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DEPRESSION AND DENTAL HEALTH

Major Depressive Disorder

Major depressive disorder is a psychiatric illness of at least two weeks’ duration in which mood, thoughts and behavioral patterns are impaired for long periods. The illness distresses the person and impairs his or her social functioning and quality of life. 

Major Depression

bulletFeeling: 
bulletsad, helpless, down or blue, hopeless, irritable, angry, agitated, anxious, or any combination of the preceding 
bulleta loss of interest or pleasure in previously enjoyed activities 
bulleta sense of worthlessness or guilt
bulletaccompanied by preoccupation over past minor failings 
bulletcomplaints  of bodily aches and pains without a physiological basis
bulletsocial withdrawal
bulletincreasing prevalence among the elderly, is the most common emotional disorder in people older than 65 years 

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The lifetime risk of developing MDD in the United States ranges from 10 to 25 percent for women and 5 to 12 percent for men and those with a family history of the disease.

Medications

It has been found that a  combination of medication and psychotherapy results in greatest improvement of depressions.  Antidepressant medications are effective for approximately 75 percent of patients, but they can take two to four weeks to work successfully. Because of the high rate of relapse, continued use of the medication is recommended for six months to one year beyond the initial recovery. Woman outnumber male subjects report use of antidepressant medications 2.3 to 1.+

For a classification of commonly used medications click here: Medications for depression.  

Medications Adverse Oral Reactions

Here is a list of adverse oral reactions that may occur due to medications:

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xerostomia-dry mouth

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altered taste sensations

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infections in the mouth

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infection in the tongue

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infection in the gums

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discoloration of the tongue

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severe gum disease-periodontitis

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clenching, grinding of the teeth- bruxism

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Affects of Depression on Oral Health

Depression

  1. Prone to suffer periodontitis due to:
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    neglect of oral hygiene

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    increased smoking

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    altered immune

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    clenching, grinding of the teeth (bruxism)

  2. Rampant dental decay due to:
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    disinterest in performing oral hygiene practice

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    preference for carbohydrates resulting from reduced serotonin levels

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    craving for intense sweets because of impaired taste perception

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    decrease in salivary output

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    a high lactobacillus count

  3. Chronic facial pain

  4. Burning sensation of the tongue

  5. Bad Breath

  6. Oral yeast infections

  7. TMJ-temporomandibular joint disorder is frequently the complaint that brings the depressed person to the dentist.

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Dental Treatment for People with Depression

Depression may be associated with extensive dental disease

      Many people may seek dental treatment before becoming aware of their psychiatric illness.

Appropriate dental management requires:

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Medical/Dental history

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Obtain current medication regimen including history of alcohol or other substance abuse

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Dental education on preventive dental education is paramount to receive instruction in proper toothbrushing and flossing methods that maximize removal of dental plaque

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Patient education on home hygiene practices.

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Increased water intake.

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Regularly scheduled dental visits.

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Precautions related to low blood pressure-hypotension 
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decreased length of dental visits.

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positioning somewhat upright in the dental chair.

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blood pressure monitoring. 

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using caution in prescribing medications with additional orthostatic hypotension (low blood pressure resulting from sudden position change) potential.**

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Use of saliva substitutes 

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Anticaries agents containing fluoride

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Dental treatments that may consist of subgingival scaling, root planing and curettage, caries control and restorative treatment

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Special precautions when prescribing or administering analgesics and local analgesics

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Awareness of potential adverse interactions of antidepressants with other medications 

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Full range of services that may enhance your self-esteem and contribute to overall health care management

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People taking antidepressants tend to receive more fillings than patients who did not take  medications that alter salivary flow^

Update on Depression and Dental Health

Medications prescribed as treatment for mood disorders can result in:

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dry mouth

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increased rate of dental caries

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periodontal disease.

      Depression May Negatively Affect Periodontal Treatment

A study has found that patients diagnosed with some form of depression are twice as likely to show poor outcome following periodontal treatment over 1 year compared to patients without depression.   Those reporting symptoms of depression had higher levels of attachment loss and alveolar bone loss than those who did not show signs of depression. 

The researchers gave 3 possible reasons for this difference:

- Depressed patients may view a course of periodontal treatment as an
overwhelming ordeal and might be more likely to not comply fully with
treatment recommendations;
- Patients with depression are more likely to continue to smoke,
which has been linked with a poor response to periodontal therapy;
- Depression may impair the immune system, slowing down the body's
reaction to fight off infection.

This is the first report of clinical depression and poor periodontal treatment outcome. As we are hearing a lot about the decrease of mental health lately, this new information is important patients to consider before periodontal treatment.

A July 1999 article in the Journal of Periodontology reported that high levels of financial stress and poor coping abilities increase twofold the likelihood of developing periodontal (gum) disease
April issue of the Journal of Periodontology , "Relationship of Clinical Depression to Periodontal Treatment Outcome" 

Journal of Evidence Based Dental Practice Vol. 3, No.1 2003

Updates

Oral health problems associated with anxiety disorders include canker sores, dry mouth, Lichen Planus (lacy white lines, red areas or mouth ulcers, burning mouth syndrome, and temporomandibular joint disorders,.

People with anxiety disorders may disregard their oral health altogether and are at an increased risk for dental caries, periodontal disease, and bruxism (grinding). Anxiety could be caused by being anxious of a needle and complicate procedures.

Tell your dentist about your anxiety disorder and what medications you are on.

Some medications decrease the mouth's ability to produce saliva, which can increase the risk of developing tooth decay and periodontal disease. Other medication side effects include dry mouth, vomiting (which could cause tooth decay and erosion), anemia and bleeding

Academy of General Dentistry, Impact 9/04

Academy of General Dentistry, Impact 12/03

 

Schizophrenia & Dental Health

Bipolar & Dental Health

Stress & Your Teeth

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^Taking Antidepressants? Collaborative Techniques pg 27, Summer 2003
Details Antidepressants' Impact on Dental Health, pg 36 Dentistry Today April 2003
**Antidepressant Medication May Have Adverse Effects on Dental Health, Journal of the American D

February 06, 2008

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