CASE 1: DENTURE PROBLEMS
DD is a 75-year-old male who comes to the pharmacy looking for relief from oral pain. DD reports wearing dentures and, despite cleaning and maintaining them, he has developed a sore on the roof of his mouth and isn’t sure whether to take an OTC pain reliever by mouth or to apply something locally to the affected area. DD has no known allergies, but reports taking an extensive list of medications for diabetes, heart failure, hypertension, and hyperlipidemia. What recommendations can you give DD?
Good oral hygiene is as important for denture wearers as it is for those with their natural teeth. As an initial intervention, it is critical to further explore DD’s hygiene routine. Dentures should be thoroughly cleaned at least once daily using a special denture brush and an abrasive cleaning solution.1 Remind DD that dentures should not be worn overnight, but rather removed and allowed to soak in a chemical cleaner to remove bacteria and plaque. It is important to ask DD about the localization or generalization of the pain; denture wearers reporting localized pain may be suffering from trauma secondary to an improper fit, whereas chronic infection with Candida albicans may result in inflammation, redness, and soreness over the entire denturebearing area.1 Given DD’s history of diabetes, he is at risk for infection. Recommend evaluation by a dental professional so that proper treatment with a prescription antifungal, if necessary, can be initiated as soon as possible.
CASE 2: AGE-RELATED MACULAR DEGENERATION
NN is a 69-year-old female who stops by the pharmacy to discuss the use of vitamins to improve her eye health. She is taking a daily multivitamin touted for promoting eye health because she wants to reduce her chance of developing macular degeneration, a vision problem that has plagued other members of her family. She reports reading about the beneficial effects of lutein, an ingredient in the vitamin supplement she is taking, and asks for your thoughts on this nutrient’s value for supporting eye health. Should she be taking an additional lutein supplement beyond what is in her multivitamin? How do you respond?
Age-related macular degeneration (AMD) is a leading cause of blindness in adults 60 years and older in the United States, so prevention of AMD is paramount.2 This condition is thought to have a hereditary component; therefore, NN may have an increased risk for it. Smoking, hypertension, dyslipidemia, obesity, and being female may also increase the risk for AMD.2 Dietary supplementation with antioxidants, specifically vitamins C and E, beta-carotene, and zinc, has been shown to have a significant benefit in slowing the progression of AMD; a study in which lutein and zeaxanthin were used in lieu of beta-carotene found similar results.3,4 While supplementation with lutein may improve vision-related symptoms in individuals with AMD, there is limited evidence that lutein can prevent AMD.5 NN should be reminded to check the label of her multivitamin; supplementary doses of lutein up to 10 mg per day should be sufficient.
Dr. Bridgeman is an internal medicine clinical pharmacist at Robert Wood Johnson University Hospital, New Brunswick, New Jersey, and clinical assistant professor at Ernest Mario School of Pharmacy, Rutgers University. Dr. Mansukhani is a clinical pharmacist at Morristown Medical Center in Morristown, New Jersey, and clinical assistant professor at Ernest Mario Rupal Patel School of Pharmacy, Rutgers University.
1. Albanese NP. Oral pain and discomfort. In: Krinsky DL, Berardi RR, Ferreri SP, et al, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 17th edition. Washington, DC: American Pharmacists Association; 2011.
2. Age-related macular degeneration overview. WebMD. www.webmd.com/eye-health/macular-degeneration/age-related-macular-degeneration-overview. Accessed December 12, 2014.
3. Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthalmol. 2001;119:1417.
4. Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA. 2013;309:2005.
5. Natural medicines in the clinical management of eye disorders: age-related macular degeneration, cataracts, and glaucoma. Natural Medicines Comprehensive Database website. www.therapeuticresearch.net. Accessed December 13, 2014.