Medication adherence is challenging when the jaw is immobilized, whether through surgical wiring or banding. Maintaining the prescribed medication schedule is fundamental for managing pain, preventing infection, and ensuring optimal healing. Since swallowing solid pills is impossible with limited or no oral opening, converting solid doses into a liquid form is necessary. This guide provides practical instruction for preparing and administering these doses, but it must be understood as supplementary to professional medical advice.
Essential Safety Checks Before Altering Medication
Before attempting to crush, dissolve, or otherwise alter any medication, you must consult directly with the prescribing physician or a pharmacist. This consultation is mandatory because altering a pill’s physical form can profoundly change how the drug works in the body. A pharmacist can often identify an approved liquid form of the medication, which is the safest alternative to the solid pill.
Many common medications are formulated with specialized coatings or internal structures that control the rate and location of drug release. For example, crushing an extended-release (XR) or sustained-release (SR) tablet destroys the mechanism designed to deliver the drug slowly over many hours. This action can cause the entire dose to be absorbed immediately, leading to a sudden, dangerously high concentration of the drug in the bloodstream and potentially an overdose.
Enteric-coated (EC) tablets, which are designed to bypass the acidic environment of the stomach and dissolve only in the small intestine, must also never be crushed. Destroying this coating exposes the stomach lining to potentially irritating substances, which can cause severe gastric distress or ulceration. Moreover, the stomach acid may destroy the drug itself, rendering the medication ineffective. Other medications like sublingual tablets or certain hazardous cytotoxic drugs are also unsuitable for crushing, and the pharmacist can provide a definitive list of safe alternatives.
Techniques for Liquifying Solid Medication
Once a healthcare professional has approved a specific solid medication for alteration, the goal is to transform it into a fine powder that can be fully dissolved. The most efficient methods for crushing include using a dedicated pill crusher or a traditional mortar and pestle, which create a uniform, fine consistency. If professional tools are unavailable, placing the pill between two spoons and pressing down firmly can also achieve the necessary powder. The resulting powder must be completely free of granules or clumps to prevent obstruction during administration.
The powdered medication should then be mixed with a minimal amount of liquid to ensure the entire dose is consumed without significant residue loss. Using 10 to 20 milliliters (mL) of water or a thin juice is typically sufficient for a single dose. Using too large a volume of liquid increases the risk of not being able to consume the entire mixture, resulting in an incomplete and ineffective dose.
For liquid-soluble tablets, an alternative method is to place the tablet directly inside the barrel of a large oral syringe and draw up 2 to 3 mL of room-temperature water. After capping the syringe tip, gently shaking or swirling the contents will allow the tablet to dissolve, creating a concentrated liquid dose. This technique minimizes residue and contains the entire process within the administration tool itself. If the medication is approved to be mixed with food, a minimal amount of a smooth, thin substance like applesauce or yogurt can be used, but all of the mixture must be consumed immediately.
Safe Administration Methods for Liquid Doses
The safest and most controlled way to administer the liquified dose is by using a needle-less oral syringe, typically in a 5 mL or 10 mL size. Before administration, the patient must be positioned fully upright or slightly leaning forward to utilize gravity and minimize the risk of aspiration. This posture is important for controlling the flow of the liquid and ensuring it is directed toward the throat for swallowing.
The tip of the oral syringe should be placed into the mouth through any available gaps, such as behind the last molar tooth or between the teeth near the cheek. The liquid medication is then dispensed slowly and deliberately into the cheek pouch, allowing the patient time to swallow the dose in small amounts. Rapid administration can overwhelm the patient, leading to choking or spillage of the medication, which results in an incomplete dose.
Immediately following the administration of the dose, a vigorous rinse of the mouth is required to prevent residue buildup around the wires, plates, and bands. This can be accomplished using an oral irrigation syringe filled with plain water or a prescribed saline solution. A thorough rinse is necessary to maintain oral hygiene and prevent the development of localized infection or tooth decay caused by medication particles trapped against the hardware.