Risks for oral health with the use of antidepressants

The relationship between psychosocial distress and oral health status in patients with facial burns and mediation by oral health behaviour

BACKGROUND

There is limited discussion on the influence of psychosocial factors on the oral health of patients with a facial burn injury. This report investigated the relationship between oral health and psychosocial distress in patients with facial burns and the role of oral health behaviour in mediating the relationship.

METHODS

The data were part of a cross-sectional study that had systematically and randomly selected patients with > 10% total burn surface area from a burn centre in Pakistan. The oral health status (DMFT, CPI, OHI-S) and severity of facial disfigurement were assessed. Validated instruments in the Urdu language were self-administered and information relating to oral health behaviour (brushing and dental visits), oral health-related quality of life (OHIP-14), satisfaction with appearance, self-esteem, anxiety and depression, resilience, and social support were collected. The statistical analyses included simple linear regression, Pearson correlation, t-test, and ANOVA. Mediation analysis was carried out to examine the indirect effect by oral health behaviour.

RESULTS

From a total of 271 participants, the majority had moderate to severe facial disfigurement (89%), low self-esteem (74.5%), and moderate to high levels of social support (95%). The level of satisfaction with appearance was low, whereas anxiety and depression were high. Disfigurement and satisfaction with appearance were associated with lower self-esteem and social support (p < 0.05). Greater severity of disfigurement, higher levels of anxiety and dissatisfaction with appearance, and lower levels of self-esteem and social support were associated with greater DMFT and OHIP-14 scores, worse periodontal and oral hygiene conditions, and less frequent tooth brushing and dental visits (p < 0.05). The main barriers to oral healthcare utilization were psychological and social issues (p < 0.05). The indirect effect by oral health behaviour was not significant for anxiety but was significant for disfigurement, satisfaction with appearance, self-esteem, and social support.

CONCLUSION

There is an association between the psychosocial factors and oral health of patients with facial burns through a direct effect and mediation by oral health behaviour.

Access to Dental Care and Depressive Illness: Results from the Korea National Health Nutrition Examination Survey

Background and Objectives: Recent evidence suggests that oral health is associated with various systemic diseases including psychiatric illnesses. This study examined the association between depression and access to dental care in Korean adults. Materials and Methods: A cross-sectional evaluation was performed using data from the Sixth Korea National Health and Nutrition Examination Survey 2014. The general characteristics of the participants, the current depression status, and issues with access to dental care were collected to evaluate the factors for not being able to make dental visits according to care needs. Results: The study population comprised a total of 5976 participants who were 19 years of age and older and represented 40.7 million Koreans. A multivariable logistic regression analysis with weighted observations revealed that participants with current depressive illness were about two times more likely to express that they could not make dental visits in spite of their perceived care needs (adjusted odds ratio (OR) = 2.097; 95% confidence interval (CI) 1.046–4.203). The reasons for not making dental visits included financial problems, perceived importance of the dental problem, and fear of visiting dental professionals. Conclusions: Korean adults with current depressive illness were less likely to make dental visits when they had dental care needs. To improve dental health accessibility for patients with depressive illness, coordinated efforts can be considered involving multidisciplinary health care professionals.

Oral health condition and occurrence of depression in the elderly

Depression is a common disorder among the elderly; however, it is not a standard element of the ageing process. Depression can affect oral health as a result of neglecting oral hygiene procedures, cariogenic nutrition, avoidance of necessary dental care which leads to an increased risk of dental caries and periodontal disease.Assessment of the relationship of oral health parameters with depression.500 subjects aged ≥65 (mean 74.4 ± 7.4) were involved in the study. Dental condition (decay-missing-filled index [DMFT], number of missing teeth [MT], removable denture wearing, teeth mobility), periodontal condition (bleeding on probing [BoP], pocket depth [PD], loss of attachment), oral dryness (the Challacombe Scale) and depression according to the Patient Health Questionnaire-9 (PHQ-9) scale were assessed.Depression on a minimal level was detected in 60.2% of the subjects, mild-in 22.2%, moderate-in 6.0% and moderately-in 2.6%. The mean of the PHQ-9 scale was 3.56 ± 4.07. Regression analysis showed a positive relationship of the PHQ-9 value with DMFT, the number of MT, oral dryness and with age. No correlation was observed between other examined oral health indicators, such as periodontal condition (BoP, PD, clinical attachment level), periodontitis, removable denture wearing a PHQ-9.The results of our study have shown that among people aged 65 and over, the severity of depression increases with a higher number of MT, the number of decayed teeth, as well as prevalence of oral dryness.

Oral health in patients taking psychotropic medications: Results from a pharmacy-based pilot study

OBJECTIVES

Individuals with mental illness face an increased risk of oral disease compared with those without mental illness. The goals of this study were to examine the self-reported oral health and dental access of individuals filling psychotropic medication prescriptions and to determine whether pharmacy patients would choose to speak with a pharmacist about their oral health if given the option to do so.

DESIGN

Pharmacists across 6 community pharmacies within a local chain identified and surveyed adult patients filling prescriptions for psychotropic medications. Surveys included questions about oral health, dry mouth, and dental care utilization.

SETTING

Six community pharmacy locations.

PARTICIPANTS

Adults (≥18 years of age) filling prescriptions for psychotropic medications.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Self-reported oral health, dental utilization, desire to discuss oral health with a pharmacist.

RESULTS

Participants (N = 178) filling prescriptions were mostly (65.9%) female with a mean age of 48.2 years (SD 14.3, range 19-82 years). One in 4 (24.9%) said their mouths "always" or "frequently" felt dry; these individuals were significantly more likely to have last seen a dentist for emergency (rather than routine) treatment (P <0.01) and rated their oral health as significantly worse (P <0.001) than participants whose mouths "never" or "occasionally" feel dry. A small percentage (5.7%) requested to speak with pharmacists about oral health; they reported poorer oral health than those who opted not to speak with a pharmacist (P <0.05).

CONCLUSION

One in 4 patients reported having dry mouth, and those with dry mouth reported significantly worse oral health than patients without dry mouth. Although dry mouth and poor oral health were common in this sample of individuals taking psychotropic medications, this did not consistently translate into seeking information regarding oral health. Future research will focus on pharmacist-initiated oral health interventions with high-risk patients.

Trajectories of depressive symptoms and oral health outcomes in a community sample of older adults

OBJECTIVE

Adverse outcomes associated with chronic depressive symptoms are of clinical importance. The objective was to identify subgroups of older adults based on their trajectories of depressive symptoms over a 10-year period and determine if these subgroups predicted oral health outcomes.

METHODS

The sample was 944 adults aged 65+ who participated in the oral health module of the the Health and Retirement Survey in 2008. Depressive symptoms were measured with a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. Latent class trajectory analysis was used to identify distinct subgroups of elders based on their CES-D scores from 1998-2008. Group membership was used to predict self-rated oral health, overall mouth condition (problems with bleeding gums, gum sensitivity, and food avoidance), and edentulism in 2008.

RESULTS

Three distinct subgroups were identified using zero-inflated Poisson regression models: (i) minimal depressive symptoms over the study period (43%), (ii) low but generally stable level of depressive symptoms (41%), and (iii) moderate symptoms and higher CES-D scores than the other groups over the 10 years (16%). Controlling for demographic and health variables and edentulism status, having a trajectory of moderate symptoms was associated with poorer mouth condition (p < 0.0001) and poorer self-rated oral health (p = 0.0003) compared with those with minimal symptoms. Having low levels of depressive symptoms was not significantly associated with these two outcomes. Group membership was not significantly associated with the probability of edentulism.

CONCLUSIONS

Chronic moderate depressive symptoms are associated with poorer oral health in older adults.

Sedative load, carious teeth and infection in the periodontium among community-dwelling older people

OBJECTIVE

To study the relation of sedative load to carious teeth and periodontal pocketing - indication of infectious periodontal disease - among older people.

MATERIALS AND METHODS

This cross-sectional study was based on a subpopulation of 158 community-dwelling, dentate, non-smoking, 75-year-old or older people from the Oral Health Geriatric Multidisciplinary Strategy study. The data were collected by interviews and clinical oral examinations during 2004-2005. Sedative load was measured by means of the sedative load model, and Poisson multivariate regression models were used to estimate relative risk (RR) with 95% confidence intervals (CI).

RESULTS

Participants with a sedative load of either 1-2 (n = 31) or ≥3 (n = 12) had an increased likelihood of having carious teeth (RR: 1.8, CI: 1.2-2.6 and RR: 2.4, CI: 1.4-4.1, respectively) compared to participants without a sedative load. There was an inverse association between sedative load and the number of teeth with periodontal pockets.

CONCLUSIONS

Presence of dental caries was associated with the use of drugs with sedative properties. The use of drugs with sedative properties was not associated with the presence of periodontal pockets.

cGVHD-Related Caries and Its Shared Features with Other 'Dry-Mouth'-Related Caries

<p>Several systemic diseases and their medical treatment may predispose the development of aggressive dental caries. Head and neck radiotherapy, chemotherapy, Sjögren's syndrome and long-standing treatment with drugs that induce hyposalivation are some of these conditions. The aim of this article is to describe the clinical features of five patients who developed chronic graft-versus-host-disease (cGVHD) as a complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) and, in spite of close dental follow-up, subsequently developed rampant caries. In these cases, the restorations showed early failure and the caries still progressed until generalized teeth destruction. The majority of the teeth therefore had to be extracted due to advanced dental caries and rapid clinical progression. Herein the term "cGVHD-related caries" is proposed to describe this under-recognized complication of cancer treatment that may evolve in allo-HSCT recipients that develop cGVHD. This condition is poorly recognized in the literature and may represent the final result of the clustering of oral complications in cGVHD patients, including mucositis, oral pain, hyposalivation, taste loss and oral infections, leading to rampant caries due to impaired oral hygiene and increased intake of highly cariogenic food. Consequently, the knowledge of this oral complication should improve the medical and dental management of cGVHD oral manifestations and improve the quality of life of patients with this post allo-HSCT complication.</p>

Use of psychotropic drugs and associated dental diseases

Patients with problems related to central nervous system dysfunctions are often treated with psychotropic drugs. These include antipsychotics, antidepressants, mood stabilizers, anticonvulsants, and drugs blocking specific receptors in the brain such as anticholinergics or beta-blockers. However, these medications have serious side effects affecting the oral health. In addition, many dental patients make use of psychoactive drugs, such as amphetamine, ecstasy, and cocaine. This article aims to review data on the psychotropic drugs being used in the last 30 years, their pharmacological profile, with special attention to the side effects related to the oral health. Oral diseases such as bruxism, orofacial dystonia, oromandibular dyskinesia, and rabbit syndrome are related to extrapyramidal effects of antipsychotic drugs because of their antagonist activity on the dopaminergic receptors. Drugs with anticholinergic and/or antiadrenergic effects such as tricyclic antidepressants may cause dry mouth and related complications such as candidiasis and other oral infections. Among mood stabilizers, lithium treatment induces a wide range of side effects on oral system including dry mouth, sialorrhea, infections, and ulceration of the oral cavity. Psychostimulants may instead provoke xerotomia, gingival enlargements, bruxism, dental erosion, mucosal ulceration, and oral/nasal lesions. This literature review supports the idea that the higher prevalence of oral diseases among patients with mental disorders may be attributed to the side effects of their medications mediated by complex interactions between different targeted receptors. Thus, dentists must be aware of the possible risks of these medications in order to take appropriate precautions in treating these patients.

Unmet dental need in community-dwelling adults with mental illness: results from the 2007 Medical Expenditure Panel Survey

BACKGROUND

Mental illness (MI) affects approximately one in five U.S. adults, and it is associated with oral disease and poor dental treatment outcomes. Little is known about dental care utilization or unmet dental need in this population.

METHODS

The authors examined data regarding presence or absence of dental visits and unmet dental need in community-dwelling adults with MI from the 2007 Medical Expenditure Panel Survey. They tested differences between adults with and without MI by using multivariate logistic regression.

RESULTS

Eighteen percent of adults (N = 19,368) had MI, and of these, 6.8 percent had unmet dental need. Although people with MI were not significantly more likely to have had a dental visit (46.3 percent) than were those without MI (42.2 percent; odds ratio [OR], 1.09; 95 percent confidence interval [CI], 0.97-1.23), they were significantly more likely to report unmet need (11.0 versus 5.3 percent; OR, 2.00; 95 percent CI, 1.67-2.41). Those with mood or anxiety disorders were most likely to report having an unmet dental need (P < .001 for all values).

CONCLUSIONS

Although people with MI did not visit the dentist significantly more often than did adults without MI, their higher level of unmet need suggests that current use of dental services is not addressing their needs adequately.

PRACTICAL IMPLICATIONS

Dentists should be familiar with MI conditions as patients with MI may have greater unmet dental need.

Oral microbial colonization in patients with systemic lupus erythematous: correlation with treatment and disease activity

Treating patients with systemic lupus erythematosus (SLE) with steroids and immunosuppressive drugs may interfere in the presence of potentially opportunistic microorganisms in the oral cavity. The aim of this study was to evaluate the presence of Candida spp., Staphylococcus spp., Enterobacteria and Pseudomonas spp. in the oral cavity of SLE patients, compared with healthy controls. A group of 40 patients who had received therapy for at least 60 days was selected (19-53 years). For the control group, 40 healthy individuals matched for age, gender and use of partial prosthesis were selected. Oral rinse samples were collected and plated on specific culture media. After incubation, the number of colony forming units (CFU) was obtained and the isolates were identified at species level. Microbial counts were compared between SLE and control by analysis of variance (ANOVA) and Mann-Whitney (p < 0.05 significant). Microorganism counts in patients with and without immunosuppressive drugs, as well with active and inactive disease (according to SLEDAI score) were also compared. No significant differences in CFU/mL between SLE and control patients were observed (yeasts, p = 0.55; Staphylococci, p = 0.24; Enterobacteria/Pseudomonas spp., p = 0.26). No differences in microbial counts were observed regarding clinical parameters tested. The most frequent species isolated in the SLE group were Candida albicans, Staphylococcus epidermidis and Klebsiella oxytoca. In conclusion, no differences in frequency and microorganism levels were found between SLE patients and healthy individuals.

Decayed and missing teeth and oral-health-related factors: predicting depression in homeless people

OBJECTIVE

The objective of the study was to determine the effect of dental health status, dental anxiety and oral-health-related quality of life (OHRQoL) upon homeless people's experience of depression.

METHODS

A cross-sectional survey was conducted on a sample of homeless people in seven National Health Service Boards in Scotland. All participants completed a questionnaire to assess their depression, dental anxiety and OHRQoL using reliable and valid measures. Participants had an oral examination to assess their experience of tooth decay (decayed and missing teeth). Latent variable path analysis was conducted to determine the effects of dental health status on depression via dental anxiety and OHRQoL using intensive resampling methods.

RESULTS

A total of 853 homeless people participated, of which 70% yielded complete data sets. Three latent variables, decayed and missing teeth, dental anxiety (Modified Dental Anxiety Scale: five items) and depression (Center for Epidemiological Studies Depression Scale: two factors), and a single variable for OHRQoL (Oral Health Impact Profile total scale) were used in a hybrid structural equation model. The variable decayed and missing teeth was associated with depression through indirect pathways (total standardised indirect effects=0.44, P<.001), via OHRQoL and dental anxiety (χ²=75.90, df=40, comparative fit index=0.985, Tucker-Lewis index=0.977, root mean square error of approximation=0.051 [90% confidence interval: 0.037-0.065]).

CONCLUSION

Depression in Scottish homeless people is related to dental health status and oral-health-related factors. Decayed and missing teeth may influence depression primarily through the psychological constructs of OHRQoL and, to a lesser extent, dental anxiety.

Oral health of psychiatric inpatients: a survey of central Taiwan hospitals

OBJECTIVE

The objective was to investigate the status of oral health and its determinants in a group of psychiatric inpatients in central Taiwan.

METHOD

A cross-sectional study of the oral health of psychiatric inpatients (n=200) in three hospitals in central Taiwan was carried out during a half-year period. Demographic data and data on oral health habits, dental visit frequency, treatment fear and dental health knowledge were collected. Oral health was determined by the Decayed/Missing/Filled Teeth (DMFT) index, Community Periodontal Index (CPI), Plaque Index and Gingival Index.

RESULTS

In terms of prevalence of caries, the mean DMFT score for all patients was 14.9 ± 8.8 (S.D.), which was significantly worse than that in the general population. The CPI showed that only 10% of patients were periodontally healthy, 9.5% had bleeding, 31% had calculus and 49.5% had periodontal pockets. Increasing age, treatment anxiety, neglect of tooth-brushing and chronic ward inpatients were predictive factors for poor periodontal health. The self-awareness of poor oral health was inadequate and the treatment needs were huge in psychiatric inpatients.

CONCLUSION

The oral health of psychiatric inpatients was poor compared with the general population and was generally ignored by the patients themselves. The phenomenon is universal, occurring in both Western and Eastern countries.

Oral health status of psychiatric in-patients in Serbia and implications for their dental care

AIM

To determine oral health status and identify predictors of oral health in a representative sample of psychiatric in-patients in Serbia.

METHODS

The study included 186 psychiatric in-patients and 186 control participants without psychiatric illness matched to the study group by age, sex, marital status, education level, employment, and monthly income. Dental examinations were done in both groups to measure the following indices of oral health: decayed, missing, and filled teeth (DMFT) index; community periodontal index; and plaque index. Participants were also interviewed about their dental health behavior and their medical records were examined.

RESULTS

Psychiatric in-patients had higher caries prevalence, poorer periodontal health, and poorer oral hygiene than controls. The average DMFT score in the patient group was 24.4 and 16.1 in the control group (P<0.001). Periodontal diseases were significantly more prevalent among psychiatric in-patients than among controls (P<0.001). The average plaque index for patients was 2.78 and 1.40 for controls (P<0.001). Multiple regression analysis demonstrated that 1) DMFT index was associated with age, male sex, duration of mental illness, use of antidepressants, time since the last visit to the dentist, and snacking frequency; 2) community periodontal index was associated with male sex; and 3) plaque index was associated with age, male sex, education level, employment, monthly income, tooth brushing technique, and snacking frequency.

CONCLUSION

Psychiatric in-patients in Serbia have poorer oral health than healthy controls. It is necessary to intensify preventive dental care in this vulnerable population.

Monitoring oral health and dental attendance in an outpatient psychiatric population

Impaired mental health has been associated with an increased need for dental care. Population surveys have indicated that people with enduring mental health problems make less frequent planned visits to the dentist and report a greater number of missing teeth than the general population. The study aims to examine oral health status, attendance to dental care, and medication in an outpatient psychiatric sample. A descriptive study combining a structured interview with a visual oral examination carried out in 113 outpatients under psychiatric care. Dental health was described in terms of sound, missing and/or filled teeth, and showed a relation between these categories and types of psychiatric diagnosis, age and numbers of antidepressant and neuroleptic drugs. Oral hygiene was found to be more neglected among men and in patients with the diagnosis of schizophrenia. The need of dental treatment was widespread, although regular dental visits were commonly reported. In order to maintain good oral health, regular dental check-ups should be encouraged for patients under psychiatric care. Further studies are required to reveal contributory causes for/to decreased oral health. The difficulty such individuals have in maintaining additional self-efficacy raises questions about the necessity for oral health interventions in outpatient psychiatric services.

Efficacy of a new oral lubricant solution in the management of psychotropic drug-induced xerostomia: a randomized controlled trial

OBJECTIVE

Xerostomia is a subjective sensation of mouth dryness often occurring as an unwanted effect of psychotropic drugs.

METHODS

The clinical efficacy and acceptability of a new oxygenated glycerol triester (OGT) oral spray (1 or 2 sprays up to 4 times daily) in the treatment of xerostomia was compared with those of a commercially available artificial saliva substitute (ASS [Saliveze]) in a 2-week, open-labeled, randomized, parallel-group study. Clinical assessment of xerostomia included evaluation of mouth dryness by means of a 10-cm-long visual analog scale, objective blinded assessment of the oral tissue condition by a dental hygienist by means of a 4-point ordinal scale, and subjective patient-based assessment of dry mouth symptoms by means of dichotomous responses to a questionnaire. [Day 14 - baseline] patient-based mouth dryness score was the primary end point.

RESULTS

Seventy-four patients (41 women and 33 men, 44 +/- 15 years) undergoing long-term psychotropic drug treatment were consecutively enrolled. At day 14, OGT resulted in better efficacy than ASS in mouth dryness score (mean difference, 1.2 +/- 0.4; P = 0.006), speech difficulties (mean difference, 1.2 +/- 0.4; P = 0.005), taste (mean difference, 1.1 +/- 0.4; P = 0.02), and overall mouth condition (mean difference, 1.4 +/- 0.9; P = 0.005). Taste of OGT was better than that of ASS (mean difference, 1.4 +/- 0.6; P = 0.04), as was OGT acceptability (mean difference, 1.4 +/- 0.9; P = 0.005).

CONCLUSION

Oxygenated glycerol triester lubricant oral spray was superior to a commercially available ASS in improving xerostomia and overall condition of the oral tissue.

Comparison of Electrokinetics-Based Multidimensional Separations Coupled with Electrospray Ionization-Tandem Mass Spectrometry for Characterization of Human Salivary Proteins

The foundation for saliva-based diagnostics is the development of a complete catalog of secreted proteins detectable in saliva. Besides protein complexity, the greatest bioanalytical challenge facing comprehensive analysis of saliva samples is related to the large variation of protein relative abundances including the presence of high-abundance proteins such as amylases, mucins, proline-rich proteins (PRPs), and secretory IgA complex. Among a number of electrokinetic separation techniques, transient capillary isotachophoresis/capillary zone electrophoresis (CITP/CZE) specifically targets trace amounts of proteins and thus reduces the range of relative protein abundances for providing unparallel advantages toward the identification of low-abundance proteins. By employing a CITP/CZE-based multidimensional separation platform coupled with electrospray ionization-tandem mass spectrometry (ESI-tandem MS), a total of 6112 fully tryptic peptides are sequenced at a 1% false discovery rate (FDR), leading to the identification of 1479 distinct human SwissProt protein entries. By comparing with capillary isoelectric focusing (CIEF) as another electrokinetics-based stacking approach, CITP/CZE not only offers a broad field of application but also is less prone to protein/peptide precipitation during the analysis. The ultrahigh resolving power of CITP/CZE is evidenced by the large number of distinct peptide identifications measured from each CITP fraction together with the low peptide fraction overlapping among identified peptides. Furthermore, when evaluating the protein sequence coverage by the number of distinct peptides mapping to each protein identification, the CITP-based proteome technology similarly achieves the superior performance with 674 proteins (46%) having three or more distinct peptides, 288 (19%) having two distinct peptides, and 517 (35%) having a single distinct peptide.

Dental plaque, gingival inflammation, and elevated levels of interleukin-6 and cortisol in gingival crevicular fluid from women with stress-related depression and exhaustion

BACKGROUND

The aim of the present study was to investigate the importance of stress for the development of periodontitis by comparing oral health status, proinflammatory markers, and cortisol in gingival crevicular fluid (GCF) and saliva in patients with stress-related mental depression and controls.

METHODS

The participants consisted of 43 women with stress-related depression and exhaustion (Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV], with a mean age of 42.0 (+/- 9.3 SD) years, and 29 controls, with a mean age of 54.5 (+/- 2.9 SD) years. Clinical examination included the assessment of dental plaque, gingival inflammation (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and number of teeth. GCF was collected with an intracrevicular washing technique from four sites in each subject. Interleukin (IL)-1beta, IL-6, and matrix metalloproteinase-9 were determined with enzyme-linked immunosorbent assay and cortisol with radioimmunoassay (125I RIA). Analysis of covariance (one-way covariance analyses) was used to remove the influence of age and smoking.

RESULTS

The amount of plaque was significantly higher in patients compared to controls (P<0.003). The patients had an average GI of 1.53 (+/-0.13 SD) compared to 0.89 (+/- 0.10 SD) for the controls (P< 0.001). The levels of cortisol in GCF was significantly higher in patients than in controls, 3.46 nmol/l (+/- 3.25 SD) and 0.30 nmol/l (+/- 0.25 SD), respectively (P<0.001), whereas cortisol in saliva did not differ between groups. The levels of IL-6 in GCF were significantly higher in the patients than in controls (P<0.05).

CONCLUSION

Women with stress-related depression and exhaustion had more plaque accumulation, GI and increased levels of IL-6 and cortisol in GCF compared to normal controls, suggesting that depression might affect immune function, which could lead to impaired periodontal health.

Symptoms of depression and anxiety in relation to dental health behavior and self-perceived dental treatment need

The purpose of this study was to investigate the dental health behavior and self-perceived dental treatment need, in relation to depressive symptoms and symptoms of anxiety, among a general population drawn from a sample of 31-yr-old-men and women born in Northern Finland in 1966 (n = 8463). The dental health behavior included toothbrushing frequency and the frequency of dental check-ups. Depressive symptoms, as well as symptoms of anxiety, were determined on the basis of the Symptom Checklist-25 (SCL-25). The participants were also asked about their education and family income. Subjects with a high number of depressive symptoms had lower toothbrushing frequency as well as a lower frequency of dental visits than subjects with no or only a few depressive symptoms. Morover, the self-perceived dental treatment need was more common among those with a high number of depressive symptoms. Symptoms of anxiety were significantly associated with lower toothbrushing frequency. The results support the view that there is an increased risk for impaired dental health among subjects with depressive symptoms or symptoms of anxiety.

Antidepressant xerogenic medications and restoration rates

OBJECTIVES

This report examines the association between xerogenic antidepressant medication use and dental restorations (a proxy for dental caries).

METHODS

Data for this study was collected from the electronic databases of two large dental group practices associated with two managed care organizations. The population examined was at least 55-year-old on the reference date and had at least 48 months of concurrent dental, medical and pharmacy coverage. We identified 915 individuals whose only exposure to a xerogenic medication was to an antidepressant. This group was compared with a group not on any medications and to a group on medications without any known xerostomic side effect.

RESULTS

Poisson regression was used to compare restoration occurrence and restoration rates among the three groups. The antidepressant medication and the no xerogenic medication groups were more likely to have restorations than the no medication group but there was no difference in restoration rates between the two medication groups. The mean restoration rates were significantly different between the three groups with the antidepressant group having the highest restoration rate. The no xerogenic group also had a higher rate than the no medication group but not as high as the antidepressant group rate.

CONCLUSIONS

This study provides objective quantification of the long-term effects that anti-depressant medications have on restoration use.

Opposite effects of antidepressants on unstimulated and stimulated salivary flow

In this study, effects on both stimulated and non-stimulated salivary flow as well as salivary components of different antidepressant drugs were compared. Rats received imipramine (IMI; 10mg/ml), fluoxetine (FLU; 20 mg/ml) or moclobemide (MOC; 30 mg/ml) by gavage. The drugs were administered 24, 5 and 1 h before saliva collection (sub-acute treatment) or as a once a day treatment for 14 days (chronic treatment). Animals were sedated with thiopental and saliva was collected using pre-weighed cotton balls inserted in the mouth for 1 min before and after pilocarpine stimulus. Pilocarpine-stimulated saliva was also collected for biochemical assays of total proteins, amylase, phosphate and calcium, performed through automated colorimetric methods. Non-stimulated salivary flow was decreased by sub-acute IMI 10 mg/kg treatment. Pilocarpine-stimulated salivary flow was significantly increased by acute treatments with IMI, FLU and MOC in comparison to the control group. The same opposite pattern of effects on non-stimulated and pilocarpine-stimulated salivation was seen after chronic treatment with the antidepressants. Increased levels of calcium following sub-acute treatment with IMI and after prolonged treatment with FLU and MOC were detected. In the assayed samples, phosphate was found to be increased following chronic treatment with FLU or MOC. These results may explain the discrepant effects of the antidepressants on salivation described in pre-clinical and clinical studies.

Oral health of psychiatric in-patients in Hong Kong

BACKGROUND

Poor oral health has been reported among various psychiatric populations. Little is known regarding the oral health among psychiatric patients in Asia.

AIMS

To examine the oral health status of a group of Chinese psychiatric in-patients in a long-term rehabilitation facility.

METHODS

A dental survey using the WHO standardised dental evaluation form was conducted in adult psychiatric patients in a rehabilitation programme. A qualified dentist examined all consenting patients.

RESULTS

Ninety-one patients (64.8% male; mean age: 44.7 +/- 9.9 years; mean length of illness: 20.3 +/- 11.5 years) were included in the study, the majority (80.2%) diagnosed with schizophrenia. Malocclusion was found in 79.1% of patients. The mean number of missing teeth was 9.5 +/- 8.9. Bleeding on probing, calculus, shallow and deep pockets were found in 7.1%, 71.8%, 72.9% and 28.2% of patients, respectively. Dental caries were found in 75.3% of dentate patients. The mean number of caries per patient was 5.5 +/- 6.1. Fifty-four per cent of patients needed dental extraction and 78.8% required conservative dental treatment. Older age and length of illness were significantly associated with poor dental health.

CONCLUSIONS

Oral health status of chronic psychiatric patients seems to be considerably worse than that of the general population. Mental health professionals should pay more attention to preventive oral health habits of psychiatric patients.

Antidepressant use in psychiatry and medicine: importance for dental practice

BACKGROUND

Many dental patients receive antidepressant therapy. However, antidepressants taken with other drugs may increase the risk of complications that require special dental precautions and care.

METHODS

The authors conducted a retrospective study of 1,800 randomly selected patient records and evaluated the prevalence of using antidepressants and other medications concurrently. They analyzed antidepressant intake relative to drug classification and mechanism of action, age, sex and associated potential for clinical complications such as xerostomia, orthostatic hypotension and interaction with vasoconstrictors. The potential for additive adverse effects between antidepressants and other medications also was analyzed.

RESULTS

Three hundred eighty-one (21 percent) of the 1,800 patient records indicated that patients were being treated with 412 antidepressants. Female subjects out-numbered male subjects by an approximate 2.3:1 ratio. Selective serotonin reuptake inhibitors were most commonly prescribed, followed by tricyclic antidepressants, atypical and third-generation antidepressants, and monoamine oxidase inhibitors. Based on reported medication intake, almost 58 percent of subjects in the antidepressant group were receiving treatment with two or more medications that had the potential for producing xerostomia. Two hundred fifty-seven (67 percent) of the 381 records documented intake of an antidepressant or other medication with orthostatic hypotension potential.

CONCLUSIONS

Three hundred eighty-one patients reported that they were receiving antidepressant therapy for psychiatric and other medical reasons. Potential adverse effects and interactions with other medications have direct implications for dental treatment.

CLINICAL IMPLICATIONS

Patients receiving antidepressant therapy are at risk of developing xerostomia and orthostatic hypotension, as well as experiencing the adverse effects of interaction with vasoconstrictors. Dentists must take appropriate precautions in treating these patients.

Late-life depression: psychopathology, medical interventions, and dental implications

BACKGROUND

Late-life depression (LLD) initially occurs after age 65 years and is a major public health concern because the elderly who are at high risk constitute an ever-expanding segment of the population. LLD is a mental illness in which mood, thought content, and behavioral patterns are impaired, causing the individual distress, compromising social function, and impairing self-maintenance skills (eg, bathing, dressing, hygiene). LLD characterized by marked sadness or a loss of interest or pleasure in daily activities and may be accompanied by weight change, sleep disturbance, fatigue, difficulty in concentration, and a high suicide rate. Diagnosis of LLD is sometimes complicated by a denial of mood change and an inability to distinguish symptoms of a concurrent physical illness from those of a depressive etiology. The disorder is most frequently treated with antidepressant medications, and although older individuals have a recovery rate that is comparable with younger adults, they often take longer to recover, have more frequent relapses, and are more sensitive to the side effects of the drugs.

CLINICAL IMPLICATIONS

Individuals undergoing treatment for LLD and those whose illness has not been diagnosed or treated often are seen with significant oral disease by the dentist. Dentists need to be cognizant of how to safely and compassionately provide care to those already receiving mental health services. They must also be familiar with the psychiatric symptoms of the disorder to effectuate a timely referral to a physician of those with occult or relapsing disease. LLD is frequently associated with a disinterest in oral hygiene, a cariogenic diet, diminished salivary flow, rampant dental decay, advanced periodontal disease, and oral dysesthesias. Many medications used to treat the disease magnify the xerostomia and increase the incidence of dental disease. Appropriate dental management necessitates a vigorous preventive dental education program, the use of artificial salivary products, antiseptic mouthwash, daily fluoride mouth rinse, and special precautions in administration of local anesthetics with vasoconstrictors and prescription of analgesics.

CONCLUSION

Dentists who invoke appropriate precautions can usually provide a full range of services to individuals with LLD, thereby enhancing patient self-esteem and contributing to the psychotherapeutic aspect of management.

Sickle cell anemia and dental caries: a literature review and pilot study

The purpose of this cohort study was to determine whether individuals with sickle cell anemia (SCA) were more susceptible to dental caries than non-sickle-cell control subjects. A review of the literature suggests several reasons why individuals with SCA may be at increased risk. Thirty-five cases of SCA aged 6 years and older were identified from a screening of 15,900 current patient files at the Howard University College of Dentistry Dental Clinic. A total of 140 non-SCA control subjects (four per case), frequency-matched on enrollment period (+/- 5 yrs) and age (+/- 2 yrs if under age 21, or +/- 5 yrs if 21 or over), was selected by a nonbiased method from the same dental clinic files. SCA cases and controls were identical on mean age (30.4 +/- 19 yrs, ranging from 5 to 92 yrs) and were similar in sex distribution (males: 34% of SCA cases, 40% of controls). The mean number of permanent teeth present was very similar for SCA cases and controls (23.4 +/- 6.4 vs. 24.2 +/- 6.4). The mean DMFT was 21% higher in the SCA cases (12.0 +/- 8.4 vs. 9.9 +/- 6.9), and the mean DMFS was 26% higher in the SCA cases (33.0 +/- 32.3 vs. 26.2 +/- 27.7). While there was virtually no difference in DMFS between SCA cases and controls for 6- to 19-year-olds, for subjects aged 20 and older, the DMFS was 30.4% higher in the SCD cases. For all ages, the M component for SCA cases was 40.7% higher, and the D component was 20.0% higher, while the F component was only 3.5% higher than for controls. Untreated decay (the D/D+F surfaces ratio) was 24.4% higher in the SCA cases. The findings from this pilot study suggest that SCA cases have a higher susceptibility to dental caries and/or that SCA patients may have different treatment pathways once caries is detected. While none of the observed differences was statistically significant, these findings were of clinical interest and should be pursued in future large-scale studies.

Salivary carbonic anhydrase isoenzyme VI

The carbonic anhydrases (CAs) participate in the maintenance of pH homeostasis in various tissues and biological fluids of the human body by catalysing the reversible reaction CO2 + H2O HCO3- + H+ (Davenport & Fisher, 1938; Davenport, 1939; Maren, 1967). Carbonic anhydrase isoenzyme VI (CA VI) is the only secretory isoenzyme of the mammalian CA gene family. It is exclusively expressed in the serous acinar cells of the parotid and submandibular glands, from where it is secreted into the saliva. In this review, we will discuss recent advances in research focused on the physiological role of salivary CA VI in the oral cavity and upper alimentary canal.