Abstract / Summary
Background and objective: Polypharmacy in older adults markedly increases the risk of adverse drug reactions (ADRs).While the systemic pharmacokinetic and pharmacodynamic consequences of polypharmacy are extensively documented, the oral cavity remains an under-evaluated site for both mucosal and functional drug toxicity.Drug-induced oral manifestations range from dysgeusia and xerostomia to gingival overgrowth, lichenoid reactions, erythema multiforme, opportunistic infection, angioedema, and medication-related osteonecrosis of the jaw, and they meaningfully impair oral health-related quality of life.This case series was undertaken to characterize oral ADRs in patients on polypharmacy through a targeted, interdisciplinary pharmacovigilance approach.This study aims to identify and characterize the spectrum of oral ADRs in patients exposed to polypharmacy, determine the drug classes most frequently implicated, and assess the causality of each reaction using a standardized probability scale.Methods: This prospective, observational case series was conducted over six months at a tertiary care teaching hospital.Ten adult patients taking five or more concurrent systemic medications who developed new-onset oral lesions or functional oral impairment were enrolled after written informed consent.The evaluation was delivered through an interdisciplinary collaboration led by a dentist, together with the Departments of Pharmacology and Community Medicine.Comprehensive medication reconciliation and a structured oral examination were performed, and causality was assessed using the Naranjo Adverse Drug Reaction Probability Scale.Results: Ten patients (mean age 67.8 years; 60% male) taking between five and eight concurrent medications were evaluated.The most frequent oral ADRs were functional salivary impairment (xerostomia, 20%) and structural modification (gingival overgrowth, 20%).The agents most often implicated were antihypertensives (calcium channel blockers and angiotensin-converting enzyme inhibitors), anticholinergics, and anticonvulsants.Causality assessment classified eight reactions (80%) as probable and two (20%) as possible; none was classified as definite or doubtful.Severity assessment using the Modified Hartwig and Siegel scale classified most reactions as moderate (70%), and preventability assessment using the Schumock and Thornton criteria identified over half as probably preventable (60%).Conclusion: Polypharmacy necessitates vigilant, proactive monitoring for oral mucosal and functional toxicity.Active interdisciplinary collaboration between a dentist, pharmacologists, and community medicine physicians can facilitate recognition and assessment of suspected oral ADRs, early mitigation of drug-induced oral morbidity, and improved patient care.