Pharmacovigilance in Dental Practice: Opportunities for Pharmacy-Dentistry Collaboration
Authors
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Abstract
Pharmacovigilance is considered to be an essential part in ensuring drug safety across healthcare disciplines, despite that, its integration into dental practice is limited and overlooked. Dentists prescribe antibiotics, analgesics, and local anesthetics on a daily basis, all of which can result in adverse drug reactions (ADRs). However, reporting of ADRs by dental professionals is significantly lower than in other medical fields, which causes gaps in public health surveillance and patient safety. This narrative review highlights the poorly developed state of pharmacovigilance in the realm of dentistry, identifying key barriers such as a lack of awareness, limited educational training, and systemic issues responsible for the under-reporting of adverse drug reactions (ADRs). The review points out the growing critical role of pharmacists for boosting drug safety through patient counseling, prescription monitoring, and facilitating ADR reporting mechanisms. The review calls for multi-professional teamwork, especially for those from the low- and middle-income countries, and proposes the infusion of online tools, target educational programs, and policy changes for the integration of pharmacovigilance into routine dental practice and public health outcomes.
##plugins.themes.bootstrap3.article.details##
Copyright (c) 2025 Mazin S. Matar, Ldan Salah Habib Alla Elatta, Walaa Abdelgayoum Suliman Basheir, Khadija Mohamed Khalid, Duaa HabibAlla Babiker, Bashir A. Yousef
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
Mazin S. Matar, Hospital Pharmacy Department, Jafar Ibn Auf Paediatric Hospital, Khartoum, Sudan.
Hospital Pharmacy Department, Jafar Ibn Auf Paediatric Hospital, Khartoum, Sudan.
Ldan Salah Habib Alla Elatta, College of Dentistry, Sudan University of Science and Technology, Khartoum, Sudan.
College of Dentistry, Sudan University of Science and Technology, Khartoum, Sudan.
Walaa Abdelgayoum Suliman Basheir, College of Dentistry, Sudan University of Science and Technology, Khartoum, Sudan.
College of Dentistry, Sudan University of Science and Technology, Khartoum, Sudan.
Khadija Mohamed Khalid, College of Dentistry, Sudan University of Science and Technology, Khartoum, Sudan.
College of Dentistry, Sudan University of Science and Technology, Khartoum, Sudan.
Duaa HabibAlla Babiker, College of Dentistry, Sudan University of Science and Technology, Khartoum, Sudan.
College of Dentistry, Sudan University of Science and Technology, Khartoum, Sudan.
Bashir A. Yousef, Department of Clinical Pharmacy and Pharmacology, Ibn Sina National College of Medical Studies, Jeddah, Saudi Arabia. Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan.
Department of Clinical Pharmacy and Pharmacology, Ibn Sina National College of Medical Studies, Jeddah, Saudi Arabia
Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan.
[1] Hamid AAA, Rahim R, Teo SP. Pharmacovigilance and Its Importance for Primary Health Care Professionals. Korean J Fam Med. 2022;43(5):290-295. https://doi.org/10.4082/kjfm.21.0193
[2] Ibrahim EEM, Badi S, Yousef BA, Elsayed LA, Elkheir HK. Evaluation of Adverse Drug Events in Patients on Anti-Retroviral Therapy Regimen at Omdurman Voluntary Counselling and Testing and Anti-Retroviral Therapy Center in Sudan - A Cross-Sectional Study. HIV AIDS (Auckl). 2024;16:153-164. https://doi.org/10.2147/HIV.S449900
[3] Alshammari TM, Alamri KK, Ghawa YA, Alohali NF, Abualkol SA, Aljadhey HS. Knowledge and attitude of health-care professionals in hospitals towards pharmacovigilance in Saudi Arabia. Int J Clin Pharm. 2015;37(6):1104-10. https://doi.org/10.1007/s11096-015-0165-5
[4] Ura H, Senoo M, Kubota K, Sadamoto K. The Current Status of Utilizing a Medication Record Handbook for Evaluating Shared Medication History: A Retrospective Study Using the Japanese National Claims Database. Cureus. 2024;16(4):e59096. https://doi.org/10.7759/cureus.59096
[5] Sree Sudha TY, Kumari K, Kalyani CV, Kankarwal M, Sasanka KSBSK. Assessment of pharmacovigilance knowledge and ADR reporting skills in undergraduate medical students using the OSPA model. Dialogues Health. 2025;7:100227. https://doi.org/10.1016/j.dialog.2025.100227
[6] De Paepe P, Petrovic M, Outtier L, Van Maele G, Buylaert W. Drug interactions and adverse drug reactions in the older patients admitted to the emergency department. Acta Clin Belg. 2013;68(1):15-21. https://doi.org/10.2143/ACB.68.1.2062714
[7] Aljadhey H, Mahmoud MA, Alshammari TM, Al-Dhaeefi M, Le Louet H, Perez-Gutthann S, et al. A qualitative exploration of the major challenges facing pharmacovigilance in Saudi Arabia. Saudi Med J. 2015;36(9):1097-102. https://doi.org/10.15537/smj.2015.9.12125
[8] Walaa AM, Eiman EMI, Kannan OA, Elmoiz B, Khalid AA, Adnan F, et al. Comparative Analysis of Adverse Effects and Graft Rejection Rates of Azathioprine versus Mycophenolate in Kidney Transplant Recipients: A Retrospective Study. Afr J Biomed Res. 2025:28(2S);732-738. https://doi.org/10.53555/AJBR.v28i2S.6682
[9] Magi CE, Bambi S, Rasero L, Longobucco Y, El Aoufy K, Amato C, et al. Health Literacy and Self-Care in Patients with Chronic Illness: A Systematic Review and Meta-Analysis Protocol. Healthcare (Basel). 2024;12(7):762. https://doi.org/10.3390/healthcare12070762
[10] Hazell L, Shakir SA. Under-reporting of adverse drug reactions: a systematic review. Drug Saf. 2006;29(5):385-96. https://doi.org/10.2165/00002018-200629050-00003
[11] Dyar OJ, Huttner B, Schouten J, Pulcini C; ESGAP (ESCMID Study Group for Antimicrobial stewardshiP). What is antimicrobial stewardship? Clin Microbiol Infect. 2017;23(11):793-798. https://doi.org/10.1016/j.cmi.2017.08.026
[12] Desai MK. Artificial intelligence in pharmacovigilance - Opportunities and challenges. Perspect Clin Res. 2024;15(3):116-121. https://doi.org/10.4103/picr.picr_290_23
[13] Contaldo M, D'Ambrosio F, Ferraro GA, Di Stasio D, Di Palo MP, Serpico R, et al. Antibiotics in Dentistry: A Narrative Review of the Evidence beyond the Myth. Int J Environ Res Public Health. 2023;20(11):6025. https://doi.org/10.3390/ijerph20116025
[14] Isah AO, Pal SN, Olsson S, Dodoo A, Bencheikh RS. Specific features of medicines safety and pharmacovigilance in Africa. Ther Adv Drug Saf. 2012;3(1):25-34. https://doi.org/10.1177/2042098611425695
[15] Calvert M, Blazeby J, Altman DG, Revicki DA, Moher D, Brundage MD; CONSORT PRO Group. Reporting of patient-reported outcomes in randomized trials: the CONSORT PRO extension. JAMA. 2013;309(8):814-22. https://doi.org/10.1001/jama.2013.879
[16] Jnaneswar A, Hazarika SJ, Jha K, Vinay S, Kumar G. Knowledge, attitude, practices, and barriers regarding pharmacovigilance and adverse drug reaction reporting among medical and dental faculties of the teaching hospitals in Bhubaneswar City. J Educ Health Promot. 2020;9:282. https://doi.org/10.4103/jehp.jehp_250_20
[17] Yadav L, Mehra P, Vasisth D, Mattu N, Biswas K, Yadav N. Assessment of Knowledge, Attitude, and Practice of Pharmacovigilance and Materiovigilance among Oral Health Practitioners in India. J Pharm Bioallied Sci. 2024;16(Suppl 1):S202-S205. https://doi.org/10.4103/jpbs.jpbs_456_23
[18] Chhabra KG, Sharma A, Chhabra C, Reddy JJ, Deolia SG, Mittal Y. Knowledge, Attitude, and Practices regarding Pharmacovigilance and Adverse Drug Reaction reporting among Dental Students in a Teaching Hospital, Jodhpur, India: A Cross-sectional Study. J Contemp Dent Pract. 2017;18(10):964-969. https://doi.org/10.5005/jp-journals-10024-2157
[19] Khan SA, Goyal C, Tonpay SD. A study of knowledge, attitudes, and practice of dental doctors about adverse drug reaction reporting in a teaching hospital in India. Perspect Clin Res. 2015;6(3):144-9. https://doi.org/10.4103/2229-3485.159938
[20] Becker DE. Pain management: Part 1: Managing acute and postoperative dental pain. Anesth Prog. 2010;57(2):67-78; quiz 79-80. https://doi.org/10.2344/0003-3006-57.2.67
[21] Manandhar T. Knowledge, attitude and practice of pharmacovigilance among undergraduate medical and dental students of a tertiary care teaching hospital. Journal of Chitwan Medical College. 2022;12(4):12-6. https://doi.org/10.54530/jcmc.1205
[22] Oshikoya KA, Awobusuyi JO. Perceptions of doctors to adverse drug reaction reporting in a teaching hospital in Lagos, Nigeria. BMC Clin Pharmacol. 2009;9:14. https://doi.org/10.1186/1472-6904-9-14
[23] Ribeiro-Vaz I, Silva AM, Costa Santos C, Cruz-Correia R. How to promote adverse drug reaction reports using information systems - a systematic review and meta-analysis. BMC Med Inform Decis Mak. 2016;16:27. https://doi.org/10.1186/s12911-016-0265-8
[24] Gupta K, Kumar S, Anand Kukkamalla M, Taneja V, Syed GA, Pullishery F, Zarbah Jowett NI, Cabot LB. Patients with cardiac disease: considerations for the dental practitioner. Br Dent J. 2000;189(6):297-302. https://doi.org/10.1038/sj.bdj.4800750
[25] AlShammari TM, Almoslem MJ. Knowledge, attitudes & practices of healthcare professionals in hospitals towards the reporting of adverse drug reactions in Saudi Arabia: A multi-centre cross sectional study. Saudi Pharm J. 2018;26(7):925-931. https://doi.org/10.1016/j.jsps.2018.04.012
[26] Elkalmi RM, Hassali MA, Ibrahim MI, Widodo RT, Efan QM, Hadi MA. Pharmacy students' knowledge and perceptions about pharmacovigilance in Malaysian public universities. Am J Pharm Educ. 2011;75(5):96. https://doi.org/10.5688/ajpe75596
[27] Lygre H, Kjome RLS, Choi H, Stewart AL. Dental providers and pharmacists: a call for enhanced interprofessional collaboration. Int Dent J. 2017;67(6):329-331. https://doi.org/10.1111/idj.12304
[28] Abdollahi M, Radfar M. A review of drug-induced oral reactions. J Contemp Dent Pract. 2003;4(1):10-31
[29] Kaplovitch E, Dounaevskaia V. Treatment in the dental practice of the patient receiving anticoagulation therapy. J Am Dent Assoc. 2019;150(7):602-608. https://doi.org/10.1016/j.adaj.2019.02.011
[30] Decloux D, Ouanounou A. Local anaesthesia in dentistry: a review. Int Dent J. 2020;71(2):87–95. https://doi.org/10.1111/idj.12615
[31] Moore PA, Hersh EV. Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. J Am Dent Assoc. 2013;144(8):898-908. https://doi.org/10.14219/jada.archive.2013.0207
[32] Lockhart PB, Tampi MP, Abt E, Aminoshariae A, Durkin MJ, Fouad AF, et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association. J Am Dent Assoc. 2019;150(11):906-921.e12. https://doi.org/10.1016/j.adaj.2019.08.020
[33] Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update. J Oral Maxillofac Surg. 2022;80(5):920-943. https://doi.org/10.1016/j.joms.2022.02.008
[34] Dionne RA, Gordon SM, McCullagh LM, Phero JC. Assessing the need for anesthesia and sedation in the general population. J Am Dent Assoc. 1998;129(2):167-73. https://doi.org/10.14219/jada.archive.1998.0173
[35] Grimes TC, Guinan EM. Interprofessional education focused on medication safety: a systematic review. J Interprof Care. 2023;37(1):131-149. https://doi.org/10.1080/13561820.2021.2015301
[36] Lopez-Gonzalez E, Herdeiro MT, Figueiras A. Determinants of under-reporting of adverse drug reactions: a systematic review. Drug Saf. 2009;32(1):19-31. https://doi.org/10.2165/00002018-200932010-00002
[37] Ferner RE, Aronson JK. Medicines legislation and regulation in the United Kingdom 1500-2020. Br J Clin Pharmacol. 2023;89(1):80-92. https://doi.org/10.1111/bcp.15497
[38] Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet. 2000;356(9237):1255-9. https://doi.org/10.1016/S0140-6736(00)02799-9
[39] Gupta SK, Nayak RP, Shivaranjani R, Vidyarthi SK. A questionnaire study on the knowledge, attitude, and the practice of pharmacovigilance among the healthcare professionals in a teaching hospital in South India. Perspect Clin Res. 2015;6(1):45-52. https://doi.org/10.4103/2229-3485.148816
[40] García-Abeijon P, Costa C, Taracido M, Herdeiro MT, Torre C, Figueiras A. Factors Associated with Underreporting of Adverse Drug Reactions by Health Care Professionals: A Systematic Review Update. Drug Saf. 2023;46(7):625-636. https://doi.org/10.1007/s40264-023-01302-7
[41] Perea-Pérez B, Labajo-González E, Santiago-Sáez A, Albarrán-Juan E, Villa-Vigil A. Analysis of 415 adverse events in dental practice in Spain from 2000 to 2010. Med Oral Patol Oral Cir Bucal. 2014;19(5):e500-5. https://doi.org/10.4317/medoral.19601
[42] Alwidyan T, Odeh M, Ibrahim AH, Harahsheh E, Banat A. Knowledge, attitude, and practice among community pharmacists toward adverse drug reaction reporting and pharmacovigilance: A nationwide survey. Explor Res Clin Soc Pharm. 2025;18:100578. https://doi.org/10.1016/j.rcsop.2025.100578
[43] Khan SA, Goyal C, Chandel N, Rafi M. Knowledge, attitudes, and practice of doctors to adverse drug reaction reporting in a teaching hospital in India: An observational study. J Nat Sci Biol Med. 2013;4(1):191-6. https://doi.org/10.4103/0976-9668.107289
[44] Alshahrani S, Ali M, Alsreaya R, Najie M, Hijri A, Almalki A, et al. Pharmacovigilance in Practice: Insights into Knowledge, Attitudes, and Practices of Pharmacists and Pharmacy Technicians in Saudi Arabia. J Res Pharm Pract. 2025;14(2):50-58. https://doi.org/10.4103/jrpp.jrpp_8_25
[45] Blebil A, Dujaili J, Elkalmi R, Tan HLK, Tai MS, Khan TM. Community Pharmacist's Role in Providing Oral Health-care Services: Findings from Malaysia. J Pharm Bioallied Sci. 2020;12(1):64-71. https://doi.org/10.4103/jpbs.JPBS_152_19
[46] Owen EC, Abrams R, Cai Z, Duddy C, Fudge N, Hamer-Hunt J, et al. Community pharmacy and general practice collaborative and integrated working: a realist review protocol. BMJ Open. 2022;12(12):e067034. https://doi.org/10.1136/bmjopen-2022-067034
[47] Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2007;65(3):369-76. https://doi.org/10.1016/j.joms.2006.11.003
[48] Sudarsono J, Satibi S, Lazuardi L, Widayanti AW. Healthcare professionals' perceptions of electronic prescription systems in outpatient services: a qualitative study at UNS hospital. Cost Eff Resour Alloc. 2025;23(1):31. https://doi.org/10.1186/s12962-025-00639-3
[49] Alshehri H, Alharbi A, Alqethami N, Alnuhait M, Alshammari A, Alotaibi AS. Knowledge, Attitude, and Practice Regarding Pharmacovigilance and Barriers to Reporting Adverse Drug Reactions Among the General Population in Saudi Arabia. Risk Manag Healthc Policy. 2024;17:2557-2572. https://doi.org/10.2147/RMHP.S484223
[50] Colakoglu G, Buyukbayram IK. Knowledge, attitudes and practices of dentists regarding pharmacovigilance and reporting of adverse drug reactions in Northwestern Turkiye: a cross-sectional study. Cumhuriyet Dental Journal. 2023;26(1):69-76. https://doi.org/10.7126/cumudj.1246959
[51] Khalili H, Mohebbi N, Hendoiee N, Keshtkar AA, Dashti-Khavidaki S. Improvement of knowledge, attitude and perception of healthcare workers about ADR, a pre- and post-clinical pharmacists' interventional study. BMJ Open. 2012;2(1):e000367. https://doi.org/10.1136/bmjopen-2011-000367
[52] Cervantes-Arellano MJ, Castelán-Martínez OD, Marín-Campos Y, Chávez-Pacheco JL, Morales-Ríos O, Ubaldo-Reyes LM. Educational interventions in pharmacovigilance to improve the knowledge, attitude and the report of adverse drug reactions in healthcare professionals: Systematic Review and Meta-analysis. Daru. 2024;32(1):421-434. https://doi.org/10.1007/s40199-024-00508-z
[53] Rajiah K, Maharajan MK, Nair S. Pharmacy students' knowledge and perceptions about adverse drug reactions reporting and pharmacovigilance. Saudi Pharm J. 2016;24(5):600-604. https://doi.org/10.1016/j.jsps.2015.03.021
[54] World Health Organization. WHO pharmacovigilance indicators: A practical manual for the assessment of pharmacovigilance systems. WHO. 2014. Available from: http://www.who.int/medicines/areas/quality_safety/safety_efficacy/EMP_PV_Indicators_web_ready_v2.pdf
[55] Pal SN, Duncombe C, Falzon D, Olsson S. WHO strategy for collecting safety data in public health programmes: complementing spontaneous reporting systems. Drug Saf. 2013;36(2):75-81. https://doi.org/10.1007/s40264-012-0014-6
[56] Härmark L, van Grootheest AC. Pharmacovigilance: methods, recent developments and future perspectives. Eur J Clin Pharmacol. 2008;64(8):743-52. https://doi.org/10.1007/s00228-008-0475-9
[57] Reumerman M, Tichelaar J, Piersma B, Richir MC, van Agtmael MA. Urgent need to modernize pharmacovigilance education in healthcare curricula: review of the literature. Eur J Clin Pharmacol. 2018;74(10):1235-1248. https://doi.org/10.1007/s00228-018-2500-y
[58] Martine C, Sutherland S, Born K, Thompson W, Teoh L, Singhal S. Dental antimicrobial stewardship: a qualitative study of perspectives among Canadian dentistry sector leaders and experts in antimicrobial stewardship. JAC Antimicrob Resist. 2024;6(3):dlae082. https://doi.org/10.1093/jacamr/dlae082
[59] Cope AL, Francis NA, Wood F, Chestnutt IG. Antibiotic prescribing in UK general dental practice: a cross-sectional study. Community Dent Oral Epidemiol. 2016;44(2):145-53. https://doi.org/10.1111/cdoe.12199
[60] Teoh L, Stewart K, Marino RJ, McCullough MJ. Part 1. Current prescribing trends of antibiotics by dentists in Australia from 2013 to 2016. Aust Dent J. 2018. https://doi.org/10.1111/adj.12622
[61] Thompson W, Williams D, Pulcini C, Sanderson S, Calfon P, Verma M. The essential role of the dental team in reducing antibiotic resistance. Geneva: FDI World Dental Federation. 2020.
[62] Davies EC, Green CF, Taylor S, Williamson PR, Mottram DR, Pirmohamed M. Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. PLoS One. 2009;4(2):e4439. https://doi.org/10.1371/journal.pone.0004439
[63] Kalaiselvan V, Srivastava S, Singh A, Gupta SK. Pharmacovigilance in India: Present Scenario and Future Challenges. Drug Saf. 2019;42(3):339-346. https://doi.org/10.1007/s40264-018-0730-7
[64] Villa A, Connell CL, Abati S. Diagnosis and management of xerostomia and hyposalivation. Ther Clin Risk Manag. 2014;11:45-51. https://doi.org/10.2147/TCRM.S76282
[65] Haider N, Mazhar F. Factors associated with underreporting of adverse drug reactions by nurses: a narrative literature review. Saudi Journal for Health Sciences. 2017;6(2):71-6. https://doi.org/10.4103/sjhs.sjhs_37_17
[66] Pirmohamed M, Atuah KN, Dodoo AN, Winstanley P. Pharmacovigilance in developing countries. BMJ. 2007;335(7618):462. https://doi.org/10.1136/bmj.39323.586123.BE
[67] Li J, Pandian V, Davidson PM, Song Y, Chen N, Fong DYT. Burden and attributable risk factors of non-communicable diseases and subtypes in 204 countries and territories, 1990-2021: a systematic analysis for the global burden of disease study 2021. Int J Surg. 2025;111(3):2385-2397. https://doi.org/10.1097/JS9.0000000000002260
[68] Hartigan-Go K. Developing a pharmacovigilance system in the Philippines, a country of diverse culture and strong traditional medicine background. Toxicology. 2002;181-182:103-7. https://doi.org/10.1016/s0300-483x(02)00263-9
[69] Pal SN, Olsson S, Brown EG. The monitoring medicines project: a multinational pharmacovigilance and public health project. Drug Saf. 2015;38(4):319-28. https://doi.org/10.1007/s40264-015-0283-y
[70] Katebi K, Eslami H, Jabbari S. Prevalence and causes of self-medication for oral health problems: a systematic review and meta-analysis. BMC Oral Health. 2024;24(1):1115. https://doi.org/10.1186/s12903-024-04900-8
[71] Palaian S, Ibrahim MI, Mishra P. Health professionals' knowledge, attitude and practices towards pharmacovigilance in Nepal. Pharm Pract (Granada). 2011;9(4):228-235. https://doi.org/10.4321/s1886-36552011000400008
[72] Kumari A, Prajapati H. Transformative education: Enhancing pharmacovigilance awareness among healthcare professionals through sensitization initiatives. J Family Med Prim Care. 2025;14(5):2026-2030. https://doi.org/10.4103/jfmpc.jfmpc_1869_24