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Depression and dental health

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Dr Chetna Bogar's picture
Joined: 26 Sep 2011

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
• Feeling: sad, helpless, down or blue, hopeless, irritable, angry, agitated, anxious, or any combination of the above.
• a loss of interest or pleasure in previously enjoyed activities.
• a sense of worthlessness or guilt
• accompanied by preoccupation over past minor failings
• complaints of bodily aches and pains without a physiological basis
• social withdrawal
• increasing prevalence among the elderly, is the most common emotional disorder in people older than 65 years

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.

Adverse oral reactions of medications
• Xerostomia
• Altered taste sensation
• Oral infections
• Tongue infections
• Tongue discoloration
• Periodontitis
• Bruxism

Affects of Depression on Oral Health
1) Prone to suffer periodontitis due to
• Neglect of oral hygiene
• Increased smoking
• Altered immune
• Bruxism
2) Rampant dental decay due to:
• Disinterest in performing oral hygiene practice.
• Preference for carbohydrates resulting from reduced serotonin levels.
• Craving for intense sweets because of impaired taste perception.
• Decrease in salivary output.
• A high lactobacillus count.
3) Chronic facial pain.
4) Burning sensation of tongue
5) Bad breath
6) Oral yeast infections
7) TMJ-TMJ disorder is frequently the complaint which brings the patient to the dentist

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:

• Medical/Dental history

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

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

• Patient education on home hygiene practices.

• Increased water intake.

• Regularly scheduled dental visits.

• Precautions related to low blood pressure-hypotension

decreased length of dental visits.

positioning somewhat upright in the dental chair.

blood pressure monitoring.

using caution in prescribing medications with additional orthostatic hypotension (low blood pressure resulting from sudden position change) potential
• Use of saliva substitutes

• Anticaries agents containing fluoride

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

• Special precautions when prescribing or administering analgesics and local analgesics

• Awareness of potential adverse interactions of antidepressants with other medications

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

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