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SCHIZOPHRENIA & DENTAL HEALTH

Schizophrenia Dental Treatment Modifications
Advanced Dental Disease Dental Management Considerations
Communication is Important
Dental Implications of Schizophrenia

Schizophrenia is a psychiatric illness characterized by:

bullet thought disturbances
bullet bizarre behaviors 
bullet cognitive impairments 

that may diminish a person's abilities in the areas of social relations, school or work and self-care. The onset of the disorder typically occurs between the late teens and mid-30s. 

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Advanced dental disease is seen frequently in patients with schizophrenia for several reasons: 

bulletthe disease impairs ability to plan and perform oral hygiene procedures
bulletsome of the antipsychotic medications  have adverse effects such as xerostomia or dry mouth
bulletlimited access to treatment because of lack of financial resources and adequate number of dentists comfortable in providing care.

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A full range of services can be provided that can enhance self-esteem and can contribute to the management of this condition through effective communicate with:

bulletPatient-complications from medications may result in dry mouth causing gum disease and rapid caries progression which lead to an extremely high requirement for periodontal treatment, fillings, and extractions, TMD and impaired gag reflex
bullet Treating psychiatrist to  obtain:
bulletpsychological statue.
bulletmedication regimen. 
bulletability to give valid consent for treatment. 
bulletmedicolegal competence to sign a consent form for proposed care. 
bulletability to participate in treatment plan in order to perform preventive hygiene procedures.
bulletmedication interactions and CNS involvement to avoid excessive CNS depression, hypotension or respiratory depression.
bulletClozapine patients need to have the most recent WBC count evaluated  to determine bone marrow suppression which is a total WBC count of less than 3,000 per mm.
bullet Family members who serve as caregivers need to be educated on oral hygiene care.

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 In addition, dental treatment can be modified because of:

bullet impaired ability to think logically.
bullet local and systemic effects of psychiatric medications.
bullet adverse interactions between these drugs and medications used in dentistry. *

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Dental Management Considerations

1.  Preventive dental education need to be done:

bulletbefore a large mirror.
bulletoral instructions need to be shown and demonstrated .
bulletcolorful posters are that effectively describe proper tooth brushing, flossing and mouthrinses can be used.

2.  Fixed prosthodontic prostheses are to be used even in patients with compromised oral hygiene and are preferred to removable appliance that may be misplaced or even ingested.

3.  In dental treatment the airway should be diligently protected because of the patients propensity to have an impaired gag reflex.  Shorter appointments may be necessary.

4.  They need 3 month intervals for exams, cleanings and application of fluoride gel.

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 * Friedlander AH, Marder S R The Psychopathology, Medical Management and Dental Implications of Schizophrenia JADA Vol. 133, pg 603-609, May 2002

Bipolar and Dental Health

Depression and Dental Health

February 06, 2008

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