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Medications and health histories: a survey of 4,365 dental patients
A survey was conducted to determine what medications dental patients are taking and to compile information from medical histories on the most frequent conditions. The frequency of use of drugs and positive medical findings is reported by group and by age, sex, and race. Use of drugs was found to increase with age; the proportion taking a medication was 1 in 4 for the teenage group, 1 in 3 for young adults, 1 in 2 for patients in their 40s, and 2 in 3 for patients aged 50 and older. Two thirds of all dental patients in the study had a medical history positive for at least one problem, and more than 50% of these patients reported multiple medical problems.
Medications and health histories: a survey of 4,365 dental patients Jam es A . C o tto n e , D M D , M S A . H. K a fr a w y , B D S , M S D
E v a l u a t i n g th e status o f a p a tie n t w h o is takin g several d ru g s or has a c o m p lic a t e d m e d ic a l h isto ry , or b o th , o fte n c h a lle n g e s th e d en tist. Y e t th ese p a tien ts are n o w m o r e lik e ly to se e k treatm ent. T h e o ld e r p a tien t is le a d in g a lo n g e r , m o r e p r o d u c tiv e life e v e n th o u g h h e m a y h a v e c a r d io v a s c u la r, e n d o c r in e , o r d e g e n e ra tiv e d is o r d e rs . S im ila rly , the y o u n g p a tien t w ith m e d ic a l p r o b le m s su c h as m ild h e m o p h ilia o r e p ile p s y is n o w c o m in g to th e d en ta l o ffic e fo r treatm en t. D en tists m u st b e aw a re o f s u ch c o n d itio n s so that p r o p e r co n s u lta tio n s w ith th eir m e d ic a l c o lle a g u e s m a y take p la c e a n d le a d to c o o r d in a te d m a n a g e m e n t o f th e p a tien t. T h e d e n tist m u st b e c o n c e r n e d w ith th e p a tie n t’s total h ealth . In crea sin g u se o f d ru g s is a fa ct in o u r so c ie ty . O n e rea son is that th ere are m o r e d ru g s a v a ila b le,
m a n y o f w h ic h are e ffe c tiv e in th e trea tm en t o f d is ease. O u r cu ltu re h as a ls o fo s te r e d th e b e lie f that a p ill ca n cu re a ll a ilm e n ts. H o w e v e r , m e d ic a tio n s ra rely h a v e a n a rro w ra n g e o f a c tio n a n d o fte n exert m u ltip le effe cts. A s su ch , d r u g s g iv e n fo r a s p e c ific e ffe c t o n o n e sy ste m m a y c o n s id e r a b ly alter th e e n tire b o d y an d aggravate s o m e o th e r c o m p le t e ly u n rela ted c o n d it io n . T h is is im p o rta n t b e c a u s e it has b e e n estim a te d that a d u lts take an a v era g e o f fo u r or fiv e d ru g s d a ily , a n d that h o s p ita liz e d p a tien ts m a y r e c e iv e fro m tw o to fiv e tim e s th is n u m b e r o f d ru g s e a ch d a y .1' 3 T h e p o s s ib ility o f d ru g in te ra ctio n s m u st b e re m e m b e re d . S e v e ra l s tu d ie s h a v e in d i c a te d that p o s s ib ly 3 % to 5 % o f th e a d m is s io n s to m e d ic a l w a rd s m a y b e d u e to d ru g r e a ctio n s a n d in te r a c tio n s .1,4 6 O fte n , a n tib io tic s o r m e d ic a tio n s c o n ta in in g a sp irin that are c o m m o n ly u s e d in d e n J A D A , V o l. 9 8 , M a y 1 9 7 9 ■ 7 1 3
tistry w e r e im p lic a t e d as th e ca u s e o f a d v e rse r e a c tio n s to d ru g s that re su lte d in h o s p ita liz a tio n .4' 6 A d d it io n a lly , as m a n y as 1 5 % o f a lre a d y h o s p ita liz e d m e d ic a l p a tie n ts m a y h a v e th e ir stay p r o lo n g e d b y th e se sa m e p r o b le m s .1,4,7 T h e re are m a n y re a s o n s w h y d e n tists n e e d to k n o w w h a t m e d ic a tio n s th e ir p a tien ts are tak in g. U n fo rtu n a te ly , it is b e c o m in g m o r e d iffic u lt to o b tain th is in fo r m a tio n as the n u m b e r a n d v a rie ty o f m e d ic a tio n in cre a se . T h is m a k es th e p r o b le m o f p o ten tia l d ru g in te r a c tio n s m o r e im p o rta n t, as it is n o w ea sier to in a d v e rte n tly e sta b lish th e c o n d itio n s n e ce s s a ry fo r th e se in te ra ctio n s . A s u r v e y 8 c o n d u c te d in 1 96 9 in d ic a t e d that d en tists w r o te 28 m i l lio n p r e s c r ip t io n s that y ea r c o m p a r e d w ith 18 m il lio n p r e s c r ip tio n s in 1 9 6 5 . T h e A m e r ic a n D en tal A s s o c ia t io n 9 r e c e n tly re p o r te d that d e n tists m a y h a v e w ritte n as m a n y as 65 m illio n p r e s c r ip tio n s in 1 9 7 5 . D en tists cu rre n tly a c c o u n t fo r a siz a b le p o r tio n o f th e n u m b e r o f p r e s c r ip tio n s w r itte n a n n u ally. W e h a v e fo u n d n o re p o r te d lis tin g o f w h ic h m e d ic a tio n s d e n ta l p a tien ts u s e m o s t o fte n in th e U n ite d States. It is a ss u m e d that m o s t d en ta l p a tien ts h a v e r e c e n tly taken , o r are c u rr e n tly tak in g, s o m e m e d ic a tio n . A lth o u g h th e y m a y n o t k n o w the n a m e o f th e ir m e d ic a tio n s a n d u s u a lly d o n o t h a v e th e d ru g or th e p r e s c r ip t io n b o ttle w ith th e m , p a tien ts o fte n k n o w th e c o n d it io n fo r w h ic h th e d ru g w a s p r e s c r ib e d . T h u s , w ith cu rre n t k n o w le d g e o f th e c o m m o n ly p r e s c r ib e d d ru g s fo r a p a rticu la r c o n d it io n , it m a y b e p o s s ib le to id e n tify that “ little p in k p i l l .” A g o o d m e d ic a l h is to r y is b a s ic to u n d e r s ta n d in g e a c h p a tie n t’ s tota l h ea lth . T o k e e p a h ig h state o f a w a ren ess, it is n e ce ss a r y to p e r io d ic a lly r e v ie w w h a t ty p e o f p a tie n t p o p u la t io n is cu r r e n tly b e in g s e e n in v a r io u s a s p e cts o f d en ta l p ra ctic e . T o c o m p ile s u c h in fo rm a tio n , it w a s d e c id e d to s u rv e y a p o p u la t io n o f d en ta l p a tien ts to d e te r m in e w h a t m e d ic a tio n s th e y are cu rr e n tly u s in g a n d to o b ta in c o r r e s p o n d in g in fo r m a tio n c o n c e r n in g th e ir m e d i ca l h istories.
S tu d y m e th o d s T h e stu d e n ts a n d fa c u lty o f th e O ra l D ia g n o sis C lin ic at In d ia n a U n iv e rs ity S c h o o l o f D en tistry w e r e a sk ed to c o m p le te a s u r v e y fo r m o n a ll p a tien ts s e e n in th e c lin ic fo r o n e a c a d e m ic year. T h e su rv e y fo r m in c lu d e d q u e s tio n s o n a g e, ra ce, g e n der, cu rre n t m e d ic a tio n s , a n d s ig n ific a n t m e d ic a l c o n d itio n s . O f th e 8 ,6 8 9 p a tien ts e x a m in e d b e tw e e n A u g u s t 7 1 4 ■ J A D A , V o l. 9 8 , M a y 1 9 7 9
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3zm
ix
x
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Drug Groups Frequency o f intake o f different drug groups.
1 975 a n d July 1 9 7 6 , c o m p le t e su r v e y fo r m s w e re o b ta in e d o n 4 ,3 6 5 . O f th e 3 ,5 0 0 p a tien ts s e e n o n an e m e r g e n c y b a sis, fo r m s w e r e c o m p le t e d b y 1 ,0 1 8 (2 9 .1 % ). O f th e 5 ,1 8 9 p a tien ts se e n fo r d ia g n o s is a n d fo r m u la tio n o f a trea tm en t p la n , 3 ,3 4 7 (6 4 .5 % ) c o m p le t e d th e fo rm s. O f th e p a tien ts s u rv e y e d , 3 ,2 2 3 w e r e w h ite (7 3 .8 % ), a n d 1,1 4 2 w e re b la ck (2 6 .2 % ). O f th e tota l, 2 ,5 7 7 p a tien ts w e r e fe m a le (5 9 .1 % ) a n d 1 ,7 8 8 w e r e m a le (4 0 .9 % ).
M e d ic a t io n s u s e d
Tabulation of findings A fte r a ll fo rm s w e r e r e c e iv e d , a ta b u la tion w a s m a d e o f th e m e d ic a tio n s b y g ro u p s . T h e s e g r o u p s w e r e a n a lg e s ic s (in c lu d in g an tia rth ritic d ru g s), a n tih y p e r te n s iv e s (in c lu d in g d iu r e tics ), p s y c h o th e ra p e u tic a gen ts (a n tia n x ie ty , a n tid e p ressa n t, a n d a n tip s y c h o tic d ru g s), h o r m o n e s (e x c lu d in g in s u lin a n d ora l c o n tr a c e p tiv e s ), a n tib io tics , a n tih is ta m in e s, c a r d ia c a gen ts, h y p o g ly c e m ic a gen ts, a n tico a g u la n ts, ora l co n tr a c e p tiv e s , a n tia sth m a tics, a n tico n v u lsa n ts , a n d m is c e lla n e o u s (v ita m in s, ant a c id s , a n o r e c tic s , a n d c o ld r e m e d ie s that ca n b e b o u g h t w ith o u t a p r e s c r ip tio n ). O f th e p a tien ts s u rv e y e d , 1,833 (4 3 .1 % ) w e re tak in g a m e d ic a tio n . O f th ese, 7 6 0 (1 7 .4 % ) w e r e tak in g m o r e th an o n e m e d ic a tio n . T h e fr e q u e n c y o f m e d i c a tio n in ta k e in th e d iffe r e n t a g e, g e n d e r , a n d ra cia l g r o u p s is su m m a riz e d in T a b le s 1 to 3. T h e Illu stra tio n su m m a riz e s th e fr e q u e n c y o f in tak e o f th e d if fe re n t d ru g g r o u p s . A n a lg e s ic s w e r e tak en b y 621 p a tien ts (1 4 .2 % ). T h e m o s t c o m m o n ly u s e d w e re a sp irin , a c e ta m in o p h e n (T y le n o l* ), a n d p r o p o x y p h e n e HC1 (D a r v o n t). O ral c o n tr a c e p tiv e s w e r e ta k en b y 245 w o m e n (1 2 .1 % ) w h o w e re o f
Table 1 ■ Frequency of medication intake by different age
groups. Age group
12 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70, older Total
Patients surveyed
Patients taking any medications
T a b le 2
sex.
Patients taking multiple medications
No.
No.
%
No.
%
788 1,419 662 532 451 330 183 4,365
189 541 254 285 275 214 125 1,883
24.0 38.1 38.4 53.6 61.0 64.8 68.3 43.1
47 160 95 135 139 125 59 760
6.0 11.3 14.4 25.4 30.8 37.9 32.2 17.4
c h ild b e a r in g ag e (12 to 4 9 years) A n tih y p e r te n siv e s, in c lu d in g d iu re tic s , w e r e ta k en b y 4 0 9 p a tien ts (9 .4 % ). T h e m o s t c o m m o n ly u s e d w e re h y d r o c h lo r o th ia z id e p re p a r a tio n s (D y a z id e t, H y d roD IU R IL §) a n d m e t h y ld o p a (A ld o m e t § ). M is ce lla n e o u s d ru g s w e r e ta k en b y 9 .4 % o f th e pa tien ts (4 0 9 ). T h e s e in c lu d e d v ita m in s , a n ta cid s , a n o r e c tics , a n d c o l d r e m e d ie s that c o u ld b e b o u g h t w it h o u t a p r e s c r ip tio n . P s y c h o th e r a p e u tic a gen ts w e re tak en b y 331 p a tien ts (7 .6 % ). T h e m o s t c o m m o n ly u s e d w e re d ia z e p a m (V a liu m ll) a n d c h lo r d ia z e p o x id e HC1 (Librium U ). H o r m o n e s , e x c lu d in g in s u lin a n d ora l co n tr a c e p tiv e s , w e r e ta k en b y 289 p atien ts (6 .6 % ). T h e m o s t c o m m o n l y u s e d w e re th y r o id h o r m o n e s a n d e stro g e n s. A n t ib io t ic s w e r e ta k en b y 214 p a tien ts (4 .9 % ). T h e m o s t c o m m o n ly u s e d w e re p e n ic illin , te tr a c y c lin e s , a n d e ry th r o m y c in . A n tih is ta m in e s w e r e tak en b y 164 p a tien ts (3 .8 % ). M o s t o f th e se w e r e p re p a ra tio n s that d id n o t req u ire a p r e s c r ip tio n . D ru g s that a ct o n th e h ea rt w e r e ta k en b y 133 p a tien ts (3 .1 % ). T h e m o s t c o m m o n ly u s e d w e re d ig ita lis, n itr o g ly c e r in a n d n itrate p re p a ra tio n s, a n d p r o p r a n o lo l HC1 (In d e ra l* * ). H y p o g ly c e m ic a gen ts w e re ta k en b y 87 p a tie n ts (2 .0 % ). T h e m o s t com m on w ere in s u lin and c h lo r p r o p a m id e (D ia b in e s e t t). P h e n y to in s o d iu m (D ila n t in t i) w a s th e m o st c o m m o n a n tic o n v u ls a n t a g en t; it w a s tak en b y 4 0 p a tien ts (0 .9 % ), a n d 28 p a tien ts (0 .6 % ) w e r e ta k in g a n tia sth m a tic a gen ts. A n tic o a g u la n ts w e re taken b y ten p a tien ts (0 .2 % ); th e m o s t c o m m o n w a s s o d iu m w a rfa rin (C o u m a d in § § ).
D iscu ssion A b o u t o n e in fo u r p a tie n ts in th e ir te e n s w e r e tak in g a m e d ic a tio n . T h e p r o p o r tio n in cr e a s e d to a b o u t 1 in 3 fo r p a tien ts in th e ir 20s a n d 3 0 s, 1 in 2 fo r p atien ts in th e ir 4 0 s , a n d 2 in 3 fo r p a tien ts in th eir 50s a n d 60 s a n d th o s e o ld e r th a n 70. Intake o f m u ltip le d ru g s a ls o in c r e a s e d w ith age. M o re fe m a le s w e r e ta k in g a m e d ic a tio n , e v e n
■Frequency of medication intake according to Patients taking any medication
Patients surveyed Sex Males Females Total
Patients taking any medication excluding OCt
No.
No.*
%
No.J
%
1,788 2,577 4,365
566 1,317 1,883
31.7 51.1 43.1
566 1,157 1,723
31.7 44.9 39.5
*C hi-square = 162.81, F < .001. t O ra l contraceptives. JC hi-square = 77.47, P < .001.
T a b le 3 ■Frequency of medication in take according to race. Patients surveyed
Patients taking medications
Race
No.
No.*
%
White Black Total
3,223 1,142 4,365'
1,367 516 1,883
42.4 45.2 43.1
*Chi-square = 2.63, P < .20.
w h e n th o s e ta k in g ora l c o n tr a c e p tiv e s w e re e x c lu d e d . R a ce d id n o t se e m to in flu e n c e th e fr e q u e n c y o f d ru g in take. M o r e p a tien ts w e r e ta k in g a n a lg e s ic s th an a n y o th e r m e d ic a tio n stu d ie d . T h is c o u ld o c c u r p o s s i b ly b e c a u s e p a tien ts w h o w e r e in p a in w e re in c lu d e d in th e stu d y . H o w e v e r , th is fr e q u e n c y o f in take o f a n a lg e sic s c o u ld b e a r tific ia lly lo w , as m a n y p a tien ts m a y n o t h a v e c o n s id e r e d a s p ir in as a re p o rta b le m e d ic a tio n , e v e n t h o u g h a n e ffo rt w a s m a d e to e lic it th is in fo r m a tio n . T h e sa m e c o n s id e ra tio n c o u ld h a v e in flu e n c e d th e r e p o r te d fre q u e n c y o f in tak e o f ora l c o n tr a ce p tiv e s . In 1 9 7 6 , B a rcla y 10 r e p o r te d h is fin d in g s o f a su r v e y o f 1 ,0 0 0 p a tien ts se e n at a d e n ta l s c h o o l in N e w Z e a la n d . H e fo u n d that 2 1 .2 % w e r e r e c e iv in g a m e d ic a t io n (e x c lu d in g o ra l c o n tr a c e p tiv e s ). In th e cu rren t stu d y , th e o v e r a ll fr e q u e n c y o f m e d ic a tio n , e x c lu d in g o ra l co n tr a c e p tiv e s , w a s 3 9 .5 % , a p p r o x im a te ly d o u b le th e fr e q u e n c y that B a rcla y r e p o rte d . A ls o , B a rcla y r e p o r te d that 1 7 .0 % o f a ll m a le s a n d 2 5 .5 % o f a ll fe m a le s w e r e ta k in g a m e d ic a tio n . In o u r stu d y , 3 1 .7 % o f th e m a le s a n d 5 1 .5 % o f th e fe m a le s w e r e tak in g a m e d ic a tio n , a g a in a lm o st d o u b le that r e p o r te d b y B a rcla y . T h e s e d iffe r e n c e s m a y b e p a rtia lly d u e to th e fa c t that th e N e w Z e a la n d s tu d y d ea lt o n ly w ith m e d ic a tio n s p r e s c r ib e d b y th e p a tie n ts ’ p h y s ic ia n s , w h e re a s o u r stu d y in c lu d e s m a n y o v e r -th e -c o u n te r p re p a ra tio n s that p o s s ib ly w e r e n o t p r e s c r ib e d b y a p h y s ic ia n . T h is is tru e o f th e g r o u p s o f a n a lg e s ic s a n d m is c e lla n e o u s m e d ic a tio n s that a c c o u n t fo r a b o u t 2 5 % o f th e e n tire d ru g tota l. A d d itio n a lly , it m a y b e a n tic ip a te d that th ere are d iffe re n t p r a c tic e s fo r p r e s c r ib in g C ottone-K afraw y: M ED IC A TIO N S A N D H EALTH H ISTO R IES ■ 715
d ru g s in th e t w o c o u n tr ie s ju st as th e y h a v e d if feren t fo r m s o f h e a lth care d e liv e r y . H o w e v e r , b o th stu d ie s r e p o rte d a s im ila r in c id e n c e o f m u ltip le d ru g th e ra p y in p a tie n ts ta k in g a m e d ic a t io n (a p p r o x im a t e ly 2 0 % ). B alter a n d o th e r s 11 r e p o r te d in 1 9 7 4 o n th e fr e q u e n c y o f u se o f a n tia n x ie ty a n d se d a tiv e d ru g s in n in e w e s te r n E u r o p e a n co u n tr ie s . T h e p e rce n ta g e o f re g u la r u se ra n g e d fr o m 3 % to 9 % w ith a m e a n o f 6 .5 % . It w a s a ls o r e p o r te d that, in th e U n ite d States, a p p r o x im a t e ly 7 % o f th e a d u lt p o p u la t io n u s e d p s y c h o th e r a p e u t ic d ru g s o n a re g u la r b a s is .12 T h is c o m p a r e s w it h th e in c id e n c e o f 7 .6 % r e p o r te d fo r th e se sa m e m e d ic a tio n s in th e cu rre n t stu d y . T h e se x d iffe re n tia l r e p o r te d , c o n c e r n in g th e fr e q u e n c y o f u s e o f th e se d ru g s (2 fe m a le s: 1 m a le ), is a lso c o n fir m e d in th e cu rre n t s tu d y (9 .4 % fe m a le s c o m p a r e d w it h 5 .0 % m a le s). P r o p r a n o lo l H C L, a lth o u g h p r o b a b ly m o s t fre q u e n tly p r e s c r ib e d to d a y to treat h y p e r te n s io n , w a s in c lu d e d in th e g r o u p o f ca r d ia c m e d ic a tio n s as it s e e m e d to b e u s e d b y th e m a jo r ity o f th e se p a tien ts fo r th e treatm en t o f a n g in a p e c to r is a n d c a r d ia c ar rh y th m ia s. T a b le 4 ■Frequency of positive health histories in differ ent age groups.
Age group
Patients surveyed
12 to 29 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70, older Total
Patients with positive responses
Patients with multiple positive responses
No.
No.
%
No.
%
788 1,419 662 532 451 330 183 4,365
383 902 484 409 367 280 164 2,989
48.6 63.6 73.1 76.9 81.3 84.8 89.6 68.5
130 416 286 252 253 198 118 1,653
16.5 29.3 43.2 47.4 56.1 60.0 64.5 37.9
T a b le 5 ■Frequency of positive health histories according to sex. Patients with positive responses
Patients surveyed Sex
No.
No.*
%
Males Females Total
1,788 2,577 4,365
1,142 1,847 2,989
63.9 71.7 68.5
M e d ic a l h is to r ie s
Tabulation of findings F r o m th e in fo r m a tio n g iv e n o n th e s u rv e y fo rm , th e p a tie n ts ’ m e d ic a l h is to r ie s w e r e ta b u la ted a c c o r d in g to a lle r g ie s ; p r o b le m s w ith th e e y e s , ears, in te g u m e n t, m u s c u lo s k e le to n ; d is o rd e rs o f th e car d io v a s c u la r , ce n tra l n e r v o u s , e n d o c r in e , g a stro in testin a l, g e n ito u rin a r y , a n d re sp ira to ry sy stem s; se r io u s illn e s s e s ; a n d h o s p ita liz a tio n s . In e a ch g r o u p , in d iv id u a l m e d ic a l p r o b le m s w e r e ra n k ed b y th e n u m b e r o f r e s p o n s e s r e c e iv e d . C h ild b irth w a s e x c lu d e d . O f th e p a tien ts s u r v e y e d , 2 ,9 8 9 (6 8 .5 % ) r e p o rte d at lea st o n e p o s it iv e m e d ic a l fin d in g a n d 1,653 (3 7 .9 % ) r e p o r te d m u lt ip le p o s it iv e fin d in g s . T h e fr e q u e n c y o f p o s it iv e m e d ic a l fin d in g s in th e d if fe re n t age, s e x , a n d ra cia l g r o u p s is su m m a riz e d in T a b le s 4 to 7. T a b le 7 illu stra tes th e fr e q u e n c y o f s ig n ific a n t m e d ic a l c o n d it io n s by th e v a rio u s grou ps. H o s p ita liz a tio n s w e r e r e p o r te d b y 1 ,7 6 8 p a tien ts (4 0 .5 % ). T h e m o s t c o m m o n ca u s e fo r h o s p ita liz a t io n w a s t o n s ille c t o m y . G e n ito u rin a ry p r o b le m s
T a b le 7
■Frequency of significant medical conditions. All patients
Group
No.
%
Hospitalization
1,768
40.5
Genitourinary
866
19.8
Allergy
839
19.2
Respiratory
780
17.9
Gastrointestinal
675
15.5
Cardiovascular
65á
15.1
Musculoskeletal
548
12.6
Eyes and ears
364
8.3
Serious illnesses
285
6.5
Endocrine
284
6.5
Central nervous system Integument
256
5.9
212
4.9
*Chi-square =» 44.51, P < .001. T a b le 6 ■ F re q u e n cy o f p o sitiv e health h istories a c c o rd in g to race.
Patients surveyed
Patients with positive responses
Race
No.
No.*
%
White Black Total
3,223 1,142 4,365
2,229 760 2,989
69.2 66.5 68.5
*Chi-square = 2.63, P > .1.
716 ■ JADA, Vol. 90, May 1979
Major entities reported Tonsillectomy Hysterectomy Appendectomy Heart disease Hepatitis Hysterectomy Kidney infection Bladder infection Venereal disease Penicillin Pollens Sulfa Aspirin Procaine Tonsillectomy Asthma Pneumonia Sinusitis Appendectomy Ulcers Gallbladder Hepatitis Hypertension Heart disease Anemia Arthritis Hernia Fractures Ear infections Glaucoma Rheumatic fever Hepatitis Tuberculosis Hypothyroid Diabetes mellitus Nervousness Epilepsy Cysts Rash
A ll patients No.
%
357 227 212 61 20 227 192 154 84 318 171 91 89 23 357 123 104 98 212 138 134 75 386 100 70 159 131 122 72 25 79 75 40 143 112 140 33 50 29
8.2 5.2 4.9 1.4 0.5 5.2 4.4 3.5 1.9 7.3 3.9 2.1 2.0 0.5 8.2 2.8 2.4 2.2 4.9 3.2 3.1 1.7 8.8 2.3 1.6 3.6 3.0 2.8 1.6 0.6 1.8 1.7 0.9 3.3 2.6 3.2 0.8 1.1 0.7
w e re re p o rte d b y 8 6 6 p a tien ts (1 9 .8 % ). T h e m o s t c o m m o n o f th ese w e r e h y s te r e c to m y a n d k id n e y in fe c tio n . A lle r g ie s w e r e r e p o r te d b y 8 3 9 p a tien ts (1 9 .2 % ). T h e m o s t c o m m o n l y r e p o r te d a lle r g y w as to p e n ic illin , f o l l o w e d b y p o lle n s . R e sp ira to ry p r o b le m s w e r e re p o r te d b y 7 8 0 p a tie n ts (1 7 .9 % ). T h e m o s t c o m m o n ly r e p o r te d p r o b le m in th is area w a s to n s illitis , f o l l o w e d b y asth m a. A p p e n d e c to m ie s, u lce rs , a n d g a llb la d d e r p r o b le m s a c c o u n t e d fo r th e m a jo rity o f th e r e p o r te d 675 (1 5 .5 % ) ga stroin testin a l p r o b le m s . C a r d io v a s c u la r a n d h e m a to lo g ic d ise a se s w e r e r e p o r te d b y 6 5 8 p a tien ts (1 5 .1 % ). T h e m a jo rity in th is g r o u p r e p o r te d h y p e r te n sio n . A rth ritis w a s m o s t c o m m o n a m o n g th e 548 p atien ts (1 2 .6 % ) w h o r e p o rte d m u s c u lo s k e le ta l p r o b le m s . Ear in fe c t io n s w e r e c o m m o n in th e g ro u p w ith ey e a n d ear p r o b le m s ; th ere w e r e 364 p o s itiv e r e s p o n s e s (8 .3 % ). S e r io u s illn e s s e s w e re re p o rte d b y 285 p a tie n ts (6 .5 % ). R h e u m a tic fe v e r a n d h e p a titis w e r e th e t w o m o s t c o m m o n illn e s s e s in th is g r o u p . E n d o c r in e p r o b le m s w e r e re p o r te d b y 284 p a tien ts (6 .5 % ). H y p o th y r o id is m w a s m o s t c o m m o n ly r e p o rte d , fo l lo w e d b y d ia b e te s m e llitu s .
2 ,5 0 0 p a tie n ts in te r v ie w e d in E n g la n d h a d m e d ic a l h is to r ie s p o s it iv e fo r at lea st o n e p r o b le m . T h is is a p p r o x im a t e ly a th ird th e in c id e n c e r e p o r te d in th e c u rre n t stu d y . A d d it io n a lly , th e y re p o r te d a lo w e r in c id e n c e o f a lle rg ie s (7 .1 % ) in c o m p a r is o n to 1 9 .2 % in o u r stu d y . H a lp e r n 14 r e p o r te d in 1 9 7 5 th at 8 .9 % o f 4 ,7 8 5 p a tie n ts w h o s e r e c o r d s w e r e r e v ie w e d w e r e h y p e r te n s iv e ; th is a grees w ith th e in c i d e n c e (8 .8 % ) in o u r stu d y . H a lp e r n r e p o r te d 3 .0 % o f th e p a tie n ts in h is stu d y w e r e d ia b e tic ; in o u r s tu d y , 2 .6 % o f th e p a tien ts h a d a p o s it iv e h is to r y o f th is d ise a s e . H alp e r n ’s s tu d y a lso a g rees w ith o u r s tu d y c o n c e r n in g th e in c id e n c e o f e p ile p s y (0 .8 % in c o m p a r is o n to 0 .7 % ) a n d v e n e r e a l d is e a s e (1 .9 % in b o t h stu d ie s). H a lp e rn r e p o rte d that 2 .0 % o f h is p o p u la t io n h a d a h is to r y o f rh e u m a tic fe v e r. T h e in c i d e n c e in o u r s tu d y w a s 1 .8 % . A c o m p a r a b le in c id e n c e o f r h e u m a tic fe v e r w a s r e p o r te d b y M c L u n d ie a n d o th e r s ,13 G o r d o n a n d H a lp e r n ,15 a n d T a rsita n o a n d O ’H a ra .16 W h a t d o e s a ll th is m e a n ? It p o in ts o u t that a p p r o x im a t e ly tw o th ird s o f a ll d e n ta l p a tie n ts in th e
“ N e r v o u s n e s s ” in g en e ra l w a s th e m o s t c o m m o n p r o b le m o f th e ce n tra l n e r v o u s sy ste m as 2 5 6 p o s i tiv e r e s p o n s e s (5 .9 % ) w e r e re p o rte d . E p ile p s y w a s th e m o s t c o m m o n o r g a n ic p r o b le m . V a rio u s u n s p e c ifie d d e rm a to se s w e r e r e p o r te d a m o n g 212
s tu d y h a d a m e d ic a l h is to r y that w a s p o s it iv e fo r at lea st o n e p r o b lé m , a n d m o r e th a n h a lf o f th e se p a tien ts h a d m u lt ip le m e d ic a l p r o b le m s . T h u s it is im p o r ta n t to k n o w th e m e d ic a l status o f a ll o u r p a tien ts. T h is in fo r m a tio n s h o u ld b e u p d a t e d s o an
p o s it iv e r e s p o n s e s u n d e r in te g u m e n t (4 .9 % ).
a p p r o p ria te treatm en t p la n c a n b e fo r m u la te d fo r e a c h p a tien t. P ro b le m s that s e e m sm a ll m a y b e o v e r lo o k e d in s o m e p a tie n ts b u t that extra in fo r m a tio n m a y m a k e d en ta l trea tm en t le s s p r o b le m a tic fo r a p a tie n t a n d re su lt in á b e tte r lo n g -t e r m p r o g n o s is . C o n s id e r th e p a tie n t w ith p e r io d o n t a l d is e a se a n d d ia b e te s. B etter m a n a g e m e n t o f th e d ia b e tic c o n d it io n o r, at th e m in im u m , r e c o g n it io n b y th e d e n tist, p a tien t, a n d p h y s ic ia n that d ia b e te s c a n in flu e n c e p e r io d o n ta l h e a lth , m a y re s u lt in b etter p a tie n t c o o p e r a tio n , a n d b etter r e s p o n s e t o p e r io d o n tal th e ra p y . M o s t p a tien ts se e k d e n ta l trea tm en t in a n e ffo r t to im p r o v e th e ir oral h e a lth a n d are w illin g to g iv e th e ir d e n tist a ll th e in fo r m a tio n n e e d e d to fo r m u
D iscu ssion A p p r o x im a te ly h a lf o f th e te e n a g e d p a tien ts r e p o r te d a h ea lth h is to r y p o s it iv e fo r at lea st o n e m e d ic a l p r o b le m . T h is in c r e a s e d to a p p r o x im a te ly t w o th ird s o f th e p a tie n ts in th e ir 2 0 s, a p p r o x i m a te ly th ree fo u rth s o f th e p a tie n ts in th e ir 3 0 s a n d 4 0 s, a n d to m o re th a n fo u r fifth s in p a tien ts in th e ir 50s a n d 6 0 s a n d th o s e o ld e r th a n 70. M o r e fe m a le s r e p o r te d s ig n ific a n t m e d ic a l p r o b le m s, p o s s ib ly b e c a u s e h y s te r e c to m ie s a n d o th e r g y n e c o lo g ic p r o b le m s w e r e in c lu d e d . R a ce d id n o t se e m to in flu e n c e th e fr e q u e n c y o f h e a lth h isto rie s that w e re p o s it iv e fo r m e d ic a l p ro b le m s . In a ll th e h e a lth h is to r ie s s tu d ie d , h o s p ita liz a tio n w a s r e p o rte d b y th e m o s t p a tien ts. T h is p o s s ib ly c o u ld b e d u e to th e fa c t that th e h o s p ita liz a tio n s w e r e o fte n c a u s e d b y a p r o b le m that m a y h a v e a lso b e e n r e c o r d e d in a n o th e r part o f th e s u rv e y . T h e r e fo r e , th e h o s p ita liz a tio n c a te g o r y m a y b e la rg e a l th o u g h it is n o t in fla te d . S evera l p r e v io u s s tu d ie s h a v e in c lu d e d s u m m aries o f p a tie n ts ’ m e d ic a l h isto rie s . In 1 9 6 9 , M c L u n d ie a n d o th e r s 13 r e p o r te d that 2 5 .3 % o f
late a c o m p r e h e n s iv e m e d ic a l h is to r y . H o w e v e r , p a tie n ts m ig h t n o t v o lu n te e r in fo r m a tio n a b ou t th e ir m e d ic a l h isto ry , a n d it is th e r e s p o n s ib ilit y o f th e d e n tis t to e lic it th is in fo r m a tio n . T h e g e n e ra l w e lfa r e o f th e p a tie n t is th e d e n tis t’s p r im a r y c o n ce rn , a n d th e in te g ra tio n o f in fo r m a tio n fr o m th e h e a lth h is to r y in a ra tio n a l trea tm en t p la n is th e n th e d e n tis t’s r e s p o n s ib ility , b a s e d o n h is k n o w l e d g e a n d e x p e r ie n c e .
Cottone-K afraw y : M ED IC A TIO N S A N D H EALTH H ISTO R IES ■ 717
S u m m ary D e n ta l p a tie n ts w e r e s u r v e y e d to d e te r m in e th e m e d ic a t io n s th e y w e r e u s in g a n d to c o m p i le in fo r m a t io n o n th e ir m e d ic a l h is to rie s. C o m p le te s u rv e y fo r m s w e r e o b ta in e d fr o m 4 ,3 6 5 p a tie n ts w h o w e re s e e n fo r e m e r g e n c y treatm en t o r fo r d ia g n o s is a n d treatm en t p la n n in g b e tw e e n A u g u s t 1 9 7 5 a n d July 19 7 6 . O f th é p a tie n ts s u rv e y e d , 1,8 3 3 (4 2 % ) w e r e tak in g m e d ic a tio n s . T h e fr e q u e n c y o f in ta k e o f d if fe re n t d ru g g r o u p s w a s: a n a lg e s ic s, 1 4 .2 % ; ora l c o n tr a c e p tiv e s , 1 2 .1 % ; a n tih y p e r te n s iv e s, 9 .4 % ; m is c e lla n e o u s (V itam ins, a n ta cid s, a n o re c tic s , n o n p r e s c r ip t io n c o l d r e m e d ie s ), 9 .4 % ; p s y c h o th e ra p e u tic a g en ts, 7 .6 % ; h o r m o n e s , 6 .6 % ; a n tib io tics , 4 .9 % ; a n tih ista m in e s, 3 .8 % ; c a r d ia c a gen ts, 3 .1 % ; h y p o g ly c e m ic s , 2 .0 % ; a n tic o n v u lsa n ts , 0 .9 % ; a n tia sth m a tics, 0 .6 % ; an d a n tico a g u la n ts , 0 .2 % . A t lea st o n e sig n ific a n t m e d ic a l p r o b le m w a s re p o r te d b y 2 ,9 8 9 p a tien ts (6 8 .5 % ). T h e fr e q u e n c y o f p o s it iv e r e s p o n s e s in th e v a r io u s g r o u p s w a s : h o s p ita liz a tio n s , 4 0 .5 % ; g e n ito u rin a r y p r o b le m s , 1 9 .8 % ; a lle rg ie s, 1 9 .2 % ; re sp ira to ry p r o b le m s , 1 7 .9 % ; g a stroin te stin a l p r o b le m s , 1 5 .5 % ; c a r d io v a s cu la r d is o r d e r s , 1 5 .1 % ; m u s c u lo s k e le ta l d is o r d ers, 1 2 .6 % ; e y e a n d ear a fflic tio n s , 8 .3 % ; e n d o c r in e d is o r d e r s , 6 .5 % ; se rio u s illn e s s , 6 .5 % ; d is o r d ers o f th e ce n tra l n e r v o u s sy stem , 5 .9 % ; a n d d is o rd e rs o f in te g u m e n t, 4 .9 % .
•McNeil Laboratories, Inc., Fort Washington, Pa 19034. tEli Lilly & Co., Indianapolis, 46206. ♦Smith Kline & French Laboratories, Philadelphia, 19101. §Merck Sharp & Dohme & Co., Inc., West Point, Pa 19486. URoche Laboratories, Nutley, NY 17110. **Ayerst Laboratories, New York, 10017. ttPfizer Laboratories, Inc., New York 10017. t+Parke Davis & Co., Detroit, 48207. §§Endo Laboratories, Inc., Garden City, NY 11530.
718 ■ JADA, Vol. 98, May 1979
The authors thank the 1977 and 1978 dental classes and the faculty and staff of the Oral Diagnosis Clinic, Indiana University School of Dentistry, for their assistance in this project.
Dr. Cottone is assistant professor, department of diagnosis and roentgenology, Dental School, University of Texas Health Sciences Cen ter at San Antonio, 7703 Floyd Curl Dr, San Antonio, 78284. Dr. Kafrawy is associate professor, department of oral diagnosis and medicine, In diana University School of Dentistry, Indianapolis. Send requests for re prints to Dr. Cottone. 1. Ross, N.M. General mechanisms of drug interactions. In Bourgault, P.C., and Ross, N.M. (eds.) Drug interactions, vol 3. Jersey City, Block Drug Co., 1976, pp 1-9. 2. Stewart, R.B. Predisposing factors and interactions of sedative hyp notics. In Bourgault, P.C., and Ross, N.M. (eds.). Drug interactions, vol 3. Jersey City, Block Drug Co., 1976, pp 10-17. 3. Stewart, R.B.; Forgnone, M.; and Cluff, L.E. Drug utilization and reported adverse drug reactions in outpatients. Drugs Health Care 2:231, 1975. 4. Karch, F.E., and Lasagna, L. Adverse drug reactions, a critical view. JAMA 234:1236-1241, 1975. 5. Miller, R.R. Hospital admissions due to adverse drug reactions: A report from the Boston Collaborative Drug Surveillance Program. Arch Intern Med 134:219-223, 1974. 6. Caranasos, G.J.; Stewart, R.B.; and Cluff, L.E. Drug-induced illness leading to hospitalization. JAMA 228:713-717, 1974. 7. Hoddinott, B.C., and others. Drug reactions and errors in administra tion on a medical ward. Can Med Assoc J 97:1001,1967. 8. Moen, B.D. Dental Rxs increase from 18 million to 28 million in five years. Pharmacy Times 37:35 July 1971. 9. Bureau of Economic Research and Statistics. Prescribing and dis pensing habits of dentists, 1975. Chicago, American Dental Association, 1976. 10. Barclay, J.K. The prevalence of drug therapy amongst dental pa tients. N Z Dent J 72(330):211-215,1976. 11. Balter, M.B.; Levine, J.; and Manheimer, D.I. Cross-diagonal study of the extent of anti-anxiety sedative drug use. N Engl JMed 290:769-774, 1974. 12. Parry, H.J., and others. National patterns of psychotherapeutic drug use. Arch Gen Psychiatry 28:769-783,1973. 13. McLundie, A.C.; Watson, W.C.; and Kennedy, G.D.C. Medical status of patients undergoing dental care, an assessment. Br Dent J 127:265-271, 1969. 14. Halpern, I.L. Patient’s medical status—a factor in dental treatment. Oral Surg 39(2):216-226, 1975. 15. Gordon, S.G., and Halpern, I.L. Medical aspects of dental patient history. Oral Surg 15:1270-1276,1962. 16. Tarsitano, J.J., and O’Hara, J.W. Rheumatic fever: in-depth ap praisal with a discussion of penicillin. JADA 77:1074-1080,1968.
Medications and health histories: a survey of 4,365 dental patients Jam es A . C o tto n e , D M D , M S A . H. K a fr a w y , B D S , M S D
E v a l u a t i n g th e status o f a p a tie n t w h o is takin g several d ru g s or has a c o m p lic a t e d m e d ic a l h isto ry , or b o th , o fte n c h a lle n g e s th e d en tist. Y e t th ese p a tien ts are n o w m o r e lik e ly to se e k treatm ent. T h e o ld e r p a tien t is le a d in g a lo n g e r , m o r e p r o d u c tiv e life e v e n th o u g h h e m a y h a v e c a r d io v a s c u la r, e n d o c r in e , o r d e g e n e ra tiv e d is o r d e rs . S im ila rly , the y o u n g p a tien t w ith m e d ic a l p r o b le m s su c h as m ild h e m o p h ilia o r e p ile p s y is n o w c o m in g to th e d en ta l o ffic e fo r treatm en t. D en tists m u st b e aw a re o f s u ch c o n d itio n s so that p r o p e r co n s u lta tio n s w ith th eir m e d ic a l c o lle a g u e s m a y take p la c e a n d le a d to c o o r d in a te d m a n a g e m e n t o f th e p a tien t. T h e d e n tist m u st b e c o n c e r n e d w ith th e p a tie n t’s total h ealth . In crea sin g u se o f d ru g s is a fa ct in o u r so c ie ty . O n e rea son is that th ere are m o r e d ru g s a v a ila b le,
m a n y o f w h ic h are e ffe c tiv e in th e trea tm en t o f d is ease. O u r cu ltu re h as a ls o fo s te r e d th e b e lie f that a p ill ca n cu re a ll a ilm e n ts. H o w e v e r , m e d ic a tio n s ra rely h a v e a n a rro w ra n g e o f a c tio n a n d o fte n exert m u ltip le effe cts. A s su ch , d r u g s g iv e n fo r a s p e c ific e ffe c t o n o n e sy ste m m a y c o n s id e r a b ly alter th e e n tire b o d y an d aggravate s o m e o th e r c o m p le t e ly u n rela ted c o n d it io n . T h is is im p o rta n t b e c a u s e it has b e e n estim a te d that a d u lts take an a v era g e o f fo u r or fiv e d ru g s d a ily , a n d that h o s p ita liz e d p a tien ts m a y r e c e iv e fro m tw o to fiv e tim e s th is n u m b e r o f d ru g s e a ch d a y .1' 3 T h e p o s s ib ility o f d ru g in te ra ctio n s m u st b e re m e m b e re d . S e v e ra l s tu d ie s h a v e in d i c a te d that p o s s ib ly 3 % to 5 % o f th e a d m is s io n s to m e d ic a l w a rd s m a y b e d u e to d ru g r e a ctio n s a n d in te r a c tio n s .1,4 6 O fte n , a n tib io tic s o r m e d ic a tio n s c o n ta in in g a sp irin that are c o m m o n ly u s e d in d e n J A D A , V o l. 9 8 , M a y 1 9 7 9 ■ 7 1 3
tistry w e r e im p lic a t e d as th e ca u s e o f a d v e rse r e a c tio n s to d ru g s that re su lte d in h o s p ita liz a tio n .4' 6 A d d it io n a lly , as m a n y as 1 5 % o f a lre a d y h o s p ita liz e d m e d ic a l p a tie n ts m a y h a v e th e ir stay p r o lo n g e d b y th e se sa m e p r o b le m s .1,4,7 T h e re are m a n y re a s o n s w h y d e n tists n e e d to k n o w w h a t m e d ic a tio n s th e ir p a tien ts are tak in g. U n fo rtu n a te ly , it is b e c o m in g m o r e d iffic u lt to o b tain th is in fo r m a tio n as the n u m b e r a n d v a rie ty o f m e d ic a tio n in cre a se . T h is m a k es th e p r o b le m o f p o ten tia l d ru g in te r a c tio n s m o r e im p o rta n t, as it is n o w ea sier to in a d v e rte n tly e sta b lish th e c o n d itio n s n e ce s s a ry fo r th e se in te ra ctio n s . A s u r v e y 8 c o n d u c te d in 1 96 9 in d ic a t e d that d en tists w r o te 28 m i l lio n p r e s c r ip t io n s that y ea r c o m p a r e d w ith 18 m il lio n p r e s c r ip tio n s in 1 9 6 5 . T h e A m e r ic a n D en tal A s s o c ia t io n 9 r e c e n tly re p o r te d that d e n tists m a y h a v e w ritte n as m a n y as 65 m illio n p r e s c r ip tio n s in 1 9 7 5 . D en tists cu rre n tly a c c o u n t fo r a siz a b le p o r tio n o f th e n u m b e r o f p r e s c r ip tio n s w r itte n a n n u ally. W e h a v e fo u n d n o re p o r te d lis tin g o f w h ic h m e d ic a tio n s d e n ta l p a tien ts u s e m o s t o fte n in th e U n ite d States. It is a ss u m e d that m o s t d en ta l p a tien ts h a v e r e c e n tly taken , o r are c u rr e n tly tak in g, s o m e m e d ic a tio n . A lth o u g h th e y m a y n o t k n o w the n a m e o f th e ir m e d ic a tio n s a n d u s u a lly d o n o t h a v e th e d ru g or th e p r e s c r ip t io n b o ttle w ith th e m , p a tien ts o fte n k n o w th e c o n d it io n fo r w h ic h th e d ru g w a s p r e s c r ib e d . T h u s , w ith cu rre n t k n o w le d g e o f th e c o m m o n ly p r e s c r ib e d d ru g s fo r a p a rticu la r c o n d it io n , it m a y b e p o s s ib le to id e n tify that “ little p in k p i l l .” A g o o d m e d ic a l h is to r y is b a s ic to u n d e r s ta n d in g e a c h p a tie n t’ s tota l h ea lth . T o k e e p a h ig h state o f a w a ren ess, it is n e ce ss a r y to p e r io d ic a lly r e v ie w w h a t ty p e o f p a tie n t p o p u la t io n is cu r r e n tly b e in g s e e n in v a r io u s a s p e cts o f d en ta l p ra ctic e . T o c o m p ile s u c h in fo rm a tio n , it w a s d e c id e d to s u rv e y a p o p u la t io n o f d en ta l p a tien ts to d e te r m in e w h a t m e d ic a tio n s th e y are cu rr e n tly u s in g a n d to o b ta in c o r r e s p o n d in g in fo r m a tio n c o n c e r n in g th e ir m e d i ca l h istories.
S tu d y m e th o d s T h e stu d e n ts a n d fa c u lty o f th e O ra l D ia g n o sis C lin ic at In d ia n a U n iv e rs ity S c h o o l o f D en tistry w e r e a sk ed to c o m p le te a s u r v e y fo r m o n a ll p a tien ts s e e n in th e c lin ic fo r o n e a c a d e m ic year. T h e su rv e y fo r m in c lu d e d q u e s tio n s o n a g e, ra ce, g e n der, cu rre n t m e d ic a tio n s , a n d s ig n ific a n t m e d ic a l c o n d itio n s . O f th e 8 ,6 8 9 p a tien ts e x a m in e d b e tw e e n A u g u s t 7 1 4 ■ J A D A , V o l. 9 8 , M a y 1 9 7 9
i
n
ni
e
i
a
m
3zm
ix
x
21
xn
zm
Drug Groups Frequency o f intake o f different drug groups.
1 975 a n d July 1 9 7 6 , c o m p le t e su r v e y fo r m s w e re o b ta in e d o n 4 ,3 6 5 . O f th e 3 ,5 0 0 p a tien ts s e e n o n an e m e r g e n c y b a sis, fo r m s w e r e c o m p le t e d b y 1 ,0 1 8 (2 9 .1 % ). O f th e 5 ,1 8 9 p a tien ts se e n fo r d ia g n o s is a n d fo r m u la tio n o f a trea tm en t p la n , 3 ,3 4 7 (6 4 .5 % ) c o m p le t e d th e fo rm s. O f th e p a tien ts s u rv e y e d , 3 ,2 2 3 w e r e w h ite (7 3 .8 % ), a n d 1,1 4 2 w e re b la ck (2 6 .2 % ). O f th e tota l, 2 ,5 7 7 p a tien ts w e r e fe m a le (5 9 .1 % ) a n d 1 ,7 8 8 w e r e m a le (4 0 .9 % ).
M e d ic a t io n s u s e d
Tabulation of findings A fte r a ll fo rm s w e r e r e c e iv e d , a ta b u la tion w a s m a d e o f th e m e d ic a tio n s b y g ro u p s . T h e s e g r o u p s w e r e a n a lg e s ic s (in c lu d in g an tia rth ritic d ru g s), a n tih y p e r te n s iv e s (in c lu d in g d iu r e tics ), p s y c h o th e ra p e u tic a gen ts (a n tia n x ie ty , a n tid e p ressa n t, a n d a n tip s y c h o tic d ru g s), h o r m o n e s (e x c lu d in g in s u lin a n d ora l c o n tr a c e p tiv e s ), a n tib io tics , a n tih is ta m in e s, c a r d ia c a gen ts, h y p o g ly c e m ic a gen ts, a n tico a g u la n ts, ora l co n tr a c e p tiv e s , a n tia sth m a tics, a n tico n v u lsa n ts , a n d m is c e lla n e o u s (v ita m in s, ant a c id s , a n o r e c tic s , a n d c o ld r e m e d ie s that ca n b e b o u g h t w ith o u t a p r e s c r ip tio n ). O f th e p a tien ts s u rv e y e d , 1,833 (4 3 .1 % ) w e re tak in g a m e d ic a tio n . O f th ese, 7 6 0 (1 7 .4 % ) w e r e tak in g m o r e th an o n e m e d ic a tio n . T h e fr e q u e n c y o f m e d i c a tio n in ta k e in th e d iffe r e n t a g e, g e n d e r , a n d ra cia l g r o u p s is su m m a riz e d in T a b le s 1 to 3. T h e Illu stra tio n su m m a riz e s th e fr e q u e n c y o f in tak e o f th e d if fe re n t d ru g g r o u p s . A n a lg e s ic s w e r e tak en b y 621 p a tien ts (1 4 .2 % ). T h e m o s t c o m m o n ly u s e d w e re a sp irin , a c e ta m in o p h e n (T y le n o l* ), a n d p r o p o x y p h e n e HC1 (D a r v o n t). O ral c o n tr a c e p tiv e s w e r e ta k en b y 245 w o m e n (1 2 .1 % ) w h o w e re o f
Table 1 ■ Frequency of medication intake by different age
groups. Age group
12 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70, older Total
Patients surveyed
Patients taking any medications
T a b le 2
sex.
Patients taking multiple medications
No.
No.
%
No.
%
788 1,419 662 532 451 330 183 4,365
189 541 254 285 275 214 125 1,883
24.0 38.1 38.4 53.6 61.0 64.8 68.3 43.1
47 160 95 135 139 125 59 760
6.0 11.3 14.4 25.4 30.8 37.9 32.2 17.4
c h ild b e a r in g ag e (12 to 4 9 years) A n tih y p e r te n siv e s, in c lu d in g d iu re tic s , w e r e ta k en b y 4 0 9 p a tien ts (9 .4 % ). T h e m o s t c o m m o n ly u s e d w e re h y d r o c h lo r o th ia z id e p re p a r a tio n s (D y a z id e t, H y d roD IU R IL §) a n d m e t h y ld o p a (A ld o m e t § ). M is ce lla n e o u s d ru g s w e r e ta k en b y 9 .4 % o f th e pa tien ts (4 0 9 ). T h e s e in c lu d e d v ita m in s , a n ta cid s , a n o r e c tics , a n d c o l d r e m e d ie s that c o u ld b e b o u g h t w it h o u t a p r e s c r ip tio n . P s y c h o th e r a p e u tic a gen ts w e re tak en b y 331 p a tien ts (7 .6 % ). T h e m o s t c o m m o n ly u s e d w e re d ia z e p a m (V a liu m ll) a n d c h lo r d ia z e p o x id e HC1 (Librium U ). H o r m o n e s , e x c lu d in g in s u lin a n d ora l co n tr a c e p tiv e s , w e r e ta k en b y 289 p atien ts (6 .6 % ). T h e m o s t c o m m o n l y u s e d w e re th y r o id h o r m o n e s a n d e stro g e n s. A n t ib io t ic s w e r e ta k en b y 214 p a tien ts (4 .9 % ). T h e m o s t c o m m o n ly u s e d w e re p e n ic illin , te tr a c y c lin e s , a n d e ry th r o m y c in . A n tih is ta m in e s w e r e tak en b y 164 p a tien ts (3 .8 % ). M o s t o f th e se w e r e p re p a ra tio n s that d id n o t req u ire a p r e s c r ip tio n . D ru g s that a ct o n th e h ea rt w e r e ta k en b y 133 p a tien ts (3 .1 % ). T h e m o s t c o m m o n ly u s e d w e re d ig ita lis, n itr o g ly c e r in a n d n itrate p re p a ra tio n s, a n d p r o p r a n o lo l HC1 (In d e ra l* * ). H y p o g ly c e m ic a gen ts w e re ta k en b y 87 p a tie n ts (2 .0 % ). T h e m o s t com m on w ere in s u lin and c h lo r p r o p a m id e (D ia b in e s e t t). P h e n y to in s o d iu m (D ila n t in t i) w a s th e m o st c o m m o n a n tic o n v u ls a n t a g en t; it w a s tak en b y 4 0 p a tien ts (0 .9 % ), a n d 28 p a tien ts (0 .6 % ) w e r e ta k in g a n tia sth m a tic a gen ts. A n tic o a g u la n ts w e re taken b y ten p a tien ts (0 .2 % ); th e m o s t c o m m o n w a s s o d iu m w a rfa rin (C o u m a d in § § ).
D iscu ssion A b o u t o n e in fo u r p a tie n ts in th e ir te e n s w e r e tak in g a m e d ic a tio n . T h e p r o p o r tio n in cr e a s e d to a b o u t 1 in 3 fo r p a tien ts in th e ir 20s a n d 3 0 s, 1 in 2 fo r p atien ts in th e ir 4 0 s , a n d 2 in 3 fo r p a tien ts in th eir 50s a n d 60 s a n d th o s e o ld e r th a n 70. Intake o f m u ltip le d ru g s a ls o in c r e a s e d w ith age. M o re fe m a le s w e r e ta k in g a m e d ic a tio n , e v e n
■Frequency of medication intake according to Patients taking any medication
Patients surveyed Sex Males Females Total
Patients taking any medication excluding OCt
No.
No.*
%
No.J
%
1,788 2,577 4,365
566 1,317 1,883
31.7 51.1 43.1
566 1,157 1,723
31.7 44.9 39.5
*C hi-square = 162.81, F < .001. t O ra l contraceptives. JC hi-square = 77.47, P < .001.
T a b le 3 ■Frequency of medication in take according to race. Patients surveyed
Patients taking medications
Race
No.
No.*
%
White Black Total
3,223 1,142 4,365'
1,367 516 1,883
42.4 45.2 43.1
*Chi-square = 2.63, P < .20.
w h e n th o s e ta k in g ora l c o n tr a c e p tiv e s w e re e x c lu d e d . R a ce d id n o t se e m to in flu e n c e th e fr e q u e n c y o f d ru g in take. M o r e p a tien ts w e r e ta k in g a n a lg e s ic s th an a n y o th e r m e d ic a tio n stu d ie d . T h is c o u ld o c c u r p o s s i b ly b e c a u s e p a tien ts w h o w e r e in p a in w e re in c lu d e d in th e stu d y . H o w e v e r , th is fr e q u e n c y o f in take o f a n a lg e sic s c o u ld b e a r tific ia lly lo w , as m a n y p a tien ts m a y n o t h a v e c o n s id e r e d a s p ir in as a re p o rta b le m e d ic a tio n , e v e n t h o u g h a n e ffo rt w a s m a d e to e lic it th is in fo r m a tio n . T h e sa m e c o n s id e ra tio n c o u ld h a v e in flu e n c e d th e r e p o r te d fre q u e n c y o f in tak e o f ora l c o n tr a ce p tiv e s . In 1 9 7 6 , B a rcla y 10 r e p o r te d h is fin d in g s o f a su r v e y o f 1 ,0 0 0 p a tien ts se e n at a d e n ta l s c h o o l in N e w Z e a la n d . H e fo u n d that 2 1 .2 % w e r e r e c e iv in g a m e d ic a t io n (e x c lu d in g o ra l c o n tr a c e p tiv e s ). In th e cu rren t stu d y , th e o v e r a ll fr e q u e n c y o f m e d ic a tio n , e x c lu d in g o ra l co n tr a c e p tiv e s , w a s 3 9 .5 % , a p p r o x im a te ly d o u b le th e fr e q u e n c y that B a rcla y r e p o rte d . A ls o , B a rcla y r e p o r te d that 1 7 .0 % o f a ll m a le s a n d 2 5 .5 % o f a ll fe m a le s w e r e ta k in g a m e d ic a tio n . In o u r stu d y , 3 1 .7 % o f th e m a le s a n d 5 1 .5 % o f th e fe m a le s w e r e tak in g a m e d ic a tio n , a g a in a lm o st d o u b le that r e p o r te d b y B a rcla y . T h e s e d iffe r e n c e s m a y b e p a rtia lly d u e to th e fa c t that th e N e w Z e a la n d s tu d y d ea lt o n ly w ith m e d ic a tio n s p r e s c r ib e d b y th e p a tie n ts ’ p h y s ic ia n s , w h e re a s o u r stu d y in c lu d e s m a n y o v e r -th e -c o u n te r p re p a ra tio n s that p o s s ib ly w e r e n o t p r e s c r ib e d b y a p h y s ic ia n . T h is is tru e o f th e g r o u p s o f a n a lg e s ic s a n d m is c e lla n e o u s m e d ic a tio n s that a c c o u n t fo r a b o u t 2 5 % o f th e e n tire d ru g tota l. A d d itio n a lly , it m a y b e a n tic ip a te d that th ere are d iffe re n t p r a c tic e s fo r p r e s c r ib in g C ottone-K afraw y: M ED IC A TIO N S A N D H EALTH H ISTO R IES ■ 715
d ru g s in th e t w o c o u n tr ie s ju st as th e y h a v e d if feren t fo r m s o f h e a lth care d e liv e r y . H o w e v e r , b o th stu d ie s r e p o rte d a s im ila r in c id e n c e o f m u ltip le d ru g th e ra p y in p a tie n ts ta k in g a m e d ic a t io n (a p p r o x im a t e ly 2 0 % ). B alter a n d o th e r s 11 r e p o r te d in 1 9 7 4 o n th e fr e q u e n c y o f u se o f a n tia n x ie ty a n d se d a tiv e d ru g s in n in e w e s te r n E u r o p e a n co u n tr ie s . T h e p e rce n ta g e o f re g u la r u se ra n g e d fr o m 3 % to 9 % w ith a m e a n o f 6 .5 % . It w a s a ls o r e p o r te d that, in th e U n ite d States, a p p r o x im a t e ly 7 % o f th e a d u lt p o p u la t io n u s e d p s y c h o th e r a p e u t ic d ru g s o n a re g u la r b a s is .12 T h is c o m p a r e s w it h th e in c id e n c e o f 7 .6 % r e p o r te d fo r th e se sa m e m e d ic a tio n s in th e cu rre n t stu d y . T h e se x d iffe re n tia l r e p o r te d , c o n c e r n in g th e fr e q u e n c y o f u s e o f th e se d ru g s (2 fe m a le s: 1 m a le ), is a lso c o n fir m e d in th e cu rre n t s tu d y (9 .4 % fe m a le s c o m p a r e d w it h 5 .0 % m a le s). P r o p r a n o lo l H C L, a lth o u g h p r o b a b ly m o s t fre q u e n tly p r e s c r ib e d to d a y to treat h y p e r te n s io n , w a s in c lu d e d in th e g r o u p o f ca r d ia c m e d ic a tio n s as it s e e m e d to b e u s e d b y th e m a jo r ity o f th e se p a tien ts fo r th e treatm en t o f a n g in a p e c to r is a n d c a r d ia c ar rh y th m ia s. T a b le 4 ■Frequency of positive health histories in differ ent age groups.
Age group
Patients surveyed
12 to 29 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70, older Total
Patients with positive responses
Patients with multiple positive responses
No.
No.
%
No.
%
788 1,419 662 532 451 330 183 4,365
383 902 484 409 367 280 164 2,989
48.6 63.6 73.1 76.9 81.3 84.8 89.6 68.5
130 416 286 252 253 198 118 1,653
16.5 29.3 43.2 47.4 56.1 60.0 64.5 37.9
T a b le 5 ■Frequency of positive health histories according to sex. Patients with positive responses
Patients surveyed Sex
No.
No.*
%
Males Females Total
1,788 2,577 4,365
1,142 1,847 2,989
63.9 71.7 68.5
M e d ic a l h is to r ie s
Tabulation of findings F r o m th e in fo r m a tio n g iv e n o n th e s u rv e y fo rm , th e p a tie n ts ’ m e d ic a l h is to r ie s w e r e ta b u la ted a c c o r d in g to a lle r g ie s ; p r o b le m s w ith th e e y e s , ears, in te g u m e n t, m u s c u lo s k e le to n ; d is o rd e rs o f th e car d io v a s c u la r , ce n tra l n e r v o u s , e n d o c r in e , g a stro in testin a l, g e n ito u rin a r y , a n d re sp ira to ry sy stem s; se r io u s illn e s s e s ; a n d h o s p ita liz a tio n s . In e a ch g r o u p , in d iv id u a l m e d ic a l p r o b le m s w e r e ra n k ed b y th e n u m b e r o f r e s p o n s e s r e c e iv e d . C h ild b irth w a s e x c lu d e d . O f th e p a tien ts s u r v e y e d , 2 ,9 8 9 (6 8 .5 % ) r e p o rte d at lea st o n e p o s it iv e m e d ic a l fin d in g a n d 1,653 (3 7 .9 % ) r e p o r te d m u lt ip le p o s it iv e fin d in g s . T h e fr e q u e n c y o f p o s it iv e m e d ic a l fin d in g s in th e d if fe re n t age, s e x , a n d ra cia l g r o u p s is su m m a riz e d in T a b le s 4 to 7. T a b le 7 illu stra tes th e fr e q u e n c y o f s ig n ific a n t m e d ic a l c o n d it io n s by th e v a rio u s grou ps. H o s p ita liz a tio n s w e r e r e p o r te d b y 1 ,7 6 8 p a tien ts (4 0 .5 % ). T h e m o s t c o m m o n ca u s e fo r h o s p ita liz a t io n w a s t o n s ille c t o m y . G e n ito u rin a ry p r o b le m s
T a b le 7
■Frequency of significant medical conditions. All patients
Group
No.
%
Hospitalization
1,768
40.5
Genitourinary
866
19.8
Allergy
839
19.2
Respiratory
780
17.9
Gastrointestinal
675
15.5
Cardiovascular
65á
15.1
Musculoskeletal
548
12.6
Eyes and ears
364
8.3
Serious illnesses
285
6.5
Endocrine
284
6.5
Central nervous system Integument
256
5.9
212
4.9
*Chi-square =» 44.51, P < .001. T a b le 6 ■ F re q u e n cy o f p o sitiv e health h istories a c c o rd in g to race.
Patients surveyed
Patients with positive responses
Race
No.
No.*
%
White Black Total
3,223 1,142 4,365
2,229 760 2,989
69.2 66.5 68.5
*Chi-square = 2.63, P > .1.
716 ■ JADA, Vol. 90, May 1979
Major entities reported Tonsillectomy Hysterectomy Appendectomy Heart disease Hepatitis Hysterectomy Kidney infection Bladder infection Venereal disease Penicillin Pollens Sulfa Aspirin Procaine Tonsillectomy Asthma Pneumonia Sinusitis Appendectomy Ulcers Gallbladder Hepatitis Hypertension Heart disease Anemia Arthritis Hernia Fractures Ear infections Glaucoma Rheumatic fever Hepatitis Tuberculosis Hypothyroid Diabetes mellitus Nervousness Epilepsy Cysts Rash
A ll patients No.
%
357 227 212 61 20 227 192 154 84 318 171 91 89 23 357 123 104 98 212 138 134 75 386 100 70 159 131 122 72 25 79 75 40 143 112 140 33 50 29
8.2 5.2 4.9 1.4 0.5 5.2 4.4 3.5 1.9 7.3 3.9 2.1 2.0 0.5 8.2 2.8 2.4 2.2 4.9 3.2 3.1 1.7 8.8 2.3 1.6 3.6 3.0 2.8 1.6 0.6 1.8 1.7 0.9 3.3 2.6 3.2 0.8 1.1 0.7
w e re re p o rte d b y 8 6 6 p a tien ts (1 9 .8 % ). T h e m o s t c o m m o n o f th ese w e r e h y s te r e c to m y a n d k id n e y in fe c tio n . A lle r g ie s w e r e r e p o r te d b y 8 3 9 p a tien ts (1 9 .2 % ). T h e m o s t c o m m o n l y r e p o r te d a lle r g y w as to p e n ic illin , f o l l o w e d b y p o lle n s . R e sp ira to ry p r o b le m s w e r e re p o r te d b y 7 8 0 p a tie n ts (1 7 .9 % ). T h e m o s t c o m m o n ly r e p o r te d p r o b le m in th is area w a s to n s illitis , f o l l o w e d b y asth m a. A p p e n d e c to m ie s, u lce rs , a n d g a llb la d d e r p r o b le m s a c c o u n t e d fo r th e m a jo rity o f th e r e p o r te d 675 (1 5 .5 % ) ga stroin testin a l p r o b le m s . C a r d io v a s c u la r a n d h e m a to lo g ic d ise a se s w e r e r e p o r te d b y 6 5 8 p a tien ts (1 5 .1 % ). T h e m a jo rity in th is g r o u p r e p o r te d h y p e r te n sio n . A rth ritis w a s m o s t c o m m o n a m o n g th e 548 p atien ts (1 2 .6 % ) w h o r e p o rte d m u s c u lo s k e le ta l p r o b le m s . Ear in fe c t io n s w e r e c o m m o n in th e g ro u p w ith ey e a n d ear p r o b le m s ; th ere w e r e 364 p o s itiv e r e s p o n s e s (8 .3 % ). S e r io u s illn e s s e s w e re re p o rte d b y 285 p a tie n ts (6 .5 % ). R h e u m a tic fe v e r a n d h e p a titis w e r e th e t w o m o s t c o m m o n illn e s s e s in th is g r o u p . E n d o c r in e p r o b le m s w e r e re p o r te d b y 284 p a tien ts (6 .5 % ). H y p o th y r o id is m w a s m o s t c o m m o n ly r e p o rte d , fo l lo w e d b y d ia b e te s m e llitu s .
2 ,5 0 0 p a tie n ts in te r v ie w e d in E n g la n d h a d m e d ic a l h is to r ie s p o s it iv e fo r at lea st o n e p r o b le m . T h is is a p p r o x im a t e ly a th ird th e in c id e n c e r e p o r te d in th e c u rre n t stu d y . A d d it io n a lly , th e y re p o r te d a lo w e r in c id e n c e o f a lle rg ie s (7 .1 % ) in c o m p a r is o n to 1 9 .2 % in o u r stu d y . H a lp e r n 14 r e p o r te d in 1 9 7 5 th at 8 .9 % o f 4 ,7 8 5 p a tie n ts w h o s e r e c o r d s w e r e r e v ie w e d w e r e h y p e r te n s iv e ; th is a grees w ith th e in c i d e n c e (8 .8 % ) in o u r stu d y . H a lp e r n r e p o r te d 3 .0 % o f th e p a tie n ts in h is stu d y w e r e d ia b e tic ; in o u r s tu d y , 2 .6 % o f th e p a tien ts h a d a p o s it iv e h is to r y o f th is d ise a s e . H alp e r n ’s s tu d y a lso a g rees w ith o u r s tu d y c o n c e r n in g th e in c id e n c e o f e p ile p s y (0 .8 % in c o m p a r is o n to 0 .7 % ) a n d v e n e r e a l d is e a s e (1 .9 % in b o t h stu d ie s). H a lp e rn r e p o rte d that 2 .0 % o f h is p o p u la t io n h a d a h is to r y o f rh e u m a tic fe v e r. T h e in c i d e n c e in o u r s tu d y w a s 1 .8 % . A c o m p a r a b le in c id e n c e o f r h e u m a tic fe v e r w a s r e p o r te d b y M c L u n d ie a n d o th e r s ,13 G o r d o n a n d H a lp e r n ,15 a n d T a rsita n o a n d O ’H a ra .16 W h a t d o e s a ll th is m e a n ? It p o in ts o u t that a p p r o x im a t e ly tw o th ird s o f a ll d e n ta l p a tie n ts in th e
“ N e r v o u s n e s s ” in g en e ra l w a s th e m o s t c o m m o n p r o b le m o f th e ce n tra l n e r v o u s sy ste m as 2 5 6 p o s i tiv e r e s p o n s e s (5 .9 % ) w e r e re p o rte d . E p ile p s y w a s th e m o s t c o m m o n o r g a n ic p r o b le m . V a rio u s u n s p e c ifie d d e rm a to se s w e r e r e p o r te d a m o n g 212
s tu d y h a d a m e d ic a l h is to r y that w a s p o s it iv e fo r at lea st o n e p r o b lé m , a n d m o r e th a n h a lf o f th e se p a tien ts h a d m u lt ip le m e d ic a l p r o b le m s . T h u s it is im p o r ta n t to k n o w th e m e d ic a l status o f a ll o u r p a tien ts. T h is in fo r m a tio n s h o u ld b e u p d a t e d s o an
p o s it iv e r e s p o n s e s u n d e r in te g u m e n t (4 .9 % ).
a p p r o p ria te treatm en t p la n c a n b e fo r m u la te d fo r e a c h p a tien t. P ro b le m s that s e e m sm a ll m a y b e o v e r lo o k e d in s o m e p a tie n ts b u t that extra in fo r m a tio n m a y m a k e d en ta l trea tm en t le s s p r o b le m a tic fo r a p a tie n t a n d re su lt in á b e tte r lo n g -t e r m p r o g n o s is . C o n s id e r th e p a tie n t w ith p e r io d o n t a l d is e a se a n d d ia b e te s. B etter m a n a g e m e n t o f th e d ia b e tic c o n d it io n o r, at th e m in im u m , r e c o g n it io n b y th e d e n tist, p a tien t, a n d p h y s ic ia n that d ia b e te s c a n in flu e n c e p e r io d o n ta l h e a lth , m a y re s u lt in b etter p a tie n t c o o p e r a tio n , a n d b etter r e s p o n s e t o p e r io d o n tal th e ra p y . M o s t p a tien ts se e k d e n ta l trea tm en t in a n e ffo r t to im p r o v e th e ir oral h e a lth a n d are w illin g to g iv e th e ir d e n tist a ll th e in fo r m a tio n n e e d e d to fo r m u
D iscu ssion A p p r o x im a te ly h a lf o f th e te e n a g e d p a tien ts r e p o r te d a h ea lth h is to r y p o s it iv e fo r at lea st o n e m e d ic a l p r o b le m . T h is in c r e a s e d to a p p r o x im a te ly t w o th ird s o f th e p a tie n ts in th e ir 2 0 s, a p p r o x i m a te ly th ree fo u rth s o f th e p a tie n ts in th e ir 3 0 s a n d 4 0 s, a n d to m o re th a n fo u r fifth s in p a tien ts in th e ir 50s a n d 6 0 s a n d th o s e o ld e r th a n 70. M o r e fe m a le s r e p o r te d s ig n ific a n t m e d ic a l p r o b le m s, p o s s ib ly b e c a u s e h y s te r e c to m ie s a n d o th e r g y n e c o lo g ic p r o b le m s w e r e in c lu d e d . R a ce d id n o t se e m to in flu e n c e th e fr e q u e n c y o f h e a lth h isto rie s that w e re p o s it iv e fo r m e d ic a l p ro b le m s . In a ll th e h e a lth h is to r ie s s tu d ie d , h o s p ita liz a tio n w a s r e p o rte d b y th e m o s t p a tien ts. T h is p o s s ib ly c o u ld b e d u e to th e fa c t that th e h o s p ita liz a tio n s w e r e o fte n c a u s e d b y a p r o b le m that m a y h a v e a lso b e e n r e c o r d e d in a n o th e r part o f th e s u rv e y . T h e r e fo r e , th e h o s p ita liz a tio n c a te g o r y m a y b e la rg e a l th o u g h it is n o t in fla te d . S evera l p r e v io u s s tu d ie s h a v e in c lu d e d s u m m aries o f p a tie n ts ’ m e d ic a l h isto rie s . In 1 9 6 9 , M c L u n d ie a n d o th e r s 13 r e p o r te d that 2 5 .3 % o f
late a c o m p r e h e n s iv e m e d ic a l h is to r y . H o w e v e r , p a tie n ts m ig h t n o t v o lu n te e r in fo r m a tio n a b ou t th e ir m e d ic a l h isto ry , a n d it is th e r e s p o n s ib ilit y o f th e d e n tis t to e lic it th is in fo r m a tio n . T h e g e n e ra l w e lfa r e o f th e p a tie n t is th e d e n tis t’s p r im a r y c o n ce rn , a n d th e in te g ra tio n o f in fo r m a tio n fr o m th e h e a lth h is to r y in a ra tio n a l trea tm en t p la n is th e n th e d e n tis t’s r e s p o n s ib ility , b a s e d o n h is k n o w l e d g e a n d e x p e r ie n c e .
Cottone-K afraw y : M ED IC A TIO N S A N D H EALTH H ISTO R IES ■ 717
S u m m ary D e n ta l p a tie n ts w e r e s u r v e y e d to d e te r m in e th e m e d ic a t io n s th e y w e r e u s in g a n d to c o m p i le in fo r m a t io n o n th e ir m e d ic a l h is to rie s. C o m p le te s u rv e y fo r m s w e r e o b ta in e d fr o m 4 ,3 6 5 p a tie n ts w h o w e re s e e n fo r e m e r g e n c y treatm en t o r fo r d ia g n o s is a n d treatm en t p la n n in g b e tw e e n A u g u s t 1 9 7 5 a n d July 19 7 6 . O f th é p a tie n ts s u rv e y e d , 1,8 3 3 (4 2 % ) w e r e tak in g m e d ic a tio n s . T h e fr e q u e n c y o f in ta k e o f d if fe re n t d ru g g r o u p s w a s: a n a lg e s ic s, 1 4 .2 % ; ora l c o n tr a c e p tiv e s , 1 2 .1 % ; a n tih y p e r te n s iv e s, 9 .4 % ; m is c e lla n e o u s (V itam ins, a n ta cid s, a n o re c tic s , n o n p r e s c r ip t io n c o l d r e m e d ie s ), 9 .4 % ; p s y c h o th e ra p e u tic a g en ts, 7 .6 % ; h o r m o n e s , 6 .6 % ; a n tib io tics , 4 .9 % ; a n tih ista m in e s, 3 .8 % ; c a r d ia c a gen ts, 3 .1 % ; h y p o g ly c e m ic s , 2 .0 % ; a n tic o n v u lsa n ts , 0 .9 % ; a n tia sth m a tics, 0 .6 % ; an d a n tico a g u la n ts , 0 .2 % . A t lea st o n e sig n ific a n t m e d ic a l p r o b le m w a s re p o r te d b y 2 ,9 8 9 p a tien ts (6 8 .5 % ). T h e fr e q u e n c y o f p o s it iv e r e s p o n s e s in th e v a r io u s g r o u p s w a s : h o s p ita liz a tio n s , 4 0 .5 % ; g e n ito u rin a r y p r o b le m s , 1 9 .8 % ; a lle rg ie s, 1 9 .2 % ; re sp ira to ry p r o b le m s , 1 7 .9 % ; g a stroin te stin a l p r o b le m s , 1 5 .5 % ; c a r d io v a s cu la r d is o r d e r s , 1 5 .1 % ; m u s c u lo s k e le ta l d is o r d ers, 1 2 .6 % ; e y e a n d ear a fflic tio n s , 8 .3 % ; e n d o c r in e d is o r d e r s , 6 .5 % ; se rio u s illn e s s , 6 .5 % ; d is o r d ers o f th e ce n tra l n e r v o u s sy stem , 5 .9 % ; a n d d is o rd e rs o f in te g u m e n t, 4 .9 % .
•McNeil Laboratories, Inc., Fort Washington, Pa 19034. tEli Lilly & Co., Indianapolis, 46206. ♦Smith Kline & French Laboratories, Philadelphia, 19101. §Merck Sharp & Dohme & Co., Inc., West Point, Pa 19486. URoche Laboratories, Nutley, NY 17110. **Ayerst Laboratories, New York, 10017. ttPfizer Laboratories, Inc., New York 10017. t+Parke Davis & Co., Detroit, 48207. §§Endo Laboratories, Inc., Garden City, NY 11530.
718 ■ JADA, Vol. 98, May 1979
The authors thank the 1977 and 1978 dental classes and the faculty and staff of the Oral Diagnosis Clinic, Indiana University School of Dentistry, for their assistance in this project.
Dr. Cottone is assistant professor, department of diagnosis and roentgenology, Dental School, University of Texas Health Sciences Cen ter at San Antonio, 7703 Floyd Curl Dr, San Antonio, 78284. Dr. Kafrawy is associate professor, department of oral diagnosis and medicine, In diana University School of Dentistry, Indianapolis. Send requests for re prints to Dr. Cottone. 1. Ross, N.M. General mechanisms of drug interactions. In Bourgault, P.C., and Ross, N.M. (eds.) Drug interactions, vol 3. Jersey City, Block Drug Co., 1976, pp 1-9. 2. Stewart, R.B. Predisposing factors and interactions of sedative hyp notics. In Bourgault, P.C., and Ross, N.M. (eds.). Drug interactions, vol 3. Jersey City, Block Drug Co., 1976, pp 10-17. 3. Stewart, R.B.; Forgnone, M.; and Cluff, L.E. Drug utilization and reported adverse drug reactions in outpatients. Drugs Health Care 2:231, 1975. 4. Karch, F.E., and Lasagna, L. Adverse drug reactions, a critical view. JAMA 234:1236-1241, 1975. 5. Miller, R.R. Hospital admissions due to adverse drug reactions: A report from the Boston Collaborative Drug Surveillance Program. Arch Intern Med 134:219-223, 1974. 6. Caranasos, G.J.; Stewart, R.B.; and Cluff, L.E. Drug-induced illness leading to hospitalization. JAMA 228:713-717, 1974. 7. Hoddinott, B.C., and others. Drug reactions and errors in administra tion on a medical ward. Can Med Assoc J 97:1001,1967. 8. Moen, B.D. Dental Rxs increase from 18 million to 28 million in five years. Pharmacy Times 37:35 July 1971. 9. Bureau of Economic Research and Statistics. Prescribing and dis pensing habits of dentists, 1975. Chicago, American Dental Association, 1976. 10. Barclay, J.K. The prevalence of drug therapy amongst dental pa tients. N Z Dent J 72(330):211-215,1976. 11. Balter, M.B.; Levine, J.; and Manheimer, D.I. Cross-diagonal study of the extent of anti-anxiety sedative drug use. N Engl JMed 290:769-774, 1974. 12. Parry, H.J., and others. National patterns of psychotherapeutic drug use. Arch Gen Psychiatry 28:769-783,1973. 13. McLundie, A.C.; Watson, W.C.; and Kennedy, G.D.C. Medical status of patients undergoing dental care, an assessment. Br Dent J 127:265-271, 1969. 14. Halpern, I.L. Patient’s medical status—a factor in dental treatment. Oral Surg 39(2):216-226, 1975. 15. Gordon, S.G., and Halpern, I.L. Medical aspects of dental patient history. Oral Surg 15:1270-1276,1962. 16. Tarsitano, J.J., and O’Hara, J.W. Rheumatic fever: in-depth ap praisal with a discussion of penicillin. JADA 77:1074-1080,1968.