, undocumented medications were investigated for their potential oral implications because this type of discrepancy presents the greatest risk to the patient when the dental provider is not aware what medications the patient is using. From phase 1, more than half (64.6%) of undocumented medications had potential to cause oral adverse effects, which is similar to the findings by Miller et al.¹ that 56.8% of all medications surveyed had the potential to affect dental treatment. Confirming findings from previous research, xerostomia was the leading potential oral adverse effect in the present study, although it was more common in this study than in the previous research. Dental providers should be aware of medications causing dry mouth and should take a proactive approach in identifying patients at risk for this adverse effect and consider drug therapy as a cause when complaints of dry mouth arise. Other adverse effects related to taste disturbances were common and should also be a high priority for assessment and education.

In addition, numerous medications were identified that could affect dental providers' plan of care by interfering with local anaesthetic/vasoconstrictor or with bleeding (7.9% and 19.1%, respectively). Although the risk is extremely low, it is advised to use caution when vasoconstrictors (e.g. epinephrine and levonordefrin) are used in patients taking antidepressants, including selective serotonin reuptake inhibitors (SSRIs)/serotonin–norepinephrine reuptake inhibitors (SNRIs), or atypical agents because of the potentially increased risk for a prolonged QT interval¹⁵. Furthermore, vasoconstrictors should be administered with caution and vital signs monitored when patients take antidepressants that inhibit the uptake of norepinephrine (e.g. venlafaxine and bupropion) owing to potential elevation in the levels of norepinephrine¹⁵. The number of undocumented medications with potential effects on bleeding (19.1%) was higher than reported by Miller et al.¹ (11.2%). For many patients taking OTC non-steroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin, there was no documentation in the dental record of use of these drugs. Because these medications can significantly impact bleeding risk in patients, dental providers should take extra efforts to identify the use of these medications available without prescription¹¹. Furthermore, vitamins/supplements were the most commonly undocumented class of medications in this study. Not all vitamins/supplements have clinical implications on oral health. However, vitamin D is reported potentially to cause a metallic taste and xerostomia, while fish oil potentially prolongs bleeding time¹⁵. To prevent clinically adverse effects that may be caused by OTC medications and supplements, dental providers must be aware of the use of medications other than prescription medications taken by their patients.

Similarly, opioid analgesics, NSAIDs and antibiotics are commonly prescribed by dental providers16., 17.. In this study, almost 20% of undocumented medications fell into one of these three classes. This exposes patients to risk of duplicate therapy and drug interactions when dentists prescribe these medications in addition to the patients' existing drug therapy. For example, a patient with chronic pain using long- and short-acting opioids and NSAIDs for pain management could easily be prescribed an additional short-acting opioid and NSAID for the treatment of pain related to a dental procedure. The risk of adverse effects from excessive opioid use and additional gastrointestinal risks from this regimen could be costly, if not devastating, to a patient. Given this scenario, the unnecessary prescribing of opioids also presents a public health risk by increasing the amount of unused opioid analgesics available in the community.

While both Miller et al.¹ and Brindley et al.² conclude that many dental patients take medications with potential oral adverse effects and support the importance of taking a comprehensive medical history at every patient visit, these reports do not assess the accuracy of medication lists collected in their studies. The medication lists collected in the study by Miller et al.¹ were obtained from the medical history form in the charts, so the accuracy of these medication lists are unknown. As claimed by Miller et al.¹ and Brindley et al.², dental providers should be able to identify oral adverse effects caused by medications. However, collecting an accurate history of patients' actual medication-taking behaviours is the first step in assessing patient use of medications with clinical importance. In the present study, medication discrepancies within the dental record occurred at an alarming rate. The discrepancy rates in this study were similar to or greater than those seen in ambulatory care practice settings without structured or standardised methods for completing medication reconciliation¹³. Much effort has been made in recent years to improve accuracy of medication lists, and this study suggests that similar advances are needed in other outpatient care settings, specifically dental practices.

In this study, a multifaceted pharmacist-led intervention resulted in a statistically significant reduction in the frequency of medication discrepancies and undocumented medications. A previous study, conducted in an ambulatory care setting, observed a general trend of improved accuracy in medication reconciliation after a pharmacist-led educational intervention¹⁸. There are opportunities to impact medication safety in practice settings not typically considered by pharmacists for collaboration. This study describes one model for intervention that was effective.

Limitations

The findings of this study are not without limitations. There are some limits regarding the ability to generalise the findings to all patients and dental practices because of the setting in which the study was conducted and the population being studied (uninsured, low-income adults). However, the findings, which were related to the clinical implications of medications on oral health and the dental care plan, were similar to those of previous studies. A potential bias could have been introduced through the data-collection procedures as although only one pharmacist was conducting patient interviews, more than 10 dental providers were treating patients. Because the focus of this study was to assess the overall medication reconciliation process carried out at the clinic rather than to focus on individual dental providers, detailed information or demographics on providers was not gathered. This prevents any analysis on the influence of specific providers on the outcomes observed. However, consistency in the individual conducting the interview mitigated variability in patient interviews. During the study period there was a turnover of one dental assistant, which could have affected the consistency of medication histories collected by the dental assistant. It is unclear what impact this could have on the results; however, the large number of discrepancies existing before and after this change was similar, suggesting that any effect was minimal. In addition, because of time restriction of the study period, the pharmacist could deliver only one educational session to the dental providers between phase 1 and phase 2 of the study. Multiple educational sessions could have had a greater impact, but a single session still provided statistically significant reductions in the number of medication discrepancies and undocumented medications; if additional sessions were offered, these reductions in the number of medication discrepancies and undocumented medications may be reduced even further.

Conclusion and next steps

Medication discrepancies are common in dental records and frequently involve medications known to cause oral health problems or potential complications with the dental procedure. This study highlights the importance of improving the accuracy of medication lists available for dental providers. Dental providers should be aware of the importance of collecting accurate medication lists through a proper medication reconciliation process. A pharmacist-led intervention, targeting medication reconciliation processes, is an effective strategy for improving the accuracy of medication lists available to dentists. This research demonstrates potential for interprofessional collaboration between dentists and pharmacists in education and medication use processes. There may be opportunities for interprofessional education in didactic curricula or experiential settings where dental students and pharmacy students conduct medication reconciliation together. Dental students can benefit by learning the process of medication reconciliation, while the student pharmacists gain knowledge on the dental implications of medications, a likely gap in pharmacy education. However, as pharmacist assistance may not be readily available in most dental practice settings, an ongoing effort to improve medication reconciliation processes is needed. One potential strategy is the incorporation of interactive software content within the dental EMR. Dental providers should also encourage patients to bring updated medication lists to each dental visit and should communicate with primary care providers or local pharmacies when patients are unable to provide a medication list. Future research could also explore the potential for technology, specifically health information technology, to improve access to complete and accurate information.

Acknowledgements

The authors wish to acknowledge Shannon Sallice, the director of operations at Catholic Charities Free Health Care Center, and dental providers and staff for their general support for the study. The authors also wish to acknowledge Pennsylvania Pharmacists Association Educational Foundation for grant funding to support this study.

Conflict of interests

The authors declare that there is no conflict of interest associated with this study.