Antidepressant use in psychiatry and medicine: importance for dental practice

The association between depression and oral health related quality of life in people who inject drugs

BACKGROUND AND AIMS

Oral health related quality of life (OHRQoL) is known to be reduced in disadvantaged populations, including people who inject drugs. Mental health issues, such as depression are also commonly reported. In this study we examined the association between depression and OHRQoL.

METHODS

Cross-sectional analysis survey data was collected from the Melbourne Injecting Drug User Cohort Study (SuperMIX) of people who inject drugs (N = 982). Three measures derived from the Oral Health Impact Profile (OHIP-14) were used to assess OHRQoL: Prevalence (reporting one or more dental issue "Very often" or "Fairly often" in the previous year), Extent (number of items reported either "Very often" or "Fairly often") and Severity (summary score of all ordinal responses). Regression analyses assessed the association between depression, indexed as scoring above 10 on the Patient Health Questionnaire (PHQ-9), and OHIP-14 measures, adjusted for sociodemographic, drug use and dental service utilisation variables.

RESULTS

Overall, participants had low levels of OHRQoL, indexed through OHIP-14 scores (46% exhibiting prevalence, mean extent of 2.35 and mean severity of 12.72). Depression was associated with increases in all OHIP-14 measures, after adjustment for potential confounders.

CONCLUSIONS

We found a significant association between depression and poor OHRQoL in this sample of people who inject drugs. Further research using a longitudinal frame is needed to determine the direction of this relationship. Interventions to improve oral health of people who inject drugs are urgently needed, and these may benefit mental health outcomes for people who inject drugs.

Effects of different antidepressant classes on dental implant failure: A retrospective clinical study

BACKGROUND

Previous studies have suggested an association between taking antidepressants and dental implant failure. This study aimed to investigate the association of different antidepressant classes with dental implant failure.

METHODS

This retrospective study included patients that received dental implants at the University of Florida from 2011 to 2016. The variables of implant failure, antidepressant use and classes (selective serotonin reuptake inhibitors [SSRI], serotonin-norepinephrine reuptake inhibitors [SNRI], tricyclic antidepressants [TCA], atypical antidepressants [AA], and monoamine oxidase inhibitors [MAOI]), age, sex, smoking, mild systemic diseases, and implant location were obtained from patients' records. Odds ratio (OR) and confidence interval (CI) of implant failure in patients taking different antidepressant classes, in relationship to non-antidepressant users, were estimated, and the influence of multiple variables on implant failure were investigated.

RESULTS

A total of 771 patients and 1,820 implants were evaluated. The statistically significant predictors for implant failure included smoking (OR = 5.221), use of antidepressants (OR = 4.285), posterior maxilla location (OR = 2.911), mild systemic disease (OR = 2.648), and age (OR = 1.037) (P <0.05). The frequency of implant failure was 33.3% in TCA users, 31.3% in SNRI users, 6.3% in SSRI users, 5.2% in Atypical antidepressant users, and 3.9% in non-users. Significant associations were observed between the use of SNRI (OR: 11.07; 95% CI: 3.265 to 33.82) and TCA (OR: 12.16; 95% CI: 1.503 to 71.58) and implant failure (P <0.05).

CONCLUSIONS

Users of antidepressants were at higher risk of implant failure than non-users. Patients taking SNRI and TCA were at the highest risk of implant loss, when compared with non-users. Conclusions about TCA, however, are based on a limited number of cases.

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.

Palliative dental care- a boon for debilitating

World Health Organization defines "palliative care" as the active total care of patients whose disease is not responding to curative treatment. Palliative care actually deals with patients at the terminal end stage of the disease. We always face a question why a dentist should be in a palliative team? What is the exact role of dentist? Dental treatment may not always be strenuous and curative, but also can focus on improving quality of life of the patient. Hence forth the present paper enlightens the importance of dentist role in palliative team.

The association between poor dental health and depression: findings from a large-scale, population-based study (the NHANES study)

OBJECTIVE

To examine the relationship of poor dental health and depression, controlling for markers of inflammation (C-reactive protein; CRP) and adiposity (body mass index; BMI).

METHOD

Data from two National Health and Nutrition Examination Surveys (2005-2008) were utilized (n=10214). Dental health was assessed using the Oral Health Questionnaire (OHQ). Depression was measured using the Patient Health Questionnaire-9 (PHQ-9), where cases were identified using a cut off score of 10 or above. Logistic regression was applied to measure magnitude of associations, controlling for a range of covariates including CRP and BMI.

RESULTS

After adjustment for covariates, a significant dose-response relationship between number of oral health conditions and likelihood of PHQ-9 defined depression was observed. Compared with individuals without an oral health condition, adjusted odds ratio (95% confidence interval) for depression in those with two, four and six conditions were 1.60 (1.08-2.38), 2.13 (1.46-3.11) and 3.94 (2.72-5.72), respectively. Level of CRP and being underweight or obese were associated with being depressed.

CONCLUSIONS

A positive association exists between poor dental health and depression that is independent of CRP and BMI.

Deletion of serotonin 2B receptor provokes structural alterations of mouse dental tissues

Rampant caries and periodontal diseases occur in patients treated with antidepressants such as serotonin reuptake inhibitors (SRIs; e.g., Prozac) which target the serotonin transporter (SERT). As the serotonin 2B receptor (5HT2BR) regulates SERT functionality and capacity to recognize SRIs, we investigated the potential role of 5HT2BR on dental tissues by exploiting 5HT2BR knockout (KO) mice. Compared to wild-type (WT) mice, several structural differences were identified in the teeth of KO mice. In the molar of KO mice, rod curvatures and twisting were altered compared to WT mice, suggesting involvement of 5HT2BR at early stages of enamel formation. The volume of the KO enamel layer was also reduced, and larger porosities were observed in the prismatic enamel, with smaller crystallite thickness. Crystallite pattern disorganization and occlusal abrasion were enhanced in female KO mice, indicating a sexual dimorphism. In the incisor, no difference was detected in the width of the enamel layer between KO and WT mice; however, enamel maturation differed in absence of 5HT2BR. Specifically, the outer aprismatic enamel border was 1.5- to 2-fold larger in KO compared to WT mice, together with a decreased etching pattern. Finally, although no noticeable difference was observed in dentin, the micro-CT three-dimensional pulp reconstruction evidenced a decrease in both length and width of dentin formation in the root canals of the KO versus WT mice. These data provide evidence that 5HT2BR-mediated signaling pathways are involved in enamel formation and dentinogenesis.

Antidepressants relevant to oral and maxillofacial surgical practice

Background:

Depression is commonly associated with a high-carbohydrate diet, lack of interest in proper oral hygiene and xerostomia connected to the use of antidepressants. Patients often consult their dentists as a result of changes affecting the hard dental substance and the soft-tissues.

Aim:

The aim of this study was to identify adverse drug interactions between the antidepressants and medications commonly administered in dentistry in order to give practicing dentists an overview of the scientific literature.

Objective:

The objective is to identify the adverse drug interactions between antidepressants and medication commonly administered in dentistry.

Study Design:

The literature search was performed using PubMed, Cochrane and the specific search items. The review (1984-2009) focused on medicines used in dental practice (vasoconstrictors, non-opioid analgesics, non-steroidal anti-inflammatory drugs, antibiotics, antifungals and benzodiazepines).

Results:

There are various drug interactions between antidepressants and medicines used in dentistry. When two or more drugs are co-administered, a drug interaction must always be anticipated though many of the interactions are potential problems, but do not seem to be real clinical issues.

Conclusion:

The probability of a drug interaction can be minimized by careful history-taking, skillful dose adjustment and safe administration of the therapeutic agent.

Timing of first dental checkup for newly Medicaid-enrolled children with an intellectual or developmental disability

We compared the extent to which having an intellectual or developmental disability was associated with rates at which Iowa Medicaid-enrolled children ages 3 to 8 had first dental checkups after an initial dental examination. We hypothesized that these children would have later first dental checkups than would children without an intellectual or developmental disability. Findings suggest no significant difference in the time to first dental checkup for children by intellectual or developmental disability status. Those who took over 12 months to see a dentist for their initial dental examination were 1.68 times as likely to have an earlier first dental checkup as children whose initial dental examination occurred within 4 months of being enrolled. Results suggest that having an intellectual or developmental disability is not associated with later first dental checkups for this population.

Impact of chronic condition status and severity on the time to first dental visit for newly Medicaid-enrolled children in Iowa

OBJECTIVE

To assess the extent to which chronic condition (CC) status and severity affected how soon children had a dental visit after enrolling in Medicaid. Data Source. Enrollment and claims data (2003-2008) for newly Medicaid-enrolled children ages 3-14 in Iowa.

STUDY DESIGN

3M Clinical Risk Grouping methods were used to identify CC status (no/yes) and CC severity (less severe/more severe). Survival analysis was used to identify the factors associated with earlier first dental visits after initially enrolling in Medicaid.

PRINCIPAL FINDINGS

Children with a CC were 17 percent more likely to have earlier first dental visits after enrolling in Medicaid (p < .0001). There was no significant difference by CC severity. Children who lived in a dental health professional shortage area and those who did not utilize primary medical care had significantly later first Medicaid dental visits, whereas these factors failed to reach statistical significance for children with a CC.

CONCLUSION

While newly Medicaid-enrolled children with a CC were significantly more likely to have earlier first dental visits, we failed to detect a relationship between CC severity and the time to first Medicaid dental visit. The determinants of first Medicaid dental visits were heterogeneous across subgroups of newly Medicaid-enrolled children. Future studies should identify the sociobehavioral factors associated with CCs that are potential barriers to earlier first Medicaid dental visits for newly Medicaid-enrolled children.

The effects of antidepressants and pilocarpine on rat parotid glands: an immunohistochemical study

OBJECTIVES

To evaluate the effects of antidepressants and pilocarpine on the quantity of myoepithelial cells and on the proliferation index of the epithelial cells of rat parotid glands.

INTRODUCTION

Hyposalivation, xerostomia, and alterations in saliva composition are important clinical side effects related to the use of antidepressants.

METHODS

Ninety male Wistar rats were allocated to nine groups. The control groups received saline for 30 (group C30) or 60 days (group C60) or pilocarpine for 60 days (group Pilo). The experimental groups were administered fluoxetine (group F30) or venlafaxine for 30 days (group V30); fluoxetine (group FS60) or venlafaxine (group VS60) with saline for 60 days; or fluoxetine (group FP60) or venlafaxine (group VP60) with pilocarpine for 60 days. Parotid gland specimens were processed, and the immunohistochemical expression of calponin and proliferating cell nuclear anti-antigen on the myoepithelial and parenchymal cells, respectively, was evaluated. Analysis of variance (ANOVA), Tukey HSD and Games-Howell tests were applied to detect differences among groups (p<0.05).

RESULTS

Compared with the controls, chronic exposure to antidepressants was associated with an increase in the number of positively stained cells for calponin. In addition, venlafaxine administration for 30 days was associated with an increase in the number of positively stained cells for proliferating cell nuclear anti-antigen. Fluoxetine and pilocarpine (group FP60) induced a significant decrease in the number of positively stained cells for calponin compared with all other groups.

CONCLUSIONS

The number of positively stained cells for calponin increased after chronic administration of antidepressants. The proliferation index of the epithelial cells of rat parotid glands was not altered by the use of antidepressants for 60 days.

Nocturnal eating predicts tooth loss among adults: results from the Danish MONICA study

The relationship between nocturnal eating, such as that associated with night eating syndrome (NES), and oral health is unknown. This study sought to determine if nocturnal eating is related to tooth loss in a large, epidemiologic sample. Danes (N=2217; age range 30-60 years, M BMI [kg/m(2)]=25.9, % Male=50.1) enrolled in the Danish MONICA (MONItoring trends and determinants of CArdiovascular disease) were assessed on oral health, eating behavior, anthropometrics, general health, and demographic characteristics in both 1987/88 and 1993/94. We hypothesized that nocturnal eating at time one (1987/88) predicts number of missing teeth at time two (1993/94), when controlling for age, education, smoking status, body mass, carbohydrate intake, binge eating behavior, and diabetes diagnosis. A negative binomial model predicting number of missing teeth from nocturnal eating while controlling for covariates was conducted. Expected change in log count of missing teeth was significantly less for non-night eaters (p=.009), non-smokers (p=.001), non-diabetics (p=.001) and for each successive younger age group (p=.0001). Additionally, expected increase in log count of missing teeth was significantly greater for individuals with less than "high school diploma" education compared to those with the highest level of education (p=.0001). In sum, nocturnal eating contributes to tooth loss. Treatment providers should encourage good oral health care practices to reduce the risk of tooth loss associated with nocturnal eating.

Effect of fluoxetine on some cognitive functions of patients of depression

BACKGROUND

This study was carried out to evaluate the effect of long-term administration of a commonly prescribed antidepressant, fluoxetine from different group on memory and psychomotor functions in patients of various psychiatric disorders using a battery of simple tests that can be conveniently applied to the Indian population.

MATERIALS AND METHODS

Memory was evaluated using the PGI memory scale and psychomotor functions were evaluated using six letter cancellation test. Statistical analysis was carried out using Wilcoxon signed-rank test.

RESULTS AND CONCLUSION

The results of the study reveal that there was significant improvement in some cognitive function. Cognitive functions are improved at first follow-up and they improved continuously up to last follow-up that is at one month. It is observed that there was improvement in the primary disease. So, final score of the cognitive parameters is because of the resultant activity of direct drug action and improvement in the underlying disease.

TMD chronic pain and masseter silent period in psychiatric patients on antidepressive therapy

The aim of the study was to evaluate the long-term effects of antidepressive therapy on chronic pain and related disability, and masseter silent period in psychiatric depressive patients with temporomandibular disorders (TMD). The study included hospitalized psychiatric depressive patients on antidepressive therapy protocol (tetracyclic antidepressant-maprotiline and anxiolytic-diazepam) (n=30) and non-psychiatric patients seeking prosthodontic treatment (control group, n=38). TMD were diagnosed by Research Diagnostic Criteria for temporomandibular disorders proposed by Dworkin and LeResche. The surface electromyography was recorded from left and right masseter muscles and masseter inhibitory reflex (masseter silent period) was recorded after mechanical stimulation. The incidence of TMD appearance was very similar, of approximately 40% in both group of patients. The results of the study also indicated a higher prevalence of joint related TMD, a lower prevalence of muscular subtype of TMD and a lower grade of chronic pain and related disability in the psychiatric group of patients on antidepressive therapy in comparison with findings in the control group. In the patients on antidepressive therapy with TMD masseter silent period was not prolonged , while in the control group of patients with TMD the prolongation of the silent period was observed. The study provided evidence that long-term, combined therapy (maprotiline and diazepam) in psychiatric depressive patients significantly modulated signs and symptoms of TMD in comparison with the control group.