Oral Adverse Drug Reactions in Patients Receiving Polypharmacy: A Prospective Interdisciplinary Case Series
4 affiliations
- 1Dentistry, Gian Sagar Dental College and Hospital, Rajpura, IND
- 2Pharmacology and Therapeutics, Christian Medical College and Hospital, Ludhiana, IND
- 3Pharmacology, National Institute of Medical Sciences (NIMS) University, Jaipur, IND
- 4Community Medicine, Government Medical College, Patiala, IND
Abstract
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.
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BibTeX
@article{singh2026oral,
title = {{Oral Adverse Drug Reactions in Patients Receiving Polypharmacy: A Prospective Interdisciplinary Case Series}},
author = {Jessica Singh and Neena Bhatti and Girish Joseph and Jatinder Singh and Manhardeep Kaur and Dharminder Ahir},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117405},
url = {https://europepmc.org/article/PMC/PMC13727764},
note = {CC BY},
}
RIS
TY - JOUR
TI - Oral Adverse Drug Reactions in Patients Receiving Polypharmacy: A Prospective Interdisciplinary Case Series
AU - Jessica Singh
AU - Neena Bhatti
AU - Girish Joseph
AU - Jatinder Singh
AU - Manhardeep Kaur
AU - Dharminder Ahir
PY - 2026
DA - 2026/10/03
JO - Cureus
DO - 10.7759/cureus.117405
UR - https://europepmc.org/article/PMC/PMC13727764
AB - 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.
SN - 2168-8184
ER -