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Three drugs (Buspirone, Trimipramine and Sertindole) have been withdrawn from sale so were excluded.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 – 13^th Jun 2016

Psychological disorders associated with poor oral health

Mental Elf – 16^th Mar 2015

Poor oral health and severe mental illness: what are the links?

Dental Elf – 8^th Sept 2011

Tooth loss three times higher in people with serious mental illness