Impact of polypharmacy on oral health in the elderly: challenges and management

Abstract

With increasing life expectancy and multimorbidity, polypharmacy—commonly defined as the concurrent use of five or more medications—has become highly prevalent in older adults and poses substantial risks for oral health. This narrative review aimed to synthesize contemporary evidence on the epidemiology, pharmacological mechanisms, and oral manifestations of polypharmacy in geriatric populations, and to propose an interprofessional management framework for dental practitioners in 2025 care settings. Recent epidemiological data indicate that polypharmacy affects more than 30%–44% of older adults globally, with even higher rates among those with cardiovascular disease, diabetes, and multimorbidity. Medications with anticholinergic burden, as well as many antihypertensive and psychotropic agents, are strongly associated with salivary gland hypofunction and xerostomia, which in turn contribute to rampant caries, oral candidiasis, mucosal lesions, dysgeusia, periodontal complications, and drug-induced gingival overgrowth. Diagnostic and therapeutic challenges are amplified by underreporting of symptoms, cognitive impairment, and fragmented medical–dental care pathways. Evidence supports a preventive and interdisciplinary approach that includes structured medication review and deprescribing in collaboration with physicians and pharmacists, optimization of salivary function using sialogogues and saliva substitutes, prescription of high-fluoride toothpastes, and tailored oral hygiene and dietary counseling with caregiver engagement. Dentists are strategically positioned to detect medication-related oral conditions, trigger timely medication optimization, and coordinate ongoing care. A structured, multidisciplinary model integrating dental, medical, and pharmacy services is essential to mitigate the oral and systemic consequences of polypharmacy and to preserve function and quality of life in aging populations.