Dental Problems From Depression Drugs

Antidepressants May Promote Cavities, Interact With Dental Drugs

From the WebMD Archives

Feb. 4, 2003 -- Antidepressants may have hidden dental side effects, a study of patient records suggests.

Different depression drugs may cause different problems, note Joseph J. Keene Jr., DDS, and colleagues at Southern Illinois University School of Dental Medicine, Alton. To see what kinds of problems dentists might encounter, the researchers reviewed the medical records of more than 1,800 dental patients. They report their findings in the January issue of the Journal of the American Dental Association.

They found that more than one in five patients was taking at least one kind of antidepressant. Why is this a dental problem?

  • More than half of these patients were taking two or more drugs that can cause dry mouth. Untreated dry mouth -- a condition called xerostomia -- can lead to rampant tooth decay, gum disease, bad breath, yeast infections, and other oral problems.
  • Two thirds of the patients were taking antidepressants or other drugs that can lower blood pressure. These drugs can have dangerous interactions with common ingredients of dental nerve-numbing drugs. And patients taking some antidepressants and other drugs may develop low blood pressure when they are lying down. They might get dizzy during prolonged dental work, leading to falls when they try to get up.

Most of these side effects are seen with the older types of depression drugs called tricyclic antidepressants. Doctors often prescribe these drugs for other conditions such as some forms of pain.

"If you are taking any kind of medication, you should tell your dentist," Keene tells WebMD. People taking antidepressants may need a stricter dental program including more frequent brushing and flossing, he says.

Atlanta-area dentist Thomas Kauffman, DDS, says his patients are taking more and more medications -- including antidepressants. But he hasn't seen a big increase in dry-mouth problems.

"In terms of antidepressants, I think one might make the argument that people who are depressed aren't as interested in taking care of themselves and their teeth," Kauffman tells WebMD. "But if you are getting the right treatment, this shouldn't be a problem. I can't think of a patient on an antidepressant medication, Zoloft or Wellbutrin, who seems at more risk of dry mouth than other patients."

Kauffman and Keene agree that dry mouth is indeed a problem that must be taken seriously. Keene suggests several ways to prevent dry mouth:

  • Practice better home dental care.
  • Drink more water.
  • Use a fluoride application.
  • Schedule more frequent dental visits.

Kauffman advises against the use of alcohol-containing mouthwashes because they can dry the mouth. Keene suggests that patients might consider using a saliva substitute, but both he and Kauffman are reluctant to prescribe saliva-stimulating drugs.

For patients who have low blood pressure as a side effect of their medications, Keene recommends:

  • Shorter dental visits.
  • Letting the patient sit more upright in the dental chair.
  • Monitoring blood pressure.
  • Care in using drugs that further lower blood pressure.

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SOURCES: Journal of the American Dental Association, January 2003 • Joseph J. Keene Jr., DDS, Southern Illinois University School of Dental Medicine, Alton, Ill. • Thomas Kauffman, DDS, Atlanta.
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