Patients who receive antidepressant medication for psychiatric and other medical reasons might be at increased risk for adverse dental effects, according to a study in January's Journal of the American Dental Association.
"Potential adverse effects and interactions with other medications have direct implications for dental treatment," concluded the researchers from Southern Illinois University's School of Dental Medicine.
Dental patients receiving antidepressant medication might be at increased risk for xerostomia or dry mouth, according to the researchers. If left untreated, xerostomia could lead to rampant tooth decay, periodontal disease (gum disease), bad breath, oral yeast infection and other oral health problems.
Other potential adverse effects of antidepressant medication include orthostatic hypertension (low blood pressure resulting from sudden position change) and interaction with vasoconstrictors (agents that narrow blood vessels). The study's authors also said other medications, administered concurrently, could increase those adverse effects.
In the retrospective study, the authors reviewed randomly selected records of patients undergoing dental therapy.
Of the 1,800 records, 381 (21 percent) patient records indicated treatment with 412 antidepressants. Based on reported medication, almost 58 percent of subjects in the antidepressant group were receiving treatment with two or more medications that had the potential for producing xerostomia. Fully, 257 (67 percent) of the 381 records documented usage of an antidepressant or other medication with orthostatic hypotension potential. Of the 381 subjects, females outnumbered male subjects by a 2.3:1 ratio.
"It is important for dentists to be knowledgeable about medications that increase the risk of xerostomia and the need for an intensive preventive dentistry program," the authors wrote.
A preventive care program for xerostomia should include patient education on home hygiene practices, increased water intake, fluoride applications, use of therapeutic agents that stimulate salivation and regularly scheduled dental visits.
Precautions related to orthostatic hypotension are important in providing proper patient care, the authors said. They should include decreased length of dental visits, positioning the patient somewhat upright in the dental chair, blood pressure monitoring and using caution in prescribing medications with additional orthostatic hypotension potential.
According to the researchers, precautions related to vasoconstrictors include conferring with a patient's physician and using a minimal quantity of vasoconstrictor with local anesthetic.
They also said blood pressure and other vital signs should be routinely monitored.
