Polypharmacy and Oral Health in Older Adults: Measure Anticholinergic and Sedative Burden, Not Pill Count Alone

OBJECTIVE: To propose a mechanism-informed approach to medication exposure in research on polypharmacy and oral health among older adults. BACKGROUND: A recent systematic review found that polypharmacy was associated with dry mouth and hyposalivation, whereas associations with multimorbidity and other oral outcomes were less consistent. Total pill count, however, cannot distinguish regimens with markedly different xerogenic, anticholinergic, or sedative effects. METHODS: We critically interpret the review findings and integrate selected evidence on anticholinergic burden, sedative load and the oral effects of psychotropic medications. RESULTS: We propose a six-component medication phenotype comprising total medicine count; anticholinergic burden; sedative burden; xerogenic medicines not captured by the selected anticholinergic scale; dose, duration and recent regimen changes; and indication with markers of disease severity. Oral outcomes should be separated into subjective xerostomia, measured salivary flow, clinical dryness, oral disease, oral function and dental attendance. CONCLUSION: Mechanism-based medication phenotyping could improve causal inference and identify modifiable risks. In practice, elevated burden should prompt coordinated dental prevention and prescriber-pharmacist review rather than indiscriminate deprescribing, with psychiatric stability explicitly protected.