Studies have identified that oral health is poorer in patients with mental health conditions. Some of this may be linked with other poor diet, smoking and alcohol consumption, or barriers to accessing care and dental phobia.
As medication plays an important role in the management of mental health issues, the side effects of these drugs may also contribute. Anticholinergic drugs have a well know effect on saliva, and antidepressants and anticholinergics have also been linked to dry mouth.
The aim of this review was to identify the oral side effects of antidepressant, antipsychotic, anticonvulsant, anti-anxiety and sedative drugs, used for the management of common mental illnesses in Australia.
Methods
Searches were conducted in the Australian Therapeutic Guidelines and the Australian Medicines Handbook for drug used for the treatment of common mental health conditions (depression, anxiety, panic, post-traumatic stress, obsessive compulsive, bulimia, insomnia, delirium, schizophrenia and bipolar disorders).
Three drugs (Buspirone, Trimipramine and Sertindole) have been withdrawn from sale so were excluded.
Results
- 57 different drugs were identified:
- 23 antidepressants
- 22 antipsychotic or anticonvulsant drugs
- 12 or the treatment of anxiety or sleep disorders (anxiolytic and sedative medications)
- 34 different oral side effects were identified.
- The most common side effects of psychotropic medications overall were:
- Xerostomia (dry mouth) (91%),
- Increased salivation (49%),
- Tardive dyskinesia (involuntary movements of the tongue, lips, face) (49%),
- dysguesia (distortion of sense of taste) (46%),
- Dysphagia (impairment of communication) (37%), and
- Oral stomatitis (inflammation of mouth and lips) (25%).
Conclusions
The authors concluded:
Xerostomia was the most prevalent reported oral side effect of these drugs, followed by excessive salivation (paradoxically), dysguesia and tardive dyskinesia. Side effects of common psychotropic drugs can increase the risk of dental diseases and therefore preventive oral health measures and multidisciplinary care is required. Physicians should work with dental practitioners, pharmacists, specialists, speech pathologists and other allied health professionals to manage associated oral health effects of psychotropic drugs.
Comments
Although caries and periodontal disease are two of the commonest diseases in the world their impact on medial morbidity is overlooked. Patients with mental health conditions are known to have poorer oral health, which may be due to compounding issues of homelessness, disabilities, poorer diet and habits, e.g. sweet drink consumption and tobacco smoking as well as dental phobias and barriers to accessing dental care. However, as is demonstrated by this review, people living with mental illness also face additional impacts from the drugs they take to help manage their condition.
As the authors of the review suggest:
- Doctors need to be aware of the impact of mental health medication on oral health
- Closer cooperation between doctors and dentists managing these patients is needed, as well as better overall multidisciplinary care
- Access to routine dental care for mental health patients needs to be facilitated.
Links
Primary paper
N Cockburn, A Pradhan, M.W. Taing, S Kisely and PJ Ford (2017) Oral health impacts of medications used to treat mental illness, Journal of Affective Disorders, http://dx.doi.org/10.1016/j.jad.2017.07.037
Other references
Dental Elf – 13th Jun 2016
Mental Elf – 16th Mar 2015
Poor oral health and severe mental illness: what are the links?
Dental Elf – 8th Sept 2011
Tooth loss three times higher in people with serious mental illness
Twitter Q&As
Does chewing gum help ‘dry mouth’
Chewing gum can increase saliva production and there is some evidence to show that sugar free gums they may have a small beneficial effect in reducing caries
https://www.nationalelfservice.net/dentistry/periodontal-disease/weak-evidence-for-positive-effect-of-medicated-sugar-free-chewing-gum-on-plaque-indices/
Mickenautsch S, Leal SC, Yengopal V, Bezerra AC, Cruvinel V. Sugar-free chewing gum and dental caries: a systematic review. J Appl Oral Sci. 2007 Apr;15(2):83-8. https://www.ncbi.nlm.nih.gov/pubmed/19089107
They may also help with drooling (hypersalivation)
Eating disorders and dental health
A review in 2015 by Kisley at looked at eating disorders and dental health finding more tooth wear (dental erosion) linked to ffrequent vomiting and consumption of citrus fruits and soft drinks -more details in our blog
https://www.nationalelfservice.net/dentistry/tooth-surface-loss/eating-disorders-associated-with-poor-oral-health/
Higher fluoride toothpastes to prevent decay
Toothpaste with up to 1500ppm fluoride is available to purchase. Higher strengths fluoride pastes at 2800ppm and 5000ppm can be prescribed.
Public Health England’s – evidence based prevention toolkit recommends for
Those giving concern to their dentist (eg, those with obvious current active caries, those with ortho appliances, dry mouth, other predisposing factors, those with special needs)
For those 10+ years with active caries prescribe 2800 ppm fluoride toothpaste
For those 16+ years with active disease prescribe either 2800 ppm or 5000 ppm fluoride toothpaste
Full guidance available at
https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention
Thank you for flagging this up. I was diagnosed with gum disease following a three year bout of mental illness four years ago. When one is stressed, the immune system is down which is how gum disease took hold. I recommend taking a daily dose of vitamin C. It has stopped my gums bleeding and may save some fairly horrible treatment. This is all part of the whole issue of physical health care for this with mental illness. Some GPs may focus on the mental health, and sideline your physical health issues. Mental health professionals, family and friends need to support patients with the physical side of their health as much as possible.
Hi
An interesting suggestion about vitamin C
Bleeding gums are a sign of scurvy http://www.nhs.uk/Conditions/Scurvy/Pages/Introduction.aspx which is rare these days.
A recent review found a significant association between chronic gum disease and level of 3 stress markers in the blood
Systemic oxidative stress biomarkers in chronic periodontitis: a meta-analysis. Liu Z, Liu Y, Song Y, Zhang X, Wang S, Wang Z. Dis Markers. 2014;2014:931083. doi: 10.1155/2014/931083. Epub 2014 Nov 16.PMID: 25477703
This might suggest a role for Vitamin C in treating gum disease although other reviews have not demonstrated significant improvements to date.
The impact of antioxidant agents complimentary to periodontal therapy on oxidative stress and periodontal outcomes: A systematic review. Muniz FW, Nogueira SB, Mendes FL, Rösing CK, Moreira MM, de Andrade GM, Carvalho Rde S. Arch Oral Biol. 2015 Sep;60(9):1203-14. doi: 10.1016/j.archoralbio.2015.05.007. Epub 2015 May 28. Review.PMID:26067357
Association of some specific nutrient deficiencies with periodontal disease in elderly people: A systematic literature review.van der Putten GJ, Vanobbergen J, De Visschere L, Schols J, de Baat C.Nutrition. 2009 Jul-Aug;25(7-8):717-22. doi: 10.1016/j.nut.2009.01.012. Review.PMID:9539173
Effects of specific nutrients on periodontal disease onset, progression and treatment. Neiva RF, Steigenga J, Al-Shammari KF, Wang HL.J Clin Periodontol. 2003 Jul;30(7):579-89. Review.PMID:12834494
People with intellectual disabilities may have a mental health illness and may be prescribed multiple psychotropic medications. Many people with intellectual disability also have other conditions such as cerebral palsy, seizure or psychiatric disorders, attention deficit/hyperactivity disorder, or problems with vision, communication, and eating. Though language and communication problems are common in anyone with intellectual disability, motor skills are typically more affected when a person has coexisting conditions.
Multi disciplinary input is important and should include pharmacy, dietician , speech therapy and occupational therapy. It is important to ensure good quality oral care in this vulnerable population group.
A good information source is:
Practical Oral Care for People With Intellectual Disability
National Institutes of Health, National Institute of Dental and Craniofacial Research (NIDCR). NIH Publication No. 09-5194
Some information from this document :
PERIODONTAL DISEASE. Medications, malocclusion, multiple disabilities, and poor oral hygiene combine to increase the risk of periodontal disease in people with intellectual disability.
Encourage independence in daily oral hygiene. Ask patients to show you how they brush, and follow up with specific recommendations on brushing methods or toothbrush adaptations. Involve your patients in hands-on demonstrations of brushing and flossing.
Some patients cannot brush and floss independently due to impaired physical coordination or cognitive skills. Talk to their caregivers about daily oral hygiene. Do not assume that all caregivers know the basics; demonstrate proper brushing and flossing techniques. A power toothbrush or a floss holder can simplify oral care. Also, use your experiences with each patient to demonstrate sitting or standing positions for the caregiver. Emphasize that a consistent approach to oral hygiene is important–caregivers should try to use the same location, timing, and positioning.
Links for NIDCR Document noted above is
https://www.nidcr.nih.gov/oralhealth/Topics/DevelopmentalDisabilities/PracticalOralCarePeopleIntellectualDisability.htm